Level In Germany Research Articles

Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany.

BackgroundThe objective of this study was to analyse the association between area deprivation at municipality level and the prevalence of type 2 diabetes (T2D) and obesity across Germany, controlling for individual socioeconomic status (SES).MethodsThe analyses are based on a large survey conducted in 2006. Information was included from 39,908 adults aged 20 years or above. Area deprivation was assessed using the German Index of Multiple Deprivation (GIMD) at municipality level. About 4,700 municipalities could be included and assigned to a deprivation quintile. Individual SES was assessed by income and educational level. Multilevel logistic models were used to control for individual SES and other potential confounders such as age, sex and physical activity.ResultsWe found a positive association of area deprivation with T2D and obesity. Controlling for all individual-level variables, the odds ratios for municipalities in the most deprived quintile were significantly increased for T2D (OR 1.35; 95% CI 1.12–1.64) as well as for obesity (OR 1.14; 95% CI 1.02–1.26). Further analyses showed that these associations were relatively similar for both men and women.ConclusionsBased on a nationwide dataset, we were able to show that area deprivation at municipality level is significantly associated with the prevalence of T2D and obesity. It will be important to focus preventive efforts on very deprived municipalities.

Teaching without faculty: policy interactions and their effects on the network of teaching in German higher education

The impact of higher education reforms on teaching at faculty level in Germany has seldom been explored. Research on teaching at university so far centres on how to teach. Yet, before any (best) practice can take place, teaching requires a specific site where a specific teacher meets a specific number of students. To bring about teaching, teaching loads have to be matched with student numbers, which to a large degree depends on how existing policies interact. Drawing on actor-network theory, we show that due to a peculiar entanglement of the products of present as well as past policies – staff planning charts, curricular norm values, student numbers, block grants, etc. – in several cases administration defines teaching loads higher than the actual teaching staff at faculty level can provide. In order to close this gap, faculties have to accommodate a teaching load that is true to administrative calculations but fictional in reality. Paradoxically, the only way to do so within the given policy entanglement is to use academics for teaching on the premise that they explicitly do not count as teachers: they have to remain disconnected from the teaching faculty.

Trends in Critical Infrastructure Protection in Germany

Abstract Critical Infrastructures failures cause harmful consequences to the population, because they disrupt the supply of necessary goods and services. The failures pose an indirect threat, as they will regularly be triggered by natural hazards, technical failure/human error or intentional acts. In the risk analyses on the national level in Germany, Critical Infrastructure failures are qualitatively described to estimate their impacts on society. Critical Infrastructure Protection is seen as a joint task of many different stakeholders. Rules and regulations with different degrees of compulsion build the framework for their cooperation, and a strategy is in place that promotes the trustful exchange of information among all the relevant stakeholders. The most important stakeholder groups are public authorities, infrastructure operators, and the population. An example is given on how a joint risk management of public authorities and infrastructure operators may be performed, and the cooperation of public authorities and the population is discussed. As Civil Protection covers the entire risk and crisis management cycle with its phases prevention, preparedness, response and recovery, the article ends with examples of the support, which the German Federal Office of Civil Protection and Disaster Assistance and the Federal Ministry of the Interior offer for other stakeholders in order to achieve well-protected infrastructures and, in consequence, well-protected citizens.

Shedding light on the appropriateness of the (high) gasoline tax level in Germany

