Search

Although small and medium-sized enterprises (SMEs) contribute considerably to Germany's carbon emissions, regional savings and cooperative banks − SMEs' most important financiers − hardly consider this aspect in lending to these businesses. However, given Germany's commitment to climate neutrality by 2045, suitable approaches for injecting climate finance into these SME lending processes are greatly required. Against this background, the paper at hand aims to introduce the specific case of regional banks into the debate on green finance and green banking and suggest future research in this context. In discussing the state of research on the peculiarities of regional savings and cooperative banks, we outline the resulting opportunities and limitations for climate impact assessments in SME lending. We argue that while the dual bottom-line orientation of regional banks in Germany precludes them from applying simple positive or negative screenings, their in-depth knowledge about local clients and circumstances enables them to be active and engaging partners for the green transformation of SMEs. Nonetheless, we explain why developing solutions to utilise this knowledge for climate finance by integrating climate impact assessments into routine lending processes remains a particularly challenging task. [ABSTRACT FROM AUTHOR]

Although drug acceptability can have a significant impact on patient adherence in pediatric therapy, data are limited, even for common therapeutic areas. We present the second part of an acceptability study conducted at the University Children's Hospital Düsseldorf, Germany. The study investigated the acceptability of most commonly used antibiotics in a pediatric hospital setting. The researchers used the acceptability reference framework to score the acceptability of five antibiotics based on 150 real-life observer reports of medicine intake. Four antibiotics assessed in this study were formulated as preparations for injection (ampicillin, ampicillin/sulbactam, ceftriaxone, and gentamicin) and one as a powder for oral liquid suspension (co-amoxiclav). All the antibiotics formulated as preparations for injection were rated negatively due to high rates of negative reactions (80%), the use of restraint (51%), the use of extra devices (99%), and long preparation and administration times (100%). The antibiotic formulated as a powder was significantly more well accepted. The study concluded that there is a lack of appropriate formulations for antibiotics for use in children. These findings are important in improving knowledge on acceptability drivers and might help in formulating and prescribing better medicines for children. The study highlights the need for healthcare professionals to have knowledge about the acceptability of different products to select the best-adapted product for each patient. [ABSTRACT FROM AUTHOR]

Until now, many efforts in the area of environmental education, intended to instill consciously responsible behaviour into the general public in Germany, have failed. Several of the available intervention studies aimed at improving environmental behaviour of pupils with classroom tuition were able to show positive results, but there were often shortcomings in the design of these studies. First, this article presents some of these and deduces improvements and extensions for the design of the following intervention study. The described study investigated whether the active involvement and organisation in environmental activities influences the environmental behaviour of pupils. Active participation and organisation means a protection activity, designed and carried out by pupils, with help from their teacher. The results of this quantitative investigation show that the method of participation and organisation is successful and very promising. Improvements in reported and observed actual behaviour can be proved after the intervention. However, the changes are bound to the behaviour that was thematised in the teaching. The environmental perception of the pupils did not improve. Gender and the environmental perception of the pupils had no effect on the changes.

The "Green Classroom" in the Botanical Garden of the University of Ulm is a learning forum outdoor school that is used by about 2500 school students annually. Its educational concept is based on experiential learning and is geared towards expanding students' biological knowledge and developing positive attitudes towards small animals and invertebrates such as insects. In the first study, 104 secondary-school students (49 who had previously visited the "Green Classroom") were asked to write an essay about small animals such as insects. Students who had visited the "Green Classroom" before showed more biological understanding and portrayed more positive emotions towards small animals, and had fewer misconceptions than their peers. In the second study, 121 students (grades 3 and 4) were asked to draw a picture of a forest as a habitat; 65 of these students had previously visited the "Green Classroom" (test group). Students of the test group drew more smaller types of animals in their pictures and furthermore more different species than the control group.

Objectives: The objective of the study was to investigate the contribution of work factors and health-related lifestyle to educational inequalities in physical health among older workers in Germany by applying causal mediation analysis with longitudinal data. Methods: Data from the German lidA study was used. 2653 persons (53% female, 47% male) aged 46 (born 1965) and 52 (born 1959) at baseline were followed up for seven years with exposure and outcome assessments in 2011 (t0), 2014 (t1) and 2018 (t2). The total effect of education on physical health was decomposed into a natural direct effect (NDE) and a natural indirect effect (NIE) by using a sex-stratified causal mediation analysis with an inverse odds weighting approach. Baseline health, partner status and working hours were entered as a first set of mediators preceding the putative mediators of interest. All analyses were adjusted for age and migrant status. Results: Independent of the first set of mediators, work factors explained 21% of educational inequalities in physical health between low and high educated women and 0% comparing moderate versus high educated women. The addition of health behaviors explained further 26% (low vs. high education) and 20% (moderate vs. high education), respectively. Among men, net of the first set of mediators, work factors explained 5% of educational inequalities in physical health between low and high educated and 6% comparing moderate versus high educated persons. Additional 24% (low vs. high education) and 27% (moderate vs. high education) were explained by adding health behaviors to the models. Conclusions: To reduce educational inequalities in physical health among older workers in Germany, interventions to promote healthy behaviors are promising. Improving working conditions is likely an important prerequisite. [ABSTRACT FROM AUTHOR]

In light of a large proportion of older workers leaving the German labour market in the near future, policy makers aim to extend working lives to ensure sustainability of the social security system. In this context, safe and healthy working conditions are considered a precondition for encouraging employment participation. To understand better the role of the work environment in pre-retirement years, we draw upon an established model of five job quality profiles for the German ageing workforce. We explored seven-year profile development and linked selected manual and non-manual job quality trajectories to the motivation to work (MTW) using data from the 2011, 2014 and 2018 assessments of the lidA cohort study (valid N = 2,863). We found that older workers shifted to physically less-demanding profiles. Individual profile stability was prevalent among one-third of the workers. In 2018, there was a higher MTW when job quality remained favourable or improved early, while later improvements were associated with lower MTW. Early deterioration of job quality was associated with lower MTW levels among workers with non-manual trajectories only. The results highlight the dynamic job quality situation of the older German workforce and the importance of adopting a person-centred perspective when investigating working conditions and its effects. They further underline the need to consider quality of work when designing and implementing strategies to extend working lives. [ABSTRACT FROM AUTHOR]

The "Green Classroom" in Ulm is an experiential learning forum outside school. Its educational concept is based on experimental learning and is geared towards expanding biological knowledge and developing environmental attitudes regarding preservation and utilisation of nature. We assessed the environmental attitude of 92 students before and after they visited the "Green Classroom", and compared the answers they gave in their questionnaires with those of 100 students from a control group. Although the students spent only one morning in the "Green Classroom", attitudes towards utilization of nature improved after their visit but not towards preservation of nature. Moreover, students displayed greater intrinsic motivation towards learning about the animals than the control group. (Contains 2 tables and 1 graph.)

