German Federal State Of Saxony Research Articles

Entangled Crisis Narratives in Germany: Strengthening the Anti-Systemic Public?

This article studies how crisis management and its narrative discourse are able to strengthen anti-systemic and far-right narratives. We compare government and opposition discourses during the COVID-19 pandemic of 2020/2022 and the energy/inflation crisis of 2022/2023 in the German federal state of Saxony. The paper argues that the two crises were intertwined not only through the existence of a ‘new cleavage’ between political mainstream and right-wing populists, but also through the authorities’ public communication that contained similar ‘crisis management’ elements: a—fairly unprecedented—stress on urgency, lack of alternatives, and rejection of consultation, justified by how high the stakes were to public health and welfare, and to national security. Our study offers insights into the interconnectedness of crises narratives and underscores the importance of long-term crisis governance that needs to better acknowledge the risk of turning opposition to government policies and its discourses into far-right anti-systemic mobilizations.

The new reporting obligation for Respiratory Syncytial Virus (RSV) in Germany - a critical view.

In summer 2023, mandatory reporting of respiratory syncytial virus (RSV) by name was introduced in Germany. The stated objectives were: to improve the database to prevent overburdening of the healthcare system, to implement targeted, early investigation and action by local health authorities to prevent further spread, and to assess vaccines after the expected approval of RSV vaccination. These objectives are examined against the background of data from mandatory reporting of RSV in the German federal state of Saxony, which has been required since 2002, and the data from the ARE (acute respiratory diseases) survey in Germany, considering the basic legal requirements and options of the Infection Protection Act, the requirements of the EU Commission for the collection of data on infectious diseases and the recommendations by experts of the European Centre for Disease Prevention and Control (ECDC), the options for individual or general preventive measures by the health authorities and previous experience with the evaluation options of the reported data (especially regarding the effectiveness of vaccinations). An extrapolation of the previously reported data from Saxony to the whole of Germany shows that over 100,000 reports per year must be expected (more than the reports of both rota and noroviruses together). Neither the requirements of the EU Commission nor the views of an expert group of the ECDC recommend mandatory RSV reporting. Mandatory reporting by name is also not appropriate from a legal perspective. A sentinel, which is also better suited to assessing vaccinations, would be more appropriate to avoid unnecessarily overburdening the health authorities. In addition, initial experience with wastewater sentinels for RSV has shown that they may be used to record local and regional RSV infections - albeit without information on the severity of the disease and thus the burden on the healthcare system.Against this background, mandatory reporting of RSV does not appear to be appropriate. Instead, the existing sentinels should be continued and further expanded, possibly supplemented by RSV wastewater monitoring.

Regional responsibility and coordination of appropriate inpatient care capacities for patients with COVID-19 - the German DISPENSE model.

As of late 2019, the COVID-19 pandemic has been a challenge to health care systems worldwide. Rapidly rising local COVID-19 incidence rates, result in demand for high hospital and intensive care bed capacities on short notice. A detailed up-to-date regional surveillance of the dynamics of the pandemic, precise prediction of required inpatient capacities of care as well as a centralized coordination of the distribution of regional patient fluxes is needed to ensure optimal patient care. In March 2020, the German federal state of Saxony established three COVID-19 coordination centers located at each of its maximum care hospitals, namely the University Hospitals Dresden and Leipzig and the hospital Chemnitz. Each center has coordinated inpatient care facilities for the three regions East, Northwest and Southwest Saxony with 36, 18 and 29 hospital sites, respectively. Fed by daily data flows from local public health authorities capturing the dynamics of the pandemic as well as daily reports on regional inpatient care capacities, we established the information and prognosis tool DISPENSE. It provides a regional overview of the current pandemic situation combined with daily prognoses for up to seven days as well as outlooks for up to 14 days of bed requirements. The prognosis precision varies from 21% and 38% to 12% and 15% relative errors in normal ward and ICU bed demand, respectively, depending on the considered time period. The deployment of DISPENSE has had a major positive impact to stay alert for the second wave of the COVID-19 pandemic and to allocate resources as needed. The application of a mathematical model to forecast required bed capacities enabled concerted actions for patient allocation and strategic planning. The ad-hoc implementation of these tools substantiates the need of a detailed data basis that enables appropriate responses, both on regional scales in terms of clinic resource planning and on larger scales concerning political reactions to pandemic situations.

