Urban Area In Germany Research Articles

Comparing methods for estimating causal treatment effects of administrative health data: A plasmode simulation study.

Estimating the causal effects of health policy interventions is crucial for policymaking but is challenging when using real-world administrative health care data due to a lack of methodological guidance. To help fill this gap, we conducted a plasmode simulation using such data from a recent policy initiative launched in a deprived urban area in Germany. Our aim was to evaluate and compare the following methods for estimating causal effects: propensity score matching, inverse probability of treatment weighting, and entropy balancing, all combined with difference-in-differences analysis, augmented inverse probability weighting, and targeted maximum likelihood estimation. Additionally, we estimated nuisance parameters using regression models and an ensemble learner called superlearner. We focused on treatment effects related to the number of physician visits, total health care cost, and hospitalization. While each approach has its strengths and weaknesses, our results demonstrate that the superlearner generally worked well for handling nuisance terms in large covariate sets when combined with doubly robust estimation methods to estimate the causal contrast of interest. In contrast, regression-based nuisance parameter estimation worked best in small covariate sets when combined with singly robust methods.

External effects of urban automated vehicles on sustainability

The transport sector is responsible for an important share of pollutant emissions, and urban mobility systems are facing major challenges, such as congestion and parking needs. Automated vehicles are expected to mitigate effects of this kind, and may positively affect the sustainability of the mobility sector. We quantify the external effects of human-driven battery electric vehicles in comparison to automated ones, regarding external costs for urban areas in Germany. In our analysis we focus on environmental, social and economic external cost components. We find that vehicle automation can lower external costs by 34%, suggesting savings of 51.6 billion euros per year for Germany alone, with congestion and parking space costs accounting for the largest share of costs and savings. Our results provide an understanding of the magnitude of the external effects of automated vehicles, conducting sensitivity analyses and additionally discussing the impact of travel behavior.

The impact of integrated care on health care utilization and costs in a socially deprived urban area in Germany: A difference-in-differences approach within an event-study framework.

We investigated the impact of an integrated care initiative in a socially deprived urban area in Germany. Using administrative data, we empirically assessed the causal effect of its two sub-interventions, which differed by the extent to which their instruments targeted the supply and demand side of healthcare provision. We addressed confounding using propensity score matching via the Super Learner machine learning algorithm. For our baseline model, we used a two-way fixed-effects difference-in-differences approach to identify causal effects. We then employed difference-in-differences analyses within an event-study framework to explore the heterogeneity of treatment effects over time, allowing us to disentangle the effects of the sub-interventions and improve causal interpretation and generalizability. The initiative led to a significant increase in hospital and emergency admissions and non-hospital outpatient visits, as well as inpatient, non-hospital outpatient, and total costs. Increased utilization may indicate that the intervention improved access to care or identified unmet need.

Estimating regional unemployment with mobile network data for Functional Urban Areas in Germany

The ongoing growth of cities due to better job opportunities is leading to increased labour-related commuter flows in several countries. On the one hand, an increasing number of people commute and move to the cities, but on the other hand, the labour market indicates higher unemployment rates in urban areas than in the surrounding areas. We investigate this phenomenon on regional level by an alternative definition of unemployment rates in which commuting behaviour is integrated. We combine data from the Labour Force Survey with dynamic mobile network data by small area models for the federal state North Rhine-Westphalia in Germany. From a methodical perspective, we use a transformed Fay–Herriot model with bias correction for the estimation of unemployment rates and propose a parametric bootstrap for the mean squared error estimation that includes the bias correction. The performance of the proposed methodology is evaluated in a case study based on official data and in model-based simulations. The results in the application show that unemployment rates (adjusted by commuters) in German cities are lower than traditional official unemployment rates indicate.

Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany.

Demographic development in rural and urban areas differs substantially. Demographics and access to specialized head and neck cancer centers may affect head and neck cancer patients' (HNCP) outcomes. Here, we compare epidemiological indicators and outcomes of HNCP in rural and urban Germany. In a retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) between 2002 and 2017, 212,920 HNCP were included. Incidence, demographics, travel distance to specialized centers, and ground values were compared between rural and urban areas with a focus on their association with patient outcomes. The mean age of HNCP was significantly higher in urban areas (mean difference = 1.4 years; p < 0.0001), but increased at a comparable rate (p = 0.26) in rural and urban areas during the observation period. Gender imbalance was higher in rural areas (mean ratio of men/women: 4.1 vs. 3.1; p < 0.0001), but showed a comparable trend toward equilibration in both, rural and urban districts (p = 0.46). The portion of HNCP of the entire HNCP population living in urban areas increased from 55.9% in the year 2002 to 76.4% in the year 2017. There was no significant difference or change in the ratio of advanced to low UICC stage during the observation period (p = 0.26). However, travel distances to medical centers were higher in rural areas, especially (p < 0.0001) in East Germany. Median survival of HNCP in rural areas was significantly lower than in urban areas (42 months [SEM = 0.7; CI: 40.5-43.5] vs. 54 months [SEM = 1.2; CI: 51.7-56.3]; p < 0.0001) in East Germany, whereas in West Germany no significant difference was observed (59 months [SEM = 0.8; CI: 57.4-60.6] vs. 60 months [SEM = 0.5; CI: 59.0-61.0]; p = 0.15). Place of residence contributes to survival outcome of HNCP. Access to specialized care and socioeconomic factors could be improved in East Germany.

Understanding intention to use bike sharing systems in urban areas in Germany: A mixed-methods analysis

Bike sharing systems (BSSs) can contribute to sustainable mobility. For the design of BSSs, detailed knowledge is still needed about decision-making processes regarding the use of BSSs. This research uses a mixed-methods approach. Using a data set of 202 respondents, a structural equation model (SEM) was calculated with the predictors Performance Expectancy, Effort Expectancy, Facilitating Conditions, Social Influence and Habit. The SEM explained 52% of the variance in Behavioral Intