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The article analyzes the image of Germany, which was formed by the journalists of the domestic daily newspaper “Russian invalid” in 1914–1915, when the Russian Empire was in active military confrontation with the states of the Triple (later Quadruple) Alliance in the European Theater of Operations, and Germany was its main and most dangerous enemy on the Eastern Front. Correspondents of the “Russian Invalid”, the official printed organ of the Russian Military Ministry, in the first years of the First World War (1914–1915) on the pages of their newspaper paid special attention to the Hohenzollern Empire, its army, socio-economic and political development, direct participation German armed forces in the fighting of the Great War. The main part of the information about Germany by the authors of the publication we studied was placed in the headings “From Foreign Life”, “Public Life”, “Naval Department”, “Military Chronicle”, “Telegram” and “Articles”. At the end of the study, it was concluded that the German Empire on the pages of “Russian Invalid” appeared as the economic and military-political locomotive of the Triple (later Quadruple) Alliance, which made enormous efforts to implement the redistribution of spheres of influence in the then world and potential redistribution in its own benefit of colonial possessions.

Abstract The number of persons forcibly displaced across international borders increased significantly over the last decade and forced migrants’ spatial family configurations have diversified and are likely to show different patterns compared to what research has found for, e.g. labour migrants. This paper examines and disentangles the diversity of spatial family arrangements across countries of nuclear and extended family members of female and male forced migrants surveyed in Germany. Moreover, I propose a typology of refugees’ family configurations based on the whereabouts of the partner, children, parents, and siblings. The empirical analyses employ representative survey data of recent refugees from Eritrea and Syria collected in Germany in 2020. This dataset allows to account for the whereabouts of members of the nuclear as well as extended family. Descriptive statistics show the prevalence and distributions of locations of specific family members and cluster analysis is conducted to identify and propose a typology of spatial configurations of refugee families. Finally, multinomial logistic regressions are used to test associations between the obtained clusters and gender, country of origin and the financial situation, controlling for other characteristics. The findings indicate that multi-transnational family constellations beyond origin and destination countries are a common pattern among refugees, especially when considering nuclear as well as extended family members. Furthermore, different types of spatial family arrangements are related to gender and country of origin as well as family financial resources.

Abstract Following implementation of a national prevention program against iodine deficiency-related disorders in 1993 in Germany, the prevalence of thyroid disorders declined, but aggregated drug dispensation data suggested a recent increase in thyroid hormone use. We aimed to systematically investigate trends in the use of thyroid diagnostic and treatment measures between 2008 and 2019 in Germany. Using the GePaRD database (claims data from ~ 20% of the German population), we determined the annual age-specific and age-standardized prevalence of the use of thyroid diagnostics (thyroid-stimulating hormone (TSH) measurement, thyroid ultrasound, scintiscan, biopsy) and treatment (medication, surgery, radioiodine therapy) from 2008 to 2019 stratified by sex. Between 2008 and 2019, the age-standardized prevalence of TSH measurement increased by 44% in males (from 165 to 238 per 1,000 persons) and by 31% in females (from 134 to 176 per 1,000). The prevalence of thyroid ultrasound use showed no clear time trend, while there was a decrease in the prevalence of scintiscan use (males/females: decrease by 42/43%) and biopsy (males/females: decrease by 42/34%). The prevalence of levothyroxine use increased by ~ 31% both in males (from 36 to 47 per 1,000) and females (from 134 to 175 per 1,000), while the prevalence of thionamide use, iodine use, thyroidectomy, and radioiodine therapy decreased. Our study suggests a continued decline in the prevalence of clinically significant thyroid disorders between 2008 and 2019. The substantial increase in the prevalence of TSH measurement and levothyroxine use during this time period might indicate overuse of diagnostics and overtreatment, warranting further investigation.

Abstract Immigrants, and particularly immigrant men, are often stereotyped as untrustworthy in European societies. However, little research has examined how stereotypes of characteristics other than ethnicity might impact natives’ perceptions of the trustworthiness of immigrants. Here, I test whether facial attractiveness, a trait associated with a variety of positive stereotypes, might modify ethnic biases in trustworthiness perceptions. I vary facial attractiveness and ethnicity using photo and name stimuli presented in a hypothetical “lost wallet” vignette, in which respondents assess the likelihood of the pictured man returning their lost wallet. Results from an German online panel survey indicate that while attractiveness has a modest positive effect on perceived trustworthiness, the value of attractiveness does not differ between ethnic majority German men and men with a Turkish migration background. Rather, the largest differences in the perceived trustworthiness of Turkish-origin men are found between respondents with inclusionary and exclusionary immigration attitudes, with inclusionary respondents reporting that Turkish-origin vignette persons are more trustworthy than ethnic majority German vignette persons. These results suggest that physical attractiveness does not act as a substantial moderator of ethnic biases in trustworthiness perceptions, but that immigration attitudes are highly relevant.

Abstract Conflicts tend to be complex and, in many cases, multi-faceted. However, by adapting an approach by Vuković, this study illustrates a method for structuring such conflicts, which can facilitate insights that are more profound by dividing them into relevant dimensions of the problem. Given that some conflicts are ongoing and new ones may emerge in certain cases, this study also assesses the potential of using the adapted methodology as a structured basis for constructing scenario analyses. In this study, two cases from Germany on the topic of water are analysed. The first case explores a pair of conflicts that arose within a short period involving a chemical company called Currenta. These conflicts are about a controversial wastewater discharge and an attempt to obtain more water rights, despite the possible future water stress. The second case concerns the Nordheide region, which is favoured for its groundwater reservoir. In recent decades, there has been a growing dispute between the water company and the residents of Nordheide about the possible harmful effects of further water extraction. Both cases illustrate the evolving nature of water conflicts, indicating that they can extend beyond a dispute over distribution. In addition to this key finding, the cases demonstrate the diverging concerns of the actors, as well as the significance of decision-makers involved in these conflicts. A nuanced assessment of water conflicts prior to further action, such as conflict resolution, is therefore encouraged by this study.

For electoral purposes, Germany’s far-right AfD party masks its xenophobia and anti-migration policies by portraying itself as a guardian of Holocaust remembrance and defender of the State of Israel. Now with a seat in the Bundestag, it is forcing the other parties to join its positions by anticipating them.

Katrin Milger,1 Dirk Koschel,2 Dirk Skowasch,3 Hartmut Timmermann,4 Olaf Schmidt,5 Karl-Christian Bergmann,6 Claus Neurohr,7 Robert Lindner,8 Sebastian Heck,9 Johann Christian Virchow10 1Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; 2Division of Pneumonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden and Fachkrankenhaus Coswig, Lung Centre, Coswig, Germany; 3Department of Internal Medicine II – Pneumology, University Hospital Bonn, Bonn, Germany; 4Schwerpunktpraxis Colonnaden, Hamburg, Germany; 5Pneumologische Gemeinschaftspraxis und Studienzentrum KPPK, Koblenz, Germany; 6Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; 7Abteilung für Pneumologie und Beatmungsmedizin, Robert-Bosch-Krankenhaus Lungenzentrum, Stuttgart, Germany; 8IQVIA Commercial GmbH & Co. OHG, Frankfurt Am Main, Germany; 9GlaxoSmithKline GmbH & Co. KG, Munich, Germany; 10Abteilung Pneumologie & Interdisziplinäre Internistische Intensivmedizin, Universitätsmedizin Rostock - Zentrum für Innere Medizin, Medizinische Klinik I, Rostock, GermanyCorrespondence: Katrin Milger, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria, Email katrin.milger-kneidinger@medunigraz.atPurpose: Asthma is affecting 4– 5% of all adults (10% of children) in Germany, ≥ half are inadequately controlled. In 2019 up to 54 thousand patients suffered from severe uncontrolled asthma, 52% were treated/co-treated by pneumonologists. 45% of them had continuous oral corticosteroid (OCS)- and short-acting β 2-agonist (SABA) overuse for ≥ 2 years. The aim of the current study was to analyze the main treatments, escalation schemes and the adherence to the GINA recommendations.Patients and Methods: Retrospective analysis in 2021 based on data from January to December 2019 in Germany, using the IQVIA™ LRx prescription database and the IQVIA™ Disease Analyzer database containing anonymized electronic medical records as the main data sources.Results: In 2019 25,200 patients with severe, uncontrolled asthma treated in a pneumonologist´s practice in Germany received GINA 3 (0,4%), GINA 4 (76%) or GINA 5 therapy (24%) during the study year compared to 59% GINA 5 therapy in the 5– 10% (1,500– 3,000) co-treated in a specialized outpatient department. In Pneumonologists` practices the most frequent choice in GINA 5 was OCS in 69% of patients (biologicals 37%, long-acting muscarinic antagonist (LAMA) 20%) compared to 66% biologicals, 55% OCS, and 25% LAMA in the outpatient department. 54,958 of 613,000 GINA 4/5 patients were treated with OCS, 9,725 even with doses above the so called “Cushing threshold” for prednisolone of 2700 mg/year. After introduction of a biological treatment, patients reduced their SABA prescriptions by 28%, OCS by 55%, and OCS overall exposure by 40%, one-third did not need OCS anymore.Conclusion: In 75% of patients with uncontrolled asthma for ≥ 2 years therapy was not escalated beyond GINA 4 or low dose OCS was used as the most frequent add-on treatment in GINA 5 contradictory to treatment recommendations. Use of biologics reduced on demand rescue medication and OCS use.Keywords: prescription database, disease analyzer, uncontrolled asthma, biological treatment, OCS use, Germany, guideline adherence

This study explores the economic cohesion of two German areas, Hamburg and Saxony, in the 18th century, created through the inflow of Atlantic colonial groceries from the former to the latter. Combining different kinds of sources revealed the following. The trade flow from Hamburg to German lands began to shift from Prussia to Saxony in the middle of the 18th century. Within Saxony, the market was concentrated in two locations: the court city Dresden and proto-industrial district of Upper Lusatia. What made Saxony stand out were its liberal commercial policy and the development of rural trade. However, given that the growth of the market in Saxony was confined to geographically narrow zones, and that Prussia refused to be integrated with Hamburg, I concluded that the German market was distorted.

Abstract The COVID-19 pandemic affected the diagnostics and treatment of breast cancer. Numerous studies reported an early decline in breast cancer (BC) incidence during the COVID-19 pandemic. Less evidence is available on changes in medical care. Reports from individual patients have provided anecdotal evidence for a shift from breast-conserving surgery to mastectomy to reduce the number of visits to radiation units during the pandemic. This study aimed to explore changes in BC incidence and surgical treatment in the south of Germany. Using data from the Baden-Württemberg Cancer Registry, the age-standardized incidence of BC (ICD-10 C50 and D05) (women) in 2018–2021 was investigated overall and by age and stage using standardized incidence ratios. Among pre-operative stage I/IIA BC patients, differences in the time to surgery and type of surgery were investigated using negative binomial and logistic regression models. The incidence of invasive BC decreased significantly from 170.9 per 100,000 women in 2018/2019 to 159.7 in 2020 and increased to 169.2 in 2021. This decrease resulted from a lower incidence around April 2020 and was also observed for non-invasive BC. In 2021, incidence of invasive BC was still decreased by 8% in women aged 80 + years. Surgical treatment was analyzed in 22,708 BC patients with a pre-operative stage ≤ IIA. The median time to surgery was 33 days in 2018/2019, 32 days in 2020 and 36 days in 2021. The proportion of mastectomies increased from 16.1% in 2018/2019 to 17.1% in 2020 and 17.3% in 2021 (adjusted odds ratio and 95% confidence interval (2021 vs. 2018/2019): 1.13 (1.03–1.24)). The adjusted increase was strongest for patients aged 50–59 years (1.34 (1.09–1.64)) and those with high-grade tumors (1.27 (1.07–1.51)). While the early return to pre-pandemic age-standardized BC incidence rates is promising, missed cases have not been caught up until 2021. Furthermore, the decreased incidence in elderly women in 2021 warrants further attention. In early-stage BC, a slightly greater rate of mastectomies was observed, although such a change was not recommended. This result underlines the importance of good communication of adapted treatment guidelines in such exceptional circumstances.

Abstract Background Despite a well-documented underrepresentation of women in STEM majors and occupations, empirical evidence on whether there really is a “leaky STEM pipeline” is mixed due to a lack of methodological consistency. Studies vary by (1) the definition of STEM, (2) the decision to measure choices alone or to also include aspirations, and (3) the use of longitudinal or cross-sectional data. Results In order to analyze how variations in the research design affect the measurement of women’s underrepresentation in the field of STEM, we critically reviewed relevant literature on the “leaky pipeline” and identified three central features in the designs of existing empirical studies. We illustrate how the variation of these affects the results by applying them to the German context. Our results support the “leakage” perspective for Germany only during the transition to the labor market. Changes in STEM aspirations between grades 9 and 12 do not follow a clear pattern. Indeed, a comparison of grade 12 aspirations to actual college major choices even shows an increasing share of women in STEM. Conclusion Germany does not exhibit a significant “leaky STEM pipeline”. Due to more men choosing STEM, gender gaps widen in higher education, while the pipeline remains stable. Therefore, we challenge the “leaky pipeline” metaphor, advocating a life-course perspective to better understand STEM trajectories. We call for refined measurement standards, emphasizing official STEM definitions, long-term observations from aspirations to career entry, and the use of longitudinal data.

Abstract The cultural background and age shape the cognitive and social development of children. This study aimed to compare perceptual, executive, and social functioning in two age groups of preschoolers from Germany and Iran. One hundred sixty-five children (83 Iranian and 82 German) participated in the study, with 87 children aged three years and 78 children aged four years. The participants completed a series of tasks to assess different cognitive functions, including the theory of mind as a measure of social cognition, picture mental rotation test to evaluate spatial ability, and several tests including digit span, Corsi block tapping, day-night, grass-snow, dimensional change card sort, and active and passive vocabulary tests to assess executive functions. The findings revealed that German children performed better than their Iranian peers regarding spatial ability and theory of mind. Additionally, German children outperformed Iranian children in working memory, cognitive flexibility, and verbal fluency, while Iranian children demonstrated better inhibitory control. Furthermore, the correlational analysis indicated that in German children, executive function correlated with the theory of mind, whereas in Iranian children, executive function was associated with perceptual functions. Age impacted the results. These results highlight the role of cultural factors in shaping cognitive functioning and emphasize the need to consider cultural influences when examining cognitive development in different populations.

