Persons In Germany Research Articles

The Problem of Imposing Criminal Liability on Legal Persons in Germany and Russia

The article is devoted to the consideration of problems in connection with the introduction of the institution of criminal liability for legal persons in Germany and Russia. The authors analyze the doctrinal discussions that have been held for over 200 years with respect to this problem and the arguments raised by supporters and opponents of introducing criminal liability for legal persons. They also consider the modern practice of making legal persons liable. In particular, the institution of“quasi criminal” liability of legal persons in Germany and their administrative liability in Russia is examined. The comparative study shows that there are many similarities with regard to this question in both Germany and Russia.

Prediction of Drug-Related Risks Using Clinical Context Information in Longitudinal Claims Data.

To develop and internally validate prediction models for medication-related risks arising from overuse, misuse, and underuse that utilize clinical context information and are suitable for routine risk assessment in claims data (i.e., medication-based models predicting the risk for hospital admission apparent in routine claims data or MEDI-RADAR). Based on nationwide claims from health-insured persons in Germany between 2010 and 2012, we drew a random sample of people aged ≥65 years (N = 22,500 randomly allocated to training set, N = 7500 to validation set). Individual duration of drug supply was estimated from prescription patterns to yield time-varying drug exposure windows. Together with concurrent medical conditions (ICD-10 diagnoses), exposure to the STOPP/START (screening tool of older persons' potentially inappropriate prescriptions/screening tool to alert doctors to the right treatment) criteria was derived. These were tested as time-dependent covariates together with time-constant covariates (patient demographics, baseline comorbidities) in regularized Cox regression models. STOPP/START variables were iteratively refined and selected by regularization to include 2 up to 11 START variables and 8 up to 31 STOPP variables in parsimonious and liberal selections in the prediction modeling. The models discriminated well between patients with and without all-cause hospitalizations, potentially drug-induced hospitalizations, and mortality (parsimonious model c-indices with 95% confidence intervals: 0.63 [0.62-0.64], 0.67 [0.65-0.68], and 0.78 [0.76-0.80]). The STOPP/START criteria proved to efficiently predict medication-related risk in models possessing good performance. Timely detection of such risks by routine monitoring in claims data can support tailored interventions targeting these modifiable risk factors. Their impact on older peoples' medication safety and effectiveness can now be explored in future implementation studies.

Infrastructure epistemologies: water, wastewater and displaced persons in Germany

Recent years have seen historically unprecedented global disaster migration; in 2016 Germany received 1.3 million displaced individuals. Regardless of past resources and future potential, disaster migrants are a new, vulnerable population. This new population increases demand for water and wastewater infrastructure services, despite being temporarily unable to pay for services. As such, this kind of sudden population increase is a resiliency challenge for the receiving infrastructure systems. Qualitative analysis of 1,884 open-ended survey responses was blended with a statistical analysis to discover how and why the German public perceives water and sanitation services have been provided to the disaster migrants. Unprompted, 36% (112/314) of respondents referenced at least one of three infrastructure epistemologies, including water and wastewater as a service, as a basic need, and as a human right. These epistemologies share statistically significant relationships with how long respondents feel water and wastewater should be provided to displaced persons. A temporally limited, normative perception of water and sanitation as a humanitarian good functions to enable water and wastewater infrastructure to deliver a high level of service despite the significant disruption of the large and vulnerable population influx, and has practical implications for the structure of cost recovery.

Pilot study to investigate sleep disorders in the blind and persons with relevant visual impairment