Background Monoclonal antibodies (mAbs) that target severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are predominantly less effective against Omicron variants. Immunocompromised patients often experience prolonged viral shedding, resulting in an increased risk of viral escape. Methods In an observational, prospective cohort, 57 patients infected with Omicron variants who received sotrovimab alone or in combination with remdesivir were followed. The study end points were a decrease in SARS-CoV-2 RNA <106 copies/mL in nasopharyngeal swabs at day 21 and the emergence of escape mutations at days 7, 14, and 21 after sotrovimab administration. All SARS-CoV-2 samples were analyzed using whole-genome sequencing. Individual variants within the quasispecies were subsequently quantified and further characterized using a pseudovirus neutralization assay. Results The majority of patients (43 of 57, 75.4%) were immunodeficient, predominantly due to immunosuppression after organ transplantation or hematologic malignancies. Infections by Omicron/BA.1 comprised 82.5%, while 17.5% were infected by Omicron/BA.2. Twenty-one days after sotrovimab administration, 12 of 43 (27.9%) immunodeficient patients had prolonged viral shedding compared with 1 of 14 (7.1%) immunocompetent patients (P =.011). Viral spike protein mutations, some specific for Omicron (e.g. P337S and/or E340D/V), emerged in 14 of 43 (32.6%) immunodeficient patients, substantially reducing sensitivity to sotrovimab in a pseudovirus neutralization assay. Combination therapy with remdesivir significantly reduced emergence of escape variants. Conclusions Immunocompromised patients face a considerable risk of prolonged viral shedding and emergence of escape mutations after early therapy with sotrovimab. These findings underscore the importance of careful monitoring and the need for dedicated clinical trials in this patient population. [ABSTRACT FROM AUTHOR]

Background: Japanese encephalitis is an arthropod-borne zoonotic flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae. Literature review: Myelitis with flaccid paralysis is a rare complication of Japanese Encephalitis, which—according to our literature search—was reported in 27 cases, some of which were published as case reports and others as case series. Overall, there is a broad clinical spectrum with typically asymmetric manifestation and partly severe motor sequelae and partly mild courses. Lower limb paralysis appears to be more frequent than upper limb paralysis. An encephalitic component is not apparent in all cases Case presentation: We herein add the case of a 29 year-old female who developed encephalitis and myelitis with flaccid paralysis during a long-time stay in Indonesia. Diagnostic workup in Indonesia did not clearly reveal an underlying cause. Upon clinical stabilization, the patient was evacuated to her home country Germany, where further diagnostics confirmed Japanese encephalitis virus as the causative agent. The patient has partly recovered, but still suffers from residual paralysis of the upper limb. Conclusion: Flaccid paralysis is a rare, and likely underdiagnosed complication of Japanese encephalitis, which, to the best of our knowledge, has never been diagnosed outside endemic areas before. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the contribution of work factors, health, and work ability to social inequalities in early exit from employment among older employees in Germany. Methods Longitudinal data from the representative German lidA Cohort study was linked with employment register data to obtain maximum information on exit routes out of paid employment. Information of N=2438 respondents, aged 46 and 52 at baseline, were obtained for a follow-up of six years (2011–2017). Causal mediation analysis with inverse odds weighting was conducted using discrete-time survival outcomes and baseline measurements of the socioeconomic status (SES: education), work factors, health, and work ability. Results Older employees with low SES were at an increased risk of exiting employment early by receiving disability pension and through long-term unemployment but not through an unspecified labor market exit when compared to those with high and moderate SES. Low work ability accounted for up to 38% of the social inequalities in work exits into disability pension. Less-than-good physical health accounted for up to 59% of inequalities in work exits into long-term unemployment. Work factors contributed considerably to inequalities in exits through unemployment but not disability pension. Conclusions This study finds social inequalities in early exits through disability pension and long-term unemployment among older employees in Germany, predominantly attributable to differences in work ability (disability pension) and physical health (unemployment). Investments in work ability and promotion of physical health may constitute promising approaches to counteract an increase of these inequalities. [ABSTRACT FROM AUTHOR]

Occupational change encompasses change of profession, employer and work tasks. This study gives an overview on occupational change in later working life and provides empirical evidence on voluntary, involuntary and desired occupational changes in the older workforce in Germany. The analyses were based on longitudinal data from 2,835 participants of the German lidA Cohort Study, a representative study of employees born in 1959 or 1965. Multinomial logistic regression analyses were performed in order to characterise the change groups in their previous job situation. The findings indicate that occupational change among older workers is frequent. In four years, 13.4 per cent changed employer, 10.5 per cent profession and 45.1 per cent work tasks. In addition, the desire for change often remains unfulfilled: the share of older workers who wanted to but did not change was 17.6 per cent for profession, 13.2 per cent for employer and 8.9 per cent for work tasks. The change groups investigated differ in terms of their socio-demographic background, health and job factors such as seniority and leadership quality. In times of ageing populations, the potential of occupational change among older workers requires more consideration in society, policy and research. Special attention should also be paid to the group of workers who would have liked to change but feel that they cannot leave. [ABSTRACT FROM AUTHOR]

• This article contributes to the debate on multi-system interactions. • Focusing on sector-specific institutional work activities along with enabling conditions helps to explain the reconfiguration of system boundaries. • We conceptualize four main forms of the reconfiguration of system boundaries. • Particularly within-system incumbents from both systems leverage their resources and engage in cross-sectoral institutional work in order to create institutional couplings. • Cross-sectoral networks as well as intellectual and physical-material resources are found to be important features for strong agency. Multi-system interactions are receiving increasing attention within transition research. However, understanding the consequences of increasing couplings between adjacent systems for transitions requires further research. In response, this paper applies the concept of institutional work to understand the role of actors creating institutional couplings for the reconfiguration of multiple systems. We further elaborate on enabling conditions for institutional work from a sector-sensitive perspective. In-depth interviews with energy and automobile sector experts and participant observation at industry association events show that cross-sectoral networks and advocacy are important mechanisms for creating regulative couplings. However, particularly actors in the automotive industry are able to advance into the electricity market due to increasing access to political institutions and enhanced intellectual and physical-material resources. Thus, we show how within-system incumbents leverage their resources and engage in cross-sectoral institutional work in order to gain knowledge and integrate new technologies. [ABSTRACT FROM AUTHOR]

In order to slow the spread of the CoViD-19 pandemic, governments around the world have enacted a wide set of policies limiting the transmission of the disease. Initially, these focused on non-pharmaceutical interventions; more recently, vaccinations and large-scale rapid testing have started to play a major role. The objective of this study is to explain the quantitative effects of these policies on determining the course of the pandemic, allowing for factors like seasonality or virus strains with different transmission profiles. To do so, the study develops an agent-based simulation model, which explicitly takes into account test demand and behavioral changes following positive tests. The model is estimated using data for the second and the third wave of the CoViD-19 pandemic in Germany. The paper finds that during a period where vaccination rates rose from 5 to 40%, seasonality and rapid testing had the largest effect on reducing infection numbers. Frequent large-scale rapid testing should remain part of strategies to contain CoViD-19; it can substitute for many non-pharmaceutical interventions that come at a much larger cost to individuals, society, and the economy. [ABSTRACT FROM AUTHOR]