Abstract This study explores culturally shared connotations of honor and dignity in North India and Germany. Both, honor and dignity refer to the worth of a person but have distinct psychological implications. Honor as both an independent and interdependent phenomenon varies greatly across cultural groups. Yet, a relatively large volume of research is focused on Middle Eastern, Muslim cultures. Moreover, though a rich body of literature shows that dignity can have different meanings across cultural contexts, its nuanced understanding, particularly in relation to honor, remains underexplored in cross-cultural settings. Given this, the current study expands both these concepts to India with its unique religious and structural characteristics and studies it along with the responses of participants in Germany, examining their cultural differences. Eleven focus group discussions were conducted in North India and Germany where participants discussed their personal associations of both honor and dignity. These discussions were transcribed and later thematically analyzed. The findings indicated unique themes for honor (duty, morality, status, sociability, and stoicism) and dignity (individuality, self-governance, resistance, and enrichment) with some dimensional similarities for both cultural groups, despite dissimilar language usage. Furthermore, the five themes for honor were seen to affect differently depending on its enhancement or loss and its eventual impact on the target of honor, self, or group. As for dignity, participants in both groups had difficulties distinguishing it from honor but had a clear understanding of its intrinsic nature, especially when seen in contradiction with honor. These findings have theoretical and practical implications, particularly while studying different cultural groups together. Moreover, they contribute to the literature on self-worth by refining the idea of dignity, while also expanding our multidimensional understanding of honor.

Abstract Humans are significantly impacting ecosystems worldwide. Scientists of the IPBES Global Assessment are therefore calling for a transformative change that includes all aspects of society in order to address drivers of biodiversity loss. However, these calls are rather abstract, and thus it remains unclear how this goal can be achieved. With this conceptual contribution, we present an analytical framework for evaluating existing processes of societal change which are enhancing biodiversity, and we illustrate its application using three case studies in Germany. We argue that an empirical analysis provides insights into the causal mechanisms that initiate or promote change processes. In doing so, we can draw recommendations for future transformative change processes with regard to biodiversity conservation. In our analysis, we are dealing with questions concerning the following three areas: the drivers and context of societal change processes, the change processes themselves and finally their impacts. Subsequently, we generate recommendations on how to enhance and support the process of future societal transformation that aims at biodiversity conservation: (a) Retaining co‐benefits for biodiversity with goals that are primarily focussing on other objectives; (b) harmonising biodiversity use and conservation by turning conflicts into drivers of transformation; (c) prioritising biodiversity conservation by taking advantage of windows of opportunity. With our conceptual framework, we provide an analytical tool to learn from existing processes of societal change how to support future transformative change. This is an important step that contributes to the generation of relevant knowledge of promoting transformative change for nature and people. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Introduction Influenza-associated excess mortality and morbidity is commonly estimated using statistical methods. In Germany, the Robert Koch Institute (RKI) uses the relative mortality distribution method (RMDM) to estimate influenza-associated excess mortality without reporting age-specific values. In order to better differentiate the distribution of the disease burden, a distinction by age is of high relevance. Therefore, we aimed to revise the existing excess mortality model and provide age-specific excess mortality estimates over multiple seasons. We also used the model to determine influenza-associated excess hospitalizations, since the RKI excess hospitalization model is currently based on another approach (i.e., combination of excess physician visits and hospitalized proportion). Methods This study was a retrospective data analysis based on secondary data of the German population from 1996–2018. We adapted the RKI’s method of estimating influenza-associated excess mortality with the RMDM and also applied this approach to excess hospitalizations. We calculated the number of excess deaths/hospitalizations using weekly and age-specific data. Results Data available in Germany are suitable for addressing the restrictions of the RKI’s mortality model. In total, we estimated 175,858 (176,482 with age stratification) influenza-associated excess all cause deaths between 1995–1996 and 2017–2018 ranging from 0 (17 with age stratification) in 2005–2006 to 25,599 (25,527 with age stratification) in 2017–2018. Total influenza-associated excess deaths were comparable to RKI’s estimates in most seasons. Most excess deaths/hospitalizations occurred in patients aged ≥ 60 years (95.42%/57.49%) followed by those aged 35–59 years (3,80%/24,98%). Compared with our model, the RKI hospitalization model implies a substantial underestimation of excess hospitalizations (828,090 vs. 374,200 over all seasons). Conclusion This is the first study that provides age-specific estimates of influenza-associated excess mortality in Germany. The results clearly show that the main burden of influenza is in the elderly, for whom prevention and control measures should be prioritized.

Abstract Background A persisting high-risk human papillomavirus (HR-HPV) infection is causal for cervical cancer; however, there is limited population-based data on the prevalence of HPV infections in Germany. We assessed the age and type-specific HPV prevalence, and associated risk factors in HPV unvaccinated women aged 30 and above. Methods The MARZY prospective population-based cohort study was conducted between 2005 and 2012 in Mainz and Mainz-Bingen, Germany. Eligible women were randomly recruited from population registries and invited for cervical cancer screening (n = 5,275). A study swab (liquid-based cytology) was taken and HPV testing was performed with GP5+/6 + polymerase chain reaction (PCR) followed by genotyping. We assessed HPV types as HR-HPV, ‘moderate’ risk and low-risk (LR-HPV). Logistic regression was performed to identify factors associated with HPV infection, stratified by HPV types. Results 2,520 women were screened with a valid PCR result. Overall HPV prevalence was 10.6% (n = 266), with 6.5% HR-HPV positive (n = 165), 1.5% ’moderate’ risk type (n = 38) and 3.3% LR-HPV type (n = 84) positive. 8.9% had a single infection (n = 225) and 1.6% had multiple types (n = 41). The most common HR-HPV types were 16, 56, 52 and 31 and LR-HPV 90 and 42. Of 187 HR-HPV infections detected (among 165 women), 55.1% (n = 103) were with HPV types not covered by available bivalent or quadrivalent HPV vaccines. About 23% (n = 43) were of types not covered by the nonavalent vaccine (HPV 35, 39, 51, 56, 59). The HR and LR-HPV prevalence were highest in the age group 30–34 years (HR 9.8%, ‘moderate’ risk 3.0% and LR 5.6%), decreasing with increasing age. HR-HPV prevalence in women with normal cytology was 5.5%. In women with a high-grade squamous intraepithelial lesion (HSIL), prevalence was 66.7%. Women currently not living with a partner and current smokers had increased chances of an HR-HPV infection. Conclusion The overall population-based HPV prevalence was relatively high. An important share of prevalent HR-HPV infections constituted types not covered by current HPV vaccines. With the advent of HPV screening and younger vaccinated cohorts joining screening, HPV types should be monitored closely, also in older women who were not eligible for HPV vaccination.

Background: The consortium project INTEGRATE-ADHD compared administrative data on the presence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with the results of a parent survey and a comprehensive clinical assessment based on the S3 guideline of the Association of the Scientific Medical Societies in Germany (AWMF). Due to the COVID-19 pandemic, the clinical assessment was carried out online. Methods: The article describes how a guideline-based clinical assessment of ADHD can be implemented in an online setting. A specially developed diagnostic matrix is presented to illustrate the assessment procedures and the diagnostic decision-making process. The matrix is intended to help the diagnostician to gain an overview of the numerous individual findings that have been collected using different assessment perspectives and methods (e.g. diagnostic interviews, rating scales, performance tests) in order to make a well-founded and transparent diagnostic decision. Discussion: The consortium project INTEGRATE-ADHD has shown that an online assessment can be implemented in a guideline-compliant manner and allows a valid clinical decision. The diagnostic strategy is discussed with reference to international guidelines and recommendations for online diagnostics (e.g. aspects of feasibility, acceptability and safety of the assessment procedures). The challenges and opportunities of using online assessments in clinical practice are also described.