Germany imposes an energy tax of 0.65€/l on gasoline which is one of the highest tax rates across countries. The effective tax is even higher when accounting for the consumption tax levied on top of the energy tax. Answers to the question whether such a high tax level is justified on efficiency grounds would add precious arguments to policy discussion debating the appropriate level of a car driver׳s tax burden. This paper sheds light on that issue by calculating the optimal gasoline tax in Germany using an optimal tax approach that accounts for gasoline/diesel car substitution and interactions of the gasoline tax with the broader fiscal system. According to the baseline calculation the optimal gasoline tax is 0.96€/l, thus, exceeding the (already high) current tax level by 48%. The corrective tax component exclusively reflecting the externalities associated with car driving contributes 0.64€/l to that optimal level while the positive net effect of the interaction of the gasoline tax with the other distortive taxes in the economy adds another 0.32€/l. Sensitivity analyses reveal that the optimal tax is very unlikely to fall below its current level. Even quite the contrary, the optimal tax rises dramatically (to approximately two times the current rate) when account is taken of the medium/long term EU fuel economy regulation legislation aiming at tightening CO2 emission standards of passenger vehicles. All in all, the present analyses suggest that there is no reasoning on efficiency grounds for adjusting the current gasoline tax downwards given the present practice of mainly levying fuel taxes rather than charging individual car drivers on a distance related basis.

The continuation of early austerity measures: the special case of Germany

The article deals with the consequences of austerity measures at municipal level in Germany. The first part describes the institutional framework, looking at the development and structure of employment, legal peculiarities, financial conditions and their more recent developments. The second part analyses employment relations, including employers’ organizations and unions, the collective bargaining structure and recent changes to it as well as measures of privatization. Finally, some preliminary conclusions are listed. From a comparative perspective, Germany constitutes a special case, with austerity measures having been initiated and causing lasting job losses long before the financial and debt crisis.

“Sustainability State” in the Making? Institutionalization of Sustainability in German Federal Policy Making

More than two decades after the Rio-conference on environment and development in 1992, sustainable development remains a big challenge. Politics and administration, especially in democratic societies, have a specific responsibility in coordinating sustainable development. In order to fulfill this role, the regulative idea of sustainability needs to be integrated into decision-making in politics and administration at all levels, from local to global. Taking this into account, we have analyzed the institutionalization of sustainability as a crosscutting and long-term challenge at the federal level in Germany. Based on a theoretical-conceptual framework deriving from democracy, bureaucracy and political steering/governance theory, we have employed qualitative methods to understand, in depth, how sustainability is integrated into political-administrative practice. In the present paper, we present key results and show that sustainability is not a routine practice at the federal level in Germany. We will conclude by giving an outlook on the structural and procedural options and argue for the need to develop a “sustainability state”.

Airborne Trifluoroacetic Acid and Its Fraction from the Degradation of HFC-134a in Beijing, China

Trifluoroacetic acid (TFA) has been attracting increasing attention worldwide because of its increased environmental concentrations and high aquatic toxicity. Atmospheric deposition is the major source of aquatic TFA, but only a few studies have reported either air concentrations or deposition fluxes for TFA. This is the first study to report the atmospheric concentrations of TFA in China, where an annular denuder and filter pack collection system were deployed at a highly urbanized site in Beijing. In total, 144 air samples were collected over the course of 1 year (from May 2012 to April 2013) and analyzed directly using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) or following derivatization by gas chromatography-mass spectrometry (GC-MS). The annual mean atmospheric concentration of TFA was 1580 ± 558 pg/m(3), higher than the previously reported annual mean levels in Germany and Canada. For the first time, it was demonstrated that maximum concentrations of TFA were frequently observed in the afternoon, following a diurnal cycle and suggesting that a major source of airborne TFA is likely degradation of volatile precursors. Using a deposition model, the annual TFA deposition flux was estimated to be 619 ± 264 μg m(-2) year(-1). Nevertheless, a box model estimated that the TFA deposition flux from the degradation of HFC-134a contributed only 14% (6-33%) to the total TFA deposition flux in Beijing. Source analysis is quite important for future TFA risk predictions; therefore, future research should focus on identifying additional sources.

