Federal States Of Germany Research Articles

Planning for wolf-livestock coexistence: landscape context predicts livestock depredation risk in agricultural landscapes.

Extensive pastoral livestock systems in Central Europe provide multiple ecosystem services and support biodiversity in agricultural landscapes but their viability is challenged by livestock depredation (LD) associated with the recovery of wolf populations. Variation in the spatial distribution of LD depends on a suite of factors, most of which are unavailable at the appropriate scales. To assess if LD patterns can be predicted sufficiently with land use data alone at the scale of one federal state in Germany, we employed a machine-learning-supported resource selection approach. The model used LD monitoring data, and publicly available land use data to describe the landscape configuration at LD and control sites (resolution 4km*4km). We used SHapley Additive exPlanations to assess the importance and effects of landscape configuration and cross-validation to evaluate the model performance. Our model predicted the spatial distribution of LD events with a mean accuracy of 74%. The most influential land use features included grassland, farmland and forest. The risk of livestock depredation was high if these three landscape features co-occurred with a specific proportion. A high share of grassland, combined with a moderate proportion of forest and farmland, increased LD risk. We then used the model to predict the LD risk in five regions; the resulting risk maps showed high congruence with observed LD events. While of correlative nature and lacking specific information on wolf and livestock distribution and husbandry practices, our pragmatic modelling approach can guide spatial prioritisation of damage prevention or mitigation practices to improve livestock-wolf coexistence in agricultural landscapes.

German general practitioners’ experiences during the COVID-19 pandemic and how it affected their patient care: A qualitative study

Background General practitioners (GPs) play a significant role in providing medical care to patients affected by the coronavirus disease 2019 (COVID-19). Little is known about the impact of the pandemic on patient care from the perspective of GPs. Objectives To gain insight into GPs’ experiences of the COVID-19 pandemic and its impact on patient care in Germany. Methods From August to December 2020, qualitative, semi-structured telephone interviews were conducted with 22 GPs from four randomly selected federal states in Germany. We analysed the data according to Kuckartz’s method of content analysis. Results Five themes emerged: changes in healthcare system, practice routines, patient care, personal life, and improving health crisis preparedness. Communication with authorities and following rapidly changing guidelines were the biggest challenges during the pandemic. Teamwork and collegial exchange in the practice were seen as important sources of support to overcome these barriers. Participants stated that they managed to secure care but expressed concerns about how social distancing might affect the doctor-patient relationship. In their professional and private lives, GPs perceived themselves as role models with a high responsibility for the health of others. Consistent guidance by health authorities and reliable information were raised as necessary for managing patient care in the pandemic. Conclusion Findings show that patient care was successful but GPs’ adaptation to unprecedented conditions was limited by poor communication and collaboration with health authorities. Therefore, providing adequate support services by policymakers is essential to strengthen primary care in future health crises.

Incidence, mortality and trends of cutaneous squamous cell carcinoma in Germany, the Netherlands, and Scotland

Aim of the studyCutaneous squamous cell carcinoma (cSCC) incidences are increasing but scarcely available separated. We analysed incidence rates of cSCC over three decades with an extrapolation to 2040. MethodsCancer registries from the Netherlands, Scotland and two federal states of Germany (Saarland/Schleswig-Holstein) were sourced for separate cSCC incidence data. Incidence and mortality trends between 1989/90 and 2020 were assessed using Joinpoint regression models. Modified age-period-cohort models were applied to predict incidence rates up to 2044. Rates were age-standardised using the new European standard population (2013). ResultsAge-standardised incidence rates (ASIR, per 100,000 persons per year) increased in all populations. The annual percent increase ranged between 2.4% and 5.7%. The highest increase occurred in the age groups ≥60 years, especially in men aged ≥80 years, with a three to 5-fold increase. Extrapolations up to 2044 showed an unrestrained increase in incidence rates in all countries investigated. Age-standardised mortality rates (ASMR) showed slight increases between 1.4 and 3.2% per year in Saarland and Schleswig-Holstein for both sexes and for men in Scotland. For the Netherlands, ASMRs remained stable for women but declined for men. ConclusionThere was a continuous increase of cSCC incidence over three decades with no tendency for levelling-off, especially in the older populations as males ≥80 years. Extrapolations point to a further increasing number of cSCC up to 2044, especially among ≥60 years. This will have a significant impact on the current and future burden on dermatologic health care which will be faced with major challenges.

