Services In Germany Research Articles

Sustainability in intensive and emergency care : Anationwide survey by the German Society of Medical Intensive Care and Emergency Medicine

The impact of climate change on humans is well known. However, the health care system is also arelevant contributor, accounting for up to 5-7% of global greenhouse gas emissions, and work should be adapted to be more sustainable. The survey investigated whether sustainability plays arole in hospitals and specifically in the field of emergency and intensive care. Concrete measures and which hurdles are already recognized were also inquired. The "AG Nachhaltigkeit" (working group on sustainability) of the "Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin" (DGIIN) conducted an electronic survey among the staff of intensive care units, emergency rooms, and ambulance services in Germany. In all, 218 survey results were included in the analysis: 108(50%) participants were from the nursing sector and 98(45%) belonged to the medical staff. The majority of participants work in an intensive care unit (181 [83%]) followed by intermediate care unit (52[24%]). A total of 104 (47%) participants indicated that their workplace had already implemented sustainability measures. However, when asked whether decision-makers in the workplaces incorporate sustainability into their decisions, management scored highest with only 20%. Potential for improvement is seen in energy and waste management, among others. The survey results show that (1)employees are highly motivated to address the issue of sustainability and to implement measures, (2)the potential to establish aresource-saving and environmentally friendly hospital is far from being exhausted, and (3)it must become apriority that decision-makers in the hospital propagate sustainability, make processes transparent, and support the motivation of employees on the subject of sustainability. In addition, this process must be supported by politicians and health insurance companies.

Well Advised

Abstract: Societal and scientific interest in the prediction and early diagnosis of Alzheimer’s disease is growing. However, decisions regarding early diagnosis must be well-considered. The decision-making process requires specific counseling for concerned individuals, which is currently missing. In our project “Well Advised”, we investigate the needs and expectations of people concerned about their memory regarding counseling services in Germany. Using a mixed-methods approach, we analyze the evaluative interviews from telephone counseling ( n = 44) and one expert focus group with 4 participants. Our evaluation shows a great need for information; the low-threshold telephone counseling service is appreciated. The topics of interest of those seeking advice concern medical-ethical issues of autonomy, the right (not) to know, and risk-benefit considerations. From these findings, we developed a training module and counseling guideline.

Automating the external placement of symbols for point features in situation maps for emergency response

ABSTRACT In this article, we address the time-critical work of emergency services in the field of disaster and emergency response. Aiming at saving valuable human and time resources during emergency operations, we present one exact and one heuristic approach for the automatic placement of tactical symbols in situation maps. Such maps are used to establish situational awareness and to convey mission-relevant information to emergency personnel. Usually, the information is communicated through the visualization of descriptive symbols which are predominantly placed in a manual process. We automate this process based on an established map layout used by emergency services in Germany that distributes the symbols to the map boundaries. Following general principles and observations from existing literature, we formalize the symbol placement as an optimization problem. We take into account the relevance of tactical symbols as well as short and crossing-free leaders and allow the grouped representation of symbols of similar semantics and spatially close map locations. In experiments with real-world data, we determine a balance between the optimization criteria and show that our heuristic generates high-quality results in less than a second. In an assessment by an expert, we get confirmation that our maps are suitable for use in emergency scenarios.

Gender-Atypical Learning Experiences of Men Reduce Occupational Sex Segregation: Evidence From the Suspension of the Civilian Service in Germany

Occupational sex segregation persists in part because men seldom enter female-dominated occupations. Whereas programs providing women with gender-atypical learning experiences aim to increase female representation in male-dominated domains, similar programs for men—despite their potential to counteract the prevailing lack of men in female-dominated occupations—are rare. In this paper, I investigate whether men’s gender-atypical learning experiences affect their likelihood of entering female-dominated occupations by studying the effect of participation in Germany’s civilian service. The civilian service offered a social-sector alternative to compulsory military service, and its suspension in 2011 induced exogenous variation in men’s gender-atypical learning experiences. Combining register data from Germany’s social security system with data from the German Microcensus shows that men’s likelihood of entering the labor market in female-dominated occupations declined by about 21 percent when the civilian service was suspended. Scaling the estimate by participation in the civilian service indicates that having completed the civilian service increased men’s likelihood of entering female-dominated occupations by about 12 percentage points. This illustrates that programs exposing men to gender-atypical learning experiences can promote occupational integration and could “unstall” the gender revolution.

