German Federal States Research Articles

Building agricultural innovation capacity from the bottom up: Using spillover effects from projects to strengthen agricultural innovation systems

CONTEXTCurrent research emphasises that agricultural innovation projects are influenced in multiple ways by the Agricultural Innovation Systems (AIS) in which they operate. Yet little attention has been paid to the reverse direction of this relationship, i.e. how agricultural innovation projects affect AIS in the course of their innovative activities. Accordingly, there are currently no tools to measure such AIS spillovers from agricultural innovation projects. OBJECTIVEThis paper shows that even where agricultural innovation projects have not been designed with the explicit aim of influencing AIS they can have spillovers on the AIS in which they operate. Based on this finding, it argues that designing agricultural innovation projects in a way that maximises such positive and reduces negative AIS spillovers would be a useful tool for strengthening agricultural innovation capacities in a particular territory or sector. METHODSBased on the concept of agricultural innovation projects as Organisational Innovation Systems (OIS) that are embedded in AIS, the paper develops an analytical framework for assessing spillovers of such projects on AIS and applies it to a case study of an Operational Group in the German Federal State of Hessen. RESULTS AND CONCLUSIONSThe case study shows that agricultural innovation projects may yield diverse spillovers on the AIS in which they operate. In addition to considering how agricultural innovation projects are shaped – constrained and/or enabled – by AIS, the research community on agricultural innovation should pay more attention to this side of the interrelation of AIS and agricultural innovation projects. Designing agricultural innovation projects responsibly so that spillovers on AIS are monitored can help to improve national or sectoral AIS. SIGNIFICANCEThis paper points to an underexplored issue in research on agricultural innovation and, related to this, a thus far unused potential policy tool for improving national and sectoral AIS. It further develops the concept of innovation projects as OIS into an approach for assessing the effects of projects on AIS; an area of project assessment that until now has not been adequately covered.

Die hausärztliche Versorgung während der COVID-19-Pandemie: eine Fragebogenerhebung unter Hausärzt*innen und Medizinischen Fachangestellten zu ihrer Perspektive auf Veränderungen, Bedarfe und Belastungen

IntroductionThe coronavirus pandemic did not only result in changes in the provision and utilization of health care services in general practice but also in an increased workload for physicians and medical practice assistants. The VeCo practice study retrospectively explores the experiences of both professional groups two years after the start of the pandemic. MethodsIn March and April 2022, general practitioners and medical practice assistants in the three German federal states of Berlin, Brandenburg and Thuringia were asked to complete a paper-based questionnaire. Results657 general practitioners and 762 medical practice assistants completed the questionnaire. Both professional groups agreed to statements indicating a reduction in regular health care provisions. Nevertheless, 74% of the physicians and 82.9% of the medical practice assistants considered the health care provided to their patients during the pandemic as good. This was only possible through considerable additional effort and stress. While more than half of both groups reported that work was still enjoyable, three quarters of both groups stated that the challenges arising from the pandemic outstripped their capacity. Both groups would like to receive more recognition from society (medical practice assistants 93.2%, general practitioners 85.3%) and from their patients (87.7% and 69.9%, respectively). DiscussionGeneral practitioners and medical practice assistants reduced regular health care provision but were still able to maintain a good quality of care for their patients during the pandemic. It became clear that more appreciation and adequate financial compensation are necessary to ensure long-term sustainability of GP care. ConclusionThe subjective view of general practitioners and medical practice assistants on their health care provision shows that appreciation and adequate financial renumeration, particularly when working under most difficult conditions, are necessary to increase the attractiveness of a career in general practice, for both physicians and medical practice assistants.

