Situation In Germany Research Articles

Dominant HPAIV H5N1 genotypes of Germany 2021/2022 are linked to high virulence in Pekin ducklings

Highly pathogenic avian influenza viruses (HPAIV) of H5 clade 2.3.4.4b pose an ongoing threat worldwide. It remains unclear whether this panzootic situation would favor low virulent phenotypes expected by the ‘avirulence hypothesis’ of viral evolution. Assessing virulence in Pekin ducklings in an intramuscular infection model revealed that the two genotypes that dominated the epidemiological situation in Germany during the period 2021 and 2022 (EU-RL:CH and EU-RL:AB) were of high virulence. In contrast, rare genotypes were of intermediate virulence. The genetic constellation of these reassortants pointed to an important role of the viral polymerase complex (RdRP), particularly the PB1 genome segment, in shaping virulence in ducklings. Occulo-nasal infection of ducklings confirmed the phenotypes for two representative viruses and indicated a more efficient replication for the high virulence strain. These observations would be in line with the ‘virulence-transmission trade-off’ model for describing HPAIV epidemiology in wild birds in Germany.

Standardized diagnosis of gastrointestinal tumors: an update regarding the situation in Germany.

To evaluate the current status of the diagnosis of gastrointestinal tumors in Germany by means of a survey of the oncological imaging working group of the German Radiological Society (DRG) with a focus on the CT protocols being used.Radiologists working in outpatient or inpatient care in Germany were invited. The survey was conducted between 10/2022 and 06/2023 using the SurveyMonkey web tool. Questions related to gastrointestinal cancer were asked with regard to the commonly used imaging modalities, body coverage, and contrast agent phases in CT as well as the use of oral or rectal contrast. The results of the survey were analyzed using descriptive statistics.Clear differences were identified regarding the acquired contrast phases in relation to the place of work - outpatient care, smaller hospitals, maximum care hospitals, or university hospitals. Variances were also recognized regarding oral and rectal contrast. Based on the results and international guidelines, proposals for CT protocols were derived.CT protocols in Germany show a heterogeneous picture regarding acquired contrast phases, as well as oral and rectal contrast for the staging of gastrointestinal cancer. Clear recommendations in the respective guidelines would aid in quality assurance and comparability between different centers. · The examination protocols for the staging of gastrointestinal tumors are heterogeneous in Germany.. · The application of oral and rectal contrast is handled differently at the various radiological centers.. · Standardization of imaging should be targeted.. · Gerwing M, Ristow I, Afat S et al. Standardized diagnosis of gastrointestinal tumors: an update regarding the situation in Germany. Fortschr Röntgenstr 2024; DOI 10.1055/a-2378-6451.

Making a case for computer literacy: the German Informatics Society and the emerging field of computer education, late 1960s–early 1990s

ABSTRACT This article examines the historical contribution of the German Informatics Society (GI) to the establishment of computer education in German schools. It highlights the role of societal interests, international developments, public and professional debates, and technological change in the GI’s educational policy recommendations. The historical source base consists of conference proceedings, position papers and other publications by key actors within and outside the GI. Methodologically, the article refers to the concept of strategic fields of action. The article shows how the GI’s understanding of computer science played an important role in its initial policy recommendations. With increasing computerisation and then the World Wide Web, the GI had to adapt its recommendations to the now more complex situation in Germany and the polyphonic debate.

From Contrarian to Propositional Speech: The Neue Rechte and Völkische Siedler in Germany

This essay explores how the contemporary German far-right ( Neue Rechte) positions itself as contrarians and cultural/political dissidents. The essay argues that the Neue Rechte is engaging more effectively with the current political and socio-economical situation in Germany than the Alte Rechte (Old Right), and in recruiting members to build up strong national and international networks. We will see how the Neue Rechte (New Right), by positioning themselves as contrarians and dissidents, adapts and appropriates symbols and ideas from a wide range of political groups, including their opponents. Moreover, for the far-right creating new forms of communal life constitutes a form of assertive non-verbal contrarianism.

Perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women: results of the pregnancy and obstetric care for refugees (PROREF) cross-sectional study.

International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))? In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data. During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status. Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia.