“In some clinics, they said it’s elective, and then they would refuse”: A Mixed-Methods Study on the impact of the COVID-19 pandemic on access to abortion services in Germany

ObjectiveThe World Health Organization recognizes abortion as essential health care and has encouraged governments to ensure access to abortion services throughout the COVID-19 pandemic. However, the threat of infection combined with government responses to COVID-19 have impacted access to abortion services globally. This study explores access to abortion in Germany during the pandemic. MethodsThis study used a mixed-methods design. An analysis of data collected by Women on Web (WoW) was carried out to assess women’s reasons for choosing telemedicine abortion outside the formal health system in Germany during the pandemic. Descriptive statistics were generated for 2057 requests for telemedicine abortion received by WoW between March 2020-March 2021. Semi-structured interviews were conducted with eight healthcare professionals involved in the provision of abortion services to explore how they perceive of women’s access to abortion services in Germany during the pandemic. ResultsThe quantitative analysis found that preferences and needs for privacy (47.3%), secrecy (44.4%) and comfort (43.9%) were the most common reasons for choosing telemedicine abortion. COVID-19 was another important reason (38.8%). The thematic analysis of the interviews was organized into two overarching themes: service provision, and axes of difference. ConclusionsThe pandemic affected the provision of abortion services as well as the circumstances of women seeking abortion. The main barriers to access were financial constraints, privacy issues, and lack of abortion providers. Throughout the pandemic, accessing abortion services was more difficult for many women in Germany, especially women experiencing multiple and overlapping forms of discrimination.

Restructuring of health care services in Germany—a challenge and a chance for neurology!

Restructuring of health care services in Germany—a challenge and a chance for neurology!

Advanced producer services in Germany: a relational perspective on spatial core–periphery structures, 2009–19

ABSTRACT This paper challenges the traditional perspective of a territorial core–periphery pattern as an organizing principle of space by introducing a relational perspective through an empirical approach. We study spatial processes of knowledge creation among advanced producer services in Germany between 2009 and 2019. We use a unique longitudinal dataset to analyse if German regions have become more integrated into the intra-firm location networks nationally and globally, and how this translates into the processes of centralization and peripheralization. The current conceptualization of core–periphery in Germany is too static and does not reflect the economic development of the regions. We find that there is no trend of urban areas becoming more integrated and peripheral areas less integrated into these networks. Instead, our research finds a discrepancy between the federal territorial classification and the functional orientation of German regions. Regions classified as peripheral have not generally decreased in connectivity to other regions. In contrast, some have increased their connectivity and have become more central in relational terms. Overall, we identified peripheralization and centralization as a relational process with dynamic, overlapping and trans-scalar networks.

Ukrainian refugees in Germany – what are the consequences for mental health care services in Germany?

AbstractSince about a year there has been an influx of refugees from Ukraine due to the current war situation.Data on the mental health condition of Ukrainian refugees will be reviewed and compared to the mental health conditions to refugees from other parts of the world in Germany. Moreover, the psychosocial and socioeconomic situation of refugees from Ukraine will be reflected on the background of the situation of refugees from other countries.Conclusions from the recent experiences for the mental health care system will be drawn and discussed with the aufience in a European perspective. Special highlight will be given to pilot best practice modells for mental health care of Ukrainian refugees within the German mental health care system.Disclosure of InterestNone Declared

Actual status of early intervention services in Germany

AbstractWe will give an overview of the status of early intervention services for psychosis in Germany. We recently established a website which provides people in Germany with the nearest early detection an intervention service available (https://www.psycho-check.com). However, the overall implementation rate of early detction in Germany is quite heterogenous. We will also present recent research and ongoing projects from Germany including the first evaluation of specialized inpatient services for early psychosis, first evaluations of Individual placement and support and a mindfulness based group intervention in people with early psychosis as well as a newly desigend youth mental health service called soulspace (www.soulspace-berlin.de).Disclosure of InterestNone Declared

Conscription Reloaded? The Debate About Compulsory Service in Germany in 2022 and the Peoples’ Attitudes Towards It