Evaluation of Attractant Composition, Application Rate, and Trap Type for Potential Mass Trapping of Ips typographus (L.)

This study focused on elucidating the possibilities of improving current trapping methods for Ips typographus (Linnaeus, 1758). Three field experiments were conducted simultaneously in one study area in the German federal state of Saxony. A comparison of six different commercial attractants revealed a significant superiority of Typosan®, especially for adult beetles after hibernation in the phase of their first swarming. It also attracted fewer individuals of Thanasimus spp. than the other highly attractive products Pheroprax® and IT Ecolure Extra®. Increasing the Pheroprax® application rate by using four instead of one dispenser in a single trap increased the total catch of I. typographus only by 15.5%. In contrast, Thanasimus spp. catch increased by 195.5% when four dispensers were used. A test of different trap types showed a species-specific catching capability, with the 12-funnel WitaTrap® being the most effective in catching I. typographus. The quantity of Thanasimus spp. bycatch in multiple-funnel traps demonstrated the necessity of a selective mechanism to minimize impacts on predator populations. Although we were not able to identify new milestones towards mass trapping, this study contributes to necessary improvements of current trapping methods. Especially in future stands with a smaller share of Norway spruce (Picea abies Karsten, 1881) the weakened beetle population in spring could be effectively reduced by properly conducted mass trapping.

Combining management plans and payment schemes for targeted grassland conservation within the Habitats Directive in Saxony, Eastern Germany

As central policies for biodiversity conservation in agricultural landscapes in the European Union (EU), the Habitats Directive and Agri-environmental programmes (AEP) have largely failed to halt biodiversity loss. In response, the German federal state of Saxony combined the instrument of management plans with AEPs to support the implementation of the Habitat Directive. In this study, we investigate the determinants of a farmers’ decisions to adjust their farming practices. Our data set consists of a quantitative survey with 131 farmers conducted between 2004 and 2011, complemented by implementation data from 333 grassland-plots. Determinants of farmers’ decisions to conserve grassland were estimated using a multinomial logit model. Our results show that a combination of management plans and AEPs can increase farmers’ disposition to adopt nature conservation measures. As central determinants, structural and location factors as well as the complementary provisiion of specifically designed AEPs increase farmers’ willingness to adopt conservation practices for grassland management. It can be concluded that additional costs are a major barrier to farmers’ adoption, particularly to those farms directing their farm management towards the optimisation of productivity and profitability . The findings highlight the complementary potential of integrated policy packages to incentivise specific measures of nature conservation within the framework of the Habitats Directive.

Associations of myeloid hematological diseases of the elderly with osteoporosis: A longitudinal analysis of routine health care data

BackgroundMyelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) are hematological stem cell diseases mainly of the elderly. Studies indicate a close relationship between bone metabolism and hematopoietic stem cells within the osteo-hematopoietic niche. However, it remains unclear how the disturbed interaction within the osteo-hematopoietic niche affects bone homeostasis in MDS and AML patients. MethodsWe utilized data of a large German statutory health insurance of approximately 2 million persons living in the German federal state of Saxony. Applying case definitions based on diagnosis, procedures and prescriptions we identified prevalent and incident cases with MDS, AML and osteoporosis (OSP) in persons aged ≥60 years. We applied time-to-event analyses to determine the relationship of MDS and AML with OSP with a specific focus on temporality. ResultsAmong all individuals aged ≥60 years (n = 891,095), 2.62% (n = 23,326), 0.14% (n = 1219) and 0.10% (n = 893) were identified with incident OSP, MDS and AML, respectively. The risk of incident OSP was significantly increased in patients with prevalent MDS (sex and age-adjusted model: HR = 1.87, 95%CI: 1.51–2.23). Conversely, patients with prevalent OSP had an increased risk to be diagnosed with incident MDS in the adjusted model (HR = 1.42, 1.19–1.65). For AML no significant associations were observed (adjusted models: inc. OSP with pre. AML; HR = 1.06, 0.65–1.47; inc. AML with pre. OSP; HR = 0.82, 0.41–1.23). DiscussionOur results could indicate a clinically relevant relationship between MDS and OSP in elderly patients, most likely resulting from a disturbed microenvironment within the osteo-hematopoietic niche. An alternative, non-causal explanation that MDS is caused by the medication prescribed for OSP can be partially ruled out, as the association between the two diseases remains if incident OSP cases are considered in patients with pre-existing MDS. These results need to be confirmed within other prospective studies and may allow then for comprehensive strategies for the prevention, early detection and clinical care of patients with MDS and OSP.

The challenge of diversity in rural regions: refugee reception in the German federal state of Saxony

Recent inflows of asylum seekers and their internal redistribution have confronted many European countries with questions of how to integrate the newcomers without neglecting needs, fears and perceptions of the resident population. This is especially true for rural regions in East Germany, which has experienced huge internal outmigration since the political and economic transformation period following 1989-1990, but which never has been were a destination for international migrants. Based on theoretical approaches from sociology and social psychology, the paper analyses local reception conditions, attitudes and perceptions of local populations and decision makers in rural regions of the East German federal state of Saxony, following the research question of how individual and group related attitudes develop and how those are reflected and responded to by public decision makers. Findings suggest that the migration history and the political and economic development are important context factors for the understanding of local reception conditions. Lacking experiences with diversity, combined with the involuntariness of refugee allocation, provides for a hostile environment and xenophobic behaviour. On the other hand, the opportunity to experience first-hand contacts to migrants in the neighbourhood can support the acculturation process and subsequently change public attitudes towards migrants and refugees. The perception of relative deprivation, which is found specifically in vulnerable groups in the context of transformation situations, can result in destructive attitudes and can jeopardize democratic processes and puts public representatives under pressure. The paper concludes that the challenge to integrate refugees could bring forward general debates about social cohesion and might furthermore fuel processes of institutional adaptation and social innovation. In order to maintain social peace, it recommends the empowerment of local actors in rural regions to take over a leading role in local discourses, actively support civic engagement and fight the effects of destructive discourses.

Two consecutive large outbreaks of Salmonella Muenchen linked to pig farming in Germany, 2013 to 2014: Is something missing in our regulatory framework?

In 2013, raw pork was the suspected vehicle of a large outbreak (n = 203 cases) of Salmonella Muenchen in the German federal state of Saxony. In 2014, we investigated an outbreak (n = 247 cases) caused by the same serovar affecting Saxony and three further federal states in the eastern part of Germany. Evidence from epidemiological, microbiological and trace-back investigations strongly implicated different raw pork products as outbreak vehicles. Trace-back analysis of S. Muenchen-contaminated raw pork sausages narrowed the possible source down to 54 pig farms, and S. Muenchen was detected in three of them, which traded animals with each other. One of these farms had already been the suspected source of the 2013 outbreak. S. Muenchen isolates from stool of patients in 2013 and 2014 as well as from food and environmental surface swabs of the three pig farms shared indistinguishable pulsed-field gel electrophoresis patterns. Our results indicate a common source of both outbreaks in the primary production of pigs. Current European regulations do not make provisions for Salmonella control measures on pig farms that have been involved in human disease outbreaks. In order to prevent future outbreaks, legislators should consider tightening regulations for Salmonella control in causative primary production settings.