Routine Data Analysis of HIV Pre-Exposure Prophylaxis Use and Rates of Sexually Transmitted Infections Since Coverage of HIV Pre-Exposure Prophylaxis by the Statutory Health Insurance in Germany

Human immunodeficiency virus pre-exposure prophylaxis (PrEP) is considered as an effective protection against a human immunodeficiency virus (HIV) infection. However, it is still unclear, how PrEP use is associated with the incidence of sexually transmitted infections (STI) other than HIV. PrEP became reimbursable in Germany from September 1, 2019 for persons with statutory health insurance (SHI). With the EvE-PrEP study, the Federal Ministry of Health commissioned the evaluation of the effects of the new reimbursement situation in Germany. In the presented module of the EvE-PrEP study, routine data from three large German SHI funds were analyzed in anonymized form for the period January 1, 2019 to March 31, 2020. Data were analyzed regarding: Characteristics and adherence of PrEP users, treatment success of PrEP, and changes in STI incidence rates before and since PrEP use. The cooperating SHI funds collectively covered about 52% of the overall population in Germany in 2019. A total of 7102 persons with PrEP use were included into the analysis. These were predominantly male (99%), on average 37.4 years old and a high proportion of persons lived in large cities. The average quotient of PrEP daily defined doses and assumed days on PrEP was 87%. The average STI rates normalized per 100 person-years at individual level pre PrEP did not statistically significant differ compared to since PrEP (chlamydia: 17.5 vs. 17.6, gonococcal infection: 29.1 vs. 30.7, and syphilis: 14.6 vs.13.6). A large data set was used to evaluate the introduction of PrEP as a SHI benefit in Germany. A potentially suspected increase in bacterial STI incidence rates was not found. A rather high average adherence rate was observed. The very high proportion of men and people from the largest German cities among PrEP users is striking. These results could indicate barriers to PrEP access for people at risk of HIV, especially if they are women or people living in less urban areas.

Dealing with Evidence in Dental Professional Liability Lawsuits-General Recommendations for Dental Expert Witness Work Using the Example of Germany: A Narrative Review.

Dental treatment can lead to disputes between patients and dentists, which are then brought before the civil courts as medical malpractice cases. The court regularly commissions a dental expert to answer questions of evidence in court. In the majority of cases, the expert is able to answer these questions based on his professional expertise and practical experience. In order to make the assessment comprehensible and credible for the judge and the parties, it can be helpful and reasonable to cite relevant literature references from dental textbooks and specialist journals. In individual cases, it may be necessary to carry out a systematic literature search on specific topics. Based on the situation in Germany, this narrative review makes recommendations of how to perform a literature search and make citations specifically for expert opinions that are generally applicable independent of national jurisdiction.

Farmers’ satisfaction and cooperation in conflicts about river restoration in Germany. What influence have economy and participation?

Interest conflicts between agriculture and river restoration are core biodiversity protection problems, as farmers' non-cooperation can be an obstacle to implementing river restoration processes within the context of the EU's Water Framework Directive (WFD). A central issue is ensuring farmers' satisfaction that affects their willingness to cooperate (WTC) in situations of economic losses.During the last years, participation measures were implemented to address this problem and to complement existing information and compensation measures. Focusing on the situation in Germany, we examine the effect of economic factors and procedural measures on farmers' satisfaction and WTC. For this reason, we conducted a structured telephone survey with 300 farmers impacted by river restorations. We investigated the effect of their economic situation, economic impairment, and participation processes on farmers' satisfaction with the project outcome, satisfaction with the participation process, and WTC. We conducted correlation and regression analysis to find relations and effects within the data. The analysis reveals four results: 1) Income situation, soil number of the affected land, and perception of land pressure are economic factors with (negative) effect on farmers' satisfaction. 2) Compensation and participation measures partly positively affect farmers' outcome and procedure satisfaction. 3) Direct talks to planners are mostly the salient significant participation procedure. 4) Satisfaction with the project's outcome and satisfaction with the participatory procedure have considerable explanatory power considering WTC. Our results provide essential information for policymakers and administration in biodiversity protection in general and river restoration in particular. They indicate that involving farmers in planning river restoration measures, assuring high transparency and inclusiveness, and convincing farmers of the reasonableness of the measure is of the same importance to achieve satisfaction and WTC as only focusing on compensation measures.

Between nature and culture - Interpreting students' sexuality in physical education.

As sexuality in physical education (PE) is often treated as a taboo subject, social media platforms, online chats, and internet forums are emerging as spaces where it is negotiated more openly and broadly by current and former actors of the field. This paper contributes to a better understanding of the discursive construction of sexuality in PE in such online communication. In line with The Sociology of Knowledge Approach to Discourse (SKAD) we investigate basic schemes of interpretation of sexuality with a heterogeneous sample of threads (17 threads from seven different online forums) on different PE situations in Germany. The threads are analyzed using grounded theory coding procedures. Our discourse analysis reveals that the multifaceted and often controversial online discussions are structured by two dominant schemes of interpreting students' sexuality in PE, both of which are differentiated in complex ways: The online communication draws on - and by that reproduces - a nature and a culture perspective on constellations of body, sex, gender, and sexuality. We detail how from each perspective, different knowledge about these constellations, different everyday phenomena and problems in PE, and different norms for dealing with these phenomena and problems become important. Discussing these results in the context of previous literature, we argue that it is important to address sexuality in a subject-specific approach and take the discursive knowledge and fundamental schemes of interpretation into account that shape the (im-)possibilities of addressing sexuality in PE.

Green and competitive: who influences the development of advanced frugal product characteristics?

ABSTRACT The societal shift to a greener economy is subject to a trade-off. Green products are often more expensive than conventional products, making them less attractive and thus slowing down the transition. Advanced Frugal Innovations overcome this trade-off and are able to accelerate the transition through the inclusion of broader population groups. Based on a company survey, this research examines the influence of societal actors on green and cost-related product attributes that influence this trade-off using correlation analyses and meaningful illustrations. Using the German manufacturing sector as an example, this new database provides first empirical results that illustrate how societal and systemic agents affect the development of green and competitive products. The results indicate that the societal and systemic situation in Germany has an inhibiting effect.

The Role of the Social Partners and the ‘Overall protection of temporary agency workers’: The ECJ decision in the TimePartner case and the legal and actual situation in Germany

This article critically examines the European Court of Justice's (ECJ) decision in the TimePartner case and its implications for labour market integration in the context of temporary agency work. The author supports the ECJ's position on the rule-exception relationship within Directive 2008/104/EC, emphasising equal treatment for temporary agency workers. The analysis explores the alignment between the ECJ's approach and the Directive's goal of creating a non-discriminatory, transparent, and proportionate framework for worker protection. Within the German legal landscape, where there has been reluctance to implement the Directive, complex collective agreements have led to substantial remuneration disparities between regular employees and temporary agency workers. The absence of statutory regulations on overall protection for temporary agency workers, coupled with reluctance on the part of courts to intervene in collective agreements, presents challenges for labour market integration. The article also addresses the assumption of an inherent warranted correctness of collective agreements and its potential implications for EU law enforcement, recognising this may limit the judicial review of collective agreements for compliance with EU Directives, potentially undermining EU law effectiveness. In conclusion, this analysis sheds light on the consequences of the ECJ's TimePartner case decision, particularly in Germany, and suggests the need for more detailed, industry-specific collective agreements to better meet the Directive's requirements.

The Epidemiology of Glaucoma - an Age-Related Disease.

Epidemiological studies describe the distribution of glaucoma and its risk factors in the general population. Epidemiological findings from population-based studies were extrapolated for the situation in Germany, in order to estimate current and future prevalence of glaucoma by using official population statistics for Germany. The prevalence of glaucoma in the adult population above 40 years of age is currently 2.1%, resulting in 980 thousand subjects with glaucoma, plus at least one more million subjects with ocular hypertension (OHT). Two thirds of all glaucoma cases are above 70 years of age. By 2060, the prevalence of glaucoma will increase to 2.8%, due to the aging of the population. Despite a decrease in the population size, glaucoma will become more prevalent in the future.

Proton Pump Inhibitors in Germany: Status Quo of a Growing Market.

The volume of prescriptions for proton pump inhibitors (PPIs) remains high, although the literature increasingly points to excessive prescribing in relation to guideline recommendations. No very recent data is available on the specific situation in Germany, particularly on the proportion of PPI consumption from over-the-counter (OTC) sales and self-selection, following PPI down-scheduling. The aim of this study was to determine the actual amount of prescribed and OTC PPIs in Germany. For this retrospective study, several IQVIA databases were used, representing all prescriptions billed to statutory and private health insurers in Germany, as well as OTC sales. Analyses were performed for the period November 2020 to October 2021 or partially November 2018 to October 2021 and were descriptive in nature. Mainly, data were collected from IQVIATM PharmaScope National® as well as IQVIA TM DPM® databases. A total of 2.87 billion PPI tablets were shown to have been sold between November 2020 and October 2021, with most drugs prescribed in the largest packages and strengths. In addition, the OTC PPI market increased by an average of 14% per year over a 3-year period. The results of this study suggest the substantial size of the PPI market in Germany is based on prescriptions, a consistent increase in OTC PPI purchases and a recent increase in prescriptions.

