Federal States Of Germany Research Articles

Digital health literacy in schools: empirically navigating novel data from students and teachers

Abstract With the introduction of the Digital Competence Framework (DigComp+) by the European Commission, European schools have committed to promoting digital and media literacy systematically. DigComp+ shares several intersections with health literacy, e.g., information management, using digital tools, and taking action on the digital and commercial determinants of health, making it an ideal curriculum to teach digital health literacy in schools. However, internationally, not much is known about digital health literacy in schools. The aim of this study is to present data from a representative school study of students and teachers in 16 federal states in Germany. Data was collected using an online survey from a representative sample of N = 1,448 students (9-18 years) and a convenient sample of N = 1,600 teachers. With SPSS, descriptive statistics, chi-square tests, and internal consistency were calculated. Cronbach’s alpha indicated good internal consistency for both tools. Low digital health literacy was reported by 52,9 of students and ∼39,3% of teachers. In students, low digital health literacy linked with younger age (X2 (2)=34.69, p = <.001), family affluence (X2 (4)=24.16, p = <.001), and parental education (X2 (2)=8.26, p=.016). In teachers, it was linked to age (p < .048), school position (p < .001), and their own digital health literacy DHL (p < .001). More than 45% of teachers reported not teaching digital health literacy in schools, while on average, 55% of students indicated they would not learn it in schools. Based on the first digital health literacy in schools study, results suggest DigComp+ is almost not used to teach digital health literacy and both students and teachers have significant deficits in their digital health literacy. Teachers should be trained in digital health literacy so that they can include it in their classroom teachings to promote the digital health literacy of students.

Transregional Cooperation of German Federal States with Eastern Regions and Countries (Late 20th — 21st Century)

This study examines the formation and development of transregional relations between the federal states of Germany (Bundesländer) and Eastern countries and regions. It presents the findings of a normative-legal analysis of the foundations of international and foreign policy activities of German federal states, based on national legislation. The focus is on the institutional framework for cross-border interactions between individual administrative units of the Federal Republic of Germany and their foreign partners. The research explores partnerships with both neighboring Middle Eastern territories and more distant Eastern regions. The findings indicate that the international and foreign economic activities of the German states are extensive, aligning with the opportunities outlined in Germany’s constitutional documents, and are significantly broader and more diverse compared to similar activities in the regions of France and Italy. It has been identified that German states engage in a system of “horizontal partnerships” primarily with provinces of the People’s Republic of China. Additionally, it is reported that a principle of “network cooperation” is applied to most other Eastern countries, encompassing not only economic but also scientific, cultural, and humanitarian ties. The study demonstrates that among the examined EU countries at the regional level, German federal states lead in establishing the most successful and effective partnerships with regions in Eastern countries.

Surgery for facial palsy in the hands of otorhinolaryngologists: a population-based study.

Modern facial surgery can improve eye closure and address facial functional and emotional expression disabilities in case of severe acute facial paralysis with low probability of recovery and in cases of chronic flaccid facial paralysis. Reports on outcome typically originate from specialized tertiary care centers, whereas population-based data from routine care beyond specialized centers is sparse. Therefore, patients' characteristics, surgical techniques, postoperative complications, and patients' satisfaction with the final outcome were analyzed for all inpatients with facial paralysis undergoing facial surgery in Thuringia, a federal state in Germany, between 2006 and 2022. 260 patients (female 41.5%; median age 65 years) were included. On average, the surgery rate was higher for men than for women (0.83 ± 0.39 versus 0.58 ± 0.24 per 100,000 population per year). For first surgery, static procedures were dominating (67.3%), followed by dynamic reconstruction (13.8%), and combined static and dynamic reconstructions (13.5%). The most frequent type of surgery was upper lid weight loading (38.5%), hypoglossal-facial jump nerve suture (17.3%), and facial-facial interpositional graft suture (16.9%). Bleeding/hematoma formation needing revision surgery was the most frequent complication (6.2%). Overall, 70.4% of the patients were satisfied with the final result. The satisfaction was higher if the target was to improve eye closure (65.2%) or to improve upper face function (65.3%) than to improve the lower face function (53.3%). If facial nerve reconstruction surgery and/or upper lid weight placement was performed, the satisfaction was significantly higher. If revision surgery was needed to improve the result, the satisfaction was significantly lower.