Trade-offs between plant species richness and carbon storage in the context of afforestation – Examples from afforestation scenarios in the Mulde Basin, Germany

The German Federal State of Saxony aims to increase forest cover, supported by the implementation of afforestation programs. To analyze consequences of an increase in forest cover, this study investigates possible trade-offs between carbon storage and plant biodiversity caused by afforestation. Six afforestation scenarios with total forest cover ranging from 27.7% to 46% were generated in the Mulde river basin in Saxony with regard to different forest types. Carbon storage was calculated by the process-based Dynamic Vegetation Model LPJ-GUESS while random forest models were used to predict changes in plant species richness. We used eight different plant groups as responses: total number of plant species, endangered species, as well as species grouped by native status (three groups) and pollination traits (three groups). Afforestation led to an increase in carbon storage that was slightly stronger in coniferous forests as compared to deciduous forests. The relationship between plant species richness and afforestation was context dependent. Species richness showed a non-linear relationship with forest cover share. The relationship was influenced by shares of land use types, climatic conditions and land use configuration expressed by the number of land use patches. The effect of forest type on plant species richness was marginal. On average the relationship between carbon storage and plant species richness was synergistic for most plant groups. However, the relationship between change in species richness and change in carbon storage varied across space. This changing relationship was used to identify priority areas for afforestation. The different plant groups responded differently to an increase in forest cover. The change in species richness for Red List species was relatively distinct from the other species groups. Neophytes and archeophytes (i.e. alien plant species introduced after and before the discovery of the Americas) showed a similar response to the afforestation scenarios. While afforestation had overall positive effects both on plant species richness and carbon storage, a number of locations were identified for which afforestation would lead to a decrease in plant species richness. Spatial planning should therefore avoid afforestation at these locations.

Reasons for elderly patients GP visits: results of a cross-sectional study.

ObjectiveThe aim of this study is to describe the frequency of reasons for elderly patients visits to a general practice (GP) setting.Subjects and methodsCross-sectional data from 8,877 randomly selected patients were assessed during a 1-year period by 209 GPs in the German federal state of Saxony. The reasons for visits, performed procedures, and results of visits were documented. In this study, the data of patients aged 65 years and older are analyzed and the procedural and nonprocedural reasons for visits are described.ResultsIn all, 2,866 patients aged 65 years and older were included. The majority of patients (1,807) were female. A total of 4,426 reasons for visits were found, distributed on 363 International Classification of Primary Care-2 codes. In the mean, there were 1.5 reasons for a GP visit from each patient. The top five nonprocedural reasons for visiting the GP were: cough (1.8%), back complaints (1.6%), shoulder complaints (1.3%), knee complaints (1.1%), and dyspnea (1.0% of all reasons for visit). The top five procedural reasons for visiting the GP included follow-up investigations of cardiovascular or endocrine disorders and immunizations. The top 30 nonprocedural reasons for visits covered 21.9% of all reasons for visiting. The top 30 procedural reasons covered 54.3% of all reasons for visits.ConclusionThe current work indicates that people aged 65 years and older consult the GP more frequently for procedural than for nonprocedural reasons. The top 30 procedural and nonprocedural reasons for visits cover ~75% of all reasons for visits in these patients.

A systematic approach for assessing spatially and temporally differentiated opportunity costs of biodiversity conservation measures in grasslands

Biodiversity loss in Europe is caused to a large extent by agricultural intensification. To halt this loss, agri-environment schemes have been introduced to compensate farmers for (costly) biodiversity conservation measures. Current agri-environment schemes often consider only a few conservation measures which is insufficient to conserve all endangered biodiversity in an agricultural region. This problem is particularly pertinent in grasslands where many different mowing and grazing dates are required to protect the variety of species breeding in the grassland at different times. A key requirement to design agri-environment schemes for grassland conservation is therefore to offer specific compensation for more measures based on a systematic approach that calculates farmers' opportunity costs in relation to the timing of grassland use which is still lacking. This will at best attract more farmers and offer compensation calculated in line with EU requirements for co-financed measures through the Rural Development Programme. We fill this gap by developing a systematic approach to assess the costs of different mowing and grazing dates. Our approach is general enough to be applicable on a large spatial scale but can still sensitively differentiate among different timings. Moreover it is straightforward and time-saving enough to be suitable for implementation in regional scale optimisation procedures. We demonstrate this by applying the systematic cost assessment in the decision support software DSS-Ecopay using the example of grassland biodiversity conservation measures in the German federal state of Saxony.