Aufbau eines fondsbasierten „Generationenkapitals“ – staats- und unionsrechtliche Zulässigkeit der Rentenfinanzierung über einen Aktienfonds

Abstract The establishment of a sovereign wealth fund to build up “generational capital” is associated with legal imponderables. In principle, the German federal state can set up a foundation under public law to operate the fund with resources allocated to it as loans from the federal budget. However, if the federal state itself takes out loans to finance the foundation, this would be problematic from a constitutional point of view. As far as the protection of fair competition is concerned, it is unlikely that the fund will be systemically relevant and thus benefit from an implicit state guarantee. However, care must be taken to ensure that the fund receives its resources from the federal budget on market terms and that the resources supplied to the fund are also used on market terms. Otherwise, serious problems would arise under EU state aid law. The fact that the fund acts in the interests of the pension insurance scheme would not allow for an exception or justification.

The Epidemiology of Colorectal Cancer in Younger and Older Patients.

Recent studies have shown that the incidence of colorectal cancer among younger persons is rising. We investigated incidence trends and survival in the German federal state of North Rhine-Westphalia. Cancer registry data from the period 2008-2019 were classified into two age groups (15-54 and 55-99). In each age group, the standardized incidence, average annual percent change (AAPC), and relative 5-year survival (RS) were calculated and stratified according to the site, histology, size, and grade of the colorectal tumor. 167 919 cases were included, with adenocarcinoma accounting for 86.4%. In 2019, the age-standardized incidence per 100 000 person-years was 13.8 and 10.3 among men and women (respectively) in the younger age group, compared with 197.9 and 126.3 in the older age group. Over the study period from 2008 to 2019, the incidence declined among older men and women (AAPC -2.6% and -2.9%) but remained nearly constant among younger men and women (- 0.5% and -0.4%). The incidence of neuroendocrine, T1, and G2 tumors rose in both age groups (AAPC range: 2.3%-12.2%; 2.2%-8.3%, 6.3%-8.8%). Younger patients have a better RS, with the largest difference between age groups being found for neuroendocrine tumors (88% and 83% in younger men and women, 65% and 61% in older men and women). The incidence of colorectal tumors has remained constant in persons under age 55 and declined in persons aged 55 and older. Nonetheless, the incidence of neuroendocrine tumors and of small and well-differentiated tumors has risen in both age groups. The trends among younger persons and the rise in neuroendocrine tumors merit further study.

Mortality and Hospitalizations Among Patients Enrolled in an Interprofessional Medication Management Program-Results of the Medicines Initiative Saxony- Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN).

Measures for improving medication safety in outpatient care are often complex and involve medication reviews. Over the period 2016-2022 (with a preceeding one-year pilot phase), an interprofessional medication management program-the Medicines Initiative Saxony-Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN)-was implemented in two German federal states. More than 5000 patients received a medication review by the end of 2019 by a team composed of physicians and pharmacists and were provides with joint, continuous care thereafter. In the framework of a retrospectively registered cohort study, the mortality and hospitalizations of this population (5033 patients) were studied using routine data from a statutory health insurer (observation period 2015-2019) and compared with those of a control group (10 039 patients) determined from the routine data by propensity score matching. Mortality was compared by survival analysis (Cox regression), and hospitalization rates were compared in terms of event probabilities within two years of enrollment in the medication management program. Robustness was tested in multiple sensitivity analyses. Over the observation period, 9.3% of the ARMIN participants and 12.9% of persons in the control group died (hazard ratio of the adjusted Cox regression, 0.84; 95% confidence interval [0.76; 0.94], P = 0.001). In the first two years after inclusion, the ARMIN participants were hospitalized just as often as the persons in the control group (52.4% versus 53.4%; odds ratio from the adjusted model, 1.04 [0.96; 1.11], P = 0.347). The effects were consistent in sensitivity analyses. In this retrospective cohort study, participation in the ARMIN program was associated with a lower risk of death. Exploratory analyses provide clues to the potential origin of this association.