Background: Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery are established treatment options for portal hypertension, but have not been systematically evaluated in patients with portal hypertension due to hepatosplenic schistosomiasis (HSS), one of the neglected tropical diseases with major impact on morbidity and mortality in endemic areas. Methods: In this retrospective case study, patients with chronic portal hypertension due to schistosomiasis treated with those therapeutic approaches in four tertiary referral hospitals in Germany and Italy between 2012 and 2020 were included. We have summarized pre-interventional clinical data, indication, technical aspects of the interventions and clinical outcome. Findings: Overall, 13 patients with confirmed HSS were included. 11 patients received TIPS for primary or secondary prophylaxis of variceal bleeding due to advanced portal hypertension and failure of conservative management. In two patients with contraindications for TIPS or technically unsuccessful TIPS procedure, proximal splenorenal shunt surgery in combination with splenectomy was conducted. During follow-up (mean follow-up 23 months, cumulative follow-up time 31 patient years) no bleeding events were documented. In five patients, moderate and transient episodes of overt hepatic encephalopathy were observed. In one patient each, liver failure, portal vein thrombosis and catheter associated sepsis occurred after TIPS insertion. All complications were well manageable and had favorable outcomes. Conclusions: TIPS implantation and shunt surgery are safe and effective treatment options for patients with advanced HSS and sequelae of portal hypertension in experienced centers, but require careful patient selection. Author summary: Hepatosplenic schistosomiasis is a severe form of chronic infection with various trematodes of the genus Schistosoma, characterized by portal venous fibrosis, splenomegaly with hypersplenism, and portal hypertension with subsequent life-threatening bleeding events. While effective anthelminthic treatment is available, portal fibrosis is only partially reversible. Portal hypertension with subsequent bleeding events as a complication is hitherto insufficiently addressed. Surgical techniques are currently the best established treatment option for HSS, despite their inherent complication risk and irreversibility. Interventional procedures like TIPS have rarely been assessed in HSS with mixed results. In a series of 13 cases with follow-up periods up to 99 months and a cumulative follow-up of 30.9 years, we demonstrate excellent bleeding prophylaxis and a low adverse event rate of TIPS and–if TIPS proves infeasible–splenorenal shunt surgery. Main complications of TIPS comprise transient hepatic encephalopathy and increase of liver enzymes, especially in patients with hepatic comorbidities. Due to necessary infrastructure and skills, TIPS implantation is currently limited to specialized centers. However, we think that our study can support the establishment and development of new treatment options for schistosomiasis and, in the medium term, also improve the prognosis of this neglected tropical disease in endemic regions. [ABSTRACT FROM AUTHOR]

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students' learning and mental wellbeing. During a period of ongoing comprehensive social distancing measures in Germany, we translated a competency-based curriculum including obstetrics, paediatrics, and human genetics to an e-learning course based on online patient and teacher encounters. In our qualitative study on students' and teachers' views, we identify potential enablers and drivers as well as barriers and challenges to undergraduate medical education under lockdown. In summer 2020, we conducted six focus group interviews to investigate medical students' and teachers' perspectives, experiences and attitudes. All focus groups were videotaped, transcribed verbatim and coded. To guide our deductive and inductive analysis, we applied the theoretical framework of Regmi and Jones. Content analysis was performed in a multi-perspective group. We identified five major themes contributing to a successful use of clinical competency-based e-learning under lockdown: Communication (with teachers, students, and patients), Mental wellbeing, Structure and self-organization, Technical issues, and Learning and commitment. We discuss enablers and potential barriers within all themes and their overlap and link them in an explanatory model. In our setting, students and teachers find e-learning holds strong potential and especially in times of COVID-19 it is greatly appreciated. We broaden the understanding of the impact of distant learning on acquiring competencies, on attitudes, and on mental wellbeing. Our model may serve for a thoughtful, necessary transition to future e-learning and hybrid programs for a competency-based medical education with ongoing social distancing measures. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of the study was to investigate the effect of voluntary employer changes on self-reported work ability among older workers in Germany and whether a honeymoon-hangover effect (HHE) exists here. In research on job satisfaction, three typical periods around a voluntary employer change characterize a HHE: a deterioration in the old job (deterioration), an initial increase in the new job (honeymoon) and a subsequent decline over time (hangover). Whether a HHE exists in respect to work ability following a voluntary employer change remained open. The analyses are based on data from the first three waves of the lidA study (2011, 2014, 2018), a representative cohort study of older employees in Germany born in 1959 or 1965. Data from 2502 workers who participated in all three study waves was analyzed. Fixed-effects regression analyses including lag and lead variables were conducted. A deterioration, honeymoon and hangover period were found. Work ability increased substantially following the voluntary employer change. Our study shows that voluntary employer changes have the potential to maintain work ability at higher working age, but not to increase the work ability in the long-term perspective. However, despite the existence of a hangover period, the positive overall effect of the voluntary change should not be underestimated. [ABSTRACT FROM AUTHOR]

Aktuelle Analysen der deutschen lidA-Studie (www.lida-studie.de) legen nahe, dass die Digitalisierung der Arbeitswelt bei Älteren noch vornehmlich auf traditionelle digitale Arbeitsmittel beschränkt ist. Sie fühlen sich dabei allermeist sicher und sind zufrieden mit der digitalen Ausstattung. Besondere Risikogruppen für „digitalen Stress" sind möglicherweise Berufsgruppen, die mit Menschen arbeiten. Aussagekräftige Zahlen sind vonnöten, um die Digitalisierung des Arbeitsalltags zu quantifizieren, Auswirkungen zu beschreiben und Risikogruppen zu identifizieren. Current findings of the lidA study (www.lida-studie.de) indicate that among older workers in Germany, digitalisation of work is widely limited to traditional digital instruments. Mostly, the workers feel safe with it and are satisfied with the digital equipment at work. Specific risk groups for "digital stress" may be occupational groups characterised by work with people. Robust data is needed to quantify digitalisation at work, describe its effects and identify risk groups. [ABSTRACT FROM AUTHOR]

Background: An ageing and a shrinking labour force implies that the prevention of a premature exit from work due to poor health will become more relevant in the future. Medical rehabilitation is a health service that aims at active participation in working life. The provision of this service will be relevant for an increasing part of the ageing labour force, namely, employees with a migrant background and their different subgroups. Thus, this study examines whether first- and second-generation employees with migrant background differ from non-migrants in their utilisation of rehabilitation services and whether within the subsample of migrant employees, those persons with foreign nationality differ from those with German nationality.Methods: Socially insured employees born in 1959 or 1965 were surveyed nationwide in 2011 as part of the lidA cohort study (n=6303). Survey data of the first study wave were used to identify the dependent variable of the utilisation of rehabilitation (in- and outpatient), the independent variable of migrant status and the covariates of sociodemographic, work- and non-work-related factors. Applying bivariate statistics with tests of independence and block-wise logistic regressions, differences between the groups were investigated. Additionally, average marginal effects were computed to directly compare the adjusted models.Results: The study showed that first-generation migrants had a significantly lower likelihood of utilising outpatient rehabilitation than non-migrants (fully adj. OR 0.42, 95% CI 0.22-0.82) and that average marginal effects indicated higher differences in the full model than in the null model. No significant differences were found between the first- or second-generation migrants and non-migrants when comparing the utilisation of inpatient rehabilitation or any rehabilitation or when analysing German and foreign employees with migrant background (n=1148).Conclusions: Significant differences in the utilisation of outpatient rehabilitation between first-generation migrants and non-migrants were found, which could not be explained by sociodemographic, work- and non-work-related factors. Thus, further factors might play a role. The second-generation migrants resemble the non-migrants rather than their parent generation (first-generation migrants). This detailed investigation shows the heterogeneity in the utilisation of health services such as medical rehabilitation, which is why service sensitive to diversity should be considered. [ABSTRACT FROM AUTHOR]