Exploring the association between phytopharmaceutical use and antibiotic prescriptions in upper respiratory infections: results from a German cohort study evaluating the impact of naturopathy qualifications of general practitioners using routine data.

Antibiotic resistance is a significant global health threat, exacerbated by inappropriate prescribing practices, particularly for upper respiratory infections that are predominantly viral. Complementary and Integrative Medicine (CIM), including the use of phytopharmaceuticals, offers a potential strategy to reduce antibiotic prescriptions. This study aimed to describe the impact of General Practitioners' (GPs) naturopathy (NP) qualifications and phytopharmaceutical prescriptions on the rate of antibiotic prescribing for upper respiratory infections (RTI). We conducted a retrospective cohort study using routine data from the CONTinuous morbidity registration Epidemiologic NeTwork (CONTENT), which includes over 200,000 patients across four federal states in Germany. The study included data from n = 36 GPs who recorded at least one ICD-10 diagnosis of RTI. Antibiotic and phytopharmaceutical prescriptions were identified and analyzed through mixed-effects logistic regression models to explore the influence of GPs' naturopathy qualifications and phytopharmaceutical use on antibiotic prescribing patterns. The study included 40,344 patients managed by 36 GPs. Prescriptions of phytopharmaceuticals significantly reduced the likelihood of antibiotic use (OR 0.48, 95% CI 0.45-0.52). Additionally, holding a naturopathy qualification was associated with lower rates of antibiotic prescriptions (OR 0.73, 95% CI 0.69-0.78). The interaction between naturopathy qualification and phytopharmaceutical prescriptions also showed a significant effect (OR 1.43, 95% CI 1.27-1.62). Patient's year of birth influenced prescribing patterns indicating a reduction of antibiotic prescriptions for younger patients, while patients' gender did not reveal a significant effect. Prescriptions of phytopharmaceuticals were significantly associated with a decrease antibiotic prescriptions among GPs, especially when combined with naturopathy qualifications. Training in naturopathic approaches could enhance antibiotic stewardship efforts in primary care settings, suggesting that broader integration of CIM elements into medical training could be beneficial in mitigating antibiotic resistance.

Barriers of adopting sustainable soil management practices for organic and conventional farming systems

There is a general consensus among stakeholders about the benefits of sustainable soil management practices for soil health, yet their implementation lags behind expectations. The aim of this paper is to analyse factors supporting or hindering the implementation of sustainable soil management practices in conventional and organic farming systems. This is achieved using a Logit model, based on penalized maximum likelihood estimation on survey data by 76 farmers from 10 federal states in Germany. Affected factors were categorized in two main groups: agricultural soil management practices, and barriers to their implementation. The measures for soil improving agricultural management included (I) structural landscape elements, (II) organic fertilization, (III) diversified crop rotation, (IV) permanent soil cover (V) conservation tillage, (VI) reduced weight pressure, and (VII) optimized timing of wheeling. Results show differences in preferences between conventional and organic farmers for key sustainable soil management practices, including conservation tillage, optimized wheeling timing, reduced weight pressure, and diversified crop rotation. Economic constraints decrease crop rotation diversification in conventional systems by 14%. Conservation tillage raises the chance of a farm being conventional by 16%, while optimizing wheeling timing reduces it by 60%, highlighting soil compaction concerns among organic farmers. Marginal effects confirm that economic factors, not knowledge, are the main barriers to sustainable soil management. Inconsistent policies, lack of support, and insufficient financial incentives from government institutions can hinder the willingness of farmers to adopt these practices, further exacerbating the barriers to adoption.