Burden of soft-tissue and bone sarcoma in routine care: Estimation of incidence, prevalence and survival for health services research

BackgroundSarcomas constitute a rare group of malignant tumors which can originate from any organ, tissue, bone or cartilage. Due to their heterogeneity, estimates of sarcoma incidence, prevalence and survival are rare. We estimated the burden of sarcoma in Germany from a large unselected cohort of patients from routine healthcare. MethodsWe utilized the AOK PLUS health services research database covering complete medical information on 2,615,865 individuals from the German federal state of Saxony from 2005 to 2012. Persons were defined as sarcoma cases if they had ≥4 medical accounts with respective ICD-10 code C49 (soft-tissue sarcoma) or C40/C41 (bone sarcoma). We assessed sarcoma burden by calculating five-year prevalences, cumulative incidences, and one- and five-year relative survival rates. ResultsOverall 1,468 persons with soft-tissue sarcoma and 671 persons with bone sarcoma were identified. Age-standardized cumulative incidence was 4.5/100,000 persons for soft-tissue and 2.1/100,000 persons for bone sarcoma (European Standard). One- and five-year relative survival was 87.8% and 66.4% for soft-tissue and 91.8% and 52.9% for bone sarcoma, respectively. ConclusionThis is the first estimation of the burden of sarcoma based on an unselected sample of routine care data and the first estimation of the burden of sarcoma in Germany. We believe that the proposed methods offer a valuable approach for further outcomes research on cancer.

A novel modeling approach to evaluate the ecological effects of timing and location of grassland conservation measures

Several billion euros are spent in Europe every year on agri-environment schemes to compensate farmers for (costly) conservation measures such as specific mowing and grazing regimes. These measures can impact grassland species during their reproductive period. Therefore, it is particularly important when (and not only where) they are applied. However, in contrast to the spatial allocation of measures, their temporal allocation has rarely been taken into consideration. Existing modeling approaches suffer from two major limitations: They consume too much computing time for optimization procedures at the landscape scale, and they are too specific to be applicable to a wide variety of species and measures. We overcome these limitations by developing a spatially and temporally explicit general modeling approach that can quantify a species-specific habitat quality as a function of timing and location of grassland measures in a straightforward and general way. We apply our approach to the example of grassland conservation in the German Federal State of Saxony, demonstrate its usefulness, and identify the effects of the timing and location of grassland measures. We find that considerable heterogeneity in the timing of measures is necessary for multi-species conservation. This type of quantitative analysis can assist decision makers in improving agri-environment schemes.

Separating the effects of changes in land cover and climate: a hydro-meteorological analysis of the past 60 yr in Saxony, Germany

Abstract. Understanding and quantifying the impact of changes in climate and land use/land cover on water availability is a prerequisite to adapt water management; yet, it can be difficult to separate the effects of these different impacts. In this paper we illustrate a separation and attribution method based on a Budyko framework. We assume that evapotranspiration (ET) is limited by the climatic forcing of precipitation (P) and evaporative demand (E0), but modified by land-surface properties. Impacts of changes in climate (i.e., E0/P) or land-surface changes on ET alter the two dimensionless measures describing relative water (ET/P) and energy partitioning (ET/E0), which allows us to separate and quantify these impacts. We use the separation method to quantify the role of environmental factors on ET using 68 small to medium range river basins covering the greatest part of the German Federal State of Saxony within the period of 1950–2009. The region can be considered as a typical central European landscape with considerable anthropogenic impacts. In the long term, most basins are found to follow the Budyko curve which we interpret as a result of the strong interactions of climate, soils and vegetation. However, two groups of basins deviate. Agriculturally dominated basins at lower altitudes exceed the Budyko curve while a set of high altitude, forested basins fall well below. When visualizing the decadal dynamics on the relative partitioning of water and energy the impacts of climatic and land-surface changes become apparent. After 1960 higher forested basins experienced large land-surface changes which show that the air pollution driven tree damages have led to a decline of annual ET on the order of 38%. In contrast, lower, agricultural dominated areas show no significant changes during that time. However, since the 1990s effective mitigation measures on industrial pollution have been established and the apparent brightening and regrowth has resulted in a significant increase of ET across most basins. In conclusion, data on both, the water and the energy balance is necessary to understand how long-term climate and land cover control evapotranspiration and thus water availability. Further, the detected land-surface change impacts are consistent in space and time with independent forest damage data and thus confirm the validity of the separation approach.