Abstract In mid-2022, Federal President Frank-Walter Steinmeier spoke out in favour of introducing compulsory service in Germany. Against the backdrop of the Bundeswehr restructuring, necessitated by the war in Ukraine, and the worsening personnel shortage in the social sector and in nursing care, he revived a debate that had been recurring in Germany for decades. Based on an online survey of more than 7,300 people, this article examines how Germans feel about compulsory service and what factors are associated with this attitude. More than 63% of respondents are in favour of compulsory service. Psychological factors such as solidarity, sense of duty, extraversion and openness play just as important a role as political attitudes. People who position themselves more right-wing/nationalist/traditional view compulsory service more positively than liberal and left-wing respondents. In terms of voting intention, CDU/CSU and AfD supporters in particular support a general compulsory service, whereas it is less strongly supported by Greens, SPD and FDP supporters and even rejected by a majority of Left supporters. Another key factor for the evaluation of compulsory service is the respondents’ own experience with completed service. Respondents who have done military service view compulsory service more positively than those who have done community service. Those who have regular voluntary commitments also view compulsory service positively.

The health-related quality of life of older people through preventive home visits: A quantitative longitudinal study.

Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study. A quantitative longitudinal study in order to investigate the effects of preventive home visits. There were no ethical concerns. Accordingly, ethical approval was granted. The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form-Health-Survey-12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.

Influencing factors on the health of nurses—a regression analysis considering individual and organizational determinants in Germany

BackgroundThe care sector is characterized by high absenteeism of nursing care employees due to illness. Organizational determinants that can affect the mental health of nurses are known. Although nurses are confronted with different framework conditions in different care settings, there is a lack of comparative data in Germany.MethodsThe purpose of this study was to examined the relationship between work demands and employee health in different care settings. This cross-sectional survey was conducted between June and October 2021 in four acute care hospitals, seven inpatient care facilities, and five outpatient care services in Germany. 528 nursing care employees (acute care hospitals n = 234; inpatient care facilities n = 152; outpatient care services n = 142) participated in the survey (participation rate: 22.6%-27.9%). For each care setting, data was collected via questionnaire on individual determinants (gender, age, profession, working time), organizational work demands (quantitative workload, qualitative workload, organization of work, social work climate, after work situation, verbal violence, threats, physical violence) and employee health (subjective health status and work ability). Descriptive statistics and binary logistic regressions were performed.ResultsIncreasing age (OR = 0.650, 95% CI = 0.424—0.996) as an individual determinant and organization of work (OR = 0.595, CI = 0.362—0.978) as an organizational determinant were negatively associated with subjective health. Furthermore, age (OR = 0.555, 95% CI = 0.353—0.875), a demanding organization of work (OR = 0.520, CI = 0.315—0.858), increasing quantitative workloads (OR = 0.565, CI = 0.343—0.930) and a poorer perceived social work climate (OR = 0.610, CI = 0.376—0.991) were associated with lower work ability.ConclusionsBased on the study results, health programs should target both individual and organizational factors. The findings seem to support the importance to include nursing care employees in the planning process, as it can have an impact on their health.Trial registrationThe project was registered in the German Clinical Trial Register (DRKS00024961, 09/04/2021).

Maintaining acomprehensive provision of inpatient child and adolescent mental health services in the years to come-aGerman perspective

Aconsiderable number of child and adolescent psychiatry inpatient units in Germany suffer from asignificant shortage of doctors, which endangers the current system of nation-wide availability of high-quality child and adolescent inpatient services. Drawing on recent data, this article pictures the status quo of child and adolescent psychiatry inpatient services in Germany. The authors then discuss the pros and cons of different suggestions of how to cope with the doctor shortage crisis in child and adolescent psychiatry. The following options for action are suggested: reduction of service provision across the board, shift from personnel-intensive inpatient towards home-based treatment, trans-sectoral cooperation by means of tele-psychiatry, delegation of clinical responsibilities to psychologists, limiting ward physicians' tasks to mere medical care of patients, improvement of working conditions in inpatient units, recruitment of doctors from abroad, and increased recruiting efforts at medical school level. From the authors' viewpoint, the latter option offers the best chance of lasting success; however, this requires along-term, nationwide approach and considerable efforts of all departments involved.

Economic Evaluation of a Mobile Stroke Unit Service in Germany.

