Major German Cities Research Articles

Children and adolescents’ experiences of mandatory SARS-CoV-2 testing in schools: a cross-sectional survey

BackgroundPublic health measures during the COVID-19 pandemic had dramatic consequences for children and adolescents. However, policy-makers and healthcare researchers did not give sufficient weight to children’s perspectives. One common public...

Diversity challenges in German nursing teams: a participatory organizational development approach

Abstract Background Migration of health care professionals, demographic change and the transformation of the health care system result in highly diverse nursing teams in German hospitals and nursing homes. Different orientations (regarding qualification, generation or migration background) collide in a working environment characterized by staff shortage, time pressure and decisions about life and death. But team cooperation not only has a strong impact on patient safety, but on job satisfaction and therefore retention management. Little is known on how teams cope with diversity challenges and how this is linked with organizational structures. Methods Based on qualitative content analysis of 197,5 hours of participatory observation, 8 group discussions and 25 interviews in 6 nursing teams in 2 hospitals and 2 nursing homes situated in a major German city, we developed workshops on the topic of team diversity and cooperation. 10 workshops (4-16 participants each) were in held in 2023/24 both on team- and management-level. Results All teams are struggling with diversity-related problems, but in their specific ways, depending on the particular neighbourhood of the facility and team composition among other things. Due to the strong team spirit and identity, the teams have a fundamental tendency to integrate diverse perspectives and orientations. But they need time capacities and supportive organizational structures. The workshops created a space to discuss the team specific problems. Starting points for structural changes could be identified and further discussed in the workshops at the next higher hierarchical level. Conclusions Organisational structures provide the framework conditions that enable teams to integrate different perspectives resulting from diversity in a productive way. One-fits all solutions are not suitable to address those problems and improve teamwork. A participatory bottom-up process seems to be the most appropriate approach. Key messages • Institutions need to provide structures in which diversity is not perceived as an additional burden. • The best way to initiate improvements is through a participatory bottom-up approach.

Critical Self-reflection on Racism by Hospital Physicians in Large German Cities. A Qualitative Reconstructive Study Using Episodic Interviews.

Racism permeates healthcare institutions and interpersonal interactions, impacting both staff and patients. The role of doctors, given their influential position in the healthcare system, is particularly crucial in this context. Despite this, there is a scarcity of evidence regarding the manifestation of racism among healthcare professionals in Germany. Critical whiteness studies emphasize the importance of white* individuals engaging in critical self-reflection to mitigate racism. This study aimed to explore the attitudes of white* physicians in hospitals in major German cities towards racism and their critical reflection on personal attitudes and actions concerning racism in interactions with staff members and patients. Data was collected through six episodic interviews with physicians, analyzed using the reconstructive qualitative procedure of the documentary method, leading to a sense-genetic typology. The sense-genetic typology revealed three distinct attitudes towards racism: acknowledging, individualistic, and ignoring. Four types emerged concerning the self-reflection of white doctors: self-critical, socially critical, worried, and defensive. The most promising potential for interventions to reduce racism lies within the self-critical and socially critical types, both demonstrating an acknowledging attitude. Conversely, the worrying and defensive types may present challenges in deconstruction. This suggests that interventions aimed at reducing racism should be tailored and implemented with a nuanced approach.

Counselling with a focus on product and price transparency for over-the-counter headache medicines: A simulated patient study in community pharmacies in Munich, Germany.

In Germany, over-the-counter (OTC) medicines may only be dispensed by community pharmacies (CPs). German CPs must ensure 'adequate' counselling, including the cost of medicines. Along with information gathering and advice giving as classic aspects of counselling, the aim was also to investigate counselling indicators of product and price transparency. The cross-sectional study was based on the covert simulated patient (SP) methodology and was conducted in a random sample of CPs stratified by districts in the major German city of Munich. Each of the 178 selected CPs was visited once by one of five trained female students. They simulated a symptom-based sub-scenario 1 with a request for an OTC medicine for a headache and a sub-scenario 2 with standardised information regarding product and price transparency. The assessment, completed immediately postvisit by the SPs, included a total of 23 items. All 178 scheduled visits were completed successfully. The median counselling score with the classic items was 3.0 out of 12 points (interquartile range [IQR] 4.25) and when expanded by items for product and price transparency the score was 4.0 out of 14 points (IQR 4.00). A selection of medicines was offered unsolicited in 38.2% of the visits and in 5.6% of the visits voluntary price information was provided before the transaction. A request for a cheaper medicine led to a significant price reduction (Wilcoxon signed-rank test; p<0.001, r=0.869). Due to the below-average level of counselling, the regional chambers of pharmacists are recommended to initiate measures for improvement. There is also potential for optimisation with regard to product and price transparency as an important extension of the classic counselling aspects. It is therefore recommended that the government raise customers' awareness of the cost of medicines.