Musculoskeletal complaints, postural patterns and psychosocial workplace predictors in police officers from an organizational unit of a German federal state police force - a study protocol

BackgroundPolice officers are exposed to a particularly high risk of musculoskeletal disorders (MSDs) and psychosocial stress due to their working conditions. Therefore, the aim of this project will be to assess the occupational physical and mental health of police officers from an organizational unit of the police force of a German federal state.MethodsThe aim is to analyze at least 200 active police officers of a state police force in Germany between the age of 18 and 65 years. In a mixed-methods design, a video raster stereography-based measurement of the upper body posture and a modified version of the Nordic Questionnaire (NQ) will be used for investigating their physical health, while the Copenhagen Psychosocial Questionnaire (COPSOQ) and the Operational Police Stress Questionnaire (PSQ-Op) will be used to analyze their mental health. In addition, job-specific psychosocial factors at the workplace will be assessed (using self-designed questions that were previously evaluated in an expert interview).DiscussionTo date, there is a lack of current questionnaire-based data on the prevalence of MSDs in police officers, or of MSDs associated with injuries or psychosocial workplace factors. Thus, in this study, these MSDs will be correlated with quantitative upper body posture data. If these results prove an increased physical and/or psychosocial stress, then the existing workplace health promotion measures should be analyzed and modified if necessary.

Back from Exile? First Records of Chewing Lice (Lutridia exilis; Ischnocera; Mallophaga) in Growing Eurasian Otter (Lutra lutra) Populations from Northern Germany.

Arthropod ectoparasites of aquatic wildlife often have complex relationships with their host species that have developed over long evolutionary time scales. Specialist parasite occurrence might depend on these hosts' distributions. Eurasian otter (Lutra lutra) populations are recovering in Northern German federal states, such as Schleswig-Holstein and Lower Saxony. Chewing lice (Lutridia exilis; Ischnocera; Mallophaga) are considered otter-specific yet rare parasites in their known range. In 2022, they were recorded for the first time on nine otters found dead in Northern Germany. All otters originated from the years 2021-2022 and were dissected during population health monitoring programs in 2022. Females (n = 6) were 0-5.5 years old and showed signs of disease in five cases. Males (n = 3), in contrast, were 0-1.6 years old and showed disease in a single case. Individual lice intensity of infection ranged from 1 to 75 specimens per otter. No direct adverse health effects of chewing lice on the otters were noted. Lutridia exilis morphological characteristics were documented and measurements were taken to study specialized adaptations that allow lice to attach to semi-aquatic otters. In addition, morphology was compared between lice from different geographical regions and specimens from previous reports. A region of the COI mDNA was amplified to molecularly characterize L. exilis for the first time and detect genetic differences between otter lice populations in Germany. It is believed that specialist parasites reduce in numbers even before their host populations decline. Recovering otter populations in Northern Germany could be an example of a reverse effect, where the comeback of a host species results in the return of a specialist parasite, which reflects an ultimate boost in overall species biodiversity.

Online enquiries and health concerns – a survey of German general practitioners regarding experiences and strategies in patient care

AimIncreasingly at GP practices, patients appear who are extremely worried as a result of health information researched online and consequently affected by doubts and concerns. The study highlights GP attitudes and experiences with regard to this patient group. Moreover, it identifies strategies adopted by GPs to respond appropriately to worried or scared patients.Subject and methodsIn the German federal states of Baden-Württemberg, Rhineland-Palatinate and Saarland, 2532 GPs were surveyed between June and August 2022. Owing to the explorative nature of the study, a descriptive analysis was conducted.ResultsOf the total respondents, 77% deemed the current problem of internet-related health concerns to be a major challenge in everyday practice. The implications affect patients’ mental stability and expectations towards the doctor (esp. demand for further instrumental diagnosis, 83%). One doctor in five (20%) has experienced the termination of patient contact because the relationship with the patient was no longer possible due to the patient’s uncontrolled online information behaviour. To respond to worried or scared patients, the respondents generally ask certain patient groups about online research (39%) and take this into account in the doctor–patient discussion (23%). Furthermore, the respondents use a detailed explanation of the diagnosis and/or treatment (65%) and recommend websites that they consider reputable (66%). Some of the doctors prefer a joint examination of the information researched by the patient (55%) as well as to explain the benefits and risks of online research (43%).ConclusionMany GPs demonstrate a high level of awareness and sensitivity with regard to extensive online research and potentially worried patients. It seems advisable to actively address the online search for information in the patient consultation to prevent possible negative effects on the doctor–patient relationship and to actively involve the patient. In this respect, it would also be worth considering expanding the medical history to include the dimension of online searching.