"Smoke-free in May 2024": concept and description of the participants

Far too many people smoke in Germany, and the number of serious attempts to stop smoking has been falling for years. Smoke-free in May 2024 is a low-threshold measure to encourage people to stop smoking. Adults who "regularly" consume nicotine products as well as support persons were eligible to take part. As part of the measure, participants and supporters were offered daily support via app notifications, emails and/or WhatsApp. They were also made aware of existing stop-smoking programmes. Finally, prizes were raffled off among the successful participants. A total of 6,386 individuals registered to take part. Of these, 550 individuals registered with a person of their choice to support them. Smokers were predominantly female (56.5%) and on average 42.9 (SD=13.2) years old. They came from all federal states in Germany, with a disproportionately high number from the federal states of Bremen, Schleswig-Holstein, Berlin, North Rhine-Westphalia, Hamburg and Bavaria in relation to the population distribution. Compared to a representative sample from a study by the Robert Koch Institute (2012), they reported a significantly higher subjective socio-economic status. Of the participants, 79.3% categorised their addiction as high. Regular use of more than one nicotine products occurred in 35.3% of the sample; 39.8% of the participants stated that they had not tried to stop smoking during the last 12 months. The number of smokers participating in the program is encouraging. In addition to an efficacy study, it should be examined in subsequent years how more males and individuals with a low subjective social status can be encouraged to initiate smoking cessation.

Towards Optimising the Derivation of Phenological Phases of Different Crop Types over Germany Using Satellite Image Time Series

Operational crop monitoring applications, including crop type mapping, condition monitoring, and yield estimation, would benefit from the ability to robustly detect and map crop phenology measures related to the crop calendar and management activities like emergence, stem elongation, and harvest timing. However, this has proven to be challenging due to two main issues: first, the lack of optimised approaches for accurate crop phenology retrievals, and second, the cloud cover during the crop growth period, which hampers the use of optical data. Hence, in the current study, we outline a novel calibration procedure that optimises the settings to produce high-quality NDVI time series as well as the thresholds for retrieving the start of the season (SOS) and end of the season (EOS) of different crops, making them more comparable and related to ground crop phenological measures. As a first step, we introduce a new method, termed UE-WS, to reconstruct high-quality NDVI time series data by integrating a robust upper envelope detection technique with the Whittaker smoothing filter. The experimental results demonstrate that the new method can achieve satisfactory performance in reducing noise in the original NDVI time series and producing high-quality NDVI profiles. As a second step, a threshold optimisation approach was carried out for each phenophase of three crops (winter wheat, corn, and sugarbeet) using an optimisation framework, primarily leveraging the state-of-the-art hyperparameter optimization method (Optuna) by first narrowing down the search space for the threshold parameter and then applying a grid search to pinpoint the optimal value within this refined range. This process focused on minimising the error between the satellite-derived and observed days of the year (DOY) based on data from the German Meteorological Service (DWD) covering two years (2019–2020) and three federal states in Germany. The results of the calculation of the median of the temporal difference between the DOY observations of DWD phenology held out from a separate year (2021) and those derived from satellite data reveal that it typically ranged within ±10 days for almost all phenological phases. The validation results of the detection of dates of phenological phases against separate field-based phenological observations resulted in an RMSE of less than 10 days and an R-squared value of approximately 0.9 or greater. The findings demonstrate how optimising the thresholds required for deriving crop-specific phenophases using high-quality NDVI time series data could produce timely and spatially explicit phenological information at the field and crop levels.