Approximating the influence of external factors on the technical efficiency score of hospital care: evidence from the federal states of Germany

BackgroundA good health care system and, especially, the provision of efficient hospital care are the goals of national and regional health policies. However, the scope of general hospital care in the 16 federal states in Germany varies considerably from region to region. The objectives of this paper are to evaluate the technical efficiencies of all general hospitals of the 16 federal states for the period from 2015 to 2020, to find out the relation between the exogenous factors and score of efficiency, and also the influence of the COVID-19 pandemic on the results of the technical efficiency of hospital care in the German states.MethodsA two-step approach was used. First, an input-oriented Data Envelopment Analysis model with constant returns to scale and variable returns to scale was applied for the 6-year period from 2015 to 2020. The calculation of technical efficiency according to the input-oriented DEA model contains the three components—total technical efficiency (TTE), pure technical efficiency (PTE) and scale efficiency (SE). In the second stage, the influence of exogenous variables on the previously determined technical efficiency was evaluated by applying the tobit regression analysis.ResultsAlthough the level of average technical efficiency of about 90% is high, total technical efficiency deteriorated steadily from 2015 to 2020. Its lowest point at around 78%, was in the year 2020. The deterioration of the average technical efficiency is notably influenced by the lower results in the years 2019 and 2020. The decomposition of technical efficiency also revealed that the deterioration of overall average efficiency was influenced by both pure technical efficiency (PTE) and scale efficiency (SE). Based on the tobit regression analysis performed, it was possible to conclude that the change in the efficiency score can be explained by the influence of exogenous factors only from 6.4% for overall efficiency and from 7.1% for scale efficiency.ConclusionsThe results of the analysis of the overall technical efficiency reveal that the aggregated data of all general hospitals of all 16 federal states show a steadily worsening total technical efficiency every year since 2015. Although, especially, the deterioration of the year 2020 with the occurrence of COVID-19 pandemic, contributes to a deteriorated efficiency average, the deterioration of the efficiency values, based on the analysis performed, is also observable between the years 2016 and 2019. Considering the output generated, for inefficient units and the relevant policy authorities in the hospital sector, it can be recommended that the number of beds and in particular the number of physicians, should be reduced as inputs. Based on this study, it is also recommended that decisions to increase the efficiency of general hospitals should be made with consideration of exogenous factors such as the change in the number of general hospitals or the population density in the respective state, as these had explanatory value in connection with the increase in efficiency values. Due to the wide variation in the size of the federal states, the recommendation is more appropriate for federal states with low population density.

Genomic epidemiology of Campylobacter fetus subsp. venerealis from Germany.

Campylobacter fetus subsp. venerealis (Cfv) causes bovine genital campylobacteriosis (BGC), a World Organization for Animal Health (WOAH)-listed trade-relevant disease characterized by severe reproductive losses, such as infertility, early embryonic death and abortion in cattle. BGC has significant economic implications that have prompted several countries to adopt stringent eradication and surveillance measures to contain the disease. In Germany, there has been a low incidence of BGC cases over the past 28 years. This study aimed to illustrate the genomic diversity of German Cfv strains isolated from different federal states in Germany. This study analyzed 63 Cfv strains, collected between 1985 and 2015, by whole-genome sequencing and compared them with genome data of 91 international Cfv isolates. The phylogenetic analysis showed that the Cfv population is genetically conserved and has geographic clusters. In Germany, one phylogenetic lineage comprising all strains was identified. This German lineage was part of a subclade that probably emerged in the nineteenth century and diversified over time. The results of this study point to a non-recurrent cross-border introduction of Cfv in Germany. The BGC control interventions in Germany can be considered successful as no outbreaks were reported since 2015.

Participation of pre-hospital emergency physicians at ambulance missions in Germany's federal states

PurposeThis study aims to determine the differences in the involvement of pre-hospital emergency physicians (PHEPs) within the ambulance service over time and between the federal states and identify possible reasons for the differences.Design/methodology/approachThe federal state-specific PHEP rates from 2012 to 2017 were analysed using publicly available data or data provided by the responsible state ministries. In addition, various correlations between PHEP rates and sociodemographic and health data were calculated.FindingsThe PHEP rates differ significantly between the 16 federal states. In 2017, Schleswig–Holstein had a PHEP participation rate of 19.00%, while in Mecklenburg-Western Pomerania the rate was 41.08%. In all surveyed states, the rate fell over time. Only in Mecklenburg-Western Pomerania, the rate increased from 37.68% in 2012 to 41.08% in 2017 (OR: 1.15 [95% CI: 1.14; 1.17]). Federal state-specific PHEP rates indicated strong deviations from the overall PHEP rate of all included federal states with ORs ranging from 0.61 (95% CI: 0,61; 0,62) for Schleswig–Holstein to 1.82 (95% CI: 1.81; 1.84) for Mecklenburg-Western Pomerania. Socioeconomic factors indicated (inverse) correlations with the federal state-specific PHEP rate.Originality/valueThe PHEP rates differ significantly between the federal states. The correlations indicate possible connections but do not show clear causes within state-specific characteristics. Consequently, the occupational autonomy of paramedics differs between the states.

ГОТЕЛЬНЕ ГОСПОДАРСТВО ЯК СКЛАДОВА ІНДУСТРІЇ ГОСТИННОСТІ КРАЇНИ (НА ПРИКЛАДІ НІМЕЧЧИНИ)

Dissertation studies of Ukrainian scientists devoted to the development of the hotel industry are considered. Ukrainian researchers pay considerable attention to the issues of the development of the country's hotel industry, its management, improvement of the quality of hotel services, spatial optimization of establishments, etc. A detailed analysis of the hotel industry of the countries of the world has not been found in the works of domestic scientists. The dynamics of the number of overnight stays in tourist facilities in Germany for the period 2018–2022 were considered. It was established that during this period the maximum rate of overnight stays fell on 2019 and amounted to 495.6 million units. A significant decrease in the number of overnight stays (about 40%) occurred in 2020 and 2021, which is due to restrictions during the COVID-19 pandemic, when there was a ban on accommodation for tourists from November 2020 to December 31, 2021, and for business travelers were allowed to live only if their stay was "absolutely necessary". In 2022, about 450.8 million overnight stays of tourists were recorded in tourist facilities in Germany. This indicator is only 9% less than in 2019, which indicates the active travel of tourists and the restoration of the functioning of accommodation facilities. An analysis of the number of overnight stays made by domestic and foreign tourists for the period 2018–2022 in the country's tourist accommodations was carried out. It was established that the number of nights spent by domestic tourists is higher. An analysis of hotels in Germany by star category was carried out. It was established that the most represented star category among German hotels is three stars, the second place was occupied by four-star hotels. Spatial analysis of the number fund by federal states of Germany was carried out. The leader in the number of hotel rooms is the region of Bavaria (39%), the last position is occupied by the region of Baden-Württemberg (0.1%). The leading cities in terms of number of hotels are highlighted: Berlin, Hamburg, Munich and Frankfurt. These megacities control one third of the total room stock of the country's hotel market.

Widespread occurrence of quaternary alkylammonium disinfectants in soils of Hesse, Germany.

Quaternary alkylammonium compounds (QAACs) are cationic organic compounds with amphiphilic properties that are widely used as surfactants and disinfectants in industry, households and agriculture. Several studies suggest that QAACs co-select for antibiotic resistant microorganisms and thus may contribute to the spread of antibiotic resistance in the environment. Data on QAAC occurrence in soil are scarce and limited to soils that are prone to direct exposure to QAACs. Therefore, we conducted a comprehensive study on the occurrence of QAACs in soils of Hesse, a federal state in Germany, covering an area of 21,115 km2. Sixty-five soil samples that comprised different land uses (arable, grassland, forest, vineyard) and area types (rural, agglomeration) were analysed for concentrations of alkyltrimethylammonium (ATMACs, with alkyl chain lengths C8-C16), benzylalkyldimethylammonium (BACs, C8-C18) and dialkyldimethylammonium compounds (DADMACs, C8-C18) via HPLC-MS/MS after ultrasonic-assisted extraction with acidified acetonitrile. QAACs were detected in 97 % of the soil samples irrespective of land use and area type. The most abundant QAAC homologues were DADMACs > BACs > ATMACs. The highest total QAAC concentrations were detected in alluvial soils influenced by the deposition of suspended particles during flood events, with DADMAC-C16 and -C18 as the dominant homologues. The high abundance of long-chain DADMACs suggests that legacy pollution and accumulation govern QAAC concentrations in soils. The presence of QAACs in forest soils points to a potential input via atmospheric deposition. Our work highlights the widespread occurrence of QAACs in soils of Hesse and the need for more research on their entry paths and fate in the soil ecosystem.