Sleep disorders are associated with serious health problems in blind and visually impaired persons. Loss of light perception may result in ashift of sleep-wake pattern, which may lead to significant impairments in daily life--the so-called non-24-hour sleep-wake disorder. To date, epidemiologic data on non-24 only exist for the USA. This pilot study was conducted to provide first epidemiologic data for the prevalence of non-24 and other sleep disorders among blind and visually impaired persons in Germany. Recruited were 111 blind and visually impaired subjects (36 subjects without light perception; male [m] = 56, 27-85years, average [Mx] = 59.53, standard deviation [SD] = 14.69) and 111 sighted controls (m = 41, 27-88years, Mx = 58.32, SD = 14.21), who answered a set of validated questionnaires referring to general health status (SF-36), sleep characteristics (PSQI), and daytime sleepiness (ESS). In addition, aquestionnaire to predict non-24-hour sleep-wake disorder, which is not yet validated in German, was provided. The prevalence of 72.2% for the non-24-hour sleep-wake disorder in blind people is in accordance with results from the USA. In contrast, our results indicated non-24 in only 21.3% of the subjects with residual light perception. Furthermore, other sleep disorders like problems falling asleep (100% vs. 79.9%), maintaining sleep (90% vs. 88.1%), sleep-disordered breathing (19.4% vs. 32%), or sleep-related movement disorders (28.1% vs. 32.9%) were also common in the group of blind or visually impaired persons. The non-24-hour sleep-wake disorder is afrequent problem among people with no light perception, associated with problems falling asleep, maintaining sleep, and daytime sleepiness. The perception of light as an external cue for our circadian rhythm plays akey role. However, sleep disruption is not fully explained by non-24, making adetailed sleep history essential.

Treatment and Prognosis of the Oldest Old with Colorectal Cancer

The demographic trend will lead to an increase of elderly persons in Germany in the future. The population is becoming smaller and older because of the deficiency in childbirths. This results in demographic ageing of the population in Germany. Studies addressing patients ≥ 85 years, the oldest old, are becoming more and more important. The prospectively collected data of 141 patients ≥ 85 years with colorectal carcinoma treated between 1995 and 2014 were analysed retrospectively. Treatment, complications and prognosis were compared with a historical group of patients ≥ 85 years treated previously between 1978 and 1994 (n = 57) and with a less old group of patients 75 - 84 years old treated between 1995 and 2014 (n = 726). The cohort consisted of 64 men and 77 women. 88 patients had colon carcinoma, 53 patients rectal carcinoma. 127 patients were treated with tumour resection; 112 were classified as R0. Compared with the historical cohort (1978 - 1994), the number of patients increased, and more patients were given tumour resection (74 vs. 90%, p = 0.003) and fewer patients had synchronous distant metastases (28 vs. 14%, p = 0.015). The 5-year locoregional recurrence rate after curative resection decreased from 11.5 to 1.4% (p = 0.027). Comparison with the younger age group (75 - 84 years) revealed more women (55 vs. 42.3%, p = 0.007), more emergencies (22 vs. 9.8%, p < 0.001) and less frequent neoadjuvant treatment (11 vs. 3%, p = 0.003). Morbidity (41 vs. 31.2%, p = 0.032) and mortality (16 vs. 5%, p < 0.001) were higher in the oldest old. After curative resection and exclusion of postoperative deaths, overall survival (2-year rate 66.4%, 5-year rate 32.9%) was found to be worse than for the less old group, whereas cancer-related survival (2-year rate 93.1%, 5-year rate 86.7%) was similar. The number of oldest old patients ≥ 85 years with colorectal carcinoma will further increase. These patients have a higher risk of postoperative complications. After recovering from the surgery cancer-related survival is not worse than for less old patients.

Transitioning from a Human Right to an Infrastructure Service: Water, Wastewater, and Displaced Persons in Germany.

Water and sanitation utilities across Europe have recently been challenged to provide services to asylum seekers and refugees fleeing complex humanitarian disasters. We explore public perceptions regarding how secondary disaster impacts (mass migration into an undamaged area) has impacted the utilities. We show that the hosting population is typically willing to provide water and sanitation services to displaced persons for a set period of time, even if the displaced persons are unable to pay (water and sanitation as human rights). However, as time passes, displaced persons are eventually expected to pay for access (water and sanitation as infrastructure services). Drawing from statistical modeling of survey data from German residents, we find the average length of time for this transition in 2016 Germany was 2.9 years. The data also show statistically significant demographic and locational attributes that influence this time frame, indicating the normative length of the transition from a right to a service is contextually dependent. Regardless, this is a significant period of time that the public expects utilities to provide services to unexpected displaced persons. To be able to meet this kind of demand, utilities, engineers, and policy makers must consider the potential for displaced populations in their regular, long-range utility planning.