Testing Heinz Kohut’s thoughts on narcissism and narcissistic rage: narcissistic injury paves the way for radicalization and subclinical paranoid states – an experimental study

According to psychoanalytic self-psychological theory, narcissistic injuries may induce radical intentions, and subclinical paranoid states via self-psychological mechanisms. The testing took place in a narcissistic-injuring situation in Germany, where a reform of psychotherapy-training was implemented with only brief period of transition for those aiming to become psychotherapists after graduating. Within a randomized controlled-experimental design, 100 psychology-students were to read information about short transition-periods for them (affectedness-by-the-reform-condition) vs. for education-students (no-affectedness-by-the-reform-condition). After reading a radicalization-prompt, discussing in a 30-minute-group-discussion, participants in both conditions completed dependent measures of separatist identification, negative affects, overconfidence, radical intentions and subclinical paranoid states. Compared to the control condition (n = 49), psychologists in the experimental-condition (n = 51) stronger experienced narcissistic injury (d between 0.79 and 1.01; manipulation-check). They experienced a stronger alloyance with an archaic-omnipotent object (d = 0.52), exhibited more negative affects (d = 0.46), claimed overconfidence (d = 0.50), more radical intentions (d = 0.52), and subclinical paranoid states (d = 0.43). Our study supports Kohut’s idea that antisocial as well as paranoid states are responses to narcissistic injuries mediated by the alloyance with an archaic-omnipotent object, negative affects and overconfidence.

Academic education of midwives in Germany (part 1): Requirements for bachelor of science programmes in midwifery education. Position paper of the Midwifery Science Committee (AHW) in the DACH Association for Medical Education (GMA).

The current situation in Germany is characterised by significant differences between the two types of higher education institutions offering bachelor's degree programmes in midwifery at both universities of applied sciences and universities. These differences are noticeable in admission procedures, resource allocation, content focus and competence assessment at the respective institutions, which in turn result in heterogeneous study experiences. This article highlights the challenges currently facing bachelor degree programmes and the academic qualification of midwives, and identifies future requirements for the development of degree programmes in theory and practice as well as theory-practice transfer, and assessment formats. Furthermore, this article covers the content-related and structural-organisational requirements to develop in-depth academic skills grounded in theory teaching, the facilitation of clinical placements at an academic level, the training of qualified practical instructors and the development of applicable competence-based assessment formats, especially for the state exam. The development of a standardised, high-quality academic education for midwives in Germany requires networking of the different academic sites/locations to exchange experiences in teaching/learning and assessment formats. Furthermore, it can facilitate the development of a standardised competence-oriented model and core curriculum as well as the definition of quality criteria and standards for study programmes of midwifery science. The Midwifery Science Committee (AHW) in the DACH Assoviation for Medical Education (GMA) offers an optimal platform for cooperation between the different universities. The existing challenges for the further professional development of midwives can only be overcome by collaboration and pooled expertise.

Discursive means and tactics of forming the media image of the president of Russia in the German political media discourse

The relevance of the study is determined by the practical necessity of a systematic research of linguistic and pragmatic aspects of communicative tactics and discursive means actualization in forming the media image of V. V. Putin, the president of Russia, in the political media discourse during the period of aggravation of the information-psychological warfare of the collective West in regard to the Russian Federation and, in particular, to the President of the Russian Federation V. Putin, in the context of the Special Military Operation (SMO) in Ukraine. The authors aim to determine the communicative tactics and discursive means of forming the media image of the President of Russia, as well as to identify his media portrait in the current political situation in Germany. The present study offers a theoretical review of modern Russian and foreign studies, devoted to the definition of media image. The material of the present study is the documentary film “Putin – Der gefährliche Despot” (ZDF). The research is based on N. B. Ruzhentseva and O. L. Mikhaleva’s classification of communicative tactics and is carried out with the help of the methods of continuous sampling, discourse analysis, contextual analysis, as well as the method of quantitative calculation. The authors identify 17 main communicative tactics and discursive means of forming the media image of the President of Russia used in 80 contexts. The obtained findings allow to demonstrate the linguistic manifestation of the critical, distrustful and wary position of Germany towards Russia and V. Putin; the presence, to a greater extent, of predominantly negative judgments about the personality of the President of Russia and his activities in the political arena; Germany’s desire to discredit Russia and its President at the federal level in the eyes of its population through the use of a diverse array of communicative tactics and discursive means of speech influence.