Regional demographic differences in Germany

Background: Spatial analysis of the main demographic processes in Germany. Research purpose: Assessment of the population situation and its changes in the federal states of Germany from 2000–2020. Methods: A literature review, descriptive statistics and taxonomy were used for the analysis. Conclusions: There are large differences between the Länder in terms of demographics and the directions and intensity of their changes. Hamburg, Berlin and the highly developed western Länder (Bavaria, Baden-Württemberg and Hesse) with diversified economic structures are in the most favourable demographic situation. This was primarily due to the intensive influx of immigrants, which increased the number of inhabitants and maintained a low level of old age. Among the western Länder, unfavourable demographic changes are found in Saarland, whose economy is dominated by heavy industry. The biggest demographic problems are faced by the eastern Länder with the lowest economic potential, i.e., Saxony-Anhalt and Thuringia, which are not only depopulating the fastest but are also ageing. Therefore, the development distance that separates them from the richest Länder is likely to increase.

Citrinin Exposure in Germany: Urine Biomarker Analysis in Children and Adults.

Citrinin (CIT), a mycotoxin known to exert nephrotoxicity, is a contaminant in food and feed. Since CIT contamination is not regularly analyzed, data on its occurrence and especially levels in food commodities are insufficient for conducting a conventional exposure assessment. Yet, human biomonitoring, i.e., an analysis of CIT and its metabolite dihydrocitrinone (DH-CIT) in urine samples allows to estimate exposure. This study investigated CIT exposure in young (2-14 years) and adult (24-61 years) residents of three federal states in Germany. A total of 179 urine samples from children and 142 from adults were collected and analyzed by a targeted LC-MS/MS based method for presence of CIT and DH-CIT. At least one of the biomarkers was detected and quantified in all urines, which indicated a widespread dietary exposure to the mycotoxin in Germany. Interestingly, the biomarker concentrations of CITtotal (sum of CIT and DH-CIT) were higher in children's urine (range 0.05-7.62 ng/mL; median of 0.54 ng/mL) than in urines from adults (range 0.04-3.5 ng/mL; median 0.3 ng/mL). The biomarker levels (CITtotal) of individual urines served to calculate the probable daily CIT intake, for comparison to a value of 0.2 µg/kg bw/day defined as 'level of no concern for nephrotoxicity' by the European Food Safety Authority. The median exposure of German adults was 0.013 µg/kg b.w., with only one urine donor exceeding this provisional tolerable daily intake (pTDI) for CIT. The median exposure of children was 0.05 µg/kg bw per day (i.e., 25% of the pTDI); however, CIT exposure in 12 individuals (6.3% of our study group) exceeded the limit value, with a maximum intake of 0.46 µg/kg b.w. per day. In conclusion, these results show evidence for non-negligible exposure to CIT in some individuals in Germany, mainly in children. Therefore, further biomonitoring studies and investigations aimed to identify the major sources of CIT exposure in food commodities are required.

Querdenker. New social movement under observation by German constitutional protection authorities in context of COVID-19 pandemic

The objective of this article is to bring a closer look into the processes of social radicalisation which are the concomitant of COVID-19 pandemics in Federal Republic of Germany. Furthermore, the author is trying to reconstruct the procedures of recon analytics taken by internal civil counterintelligence services in federal states of Germany. Nascent of grassroots movements united against COVID-19 restrictions, obligatory vaccination and general questioning of COVID-19 pandemic, has led to inscribe mentioned groups onto the official agenda of internal civil intelligence services ditto provide measures of operational reconnaissance related to these groups.