Self-assessments and determinants of HRQoL in a German MS population.

The importance of health-related quality of life (HRQoL) in multiple sclerosis (MS) is widely acknowledged. In 2015, a multicenter study was launched to assess the HRQoL and coping styles of chronically ill persons in Germany. The aims of this paper were (i) to describe how persons affected by MS assess their HRQoL and (ii) find out sociodemographic and disease-specific determinants of HRQoL. A quantitative survey (optionally per paper-pencil or online) was conducted between March and October 2015 in Germany. Recruitment ways were as follows: Associations of the German Multiple Sclerosis Society (DMSG), medical practices specialized in neurology/MS, hospitals, public events, social networks, and self-help clearinghouses. To measure HRQoL, the Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire and the short form of the Fear of Progression Questionnaire (FoP-Q) were used. A total of 1220 individuals with MS participated in the study. Frequent problems reported were related to activities of daily living as well as sentimental and sexual life. Multiple regression analyses identified disease severity and comorbidity-in different directions (positive and negative)-as the strongest factors in predicting activities of daily living, symptoms, sentimental and sexual life, and reject. The demographic variables sex, age, education, and employment status also have different impact on the HRQoL. Using HRQoL measures can be feasible outcomes in addition to clinical assessments of MS and other chronic diseases and can help better managing the care. Some challenges have to be taken into account involving patients and the limitations of our empirical study.

Verhandelte (Un-) Freiheit

Abstract The Holy Roman Empire of the German Nation is usually not perceived as a slave-holding state. Still, German envoys, merchants, missionaries, and soldiers brought back trafficked people with them – very often via other European countries and colonies. As in neighboring jurisdictions, the legal status of these trafficked persons in Germany was far from clear. Drawing on diverse court cases, this article shows how slave-holders and the enslaved sought legal arguments for their cause by activating networks and searching for precedents beyond the empire’s borders. The German case not only documents the explicit affirmation of the slave status but also reveals its entanglements with serfdom.

Differences in welfare take-up between immigrants and natives – a microsimulation study

PurposeInternational empirical evidence suggests that immigrants have a significantly higher risk than their native counterparts of being on welfare due to their observed characteristics. Nevertheless, it remains unclear if immigrants are also more prone to take-up benefits, conditional on being eligible. The authors explicitly focus on this potential explanation for higher welfare take-up rates. Therefore, the purpose of this paper is to analyze the take-up of social assistance in Germany by immigrants and natives, conditional on being eligible, and hence focus on take-up behavior rather than on determinants of eligibility.Design/methodology/approachTo simulate welfare entitlements, the authors employ a Tax-Transfer Microsimulation Model. It is a static microsimulation model that consists of a detailed implementation of the German tax and transfer system as well as an econometrically estimated labor supply model. After the simulation of welfare entitlements, the authors analyze take-up behavior within a discrete choice framework. The authors estimate probit models of observed welfare benefit take-up for the sample of eligible households taking into account unobserved heterogeneity.FindingsThe estimation results do not reveal a significant effect of being a migrant on the probability of taking-up entitlements. The authors found a significant negative effect for citizens from European countries on the take-up probability, which disappeared after controlling for unobserved heterogeneity.Research limitations/implicationsThe authors find that it is worthwhile to focus on different groups of immigrants. Although not statistically significant, the rates of non-take-up of welfare benefits differ between different immigrant groups. The analysis further shows that controlling for unobserved heterogeneity is important when analyzing welfare differences between immigrants and natives.Practical implicationsThe higher welfare rates of immigrants are explained mainly by their higher risk of welfare dependence. Thus, given that reducing the welfare dependence of immigrants is a political goal, social policy measures to improve welfare recipients’ labor market prospects are contested. However, restricting eligibility rules to reduce entitlements does not seem to be the appropriate measure, because the take-up probability does not differ between immigrants and natives after controlling for individual characteristics.Originality/valueThe authors build on Castronova et al. (2001) and analyze the take-up behavior of individuals who are entitled to basic means-tested welfare benefits for employable persons in Germany. The analysis differs from Castronova et al. (2001) in four points. First, the authors provide first evidence of immigrant-native differences in welfare benefit take-up under the new welfare system in Germany after its reorganization in 2005. Second, the authors apply a microsimulation model of the comlete tax and transfer system in Germany to determine welfare eligibility. Third, the authors extend the analysis to a panel framework and take into account individual unobserved heterogeneity. Fourth, the authors distinguish between different groups of immigrants.