Abstract Background Worldwide growing shortages among health care staff are observed. This also holds true for medical assistants in Germany. Medical assistants mainly work in outpatient care and are the first point of contact for patients while performing clinical and administrative tasks. We sought to explore profession turnover among medical assistants, that is, in terms of the underlying decision-making process, the reasons for leaving the medical assistant profession and potential retention measures from the perspective of former medical assistants. Methods For this qualitative study, we conducted semi-structured telephone interviews with 20 former medical assistants between August and November 2023. Eligible for participation were medical assistants who (i) were of legal age, (ii) completed medical assistant vocational training and ii) were formerly employed as a medical assistant, but currently employed in another profession. The interviews were recorded, transcribed verbatim and content-analyzed. Results Former medical assistants expressed various, often interrelated reasons for leaving the profession. These were changes in priorities throughout their career (e.g., in terms of working hours and salary), a constant high workload, barriers to further training, poor career prospects, and poor interpersonal relationships particularly with supervisors, but also within the team and with patients as well as the perception of insufficient recognition by politics and society. Suggestions of former medical assistants to motivate medical assistants to stay in their profession included amongst others higher salaries, more flexible work structures, improved career prospects, and more recognition from supervisors, patients, and society. Conclusion Our study provides insights into the complex decision-making process underlying ultimate medical assistant profession turnover. In light of an already existing shortage of medical assistants, we suggest to further explore how the suggested interventions that aim at retention of working medical assistants can be implemented.

Abstract Background The COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions. Methods In the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth. Results In almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part. Conclusions The unprecedented visiting restrictions in hospitals during the pandemic were like an “experiment” born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital. Trial registration German Clinical Trials Register (DRKS) (DRKS00027975).

Abstract Background The COVID-19 pandemic presented unprecedented challenges, particularly for vulnerable populations residing in confined settings such as refugee shelters: Physical distancing measures were challenging to implement in shelters due to shared rooms or communal use of kitchens and sanitary facilities, which increased the risk of infections. Meanwhile, individuals’ capabilities for individual protection strategies were severely impaired by the structure of the shelters. Consequently, shelters had the duty to develop and implement strategies for the prevention and handling of SARS-CoV-2 infections. The aim of this study was to explore the perspectives of refugees, NGO employees, and shelter directors regarding COVID-19-related measures in German refugee shelters. The study aimed to identify challenges and conflicts arising from implemented measures, as well as expectations for improved support during the pandemic. Methods Semi-structured and narrative interviews were conducted with 6 refugees, 6 facility managers, 12 NGO staff, and 2 social service agency staff from February to August 2022. Qualitative content analysis was employed to analyze the data, identifying overarching themes and codes. Results The study uncovered challenges and conflicts resulting from pandemic measures, particularly mass quarantine orders, within refugee shelters. Lack of transparency and ineffective communication worsened tensions, with refugees feeling distressed and anxious. The quarantine experience had a negative impact on refugees’ mental health, which was exacerbated by limited social interaction and leisure-time activities. Shelter managers encountered administrative challenges when implementing measures due to facility constraints and limited resources, while NGO employees encountered obstacles in providing immediate assistance due to legal regulations and a lack of cooperation from shelter managers. Conclusions The study highlights that shelters are problematic institutions from a public health perspective. It shows the importance of implementing customized pandemic interventions in refugee shelters that take account of the diverse needs and experiences of both refugee and staff. To achieve this, we recommend to establish an ethics committee and involve various stakeholders in decision-making processes. Additionally, enhancing information dissemination to promote transparency and public understanding of measures is crucial. These insights can help develop comprehensive and effective pandemic plans for refugee shelters, ensuring better preparedness for future public health crises.

Abstract: Understanding how adolescents integrate multiple cultures into their identity is a growing field of research in modern multicultural societies and requires psychometrically sound assessments tools. The Bicultural Identity Integration framework together with the Bicultural Identity Integration Scale 2 (BIIS-2; Huynh et al., 2018) offers an instrument that allows assessing BII with two factors (Blendedness vs. Compartmentalization and Harmony vs. Conflict). However, the psychometric properties of the BIIS-2 remain inconclusive for multicultural youth in Germany. To address this gap, we examined the psychometric properties of the BIIS-2 in a sample comprising 595 diverse ethnic minority adolescents in Germany (Mage = 13.26, SD = 1.3; 45.6% female). Contrary to the proposed two-factor structure (Huynh et al., 2018), our findings provide evidence for a four-factor structure (Blendedness, Compartmentalization, Harmony, and Conflict) which is also supported through unique associations in validation results.

Abstract Background Available data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care. Methods In this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM. Results Participants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice. Conclusions The study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.

Abstract Migration often impacts the mental and emotional health of those needing to move from their home countries. Studies have focused on migrants’ levels of distress or well-being, and recent research looks at older migrants’ experience with loneliness. What has yet to be researched is how different migrant groups experience loneliness, and how these feelings are affected by the contexts of leaving one country and reception in another. Drawing on the theoretical framework of integration, this article asks whether newly arrived refugees in Germany differ in their perception of loneliness from other newly arrived migrants. It examines these perceptions as related to social contacts and the context—and interplay—of exit and reception. Using OLS regressions with data from the Recent Immigration Processes and Early Integration Trajectories in Germany (ENTRA) project, we find that Syrian refugees have higher levels of loneliness than migrant groups from Poland, Italy, and Turkey. The difference is largely attributable to Syrians not having local German contacts, surviving traumatic experiences at home, and migrating specifically for physical safety. We also find that discrimination and not being in the labor force are determinants of loneliness across all four groups, and that even when considering migrant origins and other effects, having local social contacts lowers levels of loneliness. Our results point to migration policies, such as those related to family reunification and labor market access, for producing inequalities in loneliness between Syrian refugees and other migrants in Germany.

An 81-year-old male patient in Germany had prosthetic valve endocarditis caused by Pasteurella dagmatis after a domestic cat bite. We surgically treated a paravalvular abscess and administered definitive antibiotic therapy consisting of penicillin G and levofloxacin. The patient was discharged from the intensive care unit in good condition 21 days after the surgery.

ABSTRACTAcademic discussions have frequently examined the interrelation between regional employment growth and firm locations. Two growth patterns emerge: employment growth induced through new firm locations or vice versa, where firms locate in areas experiencing employment supply growth. The specific causal relationship responsible for regional employment growth in Germany remains uncertain. In the German context, however, more research is needed to identify contributors to employment growth, as most existing studies rely on highly aggregated data or focus on specific case studies. This paper aims to approach this subject by using a uniquely matched dataset of firm locations and the individual employment of 480 multi-locational firms in the knowledge economy and comparing it to total employment in Germany. We assume that a change in knowledge-intensive firms’ employment may affect regional employment growth. The study uses longitudinal historical employment data at the functional urban area (FUA) level from 1999 to 2019, aggregated to knowledge-intensive high-tech and advanced producer services (APS) sectors. The analysis employs aggregated and individual Granger causality tests, evaluating the relationship between employment in knowledge-intensive sectors and overall employment change. Results are spatialised using GIS to provide evidence of where the Granger causalities occur at the FUA level in Germany. Findings indicate that, in general, knowledge-intensive employment growth Granger causes total employment growth in a few economically more active FUAs. In contrast, for a greater number of FUAs, total employment Granger causes knowledge-intensive employment.