Area Level Deprivation Is an Independent Determinant of Prevalent Type 2 Diabetes and Obesity at the National Level in Germany. Results from the National Telephone Health Interview Surveys ‘German Health Update’ GEDA 2009 and 2010

ObjectiveThere is increasing evidence that prevention programmes for type 2 diabetes mellitus (T2DM) and obesity need to consider individual and regional risk factors. Our objective is to assess the independent association of area level deprivation with T2DM and obesity controlling for individual risk factors in a large study covering the whole of Germany.MethodsWe combined data from two consecutive waves of the national health interview survey ‘GEDA’ conducted by the Robert Koch Institute in 2009 and 2010. Data collection was based on computer-assisted telephone interviews. After exclusion of participants <30 years of age and those with missing responses, we included n = 33,690 participants in our analyses. The outcome variables were the 12-month prevalence of known T2DM and the prevalence of obesity (BMI ≥30 kg/m2). We also controlled for age, sex, BMI, smoking, sport, living with a partner and education. Area level deprivation of the districts was defined by the German Index of Multiple Deprivation. Logistic multilevel regression models were performed using the software SAS 9.2.ResultsOf all men and women living in the most deprived areas, 8.6% had T2DM and 16.9% were obese (least deprived areas: 5.8% for T2DM and 13.7% for obesity). For women, higher area level deprivation and lower educational level were both independently associated with higher T2DM and obesity prevalence [highest area level deprivation: OR 1.28 (95% CI: 1.05–1.55) for T2DM and OR 1.28 (95% CI: 1.10–1.49) for obesity]. For men, a similar association was only found for obesity [OR 1.20 (95% CI: 1.02–1.41)], but not for T2DM.ConclusionArea level deprivation is an independent, important determinant of T2DM and obesity prevalence in Germany. Identifying and targeting specific area-based risk factors should be considered an essential public health issue relevant to increasing the effectiveness of diabetes and obesity prevention.

Global-City-Formierung, Gentrifizierung und Grundrentenbildung in Frankfurt am Main

Global City formation, gentrification and the appropriation of ground rent in Frankfurt am Main. Based on statistics on land values between 1984 and 2012, this paper focuses on the relations between Global City formation, gentrification and the appropriation of ground rent in the case of Frankfurt am Main. It argues that the post-fordist urban hierarchy and the power of landowners to treat their property as a pure financial asset are reflected in rising and volatile ground rent levels in Germany’s most globalized financial center compared to the national average of urban property markets. Furthermore, it interprets the increasing potential for the appropriation of monopoly rents as a driving force behind recent gentrification processes in inner-city neighborhoods.

Integrated assessment of sustainable cereal straw potential and different straw-based energy applications in Germany

The energetic use of residues from agriculture can foster the transition towards a more renewable energy supply. However, sustainability issues have to be considered along the entire provision chain as they affect the resource and energy potential as well as the achievable contribution to climate mitigation. Straw is one of the most important agricultural residues in Germany. It is not yet used for energy purposes extensively and compared to other agricultural feedstock it shows low competition with food, feed or fiber.This paper analyses on the one hand the sustainable potential of cereal straw for energy application in Germany considering the actual agricultural conditions, and on the other hand the global warming potential from different energy provision chains based on straw. Different humus-balance tools that are able to assess the organic matter (OM) demand to presume soil fertility. The analysis of straw potentials was applied at NUTS 3 level for Germany, based on statistical data. The results of this analysis were used as input data for the modeling of concepts for straw provision and use. Greenhouse gas (GHG) emissions were calculated for each concept in order to compare the global warming potential of various energy applications, to investigate the relative contribution of different production steps and to compare them with fossil energy applications.In total, 29.8Tg of straw (fresh matter) are produced annually in Germany (1999–2007). Approximately 4.8Tg of the total straw occurrence are annually required by animal husbandry. Between 7.97 and 13.25Tg straw can be classified as sustainable straw. Highest straw potential (3.99Mgha−1) can be found in parts of Schleswig-Holstein, Mecklenburg–West Pomerania, North Rhine-Westphalia and Lower Saxony. But there are also regions that show a net deficit.The cumulated GHG emissions for the resulting concepts are between 8 and 35gCO2-eq.MJ−1. In comparison to fossil energy applications, the highest reduction potential occurs for concepts for combined heat and power (CHP) provision, i.e. 223gCO2-eq.MJel-1. This study highlights the possible contribution of straw as renewable energy carrier, but also demonstrates that there are regional restrictions for straw use.