Introduction: In times of extending working lives, it is relevant to understand why, today, most workers leave employment long before regular retirement age. Financial factors have been central for explaining retirement timing, yet their impact seems rather complicated. This study explores the motivation to keep working, in relation to the economic household conditions among older workers and it investigates the impact of socio‐demographic, individual and work factors on the motivation to keep working (MTW), again differentiated by economic household condition. Methods: Based on data from wave three (2018) of the lidA Cohort Study, a representative interview study of socially insured employees born in 1959 or 1965 in Germany, descriptives and linear regression analyses were performed among 2835 employed participants. For all analyses, the sample was divided into five household equivalized net income groups. Results: The groups with low and second lowest income were most motivated to work longer, followed by those with the highest income. The lowest income group exhibited most adverse scores for work indicators and health. Furthermore, in this group, MTW was unrelated to physical and mental health indicating that the comparably high motivation may be driven by financial imperatives. Discussion and Conclusions: The findings indicate that many workers with low income may find themselves forced to extend their working life, irrespective of their health. This requires increased attention by research as well as policy. Policy might have to acknowledge group specific negative side effects of regulations effectively extending working lives. [ABSTRACT FROM AUTHOR]

The article reports on the scope and previous understanding of the requirements of a tax adjustment in Germany. It is said that the correction of a tax, which may be over-taxed, is subject to the "adjustment of the tax amount vis-a-vis the beneficiary." This correction is made by a statement of the payer who must receive the benefit.

Fine-grained, organic-rich Paleozoic sediments are proven source rocks for conventional gas systems in NW Europe and large, unconventional gas reservoirs are assumed in Lower to Early Upper Carboniferous black shales. However, despite numerous boreholes exploring for hydrocarbons, the shale gas potential remains uncertain. This paper comprises detailed information on the sedimentary structure and lithofacies associations along with spatial distribution, thickness, thermal maturity, organic and inorganic petrology as well as geochemistry and mineralogy of Lower to Early Upper Carboniferous black shales in NE Germany to unravel the evolution of shale gas-relevant properties. Sediments of the “ Kohlenkalk ” Formation (Carboniferous Limestone) in the Rügen Island area were deposited on an extensive deep-water carbonate shelf. Transgressive–regressive cycles led to the formation of an up to 2000 m thick intercalation of mud- and limestones. High total organic carbon contents (2.4–7.0 wt.%) of a mainly Type II + III kerogen have been deposited under dysoxic to anoxic conditions and attained favorable present-day thermal maturities (0.8–1.8% VRr) indicating a shale oil potential in the upper part of the succession and a shale gas potential in the deeper parts. Sediments of the “Altmark–North-Brandenburg Culm” (Synorogenic Flysch Formation) were deposited as a turbidity current-derived intercalation of a sand/silt–mud interbedded and black mudrock lithofacies in a deep marine siliciclastic slope to basinal setting. The ~ 1900 m thick succession has TOC contents of 0.5–2 wt.% and present-day thermal maturities of 2.3–3.2% VRr indicating a possible hybrid gas accumulation in areas where the succession is buried < 5000 m. [ABSTRACT FROM AUTHOR]

The lidA Cohort Study (German Cohort Study on Work, Age, Health and Work Participation) was set up to investigate and follow the effects of work and work context on the physical and psychological health of the ageing workforce in Germany and subsequently on work participation. Cohort participants are initially employed people subject to social security contributions and born in either 1959 (n = 2909) or 1965 (n = 3676). They were personally interviewed in their homes in 2011 and will be visited every 3 years. Data collection comprises socio-demographic data, work and private exposures, work ability, work and work participation attitudes, health, health-related behaviour, personality and attitudinal indicators. Employment biographies are assessed using register data. Subjective health reports and physical strength measures are complemented by health insurance claims data, where permission was given. A conceptual framework has been developed for the lidA Cohort Study within which three confirmatory sub-models assess the interdependencies of work and health considering age, gender and socioeconomic status. The first set of the data will be available to the scientific community by 2015. Access will be given by the Research Data Centre of the German Federal Employment Agency at the Institute for Employment Research (http://fdz.iab.de/en.aspx). [ABSTRACT FROM AUTHOR]

Aim To investigate how work-related characteristics and work ability influence nursing staff decisions to change employer or leave the profession. Background Previous cross-sectional studies have indicated that decreased work ability and unfavourable work-related characteristics are important determinants for the intention to leave the profession among nursing staff. Methods A 1-year longitudinal study, using data from the European Nurses' Early Exit Study. The study population consisted of 9927 (66%) members of the eligible nursing staff of which 345 left their current employer. Work-related characteristics, work ability and employment status were assessed by questionnaires. Results Nursing staff with a low work ability were more likely to either change employer or leave the profession. Among nursing staff with a low work ability the risk of changing employer increased significantly with unfavourable work-related characteristics. However, among nursing staff with a good work ability the risk of changing employer barely changed with unfavourable work-related characteristics. Conclusion The negative effects of decreased work ability on changing employer and leaving the profession are partly counterbalanced by favourable psychological and physical work-related characteristics. Implications for nursing management Managers should implement strategies that focus on promoting the work ability of nursing staff in combination with improving work-related characteristics in order to prevent unnecessary changes of employment. [ABSTRACT FROM AUTHOR]

The introduction of the air passenger tax in Germany in 2011 has led to several controversies about its effect on the number of passengers and the overall economic impact. In this paper the effects in different market segments are discussed. It is shown that an analysis which is only based on the overall number of passengers underestimates the demand reductions. Therefore, the effect of the tax on the number of O&D passengers in Germany is calculated. According to our calculations, the demand reduction is between 1.2 and 2.8 percent. Moreover, it is argued that the usual Input-Output methodology is not suitable for analyzing the overall economic impact. As an alternative, Computable General Equilibrium models may describe the total economic effect of an air passenger tax. [ABSTRACT FROM AUTHOR]