Digital Health Information Provided by Public Health Stakeholders on Colorectal Cancer Screening: A Systematic Evaluation.

In the federal state of Germany, Saxony-Anhalt, colorectal cancer is the second most frequent cause of death among cancer patients. In order to identify cancer precursors early, colorectal cancer screenings are essential. In this context, health information contributes to informing individuals and imparting them with necessary knowledge to make a decision about (non-)utilization of preventive services. Numerous public health stakeholders (e.g., statutory health insurances) provide health information. This study aimed to evaluate the quality of web-based health information offered by public health stakeholders in Saxony-Anhalt, Germany. A systematic evaluation was used. A search was performed using pre-defined eligibility criteria and search terms. Two independent reviewers assessed the search results based on seven main categories (60 items) developed by the study team in line with the "Guideline Evidence-based Health Information". In total, 37 materials from 16 different stakeholders were included and yielded a "mediocre quality" (median = 69%). The materials had only partially fulfilled the requirements of national recommendations for evidence-based health information. Access to digital health information regarding colon cancer screening was unsatisfactory, especially for individuals with auditory or visual impairments, due to use of inappropriate communication technologies. Further efforts are required to improve digital health information about colorectal cancer screening.

Decision-Making Behaviour in Physician-Rating Portals: Results of a Vignette Study in the New Federal States of Germany

The extent to which relevant information is taken into consideration in the decision process for or against the choice of certain physicians when searching for physicians via physician-rating portals is largely unknown. In particular, the question of whether longer travel distances to a doctor's office are accepted in favour of a good rating is investigated in this study. In a vignette study, 192 respondents from new German states were shown ten hits each from a fictitious search for a primary care physician. A total of 1881 choice probabilities were evaluated with cluster-corrected regressions. A good rating and a short distance to the doctor's office were the most important determinants of a positive probability of choice. Longer distances were not accepted in favour of a good rating. Arabic-sounding names strongly reduced the probability of choice, although the respondents only assigned subordinate importance to the doctors' names as a basis for decision-making. The area served by physicians in private practice does not increase if they receive good grades on rating portals. Service quality is important, but not the most important factor in the rating score.

Measuring the effect of COVID-19-related night curfews in a bundled intervention within Germany

We estimate the impact of local night curfews in Hesse, the fifth most populous federal state in Germany, on the growth of incidences of COVID-19 cases residing within the “second wave” of the pandemic. Thereby, we take advantage of the fact that all counties had the same measures in place with the only difference that some additionally had to implement night curfews due to state regulations. This allows us to identify the effect of night curfews as a salient part of a bundled intervention. In our case where different other measures are already in place, night curfews had at best a limited effect in slowing down the spread of the pandemic. The effect is not significantly different from zero.

Update and prognosis of Dermacentor distribution in Germany: Nationwide occurrence of Dermacentor reticulatus.

A considerable range expansion of Dermacentor reticulatus has been observed in several European countries, which is concerning in the light of its vector function for several pathogens, including Babesia canis and tick-borne encephalitis virus (TBEV). The present study provides an update on the distribution of Dermacentor ticks in Germany, using a citizen science approach. Ticks were collected by citizens from March 2020 to May 2021, and submitted along with information on the date and location of collection, potential hosts and details about the circumstances of discovery. In total, 3,292 Dermacentor specimens were received, of which 76.4% (2,515/3,292) were identified as D. reticulatus and 23.0% (758/3,292) as D. marginatus, while 0.6% (19/3,292) were too damaged for species-level identification. Dermacentor reticulatus was received from all federal states of Germany. Maxent species distribution models predicted suitable environmental conditions for D. reticulatus throughout Germany. Findings on the vegetation or on pastured animals without travel history confirmed the occurrence of this tick species as far north as the most northern German federal state Schleswig-Holstein. In contrast, the distribution of D. marginatus still appears to be limited to southwestern Germany, although the northward shift of the distribution limit observed in the preceding citizen science study, as compared with previous published distributions, was confirmed. This shift was also predicted by Maxent species distribution models, reflecting the broader distribution of the tick occurrence data contributed by citizens. Most D. reticulatus ticks were found on dogs (1,311/1,960, 66.9%), while D. marginatus was mainly discovered on hoofed animals (197/621, 31.7%) and humans (182/621, 29.3%). Human tick bites were reported in 0.7% (14/1,960) of host-assigned D. reticulatus and 3.4% (21/621) of host-assigned D. marginatus. Further studies to investigate an increasing endemisation of Babesia canis in Germany as well as the relevance of D. reticulatus for TBEV spread throughout the country, e.g., by traveling dogs, are urgently needed. In view of the activity of D. reticulatus during winter or the colder months, which complements that of Ixodes ricinus, a year-round tick protection of at least dogs is strongly recommended.