Low-fare public transport and modal shift – Lessons from Bonn, Germany

The air quality in many German cities does not comply with EU-wide standards. Vehicle emissions, in particular, have been identified as an important cause of air pollution. As a result, driving bans for diesel vehicles with critical pollutant groups have been imposed by courts in many places in recent history. Against the backdrop of the growth of major German cities over the last few years, the question has become whether and how a change in the modal split in favor of more environmentally and climate-friendly public transport sector can be achieved. The Federal City of Bonn is one of five model cities that is testing measures to reduce traffic-related nitrogen dioxide emissions through a Climate Ticket as a mobility flat rate for one year for 365 €, which is part of the two-year "Lead City" project funded by the federal government. A quantitative survey (n = 1,315) of Climate Ticket users as well as the logistic regression carried out confirm that a change in individual mobility behavior in favor of public transport is possible by subsidizing the ticket price. The results show that individual traffic could be saved on the city's main congestion axes. In order to achieve a sustainable improvement in air quality, such a Climate Ticket must be granted on a permanent basis, with a well-designed mobility offer and must be generous in terms of the group of authorized persons and the area of validity.

The cycling boom in German cities. The role of grassroots movements in institutionalizing cycling

Cycling rates have grown consistently over recent years in cities across the globe. Nevertheless, the lack of policies to promote cycling results in dissatisfaction among cyclists in many cities. In response to this situation, local grassroots initiatives have emerged to pursue more ambitious cycling policies in German cities. However, there is limited knowledge of how grassroots movements influence the cycling policy agenda. Against this background, our article explores the relevance of the grassroots movement “Radentscheid” in four major German cities (Berlin, Frankfurt, Munich, and Hamburg) regarding institutionalizing cycling policymaking. By combining exploratory document analysis, expert interviews, and an analysis of secondary data, we show that the development of cycling over the last two decades in these cities follows three stages: (i) Commitment, when cycling is put on the political agenda; (ii) Imbalanced growth, characterized by a strong increase in cycling but little progress in cycling policies and a decrease in cycling satisfaction; and (iii) Institutional adaptation, when cycling becomes a key issue for local governments due to the pressure from the grassroots movement “Radentscheid”. This paper closes with a discussion of the main results and policy recommendations.

Unlocking the Potential of German Smart Cities: Strategy Analysis through Online Content Examination

This paper presents a comprehensive analysis of smart city strategies in Germany through the examination of online content. Smart city initiatives have gained significant attention worldwide as urban areas seek innovative solutions to address various challenges. In Germany, renowned for its technological achievement and commitment to sustainability, has witnessed the emergence of numerous Smart City projects. The aim of this study is to investigate the current status of Smart Cities strategy initiatives in Germany based on a sample of 82 cities. To achieve this, an online content analysis methodology is employed, using the official web presences of the selected cities and information published on them. The content analysis focuses on identifying empirical evidence related to digitalisation, data and governance, and obtaining their transparency and progress in a sample of 82 major German cities. The findings of this study reveal the diversity and richness of German smart city approaches, but also a varying degree of sophistication and transparency of strategic initiatives. As an expression of Germany's federal structure, the cities focus on different aspects, such as mobility, energy efficiency or data-driven administration. The insights gained from this online content analysis provide valuable guidance for policymakers, urban planners and stakeholders involved in the design of smart city strategies. By understanding the strengths and weaknesses of existing initiatives, policymakers can refine their approaches, address challenges and promote sustainable and inclusive urban development. Furthermore, this study contributes to the academic discourse on smart cities by providing empirical evidence on the implementation of strategies in a German context. Overall, this study contributes to a deeper understanding of the German smart city landscape and serves as a basis for future research, policy formulation and the pursuit of smarter and more liveable cities.

Association of risk perception and transport mode choice during the temporary closure of a major inner-city road bridge: results of a cross-sectional study

BackgroundSince air pollution and physical inactivity pose major public health risks, switching from cars to alternatives like public transport, cycling, and walking is important. Therefore, it is beneficial to identify key events for changes of mode choice.MethodsWe examined the association between risk perception and mode choice during the temporary closure of a road bridge between two major German cities in early 2020 using binary and multinomial regression models.Results679 people participated in the survey. We found that 22% of car users switched to alternatives. The higher the perceived health risk from traffic-related air pollution, the more likely car users switched to alternatives (odds ratio [OR] = 1.76, 95% CI [1.14, 2.71]).DiscussionAttitude, subjective norm and perceived behavioral control were associated with maintaining but not with switching transport modes. In conclusion, the closure of a main road bridge may present a key event. To explain mode choice, risk perception is a potential extension to the theory of planned behavior.