Subjective Health Impairment And Associated Factors In The Heatwave Of Summer 2022: An Online Survey

Heatwaves might diminish the sense of well-being and are associated with increased mortality. Individual measures to protect against heat are often insufficient, with the perception of one's own risk playing a crucial role. Due to varying levels of vulnerability, it is expected that the perception differs among populations. Presumably, symptom awareness is higher when people are concerned with and inform themselves about the topic of heat. Our study examined subjective health impairment during the heatwave in 2022, its association with socio-demographic and economic factors, as well as perceived heat stress and individual engagement with the issue. An online survey of a population-based sample from five federal states of Germany was carried out. Multivariable regression analyses were conducted to explore the relationship between subjective health impairment due to heat and potential risk indicators. Out of 3,111 people contacted, 1,522 responded, with 649 (20.9%) included in the analysis as they were affected by heat in their region of residence during the summer of 2022. The average subjective health impairment was 9.29 (SD: 5.25) out of 29 possible points. Higher age was associated with lower impairment; -1.36 points (95%-CI: -4.10; 1.38) in the group of those aged 80 and compared with the reference group of 60 to 69-year-old people. Furthermore, higher impairment was reported more by women and individuals with lower educational levels. Low impairment was associated with a high perceived level of information. Interventions aimed at reducing heat-related health problems should target a broader audience, particularly young people, women, individuals with lower education, and working people.

Domain-Linked and Domain-Specific Competence: a Validation Study of a Two-Dimensional Model of Economic Vocational Competence in Germany

Modeling vocational competence is increasingly crucial for monitoring and enhancing the quality of Vocational Educational Training (VET), particularly in the context of ongoing international comparative studies known as "large-scale assessments" of vocational education and training. This study endeavors to provide well-structured and guideline-compliant empirical evidence for the validation of the two-dimensional construct of economic vocational competence, advancing beyond the current state of research. A sample of 1438 first-year apprentices from two federal states in Germany participated as test-takers. The authentic assessment framework comprised 24 items, assessing two dimensions of vocational competence: domain-linked competence and domain-specific competence in the business/commercial domain. Measurement invariance was assessed across (1) federal states and (2) versions of test booklets, and the Multidimensional Random Coefficient Multinomial Logit model was employed to examine the quality of the two-dimensional vocational competence construct. The results supported the validity of the structure, highlighting the differentiation between domain-linked competence and domain-specific competence. This provides a more substantively accurate representation of trainees' vocational competence compared to a unidimensional model.

Which knowledge is required in exams on analysis 1 courses at German universities?

Abstract The purpose of this study is to describe the knowledge that is required in exams on Analysis 1 courses at German universities. To do so, we use the distinction between procedural and conceptual knowledge that is frequently used in the literature on mathematics education. For a more detailed analysis, we developed further categories for our coding scheme that better reflect the interaction of procedural and conceptual knowledge required to complete tasks. Using this coding scheme, we coded 49 exams from 12 out of 16 federal states in Germany, consisting of a total of 741 tasks. The analysis revealed that 69% of the tasks could be solved by recalling information or using procedural knowledge with only minor conceptual knowledge required, whilst 31% required substantial conceptual knowledge. Based on this analysis, we assume that most exams can be passed by focusing the knowledge of facts and procedures. These results indicate a discrepancy between the teaching focus on conceptual knowledge and the knowledge assessed, which is discussed.

An empirical analysis of organic micro-level agricultural knowledge and innovation systems (microAKIS) in three federal states in Germany