Potential Risk of Residues From Neonicotinoid-Treated Sugar Beet Flowering Weeds to Honey Bees (Apis mellifera L.).

In 2018 the European Union (EU) banned the three neonicotinoid insecticides imidacloprid, clothianidin (CLO), and thiamethoxam (TMX), but they can still be used if an EU Member State issues an emergency approval. Such an approval went into effect in 2021 for TMX-coated sugar beet seeds in Germany. Usually, this crop is harvested before flowering without exposing non-target organisms to the active ingredient or its metabolites. In addition to the approval, strict mitigation measures were imposed by the EU and the German federal states. One of the measures was to monitor the drilling of sugar beet and its impact on the environment. Hence we took residue samples from different bee and plant matrices and at different dates to fully map beet growth in the German states of Lower Saxony, Bavaria, and Baden-Württemberg. A total of four treated and three untreated plots were surveyed, resulting in 189 samples. Residue data were evaluated using the US Environmental Protection Agency BeeREX model to assess acute and chronic risk to honey bees from the samples, because oral toxicity data are widely available for both TMX and CLO. Within treated plots, we found no residues either in pools of nectar and honey crop samples (n = 24) or dead bee samples (n = 21). Although 13% of beebread and pollen samples and 88% of weed and sugar beet shoot samples were positive, the BeeREX model found no evidence of acute or chronic risk. We also detected neonicotinoid residues in the nesting material of the solitary bee Osmia bicornis, probably from contaminated soil of a treated plot. All control plots were free of residues. Currently, there are insufficient data on wild bee species to allow for an individual risk assessment. In terms of the future use of these highly potent insecticides, therefore, it must be ensured that all regulatory requirements are complied with to mitigate any unintentional exposure. Environ Toxicol Chem 2023;00:1-11. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Learning from Other Community Renewable Energy Projects: Transnational Transfer of Multi-Functional Energy Gardens from the Netherlands to Germany

Citizen energy in general and renewable energy communities (RECs) in particular are becoming key vehicles for decentralisation, but also for the democratisation of the energy system. These initiatives are now more diverse than ever and are likely to continue to act as incubators for significant projects in the transition to a renewable energy system. Beside the legal, regulatory, and financial challenges, there are several socio-economic and regulatory barriers that hinder the implementation of community energy projects. For this reason, policy learning and the dissemination of good/best practices that are transferable also to other contexts are important. This is an aspect that has not yet attracted much investigation, and only a few studies have explored the importance of transfer activities for the implementation of REC initiatives and their motives. This article aimed to address this knowledge gap by focussing on the transfer processes of best practices initiated in a particular region and discusses how these can be adapted and transferred to other contexts. We analysed the transfer case of a community renewable energy initiative, the multifunctional energy gardens, from the Netherlands to the German federal State of Thuringia, and extracted lessons with an overall validity for the transferability of drivers and success factors. We show how examples from other contexts with similar enabling conditions can represent significant foundations on which to build an effective strategy and what framework conditions are necessary to enhance the uptake of pervasive community energy initiatives in regions with low community energy development.

Cancer registries in Germany: what does the future hold for urology?