Abstract: A clear consensus exists in German society that renewable energy resources have to play a dominant role in the future German energy supply system. However, many questions are still under discussion; for instance the relevance of the different technologies such as photovoltaic systems and wind energy converters installed offshore in the North Sea and the Baltic Sea. Concerns also exist about the cost of a future energy system mainly based on renewable energy. In the work presented here we tried to answer some of those questions. Guiding questions for this study were: (1) is it possible to meet the German energy demand with 100% renewable energy, considering the available technical potential of the main renewable energy resources? (2) what is the overall annual cost of such an energy system once it has been implemented? (3) what is the best combination of renewable energy converters, storage units, energy converters and energy-saving measures? In order to answer these questions, we carried out many simulation calculations using REMod-D, a model we developed for this purpose. This model is described in Part I of this publication. To date this model covers only part of the energy system, namely the electricity and heat sectors, which correspond to about 62% of Germany's current energy demand. The main findings of our work indicate that it is possible to meet the total electricity and heat demand (space heating, hot water) of the entire building sector with 100% renewable energy within the given technical limits. This is based on the assumption that the heat demand of the building sector is significantly reduced by at least 60% or more compared to today's demand. Another major result of our analysis shows that – once the transformation of the energy system has been completed – supplying electricity and heat only from renewables is no more expensive than the existing energy supply. [Copyright &y& Elsevier]

Abstract: A clear consensus exists in the German society that renewable energies have to play a dominant role in the future German energy supply system. However, many questions are still under discussion; for instance the relevance of the different technologies such as photovoltaic systems and wind energy converters installed offshore in the North Sea and the Baltic Sea. Also concerns exist about the cost of a future energy system mainly based on renewable energies. In order to be able to address the raised issues on a scientifically sound basis we have set up a new simulation model REMod-D (Renewable Energy Model-Deutschland) that models the energy balance of the electricity and heat sector including all renewable energy converters, storage components and loads for a future German energy system for a whole year based on an hourly energy balance. The target energy systems modeled use a high fraction up to 100% of renewable energies to cover the electricity and heat demand (heating and hot water). The model includes also energy retrofit of buildings as a measure to reduce future heat loads of the building sector. A mathematical–numerical optimizer is applied in order to identify system configurations with minimal overall annual cost. In this first part of a two-paper series we describe the methodology of the REMod-D model and discuss cost and performance values of all included components and in the second part we will discuss the results. [Copyright &y& Elsevier]

The German Society of Rheumatology approved new German guidelines for the sequential medical treatment of rheumatoid arthritis (RA) based on the European League Against Rheumatism (EULAR) recommendations for the management of RA published in 2010. An update of the EULAR systematic literature research was performed in Medline, Embase, and Cochrane databases. Meta-analyses, controlled trials, cohort studies, and registry data addressing traditional and biologic disease-modifying antirheumatic drugs, glucocorticoids, and treatment strategies published between January 2009 and August 2011 were included. Two reviewers independently evaluated and compared the additional data that had been published after the time limit set by the EULAR recommendations. A national guideline working group developed an adapted set of recommendations. The new German guidelines were accepted by vote using an informal Delphi approach. Twelve recommendations and the resulting updated treatment algorithm were developed and approved as a practical orientation for rheumatologists. These recommendations are based on a successive treatment with traditional and biologic disease-modifying drugs depending on the individual progress of the disease and distinct patient characteristics. The German guidelines have been developed on the basis of the internationally well-recognized EULAR recommendations. In addition, more recent evidence from a systematic literature research was considered. They have been developed and approved by a group of national experts aiming at guidance for rheumatologists to reach best medical practice. [ABSTRACT FROM AUTHOR]

Background Previous cross-sectional findings from the European Nurses Early Exit Study (NEXT) show that nurses who were dissatisfied with their work schedule tended to consider leaving the nursing profession. Mediating factors in this decision process may be caused by self-perceived poor work ability and/or health. The aim of this paper is to investigate changes in work ability and general health among nurses in relation to requested, forced and denied change of shift schedule Methods Longitudinal data from the NEXT Study was used. In total 11,102 nurses from Belgium, Germany, Finland, the Netherlands, Poland, Slovakia, France and Italy completed both the 'basic questionnaire' (t1) and the '12 month follow-up questionnaire' (t2). To examine the time-effect (repeated measures) and the group-effect of five defined groups of nurses on the Work Ability Index (WAI) and general health (SF36), an adjusted 2-way analysis of covariance (ANCOVA) was performed. Results The nurses who wanted to, but could not change their shifts during the 12 month follow-up had the lowest initial and follow-up scores for WAI (t1: 37.6, t2: 36.6, p <0.001), lowest general health (t1: 63.9, t2: 59.2, p <0.001) and showed the highest decrease in both outcomes. Shift pattern change in line with the nurses' wishes was associated with improved work ability and to a lesser comparatively low extent with increased decline in health scores. A forced change of shift against the nurses' will was significantly associated with a deteriorating work ability and health. Conclusions The findings would suggest that nurses' desire to change their shift patterns may be an indicator for perceived low work ability and/or low health. The results also indicate that fulfilling nurses' wishes with respect to their shift work pattern may improve their personal resources such as work ability and--to somewhat lesser extent--health. Disregarding nurses' preferences, however, bears the risk for further resource deterioration. The findings imply that shift schedule organization may constitute a valuable preventive tool to promote nurses' work ability and--to lesser extent--their perceived health, not least in aging nursing work forces. [ABSTRACT FROM AUTHOR]

The article discusses benefits of specific methicillin-resistant Staphylococcus aureus (MRSA) containment regimens and the burdens patient isolation imposes on affected patients, their families, and professional caregivers. The research on clinical outcomes including quality of life might identify interventions of questionable benefit. The survey results also emphasizes the significance of MRSA as a model for the management of other complex conditions and for patient isolation.

An important insight from the recent publication of Foucault's governmentality lectures for International Relations (IR) is that international manifestations of governmentalities such as police and liberalism, rather than constituting mere domestic analogies, have inherently international dimensions. Police and liberalism are both constituted by and constitutive of the international contexts in which they emerge: historically, the European balance of power and a 'globalisation' of markets, respectively. However, Foucault's account of German and American neoliberalism in the twentieth century omits references to the international context. This article first reconstructs the 'domestic-international nexus' in Foucault's account of police and liberalism, and then recovers aspects of the missing international dimension of his analysis of German neoliberalism with recourse to Wilhelm Röpke's writing on IR. The upshot of this recovery effort is threefold. First, the international remains pivotal to (mid-) twentieth-century neoliberal governmentality. Second, (German) neoliberalism's association with multiple 'international' governmentalities, including liberal and non-liberal ones, exposes neoliberalism as a 'promiscuous' mode of governance. Third, German neoliberalism's promiscuity is underwritten by (though not reducible to) a conservative ethos of moderation. More broadly, this article contributes to efforts to theorise the relationship between domestic and international politics, and to understand neoliberalism as a 'variegated' phenomenon. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this research is to investigate the degree of distress experienced by nurses in response to the challenging behaviour of nursing home residents (residents' challenging behaviour) and their impact on nurses individual resources (general health, burnout and work ability). Background Because of the increasing and ageing population of nursing home residents, professional nursing care faces several challenges. One highly prevalent issue among nursing home residents is the so-called 'challenging behaviour'. However, to date, 'challenging behaviour' has not yet been recognised as an occupational stressor, and the extent of the impact of 'challenging behaviour' on nurses' well-being and functioning is not well understood. Design Cross-sectional study. Method Self-report questionnaire data collected from 731 registered nurses and nursing aides in 56 German nursing homes were used in a secondary data analysis. The level of residents' challenging behaviour-related distress that nurses experienced was assessed using a scale consisting of nine questions. Validated instruments were used for the assessment of individual resources. Results The mean score for residents' challenging behaviour-related distress was 41·3 ( SD 21·2). Twenty-seven per cent of all nurses reported over 50 residents' challenging behaviour. Residents' challenging behaviour had a significant impact on all three measures of individual resources. Specifically, nurses exposed to frequent residents' challenging behaviour reported a significantly lower quality of general health, reduced workability and high burnout levels. Conclusion Our findings indicate that residents' challenging behaviour-related distress is a significant work place stressor for nurses in nursing homes with a clear impact on general health, the risk of burnout and work ability. Relevance to clinical practice Our findings suggest that residents' challenging behaviour is a stressor for nurses in nursing homes. Further scientific and practical attention is necessary from the point of view of working conditions for nurses. The development of preventive concepts for nursing staff and residents is recommended. [ABSTRACT FROM AUTHOR]

