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Background: International healthcare systems face the challenge that waiting times may create barriers to accessing medical care, and that those barriers are unequally distributed between different patient groups. The disruption of healthcare systems caused by the COVID-19 pandemic could exacerbate this already strained demand situation. Using the German healthcare system as an example, this study aims to analyze potential effects of the COVID-19 pandemic on waiting times for outpatient specialist care and to evaluate differences between individual patient groups based on their respective insurance status and the level of supply.Methods: We conducted an experiment in which we requested appointments by telephone for different insurance statuses in regions with varying levels of supply from 908 outpatient specialist practices in Germany before and during the COVID-19 pandemic. Data from 589 collected appointments were analyzed using a linear mixed effect model.Results: The data analysis revealed two main counteracting effects. First, the average waiting time has decreased for both patients with statutory (mandatory public health insurance) and private health insurance. Inequalities in access to healthcare, however, remained and were based on patients' insurance status and the regional level of supply. Second, the probability of not receiving an appointment at all significantly increased during the pandemic.Conclusions: Patient uncertainty due to the fear of a potential COVID-19 infection may have freed up capacities in physicians' practices, resulting in a reduction of waiting times. At the same time, the exceptional situation caused by the pandemic may have led to uncertainty among physicians, who might thus have allocated appointments less frequently. To avoid worse health outcomes in the long term due to a lack of physician visits, policymakers and healthcare providers should focus more on regular care in the current COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This study investigated the use of cone‐beam computed tomography (CBCT) by endodontists in Germany and Switzerland. Sixty‐eight German endodontic specialists (G‐ES), 22 Swiss endodontic specialists (CH‐ES) and 95 dentists with a German Master of Science in endodontics (MSc) were invited to participate. Data on the timing of diagnostic assessments, endodontic case difficulty and indications for CBCT use were collected by questionnaire. The frequencies of pre‐, intra‐ and postoperative use of periapical radiography and CBCT were analysed by case difficulty level. In high difficulty cases, access to a CBCT device was significantly associated with the frequency of both pre‐ and intraoperative CBCT use. The type of endodontic qualification had a significant impact on the rate of preoperative CBCT use in high difficulty cases. German endodontic specialists used preoperative CBCT more frequently than CH‐ES and MSc. Our findings show that CBCT is a valuable imaging tool for endodontists, particularly in high difficulty cases. [ABSTRACT FROM AUTHOR]

In the interaction between two ecologically-associated species, the population structure of one species may affect the population structure of the other. Here, we examine the population structures of the aphid Metopeurum fuscoviride, a specialist on tansy Tanacetum vulgare, and its specialist primary hymenopterous parasitoid Lysiphlebus hirticornis, both of which are characterized by multivoltine life histories and a classic metapopulation structure. Samples of the aphid host and the parasitoid were collected from eight sites in and around Jena, Germany, where both insect species co-occur, and then were genotyped using suites of polymorphic microsatellite markers. The host aphid was greatly differentiated in terms of its spatial population genetic patterning, while the parasitoid was, in comparison, only moderately differentiated. There was a positive Mantel test correlation between pairwise shared allele distance (DAS) of the host and parasitoid, i.e. if host subpopulation samples were more similar between two particular sites, so were the parasitoid subpopulation samples. We argue that while the differences in the levels of genetic differentiation are due to the differences in the biology of the species, the correlations between host and parasitoid are indicative of dependence of the parasitoid population structure on that of its aphid host. The parasitoid is genetically tracking behind the aphid host, as can be expected in a classic metapopulation structure where host persistence depends on a delay between host and parasitoid colonization of the patch. The results may also have relevance to the Red Queen hypothesis, whereupon in the ‘arms race’ between parasitoid and its host, the latter ‘attempts’ to evolve away from the former. [ABSTRACT FROM AUTHOR]