ABSTRACTThe study examines changes in the role of CEE, Germany and China in cross-sectoral connections. The paper aims to understand the flows in the servitization of manufacturing among three economies. It tried to answer the question of how strong links are in the servitization of manufacturing and whether there are any visible trends in value-added flows within this triangle.

Klebsiella (K.) pneumoniae is a major pathogen in human and veterinary medicine, known for its high resistance rates. Comprehensive resistance data are essential to combat global antibiotic resistance. This study aims to (a) document the prevalence of resistant K. pneumoniae and (b) assess the utility of routine laboratory data for passive monitoring. We analyzed a dataset of 175,171 samples from diseased dogs and cats in Germany collected between 2019 and 2021, identifying 1185 K. pneumoniae isolates with measurable minimum inhibitory concentration values. We evaluated resistance rates to a third-generation cephalosporin (cefovecin) (16.3%), chloramphenicol (16.1%), doxycycline (13.9%), enrofloxacin (8.9%), gentamicin (6.0%), nitrofurantoin (24.8%), and sulfamethoxazole-trimethoprim (15.0%). Notably, feline K. pneumoniae isolates from the urinary tract showed a high cefovecin resistance rate of 70.0%. Comparing our findings with third-generation cephalosporin-resistant human isolates from the Antimicrobial Resistance Surveillance database (ARS) maintained by the Robert Koch Institute revealed a lower resistance rate (7.7%). This study presents Germany’s most comprehensive dataset on K. pneumoniae resistance in companion animals over a three-year period. These findings can strengthen national resistance monitoring efforts and enhance data interpretation through substantial datasets.

Abstract Background The crude mortality rate and the lifetime mortality risk from prostate cancer in Germany are above international average. However age-standardised mortality and years of life lost per capita from prostate cancer are declining. This study analyses the mortality-related measures for the federal state of North Rhine-Westphalia (NRW) in Germany. Methods Based on the cause of death statistics and data from the NRW State Cancer Registry on 45,300 deaths in the years 2007–2021, mortality rates, the lifetime mortality risk from prostate cancer, median age at death and years of life lost are presented. Additionally, the 15 most frequent causes of death of 95,013 patients diagnosed with prostate cancer are reported. Results With a stable lifetime mortality risk from prostate cancer, age-standardised mortality and years of life lost per capita are decreasing while crude mortality and median age at death are increasing in NRW. Less than half of the patients die from their prostate cancer. Cancers of the urinary bladder and other urinary organs also occur more frequently as a cause of death than it would be expected based on the age-specific risk in the total population. Conclusions More people in North Rhine-Westphalia are dying of prostate cancer over time due to demographic ageing alone. At the same time, the age-specific mortality risk has not increased and when patients die of prostate cancer, it is at an increasingly older age. However, there is a statistical association with deaths from cancers of the lower urinary tract in patients diagnosed with prostate cancer, which demands further evaluation.

Abstract Background Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection and hospitalizations among infants, young children, and the elderly. This systematic literature review aimed to summarize the epidemiological and economic burden estimates of RSV infection at any age in Germany. Methods We conducted a systematic literature search to identify full-text articles published from 2003 to 2023 and reporting data on the epidemiological or economic burden of RSV in Germany. Based on pre-specified eligibility criteria, data on incidence, rates of hospital and intensive care unit (ICU) admission, clinical manifestation, underlying conditions, seasonality, health care resource use and costs were extracted. Results After screening 315 full-text articles, we included 42 articles in the review. The characteristics of the included studies were heterogenous regarding study population, setting, age groups and RSV-related outcome measures. The most frequently reported epidemiological outcome measures were RSV detection rate (n = 33), followed by clinical manifestation (n = 19), seasonality (n = 18), and underlying conditions of RSV infection (n = 13). RSV detection rates were reported across heterogenous study populations, ranging from 5.2 to 55.4% in pediatric inpatient cases and from 2.9 to 14% in adult inpatient cases. All articles that reported RSV detection rates across several age groups demonstrated the highest burden in infants and young children. Few articles reported RSV-related outcome measures distinctively for the outpatient setting. Health care resource use, such as hospital length of stay, ICU admission rate and treatment of patients with RSV infection were described in 23 articles, of which only one study quantified associated costs from 1999 to 2003 for children ≤ 3 years. In-hospital ICU admission rates varied between 3.6 and 45%, depending on population characteristics as age and underlying conditions. Conclusions This systematic review revealed that RSV imposes substantial disease burden in infants, young children, and the elderly in Germany, whereby infants are particularly affected. To date, there has been limited exploration of the impact of RSV infection on healthy children or the elderly in Germany. Given their notably high reported burden in studies, the medical and economic RSV burden in these groups should move more into focus.

Abstract Background Organized breast cancer screening (BCS) programs are effective measures among women aged 50–69 for preventing the sixth cause of death in Germany. Although the implementation of the national screening program started in 2005, participation rates have not yet reached EU standards. It is unclear which and how sociodemographic factors are related to BCS attendance. This scoping review aims to identify sociodemographic inequalities in BCS attendance among 50-69-year-old women following the implementation of the Organized Screening Program in Germany. Methods Following PRISMA guidelines, we searched the Web of Science, Scopus, MEDLINE, PsycINFO, and CINAHL following the PCC (Population, Concept and Context) criteria. We included primary studies with a quantitative study design and reviews examining BCS attendance among women aged 50–69 with data from 2005 onwards in Germany. Harvest plots depicting effect size direction for the different identified sociodemographic inequalities and last two years or less BCS attendance and lifetime BCS attendance were developed. Results We screened 476 titles and abstracts and 33 full texts. In total, 27 records were analysed, 14 were national reports, and 13 peer-reviewed articles. Eight sociodemographic variables were identified and summarised in harvest plots: age, education, income, migration status, type of district, employment status, partnership cohabitation and health insurance. Older women with lower incomes and migration backgrounds who live in rural areas and lack private insurance respond more favourably to BCS invitations. However, from a lifetime perspective, these associations only hold for migration background, are reversed for income and urban residency, and are complemented by partner cohabitation. Finally, women living in the former East German states of Saxony, Mecklenburg-Western Pomerania, Saxony-Anhalt, and Thuringia, as well as in the former West German state of Lower Saxony, showed higher BCS attendance rates in the last two years. Conclusion High-quality research is needed to identify women at higher risk of not attending BCS in Germany to address the existing research’s high heterogeneity, particularly since the overall attendance rate still falls below European standards. Protocol registration https://osf.io/x79tq/ .