The objective of the present study was to monitor the occurrence and distribution of a spectrum of trichothecene toxins in different parts of maize plants. Therefore maize plants were sampled randomly from 13 fields in southwest Germany and the fractions kernels, cobs, husks, stalks, leaves and rudimentary ears were analyzed for eight A-type and five B-type trichothecenes. Each of the toxins was found in at least three of the total of 78 samples. The study revealed that both A-type and B-type trichothecenes may be present in all parts of the maize plant but may be unevenly distributed. For the contents of deoxynivalenol, 3- and 15-acetyldeoxynivalenol, nivalenol, scirpentriol, 15-monoacetoxyscirpenol, HT-2 and T-2 toxin significant differences (p < 0.05) were found between different parts of the maize plants whereas no significant differences were observed for fusarenon-X, 4,15-diacetoxyscirpenol, neosolaniol, T-2 triol and T-2 tetraol. Up to twelve toxins co-occurring in one sample were detected. As a group B-type trichothecenes dominated over A-type trichothecenes concerning incidences and levels. Contamination was strongest with rudimentary ears based on incidence and mean and maximum contents; mean contents with few exceptions tended towards a higher level than in other fractions with significant (p < 0.05) differences compared to leaves for seven toxins. [ABSTRACT FROM AUTHOR]

Chronic inhalation of quartz-containing dust produces reversible inflammatory changes in lungs resulting in irreversible fibrotic changes termed pneumoconiosis. Due to the inflammatory process in the lungs, highly reactive substances are released that may be detoxified by glutathione S-transferases. Therefore, 90 hard coal miners with pneumoconiosis as a recognized occupational disease (in Germany: Berufskrankheit BK 4101) were genotyped for glutathione S-transferases M1 (GSTM1) and T1 (GSTT1) according to standard methods. Furthermore, occupational exposure and smoking habits were assessed by questionnaire. Changes in a chest x-ray were classified according to ILO classification 2000. Of the investigated hard coal miners 43% were GSTM1 negative whereas 57% were GSTM1 positive. The arithmetic mean of the age at time of investigation was 74.2 yr (range: 42–87 yr). Seventy-four percent of the hard coal miners reported being ever smokers, while 26% denied smoking. All hard coal miners provided pneumoconiosis-related changes in the chest x-ray. The observed frequency of GSTM1 negative hard coal miners was not different from frequencies reported for general Caucasian populations and in agreement with findings reported for Chinese coal miners. In contrast, in a former study, 16 of 19 German hard coal miners (84%) with urinary bladder cancer displayed a GSTM1 negative genotype. The outcome of this study provides evidence that severely occupationally exposed Caucasian hard coal miners do not present an elevated level of GSTM1 negative individuals. [ABSTRACT FROM AUTHOR]

European swine influenza A viruses donated the matrix protein 2 as well as the neuraminidase (NA) gene to pandemic influenza A (H1N1) viruses that emerged in 2009. As a result, the latter became amantadine resistant and neuraminidase inhibitor (NAI) susceptible. These recent developments reflecting the close connection between influenza A virus infection chains in humans and pigs urge an antiviral surveillance within swine influenza A viruses. Here, NAI susceptibility of 204 serologically typed swine influenza A viruses of subtypes H1N1, H1N2, and H3N2 circulating in Germany between 1981 and 2008 was analyzed in chemiluminescence-based NA inhibition assays. Mean 50% inhibitory concentrations of oseltamivir and zanamivir indicate a good drug susceptibility of tested viruses. As found for human isolates, the oseltamivir and zanamivir susceptibility was subtype-specific. So, swine influenza A (H1N1) viruses were just as susceptible to oseltamivir as to zanamivir. In contrast, swine H1N2 and H3N2 influenza A viruses were more sensitive to oseltamivir than to zanamivir. Furthermore, reduction in plaque size and virus spread by both drugs was tested with selected H1N1 and H1N2 isolates in MDCK cells expressing similar amounts of α2.3- and α2.6-linked sialic acid receptors. Data obtained in cell culture-based assays for H1N1 isolates correlated with that from enzyme inhibition assays. But, H1N2 isolates that are additionally glycosylated at Asn158 and Asn163 near the receptor-binding site of hemagglutinin (HA) were resistant to both NAI in MDCK cells. Possibly, these additional HA glycosylations cause a misbalance between HA and NA function that hampers or abolishes NAI activity in cells. [ABSTRACT FROM AUTHOR]

Purpose: With about 100,000 surgeries per year in Germany, thyroid operations count among the most common procedures performed in general and endocrine visceral surgery. Twentieth century technological development gives the opportunity to perform thyroid surgery without leaving visible scar like conventional approaches do. This study is part of the work on the videoendoscopic retro-auricular access to the thyroid gland using the EndoCATS method by Schardey and Schopf. To avoid possible complications with the spinal accessory nerve (SAN), like irritation or injury of the nerve as happened during a feasibility study, a systematic study of the surgical anatomy at the nerve's entry to the posterior cervical triangle is performed especially in relation to the EndoCATS operation method. Methods: Sixty-one neck regions in fifty-three specimens were examined at the anatomical institute of Munich to investigate the course of the SAN relative to the anatomic landmarks tip of mastoid bone, sternal notch, and posterior border of the sternocleidomastoid muscle together with the SAN's course variants at its entry to the posterior cervical triangle. The results were then statistically analyzed. Results: From this analysis, we derived a simple method to predict the course of the SAN preoperatively and offer a new approach to protect the SAN during EndoCATS surgery. Additionally, we found a significant difference of the SAN's course between male and female specimens. Conclusion: The EndoCATS method can be a safe alternative to conventional thyroid surgery, but the SAN is at risk during the surgery procedure. Here we give feasible solutions to eliminate the SAN-problem performing EndoCATS thyroid surgery. [ABSTRACT FROM AUTHOR]