Primary care research - trade-off between representativeness and response rate of GP teachers for undergraduates

Low response rates are common in primary care research. Our study examines the representativeness of respondents in a survey among general practitioners (GPs). One special aim was to evaluate the representativeness of the subgroup of GP teachers for undergraduates (GPTUs) and to investigate the option of a panel of GPTUs. The representativeness of the respondents was assessed by the use of pooled public data to compare the respondents and all GPs in the German federal state of Saxony on the basis of socio-demographic and subject-specific characteristics. The representativeness of the GPTUs was examined in the same way. For the analysis, two-sided t-tests and Chi2 tests were used. The total response rate was low (32.87%). The respondents were not a representative sample; in particular, they were more highly qualified than the mean. However, the response rate among the special group of university-associated GP teachers for undergraduates was significantly higher than among other general practitioners. Because of this, the creation of a panel of these GPTUs for further primary care research was investigated. Unfortunately, analysis of this group showed that GPTUs were not a representative sample as they tended to be younger and more highly qualified. In general it is possible to create a panel of GPTUs to obtain higher response rates, but investigation of the panel's representativeness is definitely required. If the panel is not representative another option is the creation of a stratified sample according to the target population.

‘HELP-S for Children' - results of a multicentre study about the situation of families with a mentally ill parent

Background/Objectives: 26.5% of psychiatric patients in Germany have minor children. More than half of these children have specific needs, which are seldom met. The aim of this study is to examine problems, needs and used interventions for families with a mentally ill parent in the German federal state of Saxony. The study focuses on outpatients and includes mothers and fathers with any psychiatric disorder.

COMPONENTS OF UNCERTAINTY IN SPECIES DISTRIBUTION ANALYSIS: A CASE STUDY OF THE GREAT GREY SHRIKE

Sophisticated statistical analyses are common in ecological research, particularly in species distribution modeling. The effects of sometimes arbitrary decisions during the modeling procedure on the final outcome are difficult to assess, and to date are largely unexplored. We conducted an analysis quantifying the contribution of uncertainty in each step during the model-building sequence to variation in model validity and climate change projection uncertainty. Our study system was the distribution of the Great Grey Shrike in the German federal state of Saxony. For each of four steps (data quality, collinearity method, model type, and variable selection), we ran three different options in a factorial experiment, leading to 81 different model approaches. Each was subjected to a fivefold cross-validation, measuring area under curve (AUC) to assess model quality. Next, we used three climate change scenarios times three precipitation realizations to project future distributions from each model, yielding 729 projections. Again, we analyzed which step introduced most variability (the four model-building steps plus the two scenario steps) into predicted species prevalences by the year 2050. Predicted prevalences ranged from a factor of 0.2 to a factor of 10 of present prevalence, with the majority of predictions between 1.1 and 4.2 (inter-quartile range). We found that model type and data quality dominated this analysis. In particular, artificial neural networks yielded low cross-validation robustness and gave very conservative climate change predictions. Generalized linear and additive models were very similar in quality and predictions, and superior to neural networks. Variations in scenarios and realizations had very little effect, due to the small spatial extent of the study region and its relatively small range of climatic conditions. We conclude that, for climate projections, model type and data quality were the most influential factors. Since comparison of model types has received good coverage in the ecological literature, effects of data quality should now come under more scrutiny.

