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The article discusses the partial switch from a shared cost pension system to a two-level system in Germany. The author suggests that there was no economic or demographic reason for a switch, yet the partial shift from the shared costs system to a government funded system was necessary for sociopolitical reasons. He contends that the shift contributed to unifying modernization with social justice.

The article focuses on the need for reform in various areas pertaining to compulsory accident insurance in Germany. In particular, the author suggests that the terminology related to coverage for "disability" in accident insurance law is outdated. He contends that the financial burden and responsibility should be separated between accident insurance law and pensions, and calls for a restructuration with regard to insurance for traffic accidents.

The article discusses the extent to which the ideas of economic philosopher Karl Marx are reflected in and absent from contemporary German social policy and reality. The development of social security is traced from Chancellor Otto von Bismarck's historic 1881 proclamation of the "Kaiserly Embassy" which founded workers' welfare as a state undertaking. The compromises of socialism and capitalism are reviewed. Future social prospects are speculated on.

Competing Interests: LM has received fees and/or reimbursements from the following companies/institutions in the last 3 years: AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly Pharma, Kassenärztliche Bundesvereinigung, Merck Inc., MSD Sharp & Dohme, Novo Nordisk, Praxisnetz Dormagen, Servier. He declares that he sees no conflict of interest with the article he has created. TE has received fees/cost reimbursements from Lilly, Novo Nordisk and Sanofi over the last 3 years. Within the scope of a consulting activity he received a fee from the companies Sanofi and Boehringer Ingelheim Pharma. He is also supported by a Novo Nordisk Postdoctoral Fellowship, which is carried out in cooperation with the Karolinska Institutet, and by a mentorship program of the European Foundation for the Study of Diabetes (EFSD), which is supported by an Educational grant from AstraZeneca. MG received fees/cost reimbursements/study grants from the following companies: Alexion, Astellas, Baxter, Bayer, Chiesi, AstraZeneca. B-WB and BI declare that they have no potential conflicts of interest.

Introduction: The aim of the study is to compare length of hospital stay, transfusion rates, and re-intervention rates during hospitalization for transurethral resection of the prostate (TUR-P), open prostatectomy (OP), and laser therapy (LT) for surgical treatment of benign prostatic obstruction (BPO)., Methods: URO-Cert is an organization, in which clinical data of prostatic diseases from 2 university, 19 public, and 3 private hospitals and 270 office-based urologists are collected in order to document treatment quality. Data on diagnostics, therapy, and course of disease are recorded web based. The analysis includes datasets from 2005 to 2017., Results: Of 10,420 patients, 8,389 were treated with TUR-P, 1,334 with OP, and 697 with LT. Median length of hospital stay was 6 days (IQR: 4-7) for TUR-P, 9 days (IQR: 7-11) for OP, and 5 days (IQR: 4-6) for LT (p < 0.001). Risk for a hospital stay ≥7 days was higher for OP versus TUR-P (OR: 7.25; 95% CI = 6.27-8.36; p < 0.001) and LT (OR: 17.89; 95% CI = 14.12-22.65; p < 0.001) and higher for TUR-P versus LT (OR: 2.47; 95% CI = 2.03-3.01; p < 0.001). OP had a significantly higher risk for transfusions than TUR-P (OR: 2.44; 95% CI = 1.74-3.41; p < 0.001) and LT (OR: 3.32; 95% CI = 1.56-7.01; p < 0.001). Transfusion rates were not significantly different between TUR-P and LT (OR: 1.36; 95% CI = 0.66-2.79; p = 0.51). Risk of re-intervention was not different between all 3 approaches., Conclusion: OP was associated with higher transfusion rates and longer hospital stay than TUR-P and LT. Risk of transfusion was not different between TUR-P and LT, but TUR-P was inferior to LT concerning length of hospital stay. Re-intervention rates during hospitalization did not differ between the groups., (© 2021 S. Karger AG, Basel.)

Objective: Adipose tissue-derived signals potentially link obesity and adipose tissue dysfunction with metabolic and cardiovascular diseases. Although some adipocytokines have been closely related to metabolic and cardiovascular traits, it is unknown which adipocytokine or adipocytokine clusters serve as meaningful markers of metabolic syndrome (MS) components. Therefore, this study investigated the associations of 12 adipocytokines with components of the MS to identify the most relevant cytokines potentially related to specific metabolic profiles., Research Design and Methods: Twelve cytokines [adiponectin, adipocyte fatty acid-binding protein (AFABP), angiopoietin-related growth factor, chemerin, fibroblast growth factor (FGF) 19, FGF21, FGF23, insulin-like growth factor-1, interleukin 10, irisin, progranulin, and vaspin] were quantified in a cross-sectional cohort of 1046 subjects. Hypothesis-free cluster analysis, multivariate regression analyses with parameters of the MS, and discriminant analysis were performed to assess associations and the relative importance of each cytokine for reflecting MS and its components., Results: Among the studied adipocytokines, adiponectin, AFABP, chemerin, and FGF21 showed the strongest associations with MS and several MS components in discriminant analyses and multiple regression models. For certain metabolic components, these adipocytokines were better discriminators than routine metabolic markers. Other cytokines investigated in the present cohort are less able to distinguish between metabolically healthy and unhealthy subjects., Conclusions: Adiponectin, AFABP, chemerin, and FGF21 showed the strongest associations with MS components in a general population, suggesting that adverse adipose tissue function is a major contributor to these metabolic abnormalities. Future prospective studies should address the question whether these adipocytokines can predict the development of metabolic disease states.

After 400 days of integrated care the number and content of existing contracts are not yet known. This nationwide anonymity might be the result of a competition between present health insurers and healthcare providers. Anyway, it does not contribute to the quality of healthcare. Taking the contract signed with the AOK Bavaria and comprising the integrated care of patients with prostate carcinoma, prostate adenoma and prostatitis as an example the contents and consequences of this agreement will be described. Advantages and disadvantages for the parties involved are explained. Integrated care might be one of the contributions needed to effect the necessary structural changes of the German healthcare system.