Study Type – Prognosis (inception cohort) Level of Evidence 1b OBJECTIVES To validate the association of lymphovascular invasion (LVI) with disease recurrence and cancer-specific survival (CSS) in a multicentre cohort of patients treated with radical cystectomy (RC) for urothelial bladder cancer (UBC). PATIENTS AND METHODS We collected pathological and clinical data on 1099 lymph node-negative patients treated with RC at six German institutions. LVI was defined as the presence of tumour cells within an unequivocal endothelium-lined space in haematoxylin and eosin-stained sections. RESULTS LVI was present in 295 (26.8%) patients; the presence of LVI correlated significantly with increasing tumour stage, i.e. pT1, 65 (29.4%); pT2, 88 (31.5%); pT3 110 (31.8%); and pT4 32 (38.1%) ( P= 0.002) and grade ( P < 0.001). In univariable analysis the presence of LVI was significantly associated with reduced recurrence-free survival ( P= 0.008) and reduced CSS ( P= 0.039). On multivariable Cox regression analysis tumour stage ( P < 0.001), age (>75 vs ≥75 years; P= 0.018) and LVI ( P < 0.001) were identified as independent predictors of CSS. CONCLUSIONS Our large multicentre study confirms the independent prognostic value of LVI in patients with node-negative UBC. LVI can be regarded as a surrogate variable for lymphatic micrometastasis in node-negative UBC. Assessment of LVI might improve the selection of patients who are likely to benefit from adjuvant therapy after RC. The identification of factors involved in the process of LVI could reveal new therapeutic targets for UBC. [ABSTRACT FROM AUTHOR]

Abstract: Calcareous Lower Carboniferous and siliciclastic Upper Carboniferous rocks occur in the subsurface of western Pomerania (NE Germany), along the northeastern margin of the North German Basin. They have here been investigated for their shale gas characteristics, applying classical evaluation criteria. Samples of selected intervals from the Lower Carboniferous sequence were taken from three wells (Dranske 1/68, Gingst 1/73, and Rügen 2/67) and those of Upper Carboniferous age from two wells (Gingst 1/73 and Pudagla 1h/86). The shale gas potential of both the investigated Lower and Upper Carboniferous sediments is generally limited by TOC content (<1.0wt% on average). The organic material is predominantly a kerogen type III which generates gaseous compounds in open pyrolysis experiments. In wells Gingst 1/73 and Pudagla 1h/86 the Lower and Upper Carboniferous sediments have elevated maturities that are conducive to the generation of thermogenic gas (both >1.5% R r). In contrast the Lower Carboniferous sediments in wells Dranske 1/68 and Rügen 2/67 have maturities equivalent to the beginning of the oil window (∼0.5% R r) due to a different thermal history. Desorption experiments showed that methane is the dominant hydrocarbon gas sorbed on the matrix or as free gas phase in pores. The limited shale gas potential due to low average TOC contents is probably compensated by great formation thickness of both the Lower and Upper Carboniferous shaly strata, as far as gas-in-place is concerned, but is likely to present a challenge for economic production. [ABSTRACT FROM AUTHOR]

Abstract: Organic-rich mudstones of the Stassfurt Carbonate basinal and lower slope facies (Ca2, Zechstein, Upper Permian) occur in the eastern part of the North German Basin (southern Brandenburg, eastern Germany). These source rocks for oil and gas fields have been investigated as a test system for the application of procedures to characterize gas shales. Classic sedimentological investigation methods, including core descriptions and thin section microscopy, were coupled with standardized organic geochemical analysis procedures, such as total organic carbon determination, Rock-Eval pyrolysis, open system pyrolysis-gas chromatography, gas chromatography of aliphatic hydrocarbons, and thermovaporization employing microscale sealed vessels (MSSV). Furthermore, the maceral composition was analyzed and vitrinite reflectance measurements were carried out. Data from these interdisciplinary methods were evaluated to characterize the basinal Stassfurt Carbonate Ca2 utilizing mainly established guidelines for shale gas exploration in North America. The “Stinkschiefer” sediments in southern Brandenburg show a trend of increasing maturity from south to north, favoring the occurrence of gas shales near the basin center. A distinction between basin and lower slope deposits could be made for the investigated suite of samples. The Ca2 basin facies occurs below 3800m depth. It has reached a minimum thermal maturity of 2.2% R r and is therefore in the dry thermogenic gas zone. In contrast the lower slope deposits occur at depths from 1250 to 3250m and have oil window maturity, ranging from 0.7% to 1.0% R r. The organic matter is a mixed Type II/III kerogen, the Hydrogen Index ranges from 7 to 105mg HC/g rock. The low average TOC contents, varying between 0.2 and 0.8wt%, and its low formation thickness, on average 6m, are factors limiting the gas shale potential of the Ca2. However, the effective sealing by evaporites below and above the Ca2 may restrict expulsion of generated gas, leading to gas retention within Ca2 black shales. [Copyright &y& Elsevier]

The German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) was established and tested in a sample of 2561 employees in order to: (a) assess the questionnaires' psychometric properties; and (b) develop an appropriate instrument to use in the assessment of psychosocial risk factors. A shortened version of the instrument was developed, reducing the number of items from 141 to 87. With this, a database has been established since 2005. In a cooperation model between science (Freiburg Research Centre of Occupational and Social Medicine) and companies or organizations, new COPSOQ data are added to the dynamically growing database with profession-specific profiles of psychosocial factors at work. In return, companies can compare their results with job-related data in the database, facilitating the interpretation of their results and the implementation of improvement measures. The COPSOQ database has reached 425,000 respondents. Ongoing projects will expand the German COPSOQ database and include representative samples. Furthermore, a job exposure matrix for psychosocial factors at work will be constructed in 2009. Finally, in several projects, a first assessment has been followed by efforts to improve the problematic areas of psychosocial working conditions. [ABSTRACT FROM AUTHOR]

Recent work in economic geography has provided notable insights into the regional implications of finance-driven capitalism. In particular, it has been argued that the pressures created by the prioritisation of shareholder value and the rise of new financial agents, such as private equity and hedge funds, are disembedding regional social relations, and empirical evidence illustrates the devastating effects that the short-term profit orientation of these agents can have on local economic development. The relationship between a local economy's integration into the global capitalist system and its development performance is, however, more ambiguous than might be expected. This article explores this connection in greater detail within the context of a regional cluster, namely the film and TV industry cluster in Munich--one of the leading centres for this type of industry in Germany--by means of addressing the adjustments related to the entry of foreign investors after the insolvency of the Kirch Group in 2002. Initially, the research adds weight to the suspicion that financial agents erode the long-term wealth- and employment-generating capacities of national corporations. In addition, however, the results also reveal the dynamic restructuring processes triggered by these players which, at least in the specific case investigated, provided an acknowledged corrective and contributed to the cluster's recent resurgence. [ABSTRACT FROM AUTHOR]