ABSTRACT Purpose To achieve the ambitious policy goals concerning organic agriculture in Germany, it is crucial to understand which actors and institutions in the German organic microAKIS are most important to farmers and how farmers within the system share knowledge. This study explores these questions by focusing on farmers who are members of organic producer associations (OPAs) in three federal states in Germany. Design/methodology/approach Fieldwork was conducted in Brandenburg, Lower Saxony, and Bavaria from April to September 2021 through qualitative research utilizing participant observation on organic farms and in-person and Zoom interviews with farmers and experts in the organic agricultural sector. Findings This study concurs with previous studies’ findings that German organic farmers obtain and exchange knowledge, information, and innovations from a wide variety of sources surrounding their farm business as a whole; however, regarding agricultural practices and technologies, fellow farmers and OPAs are the most important sources. Practical implications Through comparing the microAKIS in Brandenburg, Lower Saxony, and Bavaria this paper explores how farmers in different states depend diversly on state structures, how in the organic sector farmers rely heavily on the private sector for knowledge and information exchanges surrounding agricultural practices and technologies, and how these networks can be improved. This enables discussions on advancing the sector and meeting policy goals by addressing farmers’ needs. Theoretical implications The microAKIS framework is advanced by engaging in a comparative analysis and bottom-up approach to identify significant actors according to farmers in the organic sector in Germany. Originality/value This study outlines the individuals and organizations that make up the organic microAKIS in Germany, which has been underexplored in the fast-growing organic sector, and utilizes empirical evidence to display farmers’ perspectives.

Evaluating German PISA stratification designs: a simulation study

Stratification is an important design feature of many studies using complex sampling designs and it is often used in large-scale assessment (LSA) studies, such as the Programme for International Student Assessment (PISA), for two main reasons. First, stratification variables that achieve a high between and low within strata variance can improve the efficiency of a survey design. Second, stratification allows one to, explicitly or implicitly, control for sample sizes across subpopulations. It ensures that some parts of a population are in the sample in predetermined proportions. In this study, we determine through simulation which stratification scheme is best for PISA in Germany. For this, we consider the constraints imposed by the international sampling design, the available information about schools, and specific national characteristics of the German educational system. We examine seven different stratification designs selected based on scenarios used in past LSAs in Germany and theoretical considerations for future implementations. The chosen scenarios were compared with two reference scenarios: (1) an unstratified design and (2) a synthetic optimal stratification design. The simulation study reveals that the stratification design currently applied in PISA produces satisfactory results regarding sampling precision. The present stratification design is based on Germany's federal states and school types. However, this approach leads to small strata, which has been problematic for estimating sampling variance in previous cycles. Therefore, alternative stratification scenarios were considered and, in addition to overcoming the small-strata problem, also led to smaller standard errors for estimates of student mean performance in mathematics, science, and reading. As a result of this study, we recommend considering three different stratification designs for Germany in future cycles of PISA. These recommendations aim to: (1) improve the sampling efficiency while keeping the sample size constant, (2) follow a sound methodological approach, and (3) make conservative and cautious changes while maintaining a reflection of the structure of the German federal school system with different school types. These suggestions include a reinvented stratification of grouped German federal states and designs with school types as explicit stratifiers and federal states as implicit stratifiers.

Climate adaptation law: a European perspective

AbstractIn contrast to climate protection law, which regulates the mitigation of climate change, climate adaptation law deals with the management of the unavoidable consequences of climate change. This article provides an overview of its legal basis from a European perspective. In addition to international law, especially the Paris Agreement, EU law is of central importance in this respect. It is primarily shaped by the EU Climate Law enacted in 2021. However, this Law only sets a general framework and is further defined by legal acts of various sectoral policies, especially in the field of environment. Climate adaptation regulations at the level of European member states are presented using the example of Germany, where a Federal Climate Adaptation Act is currently being drafted. Due to Germany's federal state structure, state legislation is also analysed. Most of the German states (“Länder”) have their own climate laws, although their content varies. The municipal level is only addressed with restraint in these laws. The reasons for this are of a fiscal constitutional nature and will be explained in more detail.