Health inequalities in very old age: Continuity, accumulation or convergence?

Abstract Background Health inequalities are well documented empirically. However, it is unclear whether health inequalities persist in very old age (continuity), whether they accumulate steadily (accumulation), or whether they even attenuate in old age (convergence) - not least because of social inequalities in life expectancy, which make it less likely for individuals with lower social status to reach old age at all. The aim of this study is to empirically test these three hypotheses. Methods The analyses are based on representative cross-sectional data from 1,863 very old people and panel data from 912 participants in the 1st and 2nd wave (W1, W2) living in North Rhine-Westphalia the largest federal state in Germany (NRW80+ study). Health outcomes of the analyses are subjective health, multimorbidity and need for long-term care. Indicators of socioeconomic status (SES) are education, occupational status, and net equivalent income. Regression models (linear, logistic, ordinal) are used to analyze cross-sectional and longitudinal data. Panel selectivity is also considered by means of a failure model. Results Cross-sectional findings show health inequalities for all SES variables: persons with low education and low income have poorer subjective health and higher need for care. Low status is associated with higher need for care. Preliminary results from longitudinal analyses show a slight increase in health inequality: low income and low status are associated with higher multimorbidity and low education with higher dependency on long-term care at W2. Conclusions Despite the socially conditioned unequal chances of reaching old age, health inequality is still present in very old age and even increases slightly over time. The results argue against the convergence hypothesis and in favor of the continuity or even the accumulation hypothesis. A better understanding of the mechanisms leading to the persistent inequality is needed to development targeted interventions also in old age. Key messages • Health inequalities persist and even increase in very old age (80+). • It is imperative that the oldest old – an increasingly large population group – be considered when designing strategies to reduce health inequalities.

Dealing with staff diversity in German hospitals: A comparative analysis of doctors and nurses

Abstract Background Germany is increasingly recruiting foreign healthcare staff due to the shortage of skilled workers. This diversity of professional and cultural backgrounds poses a challenge to everyday life in inpatient care. Previous studies have focused on the renegotiation of professional identities and competencies in nursing or medicine. In contrast, this study sheds light on group-specific mechanisms through a comparative analysis: How do doctors and nurses deal with diversity in the workplace? Where do profession-specific differences emerge and what does this mean for future interventions? Methods Eight group discussions (June 2019 to October 2020) were conducted with groups of doctors and nurses with and without a migration background in four hospitals in two federal states in Germany; including 22 nurses and 10 doctors (n = 32). The data were analysed using the documentary method to examine professional meaning-making processes. The results were validated intersubjectively. Results The respective handling of diversity in the workplace is influenced by different professional group identities. The situation is precarious for nurses with a migration background - especially for those with an academic degree, as nursing is still an apprenticeship profession in Germany. In the medical profession, on the other hand, diversity does not lead to significant controversies, even if cultural differences are discussed. Conclusions Dealing with diversity is negotiated within professional groups. As nursing or medical ‘communities of practice’ (E. Wenger), these have a mediating role through which they can mitigate institutional and individual barriers to the integration of migrants in the workplace. Key messages

Socio-demographic and socio-economic disparities in medical rehabilitation in Germany in 2019