Abstract Background Type 2 Diabetes mellitus (T2DM) and periodontitis share common risk factors and influence one another. However, primary care and oral health care continue to operate separate from each other and fail to synchronize care for patients with T2DM and periodontitis. The purpose of this practice-based trial is to evaluate the implementation of a new integrated care pathway for patients with T2DM and periodontitis. The new approach integrates a screening for T2DM risk in dental care settings in patients with periodontitis, a screening for periodontitis risk in primary care settings in patients with T2DM, and mutual referrals between dentists and primary care physicians. Methods Two practice-based studies will be carried out in parallel: (i) In dental care settings: a practice-based, multi-centric, cluster-randomized, controlled trial with a control and an intervention group; (ii) in primary care settings: a practice-based, multi-centric, non-randomized, controlled trial with a synthetic control group calculated from claims data. Following a two-step recruitment approach, 166 dentists and 248 general practitioners will be recruited, who themselves will recruit a total of 3808 patients in their practices. Patient data will be collected at baseline, 12 months, and 24 months after study enrollment. The evaluation comprises: (i) impact evaluation, using a hierarchical linear mixed model; (ii) process evaluation, based on surveys alongside the trials; (iii) economic evaluation. In addition, a Discrete-Choice-Experiment will identify provider’s payment preferences for the new care approach. Discussion Upon successful implementation, the intervention will enable health care providers to detect a risk for T2DM and periodontitis in patients at an early stage, thus providing patients an opportunity for timely diagnosis and therapy. Ultimately, this can lead to increased quality of life and reduced health care expenditures. On a methodologic level, the project provides novel insights into a complex intervention on the intersection of general practice and dental care. Trial registration The study was prospectively registered at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030587 ) on 3. July 2023 under ID “DRKS00030587“.

Abstract The structure of cellular prion proteins encoded by the prion protein gene (PRNP) impacts susceptibility to transmissible spongiform encephalopathies, including chronic wasting disease (CWD) in deer. The recent emergence of CWD in Northern European reindeer (Rangifer tarandus), moose (Alces alces alces) and red deer (Cervus elaphus), in parallel with the outbreak in North America, gives reason to investigate PRNP variation in European deer, to implement risk assessments and adjust CWD management for deer populations under threat. We here report PRNP-sequence data from 911 samples of German red, roe (Capreolus capreolus), sika (Cervus nippon) and fallow deer (Dama dama) as well as additional data from 26 Danish red deer close to the German border and four zoo species not native to Germany. No PRNP sequence variation was observed in roe and fallow deer, as previously described for populations across Europe. In contrast, a broad PRNP variation was detected in red deer, with non-synonymous polymorphisms at codons 98, 226 and 247 as well as synonymous mutations at codons 21, 78, 136 and 185. Moreover, a novel 24 bp deletion within the octapeptide repeat was detected. In summary, 14 genotypes were seen in red deer with significant differences in their geographical distribution and frequencies, including geographical clustering of certain genotypes, suggesting “PRNP-linages” in this species. Based on data from North American CWD and the genotyping results of the European CWD cases, we would predict that large proportions of wild cervids in Europe might be susceptible to CWD once introduced to naive populations.

High temperatures that prevail at sun-exposed sites such as heaths, depressions, or on slopes, increase the risk of desiccation for rove beetles (Staphylinidae). Therefore, atmospheric and sub-atmospheric humidity determine the microclimates and thus habitat preference and activity of xerothermophilous species. In the nature reserve Marienfließ, a heathland in the south of Mecklenburg-Western Pomerania, Northeast German Lowlands, air temperature and humidity were recorded year-round along a transect at 10 sites, i.e. where the vegetation was more dense and more humid than where the vegetation was sparse and it was drier, using data loggers placed in the litter layer that recorded the conditions every 30 min in 2021. Monthly visits were made to determine the biomass of vegetation, soil and litter properties, edaphic rove beetle fauna and total abundance and and that of individual species at 1 m2 sites. Statistical analysis of 365 diurnal cycles per site, with pronounced amplitude in air temperature and humidity, clearly delineated the cooler and more humid sites from warmer and drier ones. Between 10 and 22 of the 30 xerothermophilous species (73.3%), such as, e.g. Quedius persimilis Mulsant & Rey, 1876, Xantholinus gallicus Coiffait, 1956, Cousya longitarsis (Thomson, 1867) and Euaesthetus superlatus Peyerimhoff, 1937, were recorded only at the cooler and moist sites on the heath. Comparison of the abundances and distribution of species revealed that the xerothermophilous heath-dwelling and desiccation-prone species prefer rather constant environmental conditions, i.e. niches in cool and moist habitats on warm and dry heathland.

Abstract This study examines whether premature termination of vocational education and training (VET) is more likely when trainees have to make compromises between their realistic occupational aspirations and the occupation for which they are trained in terms of the occupational dimensions of gender type, prestige, and occupational interests. Specifically, it examines the relative importance of the three compromise dimensions on premature VET termination. The study is based on a sample of 3,241 VET entrants from a cohort of ninth graders in 2010 in the German National Educational Panel Study (NEPS-SC4) in combination with aggregated data on occupational characteristics. Results from discrete hazard rate models indicate a higher risk of premature VET termination for trainees whose VET occupation differs from their realistic occupational aspiration from their school days. While compromises in prestige have no overall effect, both compromises in interests and gender type threaten the stability of VET. The results also indicate that compromises in interests have the strongest effect on the risk of premature VET termination and that the effects of compromises in gender type are partly mediated by the effects of compromises in interests. Furthermore, sensitivity analysis revealed that the main effects of compromises in gender type and prestige are gender specific.

The objective of this study is to conduct a comparative analysis of how media outlets in Russia, France, and Germany reported on events during the COVID-19 pandemic. The analysis was carried out in three stages: comparing the actors of biopolitics, examining the ideologemes of biopolitics, and analyzing the spheres in which biopolitics were implemented. The theoretical and methodological framework of this study is grounded in Michel Foucault's theory of biopolitics, Edward Herman and Noam Chomsky's propaganda model, and Didier Bigo's concept of (in)securitization. Texts related to the COVID-19 pandemic were categorized into four «waves» (January 2020 – March 2022) and retrieved using the keywords «pandemic», «covid», and «coronavirus» from the archives of «Rossiyskaya Gazeta», «Kommersant», «Novaya Gazeta», «Le Figaro», «Le Monde», «Le Parisien», «Süddeutsche Zeitung», «Die Zeit», and «Die Tageszeitung». The total volume of analyzed material amounts to 67.62 million words. The results reveal that state power consistently emerges as a key subject of biopower and biopolitics across all the media studied, following Foucault's traditional framework of biopower subjects. This includes a focus on the actions and decisions of government officials and institutions. Additionally, the study found that all examined media outlets participated in promoting vaccination campaigns orchestrated by the governments of Russia, Germany, and France, indicating a widespread alignment with state-led biopolitical strategies.The analysis also shows that the insecuritization of public life during the pandemic affected various sectors including social relations, the economy, healthcare, and education. Media discourse in all three countries highlighted these areas of impact, often framing them within the broader context of public and existential security.Furthermore, the study identifies notable differences in how the media in each country portrayed biopolitical themes. In Russia, media coverage placed a strong emphasis on the central government's role, while in Germany, there was a more pronounced delineation between federal and regional authorities. In France, media outlets often focused on the personal leadership of President Emmanuel Macron. Despite these differences, there were shared themes across all three countries, such as the emphasis on the importance of vaccination and the portrayal of government measures as necessary for public safety.