Clinical Effectiveness of Newborn Screening for Spinal Muscular Atrophy

There is increasing evidence that early diagnosis and treatment are key for outcomes in infants with spinal muscular atrophy (SMA), and newborn screening programs have been implemented to detect the disease before onset of symptoms. However, data from controlled studies that reliably confirm the benefits of newborn screening are lacking. To compare data obtained on patients with SMA diagnosed through newborn screening and those diagnosed after clinical symptom onset. This nonrandomized controlled trial used data from the SMARTCARE registry to evaluate all children born between January 2018 and September 2021 with genetically confirmed SMA and up to 3 SMN2 copies. The registry includes data from 70 participating centers in Germany, Austria, and Switzerland. Data analysis was performed in February 2023 so that all patients had a minimal follow-up of 18 months. Patients born in 2 federal states in Germany underwent screening in a newborn screening pilot project. All other patients were diagnosed after clinical symptom onset. All patients received standard care within the same health care system. The primary end point was the achievement of motor milestones. A total of 234 children (123 [52.6%] female) were identified who met inclusion criteria and were included in the analysis: 44 (18.8%) in the newborn screening cohort and 190 children (81.2%) in the clinical symptom onset cohort. The mean (SD) age at start of treatment with 1 of the approved disease-modifying drugs was 1.3 (2.2) months in the newborn screening cohort and 10.7 (9.1) months in the clinical symptom onset cohort. In the newborn screening cohort, 40 of 44 children (90.9%) gained the ability to sit independently vs 141 of 190 (74.2%) in the clinical symptom onset cohort. For independent ambulation, the ratio was 28 of 40 (63.6%) vs 28 of 190 (14.7%). This nonrandomized controlled trial demonstrated effectiveness of newborn screening for infants with SMA in the real-world setting. Functional outcomes and thus the response to treatment were significantly better in the newborn screening cohort compared to the unscreened clinical symptom onset group. German Clinical Trials Register: DRKS00012699.

Study protocol for the development, trial, and evaluation of a strategy for the implementation of qualification-oriented work organization in nursing homes

BackgroundStaffing ratios in nursing homes vary among the federal states of Germany, but there are no rational grounds for these variations. In a previous study, a new instrument for the standardized calculation of staffing requirements in nursing homes was developed (Algorithm1.0). The development was based on a new empirical data collection method that derives actual and target values for the time and number of care interventions provided. Algorithm1.0 found an increased requirement of 36% of staff in German nursing homes. Based on these results, the German legislature has commissioned a model program to trial and evaluate a complex intervention comprising increased staffing combined with strategies for organizational development.MethodsThe mixed-methods study consists of (i) developing a concept for restructuring the work organization, (ii) the application of this concept combined with increased staffing in 10 nursing homes (complex intervention), and the further development of the concept using a participatory and iterative formal evaluation process. The intervention consists of (a) quantitative measures of increased staffing based on a calculation using Algorithm1.0 and (b) qualitative measures regarding organizational development. The intervention will be conducted over one year. The effects of the intervention on job satisfaction and quality of care will be evaluated in (iii) a comprehensive prospective, controlled summative evaluation. The results will be compared with ten matched nursing homes as a control group. Finally, (iv) prototypical concepts for qualification-oriented work organization, a strategy for the national rollout, and the further development of Algorithm1.0 into Algorithm 2.0 will be derived.DiscussionIn Germany, there is an ongoing dynamic legislation process regarding further developing the long-term care sector. The study, which is the subject of the study protocol presented here, generates an evidence-based strategy for the staffing requirements for nursing homes.Ethics and dissemination.This study was approved by the Ethics Committee of the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft) on 02.08.2023 (amended on 20.09.2023). Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration number: German Clinical Trails Register DRKS00031773 (Date of registration 09.11.2023).