Involving patients to promote patient safety in healthcare facilities in Germany

Background: Proactive involvement of patients in the design of safe care is a WHO-defined goal of the current decade. This paper investigated (a) which patient involvement activities and measures are implemented in German health care facilities for patient safety, and (b) which recommendations for action can be derived for our health care facilities. Aim and method: A literature and Internet search was conducted on institutional practices and organizational activities in Germany to improve patient safety with the involvement of patients. Interviews with five experts were conducted who advised our approach. An agenda for future research projects and first recommendations for clinical practice was formulated afterwards. Results: The evidence base on established measures to incorporate patient perspectives into the strategic promotion of patient safety in healthcare facilities in Germany is scarce and inconsistent. Patient surveys and the use of patient advocates are common. It remains unclear how patient councils as well as self-help groups have the potential to contribute to the promotion of patient safety in practice. Conclusions and agenda: An agenda is proposed. A more in-depth empirical survey and description of the situation in Germany, taking into account the experience of experts from clinical practice, is necessary to obtain a complete picture of the currently established measures for patient involvement, to uncover potential for realization and to define necessary framework conditions.

Development of an early alert model for pandemic situations in Germany

The COVID-19 pandemic has pointed out the need for new technical approaches to increase the preparedness of healthcare systems. One important measure is to develop innovative early warning systems. Along those lines, we first compiled a corpus of relevant COVID-19 related symptoms with the help of a disease ontology, text mining and statistical analysis. Subsequently, we applied statistical and machine learning (ML) techniques to time series data of symptom related Google searches and tweets spanning the time period from March 2020 to June 2022. In conclusion, we found that a long-short-term memory (LSTM) jointly trained on COVID-19 symptoms related Google Trends and Twitter data was able to accurately forecast up-trends in classical surveillance data (confirmed cases and hospitalization rates) 14 days ahead. In both cases, F1 scores were above 98% and 97%, respectively, hence demonstrating the potential of using digital traces for building an early alert system for pandemics in Germany.

Beyond one-sided expectations of integration: Rethinking international nurse migration to Germany

Abstract Background Like most countries, Germany is currently recruiting international nurses due to staff shortages. While these are mostly academic, the academisation of nursing in Germany has only just begun. This allows for a broader look at the participation of migrant nurses: How do care teams deal with the fact that immigrant colleagues are theoretically more highly qualified than long-established colleagues? Methods Case studies were conducted in four inpatient care teams of two hospitals in 2022. Qualitative data include 26 observation protocols, 4 group discussions and 17 guided interviews. These were analysed using the documentary method and validated intersubjectively. Results Due to current academisation efforts in Germany and the immigration of academised nursing staff from abroad, the areas of activity and responsibility of nursing in Germany are under negotiating pressure. This concerns basic care for example, which in Germany is provided by skilled workers, but in other countries is mostly provided by assistants or relatives. The question of who should provide basic care, whether all nurses or only nursing assistants, documents the struggle between an established and a new understanding of care. In this context, the knowledge and skills of migrant and academicised care workers become a crucial aspect in the struggle for a new professional identity for care in Germany. Conclusions The specific situation in Germany makes it possible to show the potential for change that international care migration can constitute for destination countries. The far-reaching process of change of German nursing is given a further dimension not only by its academization, but by the immigration of international and academically trained nursing staff, where inclusive or exclusive effects can already be observed. Key messages • The increasing proportion of migrant nurses accelerates the current discussion on nursing in Germany. • Conflict areas show up in everyday work of care teams and must be addressed there.

Bacterial infections of the skin in the context of climate change and migration

In the context of climate change and migration, both common and previously less common pathogens are gaining importance as cutaneous bacterial infections. To inform medical professionals about challenges to dermatology posed by climate change and migration. Review of the current literature on emerging antimicrobial resistance and emerging pathogens in general and on the epidemiological situation in Germany in particular. Climate change has adirect impact on microbiological ecosystems in Germany's warming coastal waters leading to an increase of marine V.vulnificus counts and human infections. Secondary to global warming, transmitting vectors of, for example, Lyme disease, rickettsioses and tularemia are also increasing. In addition, infectious diseases like cutaneous diphtheria and mycobacteriosis have been diagnosed in migrants, mostly likely acquired before migration or on the migration route and first diagnosed in Germany. In this context, antimicrobial resistance (e.g. methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant gram-negative bacteria) is gaining importance. Due to progressive changes in global climate and ongoing migration, the aforementioned pathogens of infectious skin diseases and changes in antimicrobial resistance patterns have to be expected. Physicians should be aware of these developments in order to offer appropriate diagnostics and treatment. Epidemiological and biogeographic monitoring will be indispensable for managing emerging changes.