Lower global disability and higher quality of life among ischemic stroke patients was found to be associated with the dispatch of mobile stroke units (MSUs) among patients eligible for recanalizing treatments in the Berlin_Prehospital Or Usual Delivery of stroke care (B_PROUD) study. The current study assessed the cost-utility and cost-effectiveness of additional MSU dispatch using data from this prospective, controlled, intervention study. Outcomes considered in the economic evaluation included quality-adjusted life years (QALYs) derived from the 3-level version of EQ-5D (EQ-5D-3L) and modified Rankin Scale (mRS) scores for functional outcomes 3-months after stroke. Costs were prospectively collected during the study by the MSU provider (Berlin Fire Brigade) and the B_PROUD research team. We focus our results on the societal perspective. As we aimed to determine the economic consequences of the intervention beyond the study's follow-up period, both care costs and QALYs were extrapolated over 5 years. The additional MSU dispatch resulted in an incremental €40,984 per QALY. The best-case scenario and the worst-case scenario yielded additional costs of, respectively, €24,470.76 and €61,690.88 per QALY. In the cost-effectiveness analysis, MSU dispatch resulted in incremental costs of €81,491 per survival without disability. The best-case scenario and the worst-case scenario yielded additional costs of, respectively, €44,455.30 and €116,491.15 per survival without disability. Among patients eligible for recanalizing treatments in ischemic stroke, MSU dispatch was associated with both higher QALYs and higher costs and is cost-effective when considering internationally accepted thresholds ranging from an additional €40,000 to €80,000 per QALY. ANN NEUROL 2023;93:942-951.

Running low on state-capacity: strengthening EU mobile workers’ rights by outsourcing enforcement? The role of advisory services in Germany

During the Covid-19 pandemic, the precarious working and living conditions of mobile workers made headlines across Europe. The challenges of securing better working conditions are inherent in the integration of the European single market, which removed market barriers while leaving the enforcement of labour rights to national institutions. At the same time, representing workers’ interests in a cross-border context poses difficulties regarding organisation and access. This paper focuses on the role of civil society actors in the cross-border enforcement process by examining the role of advisory services in Germany. To what extent can these new structures fill existing gaps in the enforcement of labour rights and the representation of the interests of mobile workers? Where do they reach their limits? Empirically, this paper draws on documents, reports and semi-structured expert interviews. The data was analysed using qualitative text analysis. Drawing on the literature on interest representation and the enforcement of EU law, I examine the position of these services in the enforcement process along the lines of the fire-alarm vs. police-patrol dichotomy. I argue that these advisory services function as a “sponsored” fire-alarm, compensating for some of the institutional shortcomings but falling short of structural improvements beyond individualised support.

Striking Evidence: The Impact of Railway Strikes on Competition from Intercity Bus Services in Germany

Striking Evidence: The Impact of Railway Strikes on Competition from Intercity Bus Services in Germany

Assessing Differences in Attitudes toward Occupational Safety and Health Measures for Infection Control between Office and Assembly Line Employees during the COVID-19 Pandemic in Germany: A Cross-Sectional Analysis of Baseline Data from a Repeated Employee Survey.

In our study, we investigated possible differences across occupational groups regarding employees’ perceived work-related risk of infection with SARS-CoV-2, attitudes toward technical, organisational, and personal occupational safety and health (OSH) measures for infection control, and factors associated with this attitude. We analysed baseline data (10 August to 25 October 2020) from a repeated standardised online survey distributed at a worldwide leading global supplier of technology and services in Germany. 2144 employees (32.4% women; age (mean ± SD): 44 ± 11 years) who worked predominantly remotely (n = 358), at an on-site office (n = 1451), and assembly line/manufacturing (n = 335) were included. The work-related SARS-CoV-2 risk of infection differed between office employees working remotely and on-site (mean ± SD = 2.9 ± 1.5 vs. 3.2 ± 1.5; Mann-Whitney-U-Test: W = 283,346; p < 0.002; ε2 = 0.01) and between on-site office and assembly line/manufacturing employees (3.8 ± 1.7; W = 289,174; p < 0.001; ε2 = 0.02). Attitude scores toward technical OSH-measures differed between remote and on-site office (4.3 ± 0.5 vs. 4.1 ± 0.6; W = 216,787; p < 0.001; ε2 = 0.01), and between on-site office and assembly line/manufacturing employees (3.6 ± 0.9; W = 149,881; p < 0.001; ε2 = 0.07). Findings were similar for organisational and personal measures. Affective risk perception, COVID-19-specific resilience, and information about COVID-19-related risks were associated with the employees’ attitudes. To promote positive attitudes, it seems to be important to consider occupational-group-specific context factors when implementing OSH-measures for infection control.