Sex differences in cardiologic medication provision for adults with coronary heart disease: an analysis of health claims data from 2018 to 2020 in Saxony-Anhalt, Germany

BackgroundCoronary heart diseases (CHDs) have experienced the largest increase worldwide as a cause of death, accounting for 16% of all deaths. In Saxony-Anhalt, a federal state in Germany, both CHD morbidity and acute myocardial infarction mortality rates are particularly high. Several risk factors associated with CHDs have been studied in Saxony-Anhalt, but sex differences in service use and medication have not been investigated. This study therefore aimed to investigate sex differences in the quality and quantity of cardiological care provided to adults with CHD.MethodsThis study used health claims data from 2018 to 2020 to analyse the utilisation of healthcare services and adherence to medication-related guideline recommendations in primary and specialist care. The sample included 133,661 individuals with CHD from a major statutory health insurance company (Germany).ResultsAlmost all CHD patients (> 99%) received continuous primary care. Continuous cardiologist utilisation was lower for females than for males, with 15.0% and 22.2%, respectively, and sporadic utilisation showed greater differences, with 33.5% of females and 43.4% of males seeking sporadic cardiologist consultations. Additionally, 43.1% of the identified CHD patients participated in disease management programmes (DMPs). The study also examined the impact of DMP participation and cardiologist care on medication uptake and revealed that sex differences in medication uptake, except for statin use, were mitigated by these factors. Statins were prescribed to 42.9% of the CHD patients eligible for statin prescription in accordance with the QiSA indicator for statin prescription eligibility. However, there were significant sex differences in statin utilisation. Female CHD patients were less likely to use statins (35.2%) than male CHD patients were (50.1%). The difference in statin utilisation persisted after adjustment for DMP participation and cardiologist consultation.ConclusionsThis study highlights sex differences in the utilisation of cardiological healthcare services for patients with CHD in the Saxony-Anhalt cohort. These findings underscore the continuing need for interventions to reduce sex inequalities in accessing healthcare and providing health care for patients with CHD. Factors at the health care system, patient, and physician levels should be further investigated to eventually improve statin prescription in people with CHD, especially women.

Scope of School Psychological Practice in Germany: Part 1

Many countries rely on statements issued by professional associations to delimit the scope of school psychological practice. It is, however, not always clear to what extent these statements match current practices and school psychologists’ self-perception of their professional role, as empirical data is often unavailable or limited. This study aims to address this gap by collecting empirical data on the scope of school psychological practice in Germany. In a mixed method study, we first applied the Delphi technique to develop a questionnaire in collaboration with school psychological experts from different federal states of Germany. Second, we collected information on federal policies through semi-structured interviews with regional experts. Third, we invited a representative sample of school psychologists to complete the questionnaire developed through the Delphi technique. In this first report, we focus on the Delphi procedure and overall results of the survey describing the scope of school psychological practice in Germany at a country-wide level. These findings provide a detailed characterization of the broad and heterogeneous scope providing an evidence-base for future research and political decision-making.

УКРАЇНСЬКА ГРОМАДА У БЕРЛІНІ (1991–2015)

Berlin, which is a separate federal state in Germany, has been considered one of the largest multicultural cities in the world in recent decades: it is home to numerous diasporas from different parts of the world (the Middle East, Asia, Africa, Latin America, and Southern and Eastern Europe), which largely shape its modern face. Since 1991, the Ukrainian community, which had been virtually unrepresented in the city divided after the Second World War, has also gained an important place in Berlin. Ukrainians arrived in the city for various reasons and purposes: repatriation of ethnic Germans and their families, emigration along the Jewish line, family reunification, job search, study, illegal immigration, etc. As a result, Ukrainians now have a number of their own organisations, cultural and religious centres here, and Berlin itself, along with Munich, is considered one of the most important Ukrainian centres in Germany. The purpose of the study is to analyse Ukrainian migration processes in 1991–2015 and the situation of the Ukrainian community in Berlin. Accordingly, the main objectives of the study are to examine the dynamics of the Ukrainian community in the city, to identify the main aspects of the migration movement of the new wave of Ukrainian emigration, its integration into German society, and to highlight the social and cultural life of Ukrainians in the German capital.