Although medicine acceptability is likely to have a significant impact on the patient's adherence in pediatrics and therefore on therapy success, there is still little data even for common therapeutic areas. For analgesics/antipyretics, healthcare professionals face a wide variety of products and need knowledge to select the best adapted product for each patient. We investigated acceptability of those products most used at the University Children's Hospital Düsseldorf, Germany. Based on 180 real-life observer reports of medicine intake, we used the acceptability reference framework to score acceptability of six distinct medicines. Both ibuprofen and paracetamol tablets, mainly used in adolescents, were positively accepted. This was not the case for the solution for injection of metamizole sodium. Regarding syrups, mainly used in children under 6 years of age, ibuprofen flavored with strawberry and provided with an oral syringe was positively accepted, while paracetamol flavored with orange and provided with a measuring cup was not. Suppository appeared to be an alternative to oral liquids in infants and toddlers with palatability and administration issues. Differences appeared to be driven by dosage forms and formulations. These findings improve knowledge on acceptability drivers and might help formulating and prescribing better medicines for children. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic differences in old-age mortality have not been studied in Germany. This study fills in the gap, evaluating mortality and life expectancy differentials among retired. German men aged 65+ in 2003. Methods: Mortality rates are calculated from the administrative database on all public pensions and deaths of pensioners in 2003. Relative mortality rates and life expectancies are estimated for population subgroups according to the quintiles of lifetime earnings, type of medical insurance, broad occupational group, and residence in eastern or western Germany. Results: Among pension income quintiles, mortality varies by 60% and life expectancy at age 65 ranges from 14.9 to 18.5 years. Quintile-specific mortality and life-expectancy values are only slightly more favorable in western compared to eastern Germany. The mortality of manual workers is by 35% greater than that of salaried employees, while the mortality of those with mandatory public health insurance is 44% greater than the mortality of those with private or voluntary public health insurance. When all four characteristics are taken into account, relative mortality in the group with the highest mortality is three times higher than at the opposite end of the distribution, and corresponding life expectancies are 12.5 and 20 years. Half of all male deaths at ages 65+ are attributable to this variation. The mortality differentials remain significant at ages 80+. Conclusions: Socioeconomic mortality differentials persist into old age. They are similar in both regions and their magnitude is much greater than the diminishing mortality gap between the two parts of the country. [ABSTRACT FROM AUTHOR]

A unilateral gasless single-surgeon videoendoscopic thyroidectomy procedure using a dorsal cephalic approach from the scalp with the option for a bilateral approach was developed with human cadavers and a porcine model for access training. The final preclinical trials and the first three clinical cases are described in detail. Preclinical evaluation and training for the procedure were conducted with fresh human cadavers. The procedure was defined precisely by a sequence of nodal points initiating surgical steps. A quality score was developed by issuing each important anatomic structure a specific organ value and a factor for positive identification, inability to identify a given anatomic structure, spare it (meaning omit causing a lesion) or injure the structure. The quality of each operation was expressed as a single number or quality score value, calculated by summing the points achieved for the individual anatomic structures. The results of the procedures were controlled by prospective video documentation and autopsy. After conclusion of the preclinical training, the operation was performed for patients. The reported patients are part of a feasibility study approved by the institutional review board of the University of Munich. Nodal points were helpful in preparation for the operation by mental training. During the procedure, they helped to guide the preparation in the neck, where the working space must first be created on the way to the target organ. The surgical quality score improved over the first three cases and reached the maximum score, which was reproducible every time after that. It showed that the dorsal approach from the scalp to the thyroid gland is easily achievable without complications. The technical challenge is exposure of the recurrent laryngeal nerve (RLN) and the parathyroid glands. There was no difference between the results achieved by the resident and the senior surgeon. Preclinical training was good preparation for hemithyroidectomy in patients. All cases could be managed without postoperative hemorrhage or impairment of the parathyroid or the RLN. Videoendoscopic thyroidectomy by the dorsal approach is feasible in both human cadavers and patients . It leaves no visible scars. Nodal points are helpful for executing a new operation. The surgical quality score is a complex and objective measure of ability to deal with the procedure. Further clinical studies are required for evaluation of this new procedure. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Ärztliche Fortbildung und Qualität im Gesundheitswesen is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict - namely work interfering with family conflict (WIF) - which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Methods: Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April-July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9%) participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ), work interfering with family conflict scale (WIF), and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. Results: German hospital physicians reported elevated levels of WIF (mean = 74) compared to the general German population (mean = 45, p < .01). No significant gender difference was found. Predictors for the WIF were lower age, high quantitative demands at work, elevated number of days at work despite own illness, and consequences of short-notice changes in the duty roster. Good sense of community at work was a protective factor. Compared to the general German population, we observed a significant higher level of quantitative work demands among hospital physicians (mean = 73 vs. mean = 57, p < .01). High values of WIF were significantly correlated to higher rates of personal burnout, behavioural and cognitive stress symptoms, and the intention to leave the job. In contrast, low levels of WIF predicted higher job satisfaction, better self-judged general health status, better work ability, and higher satisfaction with life in general. Compared to the German general population, physicians showed significantly higher levels of individual stress and quality of life as well as lower levels for well-being. This has to be judged as an alerting finding regarding the state of physicians' health. Conclusion: In our study, work interfering with family conflict (WIF) as part of Work-Family Conflict (WFC) was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals. [ABSTRACT FROM AUTHOR]

Background: Pediatric cancer patients face an increased risk of healthcare-associated infection (HAI). To date, no prospective multicenter studies have been published on this topic. Methods: Prospective multicenter surveillance for HAI and nosocomial fever of unknown origin (nFUO) with specific case definitions and standardized surveillance methods. Results: 7 pediatric oncology centers (university facilities) participated from April 01, 2001 to August 31, 2005. During 54,824 days of inpatient surveillance, 727 HAIs and nFUOs were registered in 411 patients. Of these, 263 (36%) were HAIs in 181 patients, for an incidence density (ID) (number of events per 1,000 inpatient days) of 4.8 (95% CI 4.2 to 5.4; range 2.4 to 11.7; P < 0.001), and 464 (64%) were nFUO in 230 patients. Neutropenia at diagnosis correlated significantly with clinical severity of HAI. Of the 263 HAIs, 153 (58%) were bloodstream infections (BSI). Of the 138 laboratory-confirmed BSIs, 123 (89%) were associated with use of a long-term central venous catheter (CVAD), resulting in an overall ID of 2.8 per 1,000 utilization days (95% CI 2.3 to 3.3). The ID was significantly lower in Port-type than in Hickman-type CVADs. The death of 8 children was related to HAI, including six cases of aspergillosis. The attributable mortality was 3.0% without a significant association to neutropenia at time of NI diagnosis. Conclusion: Our study confirmed that pediatric cancer patients are at an increased risk for specific HAIs. The prospective surveillance of HAI and comparison with cumulative multicenter results are indispensable for targeted prevention of these adverse events of anticancer treatment. [ABSTRACT FROM AUTHOR]

We estimate mortality rates by a measure of socio-economic status in a very large sample of male German pensioners aged 65 or older. Our analysis is entirely nonparametric. Furthermore, the data enable us to compare mortality experiences in eastern and western Germany conditional on socio-economic status. As a simple summary measure, we compute period life expectancies at age 65. Our findings show a lower bound of almost 50 percent (six years) on the difference in life expectancy between the lowest and the highest socio-economic group considered. Within groups, we find similar values for the former GDR and western Germany. Our analysis contributes to the literature in three aspects. First, we provide the first population-based differential mortality study for Germany. Second, we use a novel measure of lifetime earnings as a proxy for socio-economic status that remains applicable to retired people. Third, the comparison between eastern and western Germany may provide some interesting insights for transformation countries. [ABSTRACT FROM AUTHOR]