Insolvency of natural persons in Germany and Russia

The article analyzes the legal regulation of the insolvency of individuals in Germany and Russia. In German law the multipurpose bankruptcy procedure for individuals has been replaced by separate insolvency process for consumers and persons engaged in independent economic activity. Basically, in Russia multipurpose bankruptcy procedure has been introduced.

When the dying do not feel tabooed: perspectives of the terminally ill in Western Germany

This paper primarily examines the perspectives of dying persons in Germany, in terms of if and when the dying feels lonely during their final weeks. The author contrasts emic perceptions with public discourses in regards to the non-dying ones possibly neglecting or tabooing the terminally ill. Secondly, the paper explores how and where the dying persons included in the study want to pass away. The dying individuals involved did not feel tabooed or ignored by non-dying persons. Dying at home did not necessarily remain the preferred option compared to dying at institutions. The author collected data between 2013 and 2015 in Western Germany, using long-term participant observation and interviews with individuals diagnosed as terminally ill.

The Diagnosis, Treatment, and Follow-up of Renal Cell Carcinoma.

In 2014, 15 500 persons in Germany were given the diagnosis of renal cell carcinoma. This disease is the third most common cancer of the urogenital system. The mean age at diagnosis is 68 years in men and 71 in men. Pertinent publications up to 2014 were retrieved by a systematic literature search and reviewed in a moderated, formalized consensus process. Key questions were generated and answered by the adaptation of existing international guidelines, on the basis of an independent literature review, and by expert consensus. Representatives of 30 medical specialty societies, patient self-help groups, and other organizations participated in the process. The search for guidelines yielded 80 hits, 23 of which were judged by DELBI to be potentially relevant; 7 were chosen for adaptation. Smoking, obesity, and hypertension increase the risk of renal cell carcinoma. Its 5-year survival rate is 75% for men and 77% for women. Renal cell carcinoma accounts for 2.6% of all deaths from cancer in men and 2.1% in women. Nephrectomy and partial nephrectomy are the standard treatments. Locally confined tumors in clinical stage T1 should be treated with kidney-preserving surgery. Minimally invasive surgery is often possible as long as the surgeon has the requisite experience. For patients with metastases, overall and progression-free survival can be prolonged with VEGF and mTOR inhibitors. The resection or irradiation of metastases can be a useful palliative treatment for patients with brain metastases or osseous metastases that are painful or increase the risk of fracture. Minimally invasive surgery and new systemic drugs have expanded the therapeutic options for patients with renal cell carcinoma. The search for new predictive and prognostic markers is now in progress.

The Prevalence of Renal Failure. Results from the German Health Interview and Examination Survey for Adults, 2008-2011 (DEGS1).

The prevalence of non-end stage renal failure among adults in Germany is unknown. Accurate figures would enable us to estimate the overall need for kidney replacement therapies and the unexploited potential for disease prevention. Renal failure is also an important cardiovascular risk factor. Until now, American prevalence figures have often been applied to Germany despite dissimilarities between the two populations. We analyzed data on renal function from the nationwide German Health Interview and Examination Survey for Adults, 2008-2011 (DEGS1), which was carried out by the Robert Koch Institute. The glomerular filtration rate was estimated (eGFR) from the serum creatinine and cystatin C levels (CKD-EPI formula) and a semiquantitative measure of albuminuria. Relationships between renal failure and its possible determinants were quantified with adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI). Roughly 2.3% (95% CI: [1.9; 2.6 ]) of persons aged 18-79 had an eGFR below 60 mL/min/1.73 m2. The prevalence rose with age. We extrapolated these figures conservatively to persons aged 80 and above, who were not included in the DEGS1, and arrived at a figure of at least 2 million persons in Germany with renal failure. 11.5% of the population have albuminuria of at least 30 mg/L. Diabetes mellitus (PR = 2.25, 95% CI: [1.59; 3.16]) and arterial hypertension (PR = 3.46, 95% CI: [1.95; 6.12]) are important determinants. This study provides the first representative estimate of the prevalence of renal failure in Germany. The condition is highly dependent on age but less prevalent than previously assumed on the basis of American prevalence figures.