Predicting the risk of tree fall onto railway lines

Tree fall onto railway lines puts passengers at risk and causes large economic losses due to disruption of train services and damage to infrastructure. Railway lines in Germany are vulnerable to tree fall because of the large number of trackside trees that exist in that country with approximately 70% of all railway lines being tree-lined. In this paper we first tested whether a hybrid-mechanistic tree wind damage model, ForestGALES, could identify the sections of the railway network affected by tree fall in two federal states of Germany, Northrhine-Westphalia (NRW) and Thuringia (TH). We secondly tested whether the model, in combination with meteorological forecast models, could predict where tree fall occurred during a damaging windstorm. We used information on tree characteristics derived from LiDAR and aerial photography along the railway line network in NRW and TH to calculate the critical wind speed (CWS) at which damage is expected to happen for every individual tree as a function of its size and species, and the underlying soil. The railway network was then divided into 500 m sections and the statistics of the CWS, tree height, and species composition (broadleaf/conifer mix) within each section were calculated. Analysis of past tree fall events recorded by Deutsche Bahn AG (DB) showed that there was a significantly lower minimum CWS and significantly greater maximum tree height in sections that had recorded damage. In a second step we compared the calculated CWS values for all trees against downscaled wind speed assessments across the two federal states during Storm Friederike (named Storm David internationally) on 18 January 2018 and tested the ability of the model to discriminate sections with recorded damage during the storm. Excellent model discrimination was found with an AUC value of 0.82 and an overall model accuracy of 74.2%. The first test showed that the ForestGALES model with precise individual tree information can identify the sections of a railway network most vulnerable to tree fall. The second analysis showed, for the one storm tested, that the ForestGALES model when combined with predicted storm wind speeds can identify the most probable sections of the railway network to experience tree fall during an approaching damaging storm. Such information could be of value in firstly planning remedial work along railway lines, and secondly preparing the railway network ahead of a major storm.

Most patients with an increased risk for sepsis-related morbidity or death do not recognize sepsis as a medical emergency: results of a survey study using case vignettes

BackgroundSepsis is a medical emergency with potentially life-threatening consequences. Patients play a crucial role in preventing and recognizing sepsis at an early stage. The understanding of risk groups’ sepsis knowledge and their ability to use this knowledge to recognize sepsis as an emergency is incomplete.MethodsWe conducted a cross-sectional survey in Germany and included a sample of 740 persons stratified by age (< 60 years, ≥ 60 years), specific chronic diseases (e.g. diabetes, chronic diseases, cancer), and region (Berlin/Brandenburg vs. other federal states of Germany). Standardized questionnaires were administered by a market research institute through online, telephone, or face-to-face methods. We assessed sepsis knowledge through a series of questions and the ability to recognize sepsis as an emergency through five case vignettes. To identify predictors of sepsis knowledge and the ability to recognize sepsis as a medical emergency, we conducted multiple linear regressions.ResultsOf the 36 items on sepsis knowledge, participants answered less than 50 per cent correctly (mean 44.1%; standard deviation (SD) 20.1). Most patients knew that sepsis is a defensive host response to infection (75.9%), but only 30.8% knew that vaccination can prevent infections that lead to sepsis. Across the five vignettes, participants identified sepsis as an emergency in only 1.33 of all cases on average (SD = 1.27). Sepsis knowledge was higher among participants who were older, female, and more highly educated and who reported more extensive health information seeking behaviour. The ability to recognize sepsis as an emergency was higher among younger participants, participants without chronic diseases, and participants with higher health literacy, but it was not significantly associated with sepsis knowledge.ConclusionsRisk groups showed low levels of knowledge regarding the preventive importance of vaccination and a low ability to recognize sepsis as a medical emergency. Higher levels of sepsis knowledge alone were not sufficient to improve the ability to identify sepsis as a medical emergency. It is crucial to develop effective educational strategies—especially for persons with lower education levels and infrequent health information seeking behaviour—that not only transfer but also facilitate the choice of appropriate actions, such as seeking timely emergency care.Trial registration: DRKS00024561. Registered 9 March 2021.