Cancer registries are defined as systematically collected information in the form of a database on tumour diseases. They can provide information about the quality of oncological care or progress in the treatment of individual cancers over time. Since 1995, all German federal states have been required by law to establish and maintain a cancer registry. The Center for Cancer Registry Data (ZfKD) at Robert Koch Institute has collected this nationwide data since 2009 and compiled it into an annually audited dataset available for research purposes. By virtue of the Cancer Early Detection and Registry Act (KFRG), which was passed in 2013, the cancer registries were given a new perspective. Since then, they have made a central contribution to the quality assurance of oncological care. The cancer registries are mainly financed by the health insurance funds. An upcoming expansion of the dataset including clinical variables and earlier provision by the ZfKD starting next year offers new opportunities for the scientific use of cancer registry data. In particular, the course of the disease will now be mapped in considerable detail. Apart from the cancer registries, there are not many useful supplemental datasets in Germany for the assessment of the nationwide healthcare situation and treatment reality on a national level. The DRG database (case-based hospital statistics) of the Federal Statistics Office records all billing data of all German hospitals with few exceptions. Another interesting supplement to the cancer registry data are the datasets of the structured quality reports, which have been mandatory for hospitals since 2003. In the future, the scientific role of cancer registries is to be further enhanced by the Act on the Pooling of Cancer Registry Data, which was passed in 2021.

COVIX—An Index Allowing for the Assessment of the Pandemic Situation Based on Infections and Hospitalisation Data

Monitoring and assessing the severity of the pandemic situation is one of the key challenges that public officials faced during the COVID-19 pandemic. Daily new infections may lead to flawed assessments, as infected individuals lead to different constraints imposed on the health care system amid varying pandemic determinants. On the other hand, hospitalisations or hospital bed occupancy may lead to outdated assessments, as the corresponding data are only observable with considerable delay. In this study, we introduce a hospital beds model, which relates the three quantities of daily new infections, daily hospitalisation rates, and daily hospital bed occupancy in the context of the COVID-19 pandemic. Using this model, we develop COVIX—a severity index that assesses the impact of a pandemic in comparison to a specified reference date while taking infection and disease risks into account. The developed methodology and its implications are illustrated on data for the German federal state of Bavaria.

5586004 INCREASE IN HEMOGLOBINOPATHIES CARRIAGE AMONG PREGNANT WOMEN IN GERMANY PREDICTED BY MIGRATION AND BIRTH DATA ANALYSIS

Background: Germany is one of the most densly populated countries in Europe, yet it has low allele frequencies for hemoglobinopathies in its population. According to estimates by Kohne et al. (2010), approx. 0.48%1 of Germany’s population are carriers for at least one hemoglobinopathy. Modell et al. (2007) estimated the proportion of carriers among pregnant women in Germany at 0.54%2. Given the sharp increase in migration between 2014 and 2016, predominantly from high prevalence countries for hemoglobinopathies (Figure 1), we expect a rise in carrier numbers among present German population. Although new-born screening for sickle cell disease has been introduces as standard of care in Germany in 2021, low awareness for hemoglobinopathies among general medical staff in general and the lack of existing routine screening in later life, e.g. during pregnancy, still pose a major challenge to monitor the development of these disorders and to ensure appropriate clinical care and consulting services.Aims: To estimate hemoglobinopathies carriage rates among pregnant women in Germany during the last decade. Methods: We extracted data on number and origin of foreign women at childbearing age (15 - 50 years) between 2010 and 2020 in Germany by federal state and year3 from the GENESIS database of the German federal statistical office. Using the published data by Modell and Darlison on carriage rates in pregnancies by country4, we calculated the proportion of women at childbearing age with risk for carrying a hemoglobinopathy per state and year. With the help of data on life births by mothers’ citizenship status (German or foreign)3, we calculated a fertility adjustment factor (= fertility rate of all foreign women/ total fertility rate in Germany, both per state and year) and estimated the yearly proportion of pregnancies at risk for carrying a hemoglobinopathy per state. Results: The estimated hemoglobinopathies carriage rates among pregnancies showed an increasing trend in all 16 German federal states in the last decade (Figure 2). The states Bremen, Hamburg, Berlin, and Hesse showed the highest carriage rates in 2020 with 3.84%, 2.78%, 2.66% and 2.64% respectively (HbS heterozygosity included). Notably, the states with lowest estimated carriage rates in 2020 (Thuringia, Saxony, Saxony-Anhalt and Brandenburg) showed the strongest increases compared to its initial rates in 2010 (Figures 2-4). On a national average, we calculated an increase of approximately 60% in pregnancies at risk for hemoglobinopathy carriage (Figure 5).Conclusion: Our analysis indicates a clear and strong increase in hemoglobinopathy carriage rates among pregnancies in all federal states in parallel to the increase in migration into Germany between 2014 and 2016. Further studies are required to verify these findings and to evaluate the necessity of new public health measures as prenatal screening and consulting services for hemoglobinopathies in Germany.