Abstract Background German hospitals are legally obliged to implement digital patient portals within the next years. Systematic reviews show that the use of patient portals may be associated with improved patient-centeredness and workflows. However, mandatory digital healthcare innovations are sometimes not used by the target group as planned or even completely rejected. Based on Roger's theory of innovation diffusion, it can be assumed that the time factor is of particular importance for the adoption of the patient portal. The aim of the project is to assess determinants of patient portal adoption and to examine whether Roger’s theory can be confirmed. Methods The project investigates the use of the patient portal in three different clinics of a large academic teaching hospital in Germany using a longitudinal study design with three cross-sectional time points (pre, post, post). Doctors and patients are surveyed about factors that predict the use of the patient portal and whether the strength of these factors changes over time. They are also interviewed about possible barriers they experience when using the patient portal or about the reasons why the patient portal is not used. Regression models and content analyses are used to answer the research questions. Discussion Determinants of patient portal use will be discussed under the light of the temporal component of Roger's theory. At the same time, it is expected that some determinants will remain unchanged over time. Identifying determinants independent of time allows targeting the groups, enabling specific communication strategies to empower these groups to use the patient portal, contributing to an equal health care system. Trial registration The study was prospectively registered in the German register of clinical trials (DRKS00033125) in May 2024.

Abstract Lung cancer is known for its high mortality; many patients already present with metastases at the time of diagnosis. The aim of this study is to assess the impact of new treatment strategies on the survival of primarily metastatic lung cancer patients and to analyze the differences in outcomes between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Population-based data, provided by the Robert-Koch Institute in Germany, was used and patients diagnosed between 2007 and 2018 were included in the study. We differentiated between NSCLC and SCLC patients and analyzed the survival over time for both sexes separately, using the Kaplan–Meier method. To evaluate survival advantages, we calculated multivariable hazard ratios. In total, 127,723 patients were considered for the study. We observed a moderate increase in survival over time. All patients showed an increased survival rate when undergoing chemotherapy. Minimal to no increase in survival was shown in NSCLC patients when receiving radiotherapy, whereas SCLC patients’ survival time did benefit from it. NSCLC patients receiving immunotherapy showed an increase in survival as well. It can be concluded that advancements in radiotherapy, the application of chemotherapy, and the introduction of immunotherapies lead to an increased survival time of both NSCLC and SCLC primarily metastatic lung cancer patients.

Abstract Background Health System Performance Assessments (HSPA) and analyses of unwarranted regional variation in health care both aim at identifying strengths and weaknesses of health systems to improve care. Applying HSPA’s conceptual approach of interrelated health system dimensions (e.g., access, quality) to regional levels might help to better understand variation in care to reduce inequity and improve performance. Methods We use four indicators identified and analysed in a pilot study for a German HSPA to assess variation in access to and quality of acute stroke care between Germany’s 16 federal states and urban vs. rural regions from 2014 to 2020. Stroke unit (SU) density, share of the population reaching a SU within 30 min by car, share of inpatient stroke cases treated in a hospital with a SU, and inpatient mortality were computed based on hospital quality reports and discharge data covering all acute care hospitals. Inpatient mortality was adjusted for age, sex, stroke type, and comorbidities. Results About 500 SU were identified, i.e., 2.0 per 1,000 inpatient stroke cases. Almost 95% of Germans could reach a SU hospital within 30 min (rural: 90%; urban: 99%; > 88% in all states but one). The share of inpatient stroke cases treated in a SU hospital increased to 93% with a decreasing span between rural (92%) and urban (95%) regions and between states (74–98%). Inpatient mortality stagnated around 8.5% and increased to 9.0% in 2020 (rural: 8.7%; urban: 9.2%; states: 7.0–9.7%, one outlier of 13.3%). Conclusions The results especially revealed varying performance patterns in access to and quality of acute stroke care between the federal states, indicating different areas for improvement which might be addressed by more targeted policy measures in the future.

Türkiye’nin 1959’da başlayan AB serüveni 1999 yılında adaylık statüsü elde etmesi ve 2005 yılında da tam üyelik müzakerelerine başlaması ile sürmüştür. Özellikle Soğuk Savaşın bitimiyle birlikte AB içindeki etkisi ve gücü artan Almanya süreç boyunca AB’nin Türkiye’nin üyeliğine dair politikasında belirleyici olmuştur. Bu çalışmanın amacı 2005 yılından 2021’e kadar iktidarda bulunan Angela Merkel’in başbakanlığı döneminde Almanya’nın Türkiye’nin AB üyelik sürecine yaklaşımını ve bu süreçteki etkisini tartışmaktır. Çalışmanın temel tezi; Merkel hükümetleri boyunca Almanya Türkiye’nin AB üyeliğine açıkça karşı çıkmış ve tam üyelik yerine imtiyazlı ortaklık fikrini desteklemiştir. Ancak Almanya hem AB’nin hem de kendi güvenliği ve çıkarları gibi akılcı sebeplerden dolayı Türkiye’nin müzakere sürecinin sonlandırılmasını ve AB’nin dışına itilmesini göze alamamış ve Türkiye’nin AB ve diğer AB üyesi ülkeler ile yaşadığı krizlerde de dengeleyici bir rol oynayarak Türkiye’yi AB yörüngesinde tutmaya çalışmıştır.

By displacing Rachel Carson’s approach in Silent Spring to another time, another place and another family of pesticides, this paper tells the story of the wide adoption of arsenates, despite their known toxicity, to control the then newly present Colorado potato beetle in Western Europe from the 1920s to the 1950s. Although arsenate use entailed health and environmental risks, it was extended to other insect pests because this control method proved effective. The Colorado beetle appears as the matrix around which plant protection was developed in France and Germany. The regulations, administrative structures and habits that revolved around the wide use of arsenates then paved the way for the quick and massive adoption of organochlorides after 1945.

Abstract Introduction In Germany, the estimation of the disease burden of respiratory syncytial virus (RSV) in older adults is limited. This makes it challenging for public health decision-makers to develop evidence-based recommendations for newly available vaccines against RSV for individuals aged 60 years and older (60+). This study investigates publicly available data sources in Germany to address the current gaps in evidence regarding the burden of RSV. Methods Hospitalisation databases from the German Federal Statistical Office and national mortality statistic between 2000 and 2023, as well as regular surveillance reports from the national public health institute since 2014, were utilised to extract, combine and analyse data on RSV-related morbidity and mortality. These data were used to triangulate the age-specific burden of RSV. Results The data indicate that the number of RSV-related outpatient consultations ranges between 1,313,100 and 3,911,800 cases per season from 2014/2015 to 2022/2023 for all age groups, with approximately 13.0% of outpatient consultations occurring in adults 60+. The significant increase in hospitalisations over time suggests that heightened testing due to the coronavirus disease 2019 (COVID-19) pandemic revealed the underdetection of inpatient RSV cases in pre-pandemic seasons. In the most recent season recorded, 2022/2023, the data show 12,800 RSV-related hospitalisations in adults 60+ (24% of all RSV-related hospitalisations) and 1340 in-hospital deaths in adults 60+ (93% of all RSV-related deaths). Conclusion The comparison of pre- to post-pandemic seasons strongly suggest up to a sevenfold underdetection of RSV in individuals 60+, and the analysis of in-hospital mortality reveals higher mortality rates compared with the general German mortality statistics. These findings highlight the urgent need to improve surveillance and implement targeted prevention strategies to mitigate the impact of RSV in older adults.

Background: Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus). Methods: The diabetes risk of persons without diabetes (n = 4,698, 18 – 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 – 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 – 79 years) were stratified according to sociodemographic and migration-related characteristics. Results: Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes. Conclusions: The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.