Pain medication in German nursing homes: a whole lot of metamizole.

Prescribing of metamizole (dipyrone), an analgesic that has been withdrawn from the market or never approved in many countries owing to safety concerns, is high in elder persons in Germany. This study assessed the use of pain medications in German nursing homes with a special focus on prescribing patterns of metamizole. Using data of the 'Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes' (IMREN) study conducted between October 2014 and April 2015 in nursing homes in Bremen and Lower Saxony, we studied prescribing of analgesics including both scheduled and as-needed medications. For residents with scheduled medication, dosage and duration of use were analysed. A total of 852 residents from 21 nursing homes were included. They were on average 83.5 years old, and 76.5% were women; 73.8% received at least one analgesic with 70.3% obtaining World Health Organization step I drugs. The most frequently prescribed substances were metamizole (for 40.6%) and paracetamol (acetaminophen; 35.6%), with paracetamol given mostly as-needed. The proportion of residents receiving metamizole increased with age (up to 47.4% in persons aged 90 years and over). Of 143 residents with scheduled metamizole (16.8%), the mean daily dosage was 1843 mg (interquartile range [IQR]: 1500-2250); 66.9% received metamizole for at least 90 days and 23.2% for at least 365 days (mean duration 276 days; IQR: 59-314). There is a discrepancy between prescribing of metamizole for older persons, on the one hand, and evidence on comparative effectiveness and safety as well as approval and recommendations, on the other hand. Copyright © 2016 John Wiley & Sons, Ltd.

The Economic Burden of Obesity in Germany: Results from the Population-Based KORA Studies

Objective: To estimate the excess costs of obese compared to normal-weight persons in Germany based on self-reported resource utilisation and work absence. Methods: Five cross sectional surveys of cohort studies in southern Germany were pooled resulting in 9,070 observations for 6,731 individuals (31-96 years). BMI was measured in the study centre. Self-reported health care utilisation and work absence was used to estimate direct and indirect costs for the year 2011 based on unit costs. Using regression analyses, adjusted costs for different BMI groups were calculated. Results: Overweight and obese people showed significantly higher odds of health care utilisation and productivity losses compared with normal-weight people in most categories. Total direct/indirect costs were significantly higher with increasing severity of obesity (pre-obese (1.05 (0.90-1.23) / 1.38 (1.11-1.71)), obesity level I (1.18 (1.00-1.39) / 1.33 (1.02-1.73)), obesity level II (1.46 (1.14-1.87) / 1.77 (1.18-2.65)) or level III (2.04 (1.40-2.97) / 1.99 (1.20-3.30)) compared to normal-weight participants. In particular, higher obesity classes were significantly associated with increased costs for medication, general practitioner utilisation and work absence. Conclusion: Our results show that overweight and obesity are associated with enormous societal direct and indirect costs in Germany. This supports the evidence from previous top-down studies, but provides important new information based on a large pooled data set and measured BMI.