Vaccine-Induced or Hybrid Immunity and COVID-19-Associated Mortality During the Omicron Wave.

It is not yet entirely clear to what extent vaccine-induced or hybrid immunity protects individuals in Germany from death during the omicron wave of the COVID-19 pandemic. In this retrospective study, we evaluated 470 159 cases over age 59 in the German federal state of Bavaria who tested positive for SARS-CoV-2 between 1 January and 30 June 2022. Cox models were used to estimate adjusted hazard ratios (aHR) for dying within 60 days of the infection, depending on sex, age, time point of infection, and a range of immunity levels. Over the period of observation, 3836 COVID-19-associated deaths were registered (case fatality rate 0.82 %). Risk of death was significantly lower in cases with a higher immunity level than in unvaccinated cases (aHR for a full primary immunity level, if reached less than six months before the time of the infection: 0.30, 95 %-confidence interval [0.23; 0.39]; if reached more than six months before: aHR 0.46 [0.35; 0.60]). A boosted immunity level lowered risk of death even further (if reached less than three months before the infection: aHR 0.17 [0.15; 0.20]; if reached more than three months before: aHR 0.25 [0.21; 0.29]). Among elderly persons in Bavaria, a higher immunity level was associated with a substantial degree of protection against death during the Omicron wave; the strength of protection may have diminished somewhat over time.

Overcoming Language Barriers in Paramedic Care With an App Designed to Improve Communication With Foreign-Language Patients: Nonrandomized Controlled Pilot Study

Communication across language barriers is a particular challenge for health care providers. In emergency medical services, interpreters are mostly not available on rescue scenes, which jeopardizes safe and high-quality medical care. In a cocreative process together with paramedics and software designers, we developed a fixed-phrase translation app with 600 phrases and 18 supported languages that supports paramedics when providing care to foreign-language patients. This paper reports on the results of a pilot study to evaluate the app's effect on paramedic-patient communication. This study aims to gain insights into the efficacy and feasibility of a multilingual app that helps paramedics to communicate with patients who are not proficient in the local language. A 3-armed nonrandomized interventional pilot study was conducted in 4 rescue stations in the German Federal State of Lower Saxony: 3 rural areas and 1 in urban environment. The intervention group comprised rescue missions with patients with limited German language proficiency (LGP) with whom the app was used; control group 1 comprised LGP patients without app usage; and control group 2 consisted of rescue missions with German-speaking patients. For each rescue operation with LGP patients, paramedics filled out questionnaires about the communications with patients. From standardized Rescue Service Case Protocols, we extracted information on patient demographics (age and sex), clinical aspects (preliminary diagnosis and Glasgow Coma Scale), and rescue operation characteristics (time spent on emergency scene and additional dispatch of emergency physicians). The primary outcome was the paramedics' perceived quality of communication with LGP patients. The secondary outcome was the ability to obtain necessary information from patients and the ability to provide important information to patients. A linear regression model was applied to assess the impact of the app on perceived communication, controlling demographic factors, and severity of illness. A total of 22 LGP patients were recruited into the intervention group and 122 into control group 1. The control group 2 included 27,212 German-speaking patients. LGP patients were more than 2 decades younger than German-speaking patients. App usage among LGP patients was associated with higher perceived overall quality of communication (0.7 points on a 5-point Likert scale, P=.03). Applying a linear regression model controlling for age, sex, and Glasgow Coma Scale, the quality of communication was associated with an increase of 0.9 points (95% CI 0.2-1.6, P=.01). Compared to either German-speaking patients or LGP patients, paramedics spent 6-7 minutes longer on an emergency scene when the app was used (P=.24). The use of the app suggests a relevant improvement in communication with patients with limited proficiency in the locally spoken language in paramedic care. The small sample size and the lack of randomization reduce the generalizability of the findings. German Clinical Trials Register DRKS00016719; https://drks.de/search/de/trial/DRKS00016719.