Exploring citizen discussions’ potential to inform smart city agendas: Insights from German-city-centered online communities

With more than 50% of the world’s population living in urban areas, the smart city concept has been introduced as a solution to urbanization problems, with a focus on technological and social innovation. However, critics argue that the concept is more about marketing than actual benefits for citizens. Given the limitations of conventional and formalized e-participation and smart city procedures, we highlight the value of shared citizen knowledge and the potential of e-interaction in this context by analyzing city-related informal social media communication, following recent calls to embrace citizens’ opinions in the smart city framework. This work focuses on major German cities with more than 100,000 inhabitants. The authors identify nine categories of interest in citizens’ discussions. Unlike official channels, citizens tend to focus on social and societal issues. The results of this study can complement existing tools by including citizens’ perspectives in smart city decision-making processes.

Barriers and Solutions to Green Facade Implementation—A Review of Literature and a Case Study of Leipzig, Germany

The expansion of green infrastructure through vertical forms of greenery is an innovative way to address urban sustainability challenges. Despite various social, economic, and environmental benefits, however, facade greening is rarely implemented. This article examines barriers to and solutions for the implementation of green facades through a systematic literature review and a participatory case study of Leipzig, Germany. We found a total of 24 social, political-administrative, economic, practical-technical, and environmental barriers hindering key actors to (successfully) implement green facades. The lack of information and knowledge was found to be an underlying issue. Solutions co-created with local stakeholders and experts include the provision of informative, regulatory, and financial incentives, the adaptation of political-administrative strategies, regulations, and procedures, as well as the support of the practical-technical implementation process through information and experts. To overcome barriers, various measures must be combined, but establishing public relations and advisory services on green facades is of priority in Leipzig. By combining insights from academic literature with applied knowledge of a diverse group of local actors, we identify how barriers to facade greening may be overcome in the specific case of a major German city and provide a blueprint for similar research in other socio-political contexts.

Spatial segregation of families with migrant background in the high-status City of Munich: How strong is the effect of socio-economic status?

Ethnic residential segregation can result from preferential choices or from market forces. Depending on whether it evolved voluntarily or forcibly, segregation can have differential effects on immigrant integration. Using the example of Munich as a major German city, we examine the unequal spatial distribution of migrants and non-migrants. Following an approach proposed by Frank Kalter we calculate indices of residential segregation, which are adjusted for differences in socio-economic status. Results show that almost 14 percent of the residential segregation of immigrants can be attributed to socio-economic restrictions. This finding suggests that factors related to immigration and, possibly, also ethnic boundaries are determinants of the unequal spatial distribution also in high-status cities such as Munich.

Local cultures of control, order maintenance policing, and gentrification: A comparison of railway station districts in three German cities

ABSTRACT In recent years, many major German cities have expanded the capacity and legal authority of their municipal order enforcement services and order maintenance policing. The focal action points are central neighborhoods characterized by a concentration of social problems, reinvestment in the built environment, and prevailing feelings of insecurity and the need to improve the quality of life. This study explores the causes of local cultures of control and their relations to order maintenance policing and neighborhood change. We used a document analysis and guided interviews with experts in the railway station districts of Düsseldorf, Leipzig, and Munich. Our findings demonstrate how the local control habitus shapes neighborhood change while being shaped through neighborhood-specific demands for formal social control. Demands for order maintenance policing originate from both the supply (business people) and demand sides (new residents). Moral entrepreneurs convey such demands through the local political context.

Primary and secondary data in emergency medicine health services research – a comparative analysis in a regional research network on multimorbid patients