This study examines the connectedness among the sectoral indices for the USA, India, France, Germany and Russia stock markets pre and post-COVID-19. We use the Diebold and Yilmaz spillover index to examine the study's objectives. This study finds that volatility spillover is higher during COVID-19 than before COVID-19. In addition, the volatility transmission across the sectors demonstrated mixed results regarding net volatility receivers and transmitters. However, the degree of transmission is higher for the net volatility receivers than for the net volatility transmitters. This study will help policymakers draft related policies to immunise their economy and market from spillover contagions of international markets during varying pandemic scenarios. This study would also help potential investors, including foreign institutional investors, diversify their portfolios based on the sectors with net volatility transmitters and receivers.

Objectives Aim: The purpose of the research is the diagnosis of competencies of people holding managerial positions in the geriatric care sector in Germany. Material and methods Scheitler's concept of competency was employed in this study. The method of in-depth unstructured interviews was also used. The method of qualitative content analysis according to Mayring was applied to evaluate the obtained data. Results As a result of the conducted analyses, professional tasks and competencies of people holding managerial positions in the geriatric care sector in Germany were presented. Conclusions The research results showed that the tasks of people performing managerial functions in geriatric care in Germany are complex and exceed medical or caregiving tasks. They are related to personnel management, responding to their needs, as well as the needs and expectations of people managing medical facilities. An extremely important task is cooperation with the relatives of the elderly. The research results also revealed the importance of having a wide variety of competencies. The respondents were of the opinion that professional skills are less important and social and personal skills are gaining in importance.

Background: The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany. Methods: GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health. Results: 87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good. Conclusions: There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.

Abstract Background Medical students and doctors face various challenges in clinical practice. Some of these challenges are related to ethical issues. Therefore, teaching ethics respectively building moral competences has become an integral part of the medical curriculum in Germany and many other countries. To date, there is little evidence on moral competence of medical students. Methods Self-administered survey among medical students from one German medical school in the first (cohort 1) and fifth semester (cohort 2) in the winter term 2019/20 (T0). Both cohorts received the same questionnaire one year later in winter term 2020/21 (T1). Assessment was performed with Lind’s Moral Competence Test. We performed convenience sampling. We analyzed the data with descriptive statistics and C-Scores as a measure of moral competence (higher scores = higher competence, ≥ 30 points = high competence). Results A total of 613 students participated in the study (response rate 67.5%, n = 288 with data on both time points). 69.6% of the participants were female, the mean age was 21.3 years. Mean C-Score for both cohorts for T0 (first and fifth semester) is 32.5 ± 18.0 and for T1 (third and seventh semester) is 30.4 ± 17.9. Overall, 6.6% (T0) and 6.7% (T1) of respondents showed some but very low moral competence. 3.3% (T0) and 3.0% (T1) showed no moral competence. Additionally, students without prior experience in the healthcare system scored 3.0 points higher. Conclusions Improvement of assessment of moral competence as well effective interventions are particular needed for supporting those students which have been identified to demonstrate little moral competences.

Abstract Background Despite the significant role of scientific knowledge pertaining to public health, the discipline of public health remained outside the centre stage within the pandemic discourse. Against this background, we investigated the role of German public health academics during the pandemic in our study, focusing on their orientations and associated values. Methods We interviewed 21 public health scholars from Germany and collected 36 documents published by public health scientific societies. We analyzed data by grounded theory and situational mapping. Results We identified five types of self-images identified among healthcare academics: the scientific study supplier, the expert facing political issues, the restrained scholar, the public informer and the changemaker. The typology yields insights into the multiple dimensions of public health and its role in times of crisis. Conclusions The findings provide implications to inter- and transdisciplinary interaction and to managing the expectations of public health professionals in relation to crisis management.

Abstract Background Pre-exposure prophylaxis (PrEP) with oral emtricitabine/tenofovir disoproxil (FTC/TDF) proved highly efficient in preventing HIV. Since 09/2019, FTC/TDF-PrEP is covered by health insurances in Germany, if prescribed by licensed specialists. However, methods to longitudinally monitor progress in PrEP implementation in Germany are lacking. Methods Utilizing anonymous FTC/TDF prescription data from 2017-2021, we developed a mathematical model to disentangle HIV-treatment from PrEP prescriptions, as well as to translate PrEP prescriptions into number of PrEP users. We used the model to estimate past- and future PrEP uptake dynamics, to predict coverage of PrEP needs and to quantify the impact of COVID-19 on PrEP uptake on a national and regional level. Results We identified significant (p

Abstract Background The Thriving from Work questionnaire is a comprehensive indicator of positive well-being for employees, applicable in both research and practical contexts. Current discussions underline the crucial impact that employment should have in enriching workers’ lives positively and meaningfully, along with the necessity for accurate and dependable tools to assess employee well-being. This study investigated the reliability, validity, and dimensionality of the translated German adaptation of the Thriving from Work questionnaire developed by Peters and colleagues [1, 2]. The questionnaire assesses work-related well-being with 30 items clustered in six domains: emotional and psychological well-being, social well-being, work-life integration, physical and mental well-being, basic needs for thriving, and experiences of work. Methods This study aimed to convert the Thriving at Work Questionnaire from English into German. We assessed the psychometric characteristics of the German version of the questionnaire by using item response theory with a sample of 567 German employees and examined its criterion validity. Results We found that the long and short German Thriving from Work questionnaire versions are reliable with good construct validity. Criterion validity was demonstrated by relationships with important work and life outcomes, such as life satisfaction, trust in the organizations’ management, general well-being, work-related fatigue, and work stress. Conclusions The current study demonstrated that the German language version of the questionnaire is both a reliable and valid measure of employee well-being. We discuss recommendations for further adaptation and future research.

This paper tackles the question of how women leaders in executive positions have tackled the debut of the COVID-19 pandemic (March-July 2020). For granularity I will restrict the analysis to two particular cases, Serbia (ex-Prime Minister Ana Brnabic) and Germany (ex-Chancellor Angela Merkel), but the conclusions can be tested in future crisis situations. Drawing on analyses of the measures implemented and the political discourses/interviews of the two leaders related to the pandemic I will describe and evaluate their decision-making strategies. Subsequently I will analyse how the context/ specificity of the significantly different socio-political characteristics of the two states interfere with the leader’s decision and meaning making process. In order to do this, I will also use and analyse data provided by the Varieties of Democracy Institute. The final results show different approaches for Brnabic (failed to successfully fulfil the roles expected of leaders in crisis situations, according to crisis management literature) and Merkel (resembles the leader “prototype” in times of crisis). However, among other factors, I take into consideration that the state of the regime in Serbia (tendencies of democratic backsliding) can be held accountable for Brnabic’s poor performance as a leader in crisis.

Abstract Background The recurrent mental illness bipolar disorder is a major burden on the healthcare system, which underlines the importance of research into this disease. Germany is one of the most productive countries in this research activity. This bibliometric analysis aims to outline the social and conceptual structure of the German research landscape on bipolar disorder over the last decade. Furthermore, we provide a short overview over current public funding. Results Concerning the social structure, most of the German publications were collaboration projects, both with a national but also international orientation, in the latter case predominantly with countries of the global North. Analysis of the conceptual structure of German research activity identified psychiatric genetics, early recognition of bipolar disorder, neuroimaging, and pharmacological interventions as important topics within the field. In the context of a survey, only few publicly funded research projects were reported, many of which did not exclusively investigate bipolar disorder but followed a transdiagnostic approach. Conclusions Our bibliometric analysis revealed internationally well-networked German research activities on bipolar disorder. In stark contrast to its high prevalence and correspondingly high financial burden to the healthcare system, current grant support for research on this illness is strikingly low, particularly concerning the development of novel treatments.