Abstract Medical rehabilitation is a valuable component to restore physical and mental health, to prevent social isolation and to ensure a return to work. Due to the demographic change and the still increasing number of Post-Covid-19 patients, the demand for rehabilitation is still increasing. Latest, the COVID-19 pandemic elucidated that especially people from lower socio-economic backgrounds are disproportionally affected by health crisis. The aim of this study was to determine the influence of socio-demographic and socio-economic factors on quantitative exercise therapy in medical rehabilitation and to clarify the divergence of existing research findings. In our study we used data from 824.606 rehabilitation cases (German Federal Pension Insurance) and investigated the role of age and gender, marital status, social status and location towards inequalities in access to medical rehabilitation. Multiple linear regression and effect size calculation were used to show associations and to discuss the relation to clinical relevance. We were able to show a highly significant difference (P < 0.001) in access to exercise therapy in our study group. Patients aged 65+, women, single or widowed people, rehabilitants of low socioeconomic status or people located in the new federal states in Germany received shorter and less frequent exercise therapy. There are differences of up to 3.5 hours of treatment duration and 4.25 treatments per week, when disadvantaged social factors accumulate. However, despite the presented differences, the received treatments for the disadvantaged groups are still in the range of suggested minimum therapeutic requirements by the German Federal Pension Insurance. We could show a significant difference in rehabilitative therapy, which is solely based on social factors. There is an urgent need to draw special attention to the here discussed inequalities in access to medical rehabilitation for socially disadvantaged population and the overarching impact on society. Key messages • The social inequality in medical rehabilitation to the detriment of the socially disadvantaged population that we have identified must give rise to clear changes in order to establish social justice. • Equal opportunities and health quality assurance that address the individual needs of each patient should be the focus of socio-medical, policy development.

The role of public health services in implementing heat health action plans in Germany

Abstract Background The rise in extreme heat periods is a major public health challenge of climate change and the World Health Organization therefore recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are not implemented in a comprehensive manner nor nationwide. Public health authorities have been identified as key actors with regards to heat and health. This study aims at assessing the role of public health services in the implementation of HHAPs in Germany. Methods First, a review of the scientific and grey literature on the role of public health services in heat adaptation in Europe was conducted. Second, a policy document analysis of the legislation of Germany's federal states for public health services and their potential role in the implementation of HHAPs was carried out. Finally, semi-structured interviews with selected experts from multiple sectors at the local, federal and national level on their perception of the role of public health services in the implementation of HHAPs in Germany were undertaken. Results Preliminary findings show that the legal framework for public health services in the different federal states addresses environmental health and civil protection to varying extents, but that climate change-specific health risks are barely mentioned. The expert interviews revealed perceived barriers for the public health services to implement HHAPs, notably with regards to personnel (e.g. competencies, time), organizational structures (e.g. financial resources, administrative structures, legal mandates) and competing other tasks (e.g. COVID-19 response). Facilitators included motivated individuals, funding opportunities for cross-sectoral collaboration and political support. Conclusions The role of public health services in HHAP implementation in Germany varies widely between the different geographic settings and is influenced by several factors at the individual, organizational and political level. Key messages

Detection of Anaplasma phagocytophilum in Ovine Serum Samples—A Retrospective Study

Tick-borne fever in sheep is caused by Anaplasma phagocytophilum and this obligate intracellular bacterium multiplies mostly in neutrophil granulocytes of its host. In Europe, the pathogen is mainly transmitted by the tick species Ixodes ricinus. Data on the dissemination of A. phagocytophilum in the German sheep population are scarce. Hence, this pilot study aimed to investigate the presence of A. phagocytophilum in ovine serum samples retrospectively. The use of sera is beneficial because the specimens are available in large numbers and usually stored over a long period of time. Ten sheep flocks located in five federal states of Germany (Baden-Württemberg, Bavaria, Lower Saxony, North Rhine-Westphalia, Schleswig-Holstein) were included in the investigations, due to the high intra-flock seroprevalence (>63%) of antibodies against the Anaplasma species. In total, 357 serum samples from seropositive sheep were analysed by 16S rRNA real-time PCR. DNA of A. phagocytophilum was detected in two ewes from the same farm in the northern German federal state of Schleswig-Holstein and represented an overall detection rate of 0.6%. Serum samples can be used to determine A. phagocytophilum, but sensitivity might be reduced in comparison to whole blood samples. Moreover, the sampling time may influence the detection of A. phagocytophilum in sheep, due to the seasonal pattern of tick activity in Germany. Our results support the findings of previous studies and demonstrate that A. phagocytophilum is also present in sheep from northern Germany (Schleswig-Holstein).