BackgroundThis analysis addresses the characteristics of two emergency department (ED) patient populations defined by three model diseases (hip fractures, respiratory, and cardiac symptoms) making use of survey (primary) and routine (secondary) data from hospital information systems (HIS). Our aims were to identify potential systematic inconsistencies between both data samples and implications of their use for future ED-based health services research.MethodsThe research network EMANET prospectively collected primary data (n=1442) from 2017-2019 and routine data from 2016 (n=9329) of eight EDs in a major German city. Patient populations were characterized using socio-structural (age, gender) and health- and care-related variables (triage, transport to ED, case and discharge type, multi-morbidity). Statistical comparisons between descriptive results of primary and secondary data samples for each variable were conducted using binomial test, chi-square goodness-of-fit test, or one-sample t-test according to scale level.ResultsDifferences in distributions of patient characteristics were found in nearly all variables in all three disease populations, especially with regard to transport to ED, discharge type and prevalence of multi-morbidity. Recruitment conditions (e.g., patient non-response), project-specific inclusion criteria (e.g., age and case type restrictions) as well as documentation routines and practices of data production (e.g., coding of diagnoses) affected the composition of primary patient samples. Time restrictions of recruitment procedures did not generate meaningful differences regarding the distribution of characteristics in primary and secondary data samples.ConclusionsPrimary and secondary data types maintain their advantages and shortcomings in the context of emergency medicine health services research. However, differences in the distribution of selected variables are rather small. The identification and classification of these effects for data interpretation as well as the establishment of monitoring systems in the data collection process are pivotal.Trial registrationDRKS00011930 (EMACROSS), DRKS00014273 (EMAAGE), NCT03188861 (EMASPOT)

Sustainable City Evaluation Using the Database for Estimation of Road Network Performance

This article introduces the Database for Estimation of Road Network Performance (DERNP) to enable wide-scale estimation of relevant Road Network Performance (RNP) factors for major German cities. The methodology behind DERNP is based on a randomized route sampling procedure that utilizes the Worldwide Harmonized Light Vehicles Test Procedure (WLTP) in combination with the tile-based HERE Maps Traffic API v7 and a digital elevation model provided by the European Union’s Earth Observation Programme Copernicus to generate a large set of independent and realistic routes throughout OpenStreetMap road networks. By evaluating these routes using the PHEMLight5 framework, a comprehensive list of RNP parameters is estimated and translated into polynomial regression models for general usage. The applicability of these estimations is demonstrated based on a case study of four major German cities. This case study considers network characteristics in terms of detours, infrastructure, traffic congestion, fuel consumption, and CO2 emissions. Our results show that DERNP and its underlying randomized route sampling methodology overcomes major limitations of previous wide-scale RNP approaches, enabling efficient, easy-to-use, and region-specific RNP comparisons.

Mode choice of city tourists: Discrete choice modeling based on survey data from a major German city

With growing city tourism, there is an increasing need for urban travel demand models to consider traffic generated by visitors. Existing research has concentrated on socio-demographic and journey-related factors to determine what influences the mode choice of tourists. In contrast, revealed preference data, such as travel time, is almost never considered. In this article, we present the results of discrete choice modeling of city tourists’ mode choice based on revealed preference data from a survey we conducted in Kassel, Germany. We used multinomial logit models and determined the model parameters using maximum likelihood estimations. Surprisingly, travel time played a smaller role in mode choice than assumed from previously established understanding about everyday mobility. In the final model, travel time was only significant for the alternative of walking. Also, most other sociodemographic and journey-related variables showed no significant influence. The final model reproduced the mode choice, but the goodness of fit was lower than expected from other research. We conclude that modeling the travel behavior of tourists is more complex than everyday mobility. An alternative approach that we suggest would be to model trip chains rather than single trips.

Using real mobility patterns to assess the impact of 100% electrified mobility in a German city

Until now, individual motorized mobility has been almost exclusively powered by fossil energy sources. The battle against climate change, however, requires a transformation of the mobility system with the ultimate objective of a full electrification of transport. Ultimately, this will increase considerably the load on the distribution grid both in overall size and through temporarily and locally distributed charging. This paper explores the effects of an assumed full electrification of individual motorized transport on the power grid in a major German city using real traffic data collected from a German traffic panel and employing a microscopic and dynamic travel simulation with the Simulation of Urban MObility tool. The main finding of the traffic simulation is that the local and temporary impact on the distribution grid is very sensitive to the distribution of charging stations and their geographical aggregation in transformers. However, behavior change in the form of charging at different points in time and locations or using less power can alleviate local peaks, up to 50% in the simulated scenario. Therefore, this paper addresses the previously uncovered need for a more profound and realistic computation that includes all important aspects of a proper traffic simulation. It further extends the barely covered field of dynamic simulations that operate on real mobility data. With that, limitations arise from the process of transposing driving data into geographical data as it is very sensitive to underlying assumptions. However, we are convinced that the spatialization of charging stations and the randomization of trip assignments represent the most transparent and meaningful way of overcoming these limiting factors.

Road Users’ Reports on Danger Spots: The Crowd as an Underestimated Expert?