Structural barriers in the context of opiate substitution treatment in Germany - a survey among physicians in primary care

BackgroundOpiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST.MethodsAn anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively.ResultsThe response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future.ConclusionDespite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.

It's the Debt-Growth Nexus Again Evidence from a Long Panel of Regional-Government Liabilities

In this paper, we study the long- and short-run relationship between regional public debt and economic performance for a sample of German federal states over the period of four decades (1970-2010). By choosing a sample of regional entities with comparable institutional settings, we complement the large literature on the debt-growth nexus based on heterogeneous cross-country samples. We estimate a dynamic error correction model that accounts for slope heterogeneity among cross-sections and the presence of unobserved common factors. While – in line with the Keynesian view – our findings hint at a non-linear inverted U-shape relationship between changes in the public debt intensity and economic growth in the short-run, we get strong statistical evidence for linear negative relationship between regional public depth and per capita GDP in the long-run. By means of a simple though experiment, we show that these negative longrun effects are not negligible for the size of interregional differences in per capita GDP levels and are in line with most international evidence on the detrimental growth effects of high public debt levels. Finally, these results also underline the need for effective fiscal rules at the federal state level in Germany.

Cyber insecurity as a national threat: overreaction from Germany, France and the UK?

The US billion dollars investments in cyber security are creating a securitisation of cyberspace. What has happened meanwhile in Europe? The argument is threefold. First, cyber threats were raised to the national threat level in Germany (2006), France (2008) and the UK (2008), but the justifications put forward for such an upgrade did not hold, as well as invested resources at that point in time. Second, cyber security strategy followed up this upgrade and designed a framework to tackle the threat that was found coherent with the assessment of the respective national security strategies. Third, cyber insecurity stemmed from criminals operating in cyberspace. Therefore, deterring criminals should have been at the core of tackling cyber insecurity but the defence strategies of France, Germany and the UK were instead focused on mitigating the effects of cyber attacks.

It's the Debt-Growth Nexus Again – Evidence from a Long Panel of Regional-Government Liabilities

In this paper, we study the long- and short-run relationship between regional public debt and economic performance for a sample of German federal states over the period of four decades (1970-2010). By choosing a sample of regional entities with comparable institutional settings, we complement the large literature on the debt-growth nexus based on heterogeneous cross-country samples. We estimate a dynamic error correction model that accounts for slope heterogeneity among cross-sections and the presence of unobserved common factors. While - in line with the Keynesian view - our findings hint at a non-linear inverted U-shape relationship between changes in the public debt intensity and economic growth in the short-run, we get strong statistical evidence for linear negative relationship between regional public depth and per capita GDP in the long-run. By means of a simple though experiment, we show that these negative longrun effects are not negligible for the size of interregional differences in per capita GDP levels and are in line with most international evidence on the detrimental growth effects of high public debt levels. Finally, these results also underline the need for effective fiscal rules at the federal state level in Germany.

Climate change adaptation planning in agriculture: processes, experiences and lessons learned from early adapters

This paper explores the lessons learned by leaders in agricultural adaptation planning in order to assist other jurisdictions to develop adaptation strategies. It seeks to identify effective institutional, participatory and collaborative processes involved in designing agricultural adaptation strategies at the national and sub-national levels in Germany, Finland, the United Kingdom, the United States and Canada. Its methodology is based on review of agricultural adaptation policy documents, research initiatives, stakeholder engagement processes, and cross-sectoral collaborations as well as interviews with key informants such as leaders and actors in adaptation planning. The gathered data show that early adapters have an improved regional and national understanding of climatic impacts, and of the risks to agriculture before the initiation of the planning process. The results indicate that the interplay between bottom-up and top-down initiatives has been crucial in the development of adaptation strategies. The former has provided rich and robust participation in designing, implementing and monitoring adaptations, while the latter was important for prioritizing and legitimizing the development of strategy. It also provided access to high-level decision makers and funding. The results of the study suggest that fostering cross-sectoral collaborations—especially by focusing on broader questions such as the role of agriculture in society—has become an important part of adaptation planning. Finally, our results also stress that adaptation planning in agriculture could be enhanced by skills development and mutual learning across stakeholder groups, research and policy-makers, and through the ongoing interactive development of institutional capabilities.