Quality of performance assessment of PV plants based on irradiation maps

For the estimation of the expected annual energy yield and the month-by-month check of a PV system’s performance, methods based on irradiation maps published by weather services, both general or dedicated to solar energy application, are in use. Examples for this type of information for Germany are the annual and monthly irradiation maps as published by the German Weather Service (DWD), the data bank of hourly irradiance data with continuous spatial coverage prepared by the University of Oldenburg, and the irradiation data products of the Climate Monitoring Satellite Application Facility (CMSAF) assembled by a consortium of European Weather Services. To assess the validity of these data sets for the aforementioned tasks, a case study is performed for the region of the German federal state of Saxony using data for the year 2005. For this region a set of ground-measured irradiance data from meteorological stations operated by the German Weather Service (DWD) is available. The comparison of hourly irradiance information is done by the monthly analysis of the bias and the RMS-error for the Oldenburg data bank of hourly values versus the ground station data. For an additional inter-comparison of the different data sources, the annual maps presenting the estimated irradiation sums for 2005 are analyzed. This gives information on data accuracy with respect to the spatial structure of the irradiation field. The assessment of the end use accuracy of the irradiation data is made by investigating a set of monthly energy yield data of grid-connected PV systems. This is done via the estimation of the energy yield using a PV system simulation applying the irradiation data generated at the University of Oldenburg.

Flood precaution of companies and their ability to cope with the flood in August 2002 in Saxony, Germany

The German federal state of Saxony was the most affected region during the severe flood in August 2002, and damage to companies was high. A survey of 415 companies representing a variety of sectors and sizes was undertaken to identify deficits in the flood management of companies. In August 2002, preparedness and precaution of companies was low. Additionally, 45% of the companies had not received any flood warning. Consequently, many companies were unable to perform emergency measures successfully. The mean total damage to companies amounted to 1.1 million euros. However, because of relatively good flood compensation, recovery advanced quickly. After the flood, preparedness and precaution increased, but there is still significant potential for more precautionary measures. The flood warning system should be further improved. Specific incentive and communication programs should be developed for the service and financial sectors, where preparedness and precaution is weakest, as well as for the manufacturing sector, which has the highest damage potential.

Praxis der intravesikalen Instillationsprophylaxe beim oberflächlichen Harnblasenkarzinom - Ergebnisse einer Umfrage in Sachsen

For patients with superficial bladder cancer, adjuvant intravesical chemotherapy or immunotherapy with Bacillus Calmette-Guerin (BCG) is recommended in national and international guidelines. We analyzed whether the recommended therapeutic regimens are used in daily urological practice. Questionnaires concerning the adjuvant intravesical therapy were sent to 152 urologists in the German Federal State of Saxony. Of the surveyed physicians, 134 practiced in an outpatient medical facility and 18 in a hospital. Of the questionnaires, 73 (48.02 %) were returned and evaluated. An adjuvant intravesical therapy after transurethral bladder tumor resection was performed in every second patient (median value 50.07 %). The majority of the urologists (79.4 %) treated the bladder tumors with intravesical chemotherapy or BCG depending on tumor stage and grade of malignancy. Chemotherapeutic agents or BCG was exclusively used in 13.6 % and 4.1 % of treated patients, respectively. Chemotherapeutic agents were predominantly applied up to the primary tumor stage T1 and malignancy grade G2. In cases with recurrent T1 bladder tumors of G2 or higher grade of malignancy, BCG was the main agent for intravesical treatment. In patients with recurrent T1G3 tumors, the majority of urologist (57.1 %) preferred another therapeutic regimen than intravesical instillation. Only 23.2 % of the urologists believed that intravesical BCG is superior to chemotherapeutic agents. These data demonstrate that adjuvant intravesical instillation with chemotherapeutic agents and BCG is well established in urological practice. In contrast to the recommendations of national and international guidelines, chemotherapeutic agents are more frequently used in cases with a high risk of progression.