Frailty in Germany: status and perspectives : Results from a workshop of the German Society for Epidemiology

A standardized, valid and comparable operationalization and assessment of frailty in population-based studies is essential in order to describe the prevalence and determinants of frailty in the population. After an introduction to the subject the main goal of a workshop at the 9th annual meeting of the German Society for Epidemiology (DGEpi) was to present approaches and results from four different studies in Germany. The following four population-based studies were used to describe frailty in Germany: the German health interview and examination survey for adults (DEGS1), the epidemiological study on the chances of prevention, early recognition and optimized treatment of chronic diseases in the older population (ESTHER), the cooperative health research in the region Augsburg (KORA Age) study and the longitudinal urban cohort ageing study (LUCAS) in Hamburg. The four studies consistently showed that frailty is widespread in older and oldest-old persons in Germany. It is obvious that frailty represents a relevant concept in Germany even if there is currently no uniform basis for operationalization. Concepts and instruments for the collation of frailty should be included in future population-based studies in order to make a better assessment of older people's health situation and to describe the unused potential for prevention in an aging society.

Treatment Options for Statin-Associated Muscle Symptoms.

About 4.6 million persons in Germany are now taking statins, i.e., drugs that inhibit the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase. Statins lower the concentration of low-density lipoproteins (LDL) and thereby lessen the rate of cardiovascular events; the size of this effect depends on the extent of lowering of the LDL cholesterol concentration. Muscle symptoms are a clinically relevant side effect of statin treatment. This review is based on pertinent publications retrieved by a selective literature search, and on the current recommendations of the European Atherosclerosis Society. At least 5% of patients taking statins have statin-associated muscle symptoms (SAMS). The etiology of SAMS is heterogeneous. SAMS may seriously impair quality of life and cause complications of variable severity, up to and including rhabdomyolysis (in about 1 in 100,000 cases). SAMS often lead to a reduction in the prescribed dose of the statin, while also negatively affecting drug adherence. More than 90% of patients with SAMS can keep on taking statins over the long term and gain the full clinical benefit of statin treatment after a switch to another type of statin or a readjustment of the dose or frequency of administration. If the LDL cholesterol concentration is not adequately lowered while the patient is taking a statin in the highest tolerable dose, combination therapy is indicated. SAMS are important adverse effects of statin treatment because they lessen drug adherence. Patients with SAMS should undergo a thorough diagnostic evaluation followed by appropriate counseling. In most cases, statins can be continued, with appropriate adjustments, even in the aftermath of SAMS.

Rates of pneumonia among children and adults with chronic medical conditions in Germany.

BackgroundThe objective of this study is to evaluate rates of all-cause pneumonia among “at-risk” and “high-risk” children and adults in Germany—in comparison with age-stratified healthy counterparts—during the period following the 2006 recommendation for universal immunization of infants with pneumococcal conjugate vaccine.MethodsRetrospective cohort design and healthcare claims information for 3.4 M persons in Germany (2009–2012) were employed. Study population was stratified by age and risk profile (healthy, “at-risk” [with chronic medical conditions], and “high-risk” [immunocompromised]). At-risk and high-risk conditions, as well as episodes of all-cause pneumonia, were identified via diagnosis, procedure, and drug codes.Results and discussionRates of all-cause pneumonia were 1.7 (95 % CI 1.7-1.8) to 2.5 (2.4-2.5) times higher among children and adults with at-risk conditions versus healthy counterparts, and 1.8 (1.8-1.9) to 4.1 (4.0-4.2) times higher among children and adults with high-risk conditions. Rates of all-cause pneumonia among at-risk persons increased in a graded and monotonic fashion with increasing numbers of conditions (i.e., risk stacking).ConclusionsAn increased risk for all-cause pneumonia in German children and adults with a spectrum of medical conditions persists in the era of widespread pneumococcal vaccination, and pneumonia risk in persons with ≥2 at-risk conditions is comparable or higher than those with high-risk conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1162-y) contains supplementary material, which is available to authorized users.

Working atmosphere in residential facilities for disabled persons in Germany

Working atmosphere in residential facilities for disabled persons in Germany

The Health Literacy Questionnaire: Translation and construct replication in 1,058 persons in Germany

Background Both the prediction and evaluation of outcomes from health interventions frequently rely on self-report data. As these have the potential to not only influence daily healthcare but also influence large-scale policy decisions, it is imperative that data collected are pertinent to patients, clinicians and other stakeholders. Consequently, researchers have an ethical responsibility to apply only those instruments that generate …