The Landscape of Outpatient Palliative Care in Germany: Results from a Retrospective Analysis of 14,792 Patients.

Palliative care comprises multiprofessional, integrated, person-centered healthcare services for patients and their families facing problems related to progressive or advanced diseases and limited life expectancy. Although non-oncology patients' needs are similar to those of tumor patients, they are often underestimated. The purpose of our study was to investigate the actual utilization of palliative care services in Germany, especially in the outpatient setting. Using the IQVIA Disease Analyzer database, a total of 14,792 outpatients from 805 primary care practices in Germany with documented palliative care and related diagnosis between 2018 and 2021 were analyzed. Proportions of different diagnoses among patients receiving outpatient palliative care were stratified by gender and different age groups. The most common underlying diagnosis for outpatient palliative care was cancer (55%), followed by heart failure (16%) and dementia (8%), with age- and sex-specific differences found in the proportion of diagnoses for utilization. While the relative proportions of cancers decreased with age (87% in the 18- to 50-year-old age group versus 37% in the 80-plus age group), the proportion of palliative care related to heart failure increased in the older population (2% in the 18- to 50-year-old age group versus 25% in the 80-plus age group). This study provides an overview of the situation of outpatient palliative care in Germany and shows age- and gender-specific trends regarding the underlying medical diagnoses. Based on these data, palliative care should be adapted to current demographic developments.

Opportunities to increase the attractiveness of the German Public Health Service as an employer

Abstract For decades, the public health service in Germany (PHS) experienced shortages of young professionals and challenges in recruiting qualified personnel. To sustainably counteract this challenge, it is necessary to understand the reasons of the perceived low attractiveness of PHS as a potential employer among students and young professionals. Two cross-sectional online surveys were conducted to assess the attitudes of medical, public health, and health science students towards the PHS as a potential employer. Wave 1, conducted from 2019-12 to 2020-04, focused on factors associated with high and with low interest in working for the PHS. Wave 2 was conducted from 2020-06 to 2020-09 to capture changes that may have resulted from the newfound attention of the PHS during the SARS-CoV-2 pandemic. Participants in both waves were asked about opportunities to increase the attractiveness of the PHS, which were analyzed using qualitative content analysis. In total 3040 students participated. Low interest in the PHS was associated with limited knowledge about public health, primary interest in clinical medicine, and a negative image of the public service. The qualitative analysis indicated as major obstacles: low visibility of and low awareness about the PHS, a perception of hierarchical and bureaucratic workplaces, and perceptions of repetitive occupations, among others. The participants suggested: improving awareness about the PHS in the population, including PHS in curriculum, and reducing entry barriers for non-medical students. The results of the largest survey of students on the attractiveness of the ÖGD in Germany provide valuable insights for ongoing reform processes. In addition to approaches to increase external visibility, existing processes and procedures within the ÖGD should be considered. Key messages • To counteract the shortage of skilled workers, the PHS must become more attractive to young professionals. This requires both, greater external visibility and modernization of internal structures. • Successful inclusion of the perspective of young professionals in the current modernization processes introduces opportunities to increase the attractiveness of the PHS in the long-term.

Making Regional Railroads More Attractive—Research Studies in Germany and Patronage Characteristics

This article summarizes current research on regional rail passenger service in Germany. The aim of the research was to help rail operators, municipalities along the rail lines, and transportation planners identify the most effective strategies for improving rail service and patronage. The article outlines study contents and purpose and then summarizes the most important study findings. It also presents action and research recommendations. In addition, current rail developments in Germany and methods for increasing patronage and reducing costs with special focus on the separation of infrastructure and operations are described. Finally, patronage data for different rail segments are compared to help determine whether improvement measures should be applied and what impacts they could have on patronage.