For herbivorous insects, studies of isolation by distance (IBD) are available for large spatial scales, whereas studies over small geographic distances are relatively rare, in particular for species where population turnover is high. In this study, we investigated IBD and population genetic structure in the aphid Macrosiphoniella tanacetaria, a specialist herbivore of tansy (Tanacetum vulgare). Owing to clonal growth, an individual plant (genet) has one to many shoots (ramets), which can host aphid colonies. Both at the level of ramets and genets, aphid persistence is short, in the order of weeks. Sampling of 17 populations was performed on a logarithmic scale, along the Saale River in Germany in June 2001, with distances between populations ranging from 1?m to 170?km. For the six microsatellites used, allelic and genotypic variability within aphid populations was high, and deviations from Hardy-Weinberg equilibrium and linkage disequilibrium were frequent. Most pairs of populations were significantly differentiated but there was no pattern of IBD. However, including into the analysis four additional populations from Alsace, France, collected at distances of, on average 470?km, resulted in a weak but significant IBD. Aphids are passive dispersers that are known to occasionally disperse over large distances, even though most dispersal is likely to occur over a small spatial scale. We suggest that for the host-specific M. tanacetaria, patterns of genetic variation among populations are, at an ecologically meaningful scale, governed by colonization/extinction dynamics and genetic drift rather than by a drift-dispersal equilibrium.Heredity (2004) 93, 577-584. doi:10.1038/sj.hdy.6800559 Published online 25 August 2004 [ABSTRACT FROM AUTHOR]

The incorporation of coloproctology as a part of the surgical training and further education of assistant and specialist physicians shows great differences between Germany, Austria and Switzerland. In this article the international and national possibilities before and after specialist medical training are described in detail. In Austria, an optional coloproctology module can already be chosen in the third year of surgical training. Coloproctology is a compulsory component during the complete surgical training in Germany but a lower number of operations are required. In the basic module in Switzerland coloproctology is compulsory but contained in the operation catalogue to a lesser extent, although it has to be explicitly chosen in the further specialist training. The mandatory training in coloproctology in Germany enables all surgical assistants to undergo training, even if it is less intensive. As a result of partially compulsory and partially optional modules in Switzerland, a lower proportion of trainees receive specific training but it is more detailed. The number of trainees who are trained in coloproctology is even smaller in Austria due to the coloproctological training being optional. In the German-speaking regions a variety of specialized courses and further education are available for assistants and surgeons to further deepen their knowledge, no matter which form of training they had. At the international level the European Board of Surgical Qualification (EBSQ) for coloproctology has been available since 1998 and for many European specialists is the only possibility for formal specialization. The quality of a coloproctology training and further education curriculum may vary with national and international factors; however, it is a parameter for high standards in coloproctology in routine daily work, for the numbers of young coloproctology surgeons and is associated with a sufficient research performance in this discipline.

Physicians in German university hospitals feel themselves confronted with a multiple workload due to patient care, teaching and research. Furthermore, this load is increased by administrative duties and conference trips; however, the framework conditions surrounding this multiple workload of patient care, research and teaching as well as administrative activities are becoming increasingly more difficult. In particular, there is very little free time for scientific activities. Research is therefore often carried out during leisure time. The path of the clinician scientist, a duo of scientiific and clinical activities, opens up many possibilities; however, the question arises whether the career path of a clinician scientist is even possible under the current conditions or whether this is an endangered "species". This article presents the problems but solutions and ideas are also developed for optimum organization of this multiple workload and to appreciate the additional value of clinician scientists.

Introduction: The decision to consolidate European higher education was reached by the Bologna Conference. Based on the Anglo-American system, a two-cycle degree program (Bachelor and Master) has been introduced. Subjects culminating in a state examination, such as Medicine and Dentistry, were excluded from this reform. Since the state examination is already comparable in its caliber to a Master's degree in Medicine or Dentistry, only advanced Master's degree programs with post-graduate specializations come into consideration for these subjects. In the field of dentistry numerous post-graduate study programs are increasingly coming into existence. Many different models and approaches are being pursued., Method: Since the 2004-2005 winter semester, the University of Greifswald has offered the Master's degree program in Dental Functional Analysis and Therapy. Two and a half years in duration, this program is structured to allow program participation while working and targets licensed dentists who wish to attain certified skills for the future in state-of-the-art functional analysis and therapy., Aim: The design of this post-graduate program and the initial results of the evaluation by alumni are presented here., Conclusion: Our experiences show that the conceptual idea of an advanced Master's program has proved successful. The program covers a specialty which leads to increased confidence in handling challenging patient cases. The sharing of experiences among colleagues was evaluated as being especially important.