Patient Experiences With Prescription Cannabinoids in Germany: Protocol for a Mixed Methods, Exploratory, and Anonymous Web-Based Survey.

Medical cannabinoids are controversial. Their use is comparatively rare, but it is rising. Since 2017, cannabinoids can be prescribed in Germany for a broader range of indications. Patient surveys on these drugs are hampered by the stigmatization of cannabinoids and their (still) low prevalence in medical contexts. Against this background, patients' willingness to provide information is limited. Moreover, it is logistically challenging to reach them with a survey. A thorough knowledge of currently ongoing therapies and their effects and side effects, however, is important for a more appropriate and effective use of cannabinoids in the future. This study is an exploratory data collection using a representative sample. The main goal is to provide a detailed picture of the current use of medical cannabinoids in Germany. It is intended to identify subgroups that may benefit particularly well or poorly. We are conducting a representative, anonymous, cross-sectional, one-time, web-based survey based on mixed methods in 3 German federal states. Health conditions under cannabinoid therapy and before are documented with validated, symptom-specific questionnaires. This allows an estimation of the effect sizes of these therapies. The selection of parameters and questionnaires was based on the results of independent qualitative interviews in advance. Representative samples of the hard-to-reach study population are obtained by cluster sampling via contracted physicians of the statutory health insurance companies. Recruitment was ongoing until the end of June 2022, with 256 enrolled participants. Validated questionnaires on pain, spasticity, anorexia or wasting, multiple sclerosis, nausea or vomiting, depression, and attention deficit hyperactivity disorder (ADHD) were selected. Symptom scores are being assessed for both current conditions under cannabinoid therapy and conditions prior to this therapy (in retrospect). Validated questionnaires are also used for treatment satisfaction and general quality of life. These are supplemented by existing diagnoses, a detailed medication history, any previous experiences with cannabis or illegal substances, experiences with the prescription process, and sociodemographic data. Based on the results of the previous qualitative interviews, questions were added regarding prior experience with relaxation methods and psychotherapy, personal opinions about cannabinoids, pre-existing or symptom-related psychological trauma, and different experiences with different cannabis-based therapies. The exploratory mixed methods approach of this project is expected to provide valid and relevant data as a basis for future clinical research. The study design may be representative for a large proportion of outpatients treated with cannabinoids in the German federal states studied. It may have less bias toward social desirability and may provide valuable information in addition to existing studies. Due to the observational and cross-sectional nature of this study, various limitations apply. Causal relations cannot be drawn. German Clinical Trials Register DRKS00023344; https://drks.de/search/en/trial/DRKS00023344. DERR1-10.2196/38814.

Hate speech on social media against German mayors: Extent of the phenomenon, reactions, and implications

AbstractDrawing on an online survey of mayors from the German federal state of Baden‐Wuerttemberg this article analyses (1) to what extent social media is used abusively at the municipal level, (2) how mayors react to hate speech and (3) whether the experience of such insulting comments and threats is correlated with their perception of social media as a tool for political communication. The analysis shows that hateful comments are part of the social media experience on the local level. 53.9% of the mayors have at least once experienced personal insults and hostilities on social media in their role as politicians. The majority of them (56.7%) ignored the hate speech without reaction. Significantly fewer reacted more actively: 29.8% responded to the insulting message, 5.4% blocked the hater, and 8.2% filed a judicial complaint. The statistical analysis shows that mayors who use social media in a more professional way are more likely to react to hate speech in such an active manner. Moreover, the experience of hate speech and particularly an active type of reacting are found to be positively related to mayors' perceptions of how useful they consider social media to be for political communication.

Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it

Background Although mental health professionals’ mental health problems are gaining increased attention, there is little systematic research on this topic. Aims This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities. Methods An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated. Results Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues. Conclusion The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.

Exposure to anticholinergic and sedative medication is associated with impaired functioning in older people with vertigo, dizziness and balance disorders-Results from the longitudinal multicenter study MobilE-TRA.

Introduction: Anticholinergic and sedative medication is prescribed for various conditions in older patients. While the general association between anticholinergic and sedative medication and impaired functioning is well established, its specific role in older individuals with vertigo, dizziness, and balance disorders (VDB) is still incompletely understood. The objective of this study was to investigate, whether an exposure to anticholinergic and sedative medication is associated with lower generic and lower vertigo-specific functioning in older patients with VDB. Methods: Data originates from the longitudinal multicenter study MobilE-TRA with two follow-ups, conducted from 2017 to 2019 in two German federal states. Exposure to anticholinergic and sedative medication was quantified using the drug burden index (DBI). Generic functioning was assessed by the Health Assessment Questionnaire Disability Index, appraising the amount of difficulties in performing activities of daily living (ADL). Vertigo-specific functioning was measured using the Vestibular Activities and Participation (VAP) questionnaire, assessing patient-reported functioning regarding activities of daily living that are difficult to perform because of their propensity to provoke VDB (Scale 1) as well as immediate consequences of VDB on activities and participation related to mobility (Scale 2). Longitudinal linear mixed models were applied to assess the association of exposure to anticholinergic and sedative medication at baseline and the level of generic and vertigo-specific functioning status over time. Results: An overall of 19 (7 from Bavaria) primary care physicians (mean age = 54years, 29% female) recruited 158 (59% from Bavaria) patients with VDB (median age = 78years, 70% female). Anticholinergic and sedative medication at baseline was present in 56 (35%) patients. An exposure to anticholinergic and sedative medication at baseline was significantly associated with lower generic functioning [Beta = 0.40, 95%-CI (0.18; 0.61)] and lower vertigo-specific functioning [VAP Scale 1: Beta = 2.47, 95%-CI (0.92; 4.02)], and VAP Scale 2: Beta = 3.74, 95%-CI [2.23; 5.24]). Conclusion: Our results highlight the importance of a close monitoring of anticholinergic and sedative medication use in older patients with VDB. When feasible, anticholinergic and sedative medication should be replaced by equivalent alternative therapies in order to potentially reduce the burden of VDB.

Performance of the flood warning system in Germany in July 2021 – insights from affected residents

Abstract. In July 2021 intense rainfall caused devastating floods in western Europe and 184 fatalities in the German federal states of North Rhine-Westphalia (NW) and Rhineland-Palatinate (RP), calling into question their flood forecasting, warning and response system (FFWRS). Data from an online survey (n=1315) reveal that 35 % of the respondents from NW and 29 % from RP did not receive any warning. Of those who were warned, 85 % did not expect very severe flooding and 46 % reported a lack of situational knowledge on protective behaviour. Regression analysis reveals that this knowledge is influenced not only by gender and flood experience but also by the content and the source of the warning message. The results are complemented by analyses of media reports and official warnings that show shortcomings in providing adequate recommendations to people at risk. Still, the share of people who did not report any emergency response is low and comparable to other flood events. However, the perceived effectiveness of the protective behaviour was low and mainly compromised by high water levels and the perceived level of surprise about the flood magnitude. Good situational knowledge and a higher number of previously experienced floods were linked to performing more effective loss-reducing action. Dissemination of warnings, clearer communication of the expected flood magnitude and recommendations on adequate responses to a severe flood, particularly with regard to flash and pluvial floods, are seen as major entry points for improving the FFWRS in Germany.