As part of the project EDDA+ (Early Detection of Dangerous Areas in road traffic using smart data), a web-based crowdsourcing platform has been launched on which road users can report danger spots they face in everyday traffic. Whereas official police collision data can only be used reactively, these user reports are intended to warn other road users and provide road safety stakeholders with detailed information for proactive measures. Since this approach is relatively novel, the present pilot study aimed to evaluate the validity of these subjective road user reports. A quasi-randomized sample of N = 77 danger spots distributed over four major German cities was audited using a 70-item objective road safety deficit inventory to identify infrastructural deficits. Based on these items, an overall rating of objective hazardousness for each danger spot was derived. In more than half of the audited danger spots, infrastructural deficits were identified in the audit (=confirmed hazard). In another quarter of audited dangers spots, the reported hazard could not be identified without any doubt due to a lack of infrastructural deficit or detailed information about the nature of the hazard (=uncertain, no certain match between audit and report). Our analysis further revealed that an increased number of road user interactions for the respective danger spot yielded a higher likelihood of confirmation of a danger spot’s hazardousness. Descriptively, pedestrians and bicyclists were most often mentioned as exposed to danger, with the most prevalent nature of danger being areas with poor visibility and misconduct by drivers. The results were blended with police collision data in the next step. We did not find a significant relationship between our danger spots’ rating and the number of collisions at the respective spot. Our results indicate that reports of danger spots and the increased user related activity can serve as an indicator for the early detection of road traffic hazards.

The acoustic environment before and during the SARS-CoV-2 lockdown in a major German city as measured by ecoacoustic indices.

The SARS-CoV-2 pandemic drastically changed daily life. Lockdown measures resulted in reduced traffic mobility and, subsequently, a changed acoustic environment. The exceptional lockdown was used to analyze its impact on the urban acoustic environment using ecoacoustic indices. Using data from 22 automated sound recording devices located in 9 land use categories (LUCs) in Bochum, Germany, the normalized difference soundscape index (NDSI) and Bioacoustics index (BIO) were explored. The NDSI quantifies the proportion of anthropophonic to biophonic sounds, and BIO quantifies the total sound activities of biological sources. The mean differences and standard deviation (SD) were calculated 5 weeks before and 5 weeks during the first lockdown. Pronounced peaks for the NDSI and BIO before lockdown that diminished markedly during lockdown were observed, however, with distinct differences in terms of the LUC. The mean NDSI increased from 0.00 (SD = 0.43) to 0.15 (SD = 0.50), the mean BIO decreased from 4.74 (SD = 2.64) to 4.03 (SD = 2.66). Using the NDSI and BIO together reveals that changes of the acoustic environment during lockdown are mainly driven by decreased anthropophonic sound sources. These results suggest that further studies are needed to tailor ecoacoustic indices more accurately to conditions of the urban environment.

Integrating Retail into an Urban Data Platform from a Stakeholder Perspective: Network Approaches in Leipzig (Germany)

Growth rates in e-commerce, changing consumer behaviors, and COVID-19 have all put pressure on local retailers worldwide, threatening the resilience of city centers. Local online platforms (LOPs) have been considered as a solution to help local retailers increase their visibility and survive on the market. However, most platforms fail to attract a significant number of stakeholders. Simultaneously, digital platform solutions with more holistic urban perspectives, such as urban data platforms (UDPs), have emerged. However, a question remains: how can the integration of retail data (e.g., product availabilities) into a UDP succeed? Therefore, in this paper, we explore stakeholder-oriented networking processes to integrate local retail data into a UDP in Leipzig, Germany. Leipzig has increased its population by 26% since 2000, but presents the highest retail vacancy rate, compared to other major German cities. To investigate the networking process in Leipzig, we conduct a social network analysis which combines qualitative interviews, mapping, and ethnographic research. We interview ten stakeholders and uncover conflicts within the networking process: First, all stakeholders have different understandings of UDPs and how to integrate local retail data; second, the interviewees acknowledge the importance of, but none of them feel responsible for, initiating or managing the process; and third, the city administration has shown diverging interest, in terms of taking on more responsibility.

Eine Verkehrstypologie deutscher Großstädte

Comparisons of cities are frequently used to evaluate urban transportation planning and policies. A typology of cities can contribute to adequately interpret the identified differences between cities. For this purpose, this paper collects 27 indicators of socio-economic characteristics, spatial structures, travel behaviour and the evaluation of local transport situation for 44 major German cities. We generate clusters of cities based on a factor and cluster analysis. The factor analysis identifies five latent variables called metropolitan character, bicycle-friendliness, affluence, influence of students, and private car orientation. The subsequent cluster analysis identifies five clusters. According to this typology, most cities that are considered good practices of urban transport policy in Germany belong either to the cluster of metropolitan cities or university cities with a cycling-friendly environment.