Population Level Survival of Patients with Chronic Myeloid Leukemia in Germany in the Early 21st Century

AbstractAbstract 759 Background:Chronic myeloid leukemia (CML) is a rare but highly treatable form of leukemia. Recent advances in the treatment of CML have dramatically improved survival in clinical trials. Prior work using the Surveillance, Epidemiology, and End Results (SEER) database in the United States (US) suggest that survival on the population level has increased, but still lags behind that seen in clinical trials1. In the past, evaluation of population level survival in other countries has been hampered by the lack of high quality data from a large enough population to evaluate trends in survival in this rare disease. Recently, a collaborative effort between the German Cancer Research Center and several German cancer registries has provided the chance to evaluate population level survival for rare cancers. Here, we examine survival for patients with CML in Germany in the early 21st century, comparing it to survival in the US. Methods:Data was extracted from the SEER13 database in the US and 13 epidemiologic cancer registries in Germany. Patients diagnosed with CML between 1997 and 2006 were included in the analysis. Data quality analysis showed an excessive level of cases diagnosed by death certificate only in older patients (age 70+) so analysis was restricted to patients age 15–69. Patients diagnosed by death certificate only were excluded from the analysis. Period analysis was used to provide the most up-to-date possible estimates of five year relative survival. Results:1848 cases of CML were identified in the German database and 2910 cases in the SEER database. More cases were seen in younger patients in the US, whereas each age group was roughly equal in size in Germany (see table). Five year relative survival was 68.7% overall in Germany and 72.7% in the US. Survival was higher in the US for all age groups except for age 15–39, but the difference was only significant for ages 50–59, where a difference of 10.2 percentage units was seen (see table). Survival decreased with age, ranging from 83.1% and 81.9%, respectively, in Germany and the US for patients age 15–39 to 54.2% and 54.5%, respectively, in patients age 65–69. Conclusions:Estimated five year survival increased in the US compared to previous estimates of survival in the 2000–2004 period1. Five year survival estimates were higher in the US than in Germany overall, but the difference was only significant for age 50–59. These results are the first detailing survival in CML on the population level in Germany and providing an international comparison. Survival did not equal that seen in clinical trials of tyrosine kinase inhibitors2 for either country, but comparison with previous estimates in earlier time periods suggests that improvement in survival is ongoing. Greater concentration on treatment of CML in older patients may help improve survival for this population, for which survival lags.Table:Five year relative survival of patients diagnosed with CML in Germany and the US by age.GermanyUSGermany - USAgeNRSSENRSSEDiffP (Model)15-3932483.13.081881.92.0+1.20.940340-4932878.03.468082.82.2−4.80.177750-5942367.53.569777.72.6−10.20.001860-6436165.33.834070.34.1−5.00.206565-6941254.24.037554.54.2−0.30.5093Overalla184868.71.6291072.71.5−4.00.0036a=age adjusted using the percentage of cases in each age group in GermanyN=Number of casesRS=Relative SurvivalSE=Standard ErrorDiff=Difference between survival in Germany and the US Disclosures:No relevant conflicts of interest to declare.

The Shadow Economy in German Regions: An Empirical Assessment

Abstract Despite the increasing number of contributions to the literature, regional variations of the shadow economy have been hardly studied. This article analyses the determinants and derives the size of the shadow economy on the district level in Germany. I find that an inferior local labour market and the burden of taxation significantly contribute to the existence of the shadow economy, while a better enforcement of tax rules and regulations has the potential to deter such activities. Districts in the affluent south of Germany experience on average smaller shadow economies.

Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany

Inadequate use of antibiotics can lead to problems such as resistance. Overuse is especially a problem for children, since they are more affected by acute (often virus-caused) infections. While the problem has been addressed internationally over the past several years, regional variations in prescriptions are striking. Therefore, the present study aims to analyze regional variations in antibiotic prescription on a district level in Germany and tries to identify reasons for those variations through adding possible influencing factors to the analysis on individual and district levels. We analyzed 1.2 million children insured in a German health insurance fund. Antibiotic prescriptions were quantified in 2010 and reasons for prescriptions were analyzed in multilevel regressions based on the district of residence, regional deprivation, and age and sex of the child. Thirty-six percent of all children aged 0-17 years received an antibiotic prescription in 2010. In the south, prevalences are generally lower, and also to the very north. The highest prevalences are found in the close-to-border districts in the west, as well as in a band throughout the middle of Germany, in rather low population density areas. Regional variation in the prevalence range from 19 to 53 % between districts. Regional deprivation can explain part of this variation. Including area deprivation measures helped identify an influence of especially regional income and occupational deprivation on antibiotic prescriptions for children. Regional analysis such as this can help identify specific regions and groups of persons to address information programs on the risks of preventable antibiotic consumption and alternative treatment methods.

Krankheitsspezifische Versorgungsmerkmale in Deutschland: Analyse anhand der Bundesauswertung der German Inpatient Quality Indicators (G-IQI)

Using the categories of the German Inpatient Quality indicators (G-IQI) important characteristics of inpatient care were analyzed on the national level in Germany. The evaluation gives an overview of total national case numbers and number of hospitals involved in the treatment of important diseases. The analysis was based on the national so called 'DRG database' for the year 2010, which covers all German inpatient DRG cases (all patient / all payer database). With the major exception of psychiatric and psychosomatic cases this database covers 17.43 of the 18.49 million German inpatient cases. The coded diagnoses and procedures as well as demographic information were used to group cases into G-IQI disease categories. The respective total case numbers, number of hospitals providing the services, interquartile range of case distribution, in-hospital mortality and interquartile range of standardized mortality ratios were investigated. Especially for less frequent diseases and procedures it is shown, that many hospitals treat very low case numbers. For example for gastric resection the lower quartile is 4, for esophageal resection 1 and for cystectomy 5. Even for a more frequent disease like myocardial infarction the lower quartile is 36. Mortalities also show considerable variation. However, due to the low case numbers in many hospitals, the deviation of hospital mortality from the German average can only become significant for rather few hospitals. On the one hand this paper provides national reference values for the German Inpatient Quality Indicators, which cover 38.7 % of all inpatient cases and 50.8 % of in-hospital deaths. On the other hand it gives a first overview of the disease specific patterns of inpatient hospital care in Germany. Despite the high overall quality of the German health care system it suggests, that further improvement might be possible, if structural problems were addressed.

Heavy Metal Contamination in Arable Soils and Vegetables around a Sulfuric Acid Factory, China

AbstractThis study was designed to investigate heavy metal (Tl, Pb, Cu, Zn, and Ni) contamination levels of arable soils and vegetables grown in the vicinity of a sulfuric acid factory in the Western Guangdong Province, China. Health risks associated with these metals by consumption of vegetables were assessed based on the hazard quotient (HQ). The soils show a most significant contamination of Tl, followed by Pb, Cu, Zn, and Ni. The heavy metal contents (µg/g, dry weight basis) in the edible parts of vegetables range from 5.60 to 105 for Tl, below detection limit to 227 for Pb, 5.0–30.0 for Cu, 10.0–82.9 for Zn, and 0.50–26.0 for Ni, mostly exceeding the proposed maximum permissible level in Germany or China. For the studied vegetables, the subterranean part generally bears higher contents of Tl and Zn than the aerial part, while the former has lower contents of Cu and Ni than the latter. In addition, the results reveal that Tl is the major risk contributor for the local people since its HQ values are mostly much higher than 1.0. The potential health risk of Tl pollution in the food chain and the issue of food safety should be highly concerned and kept under continued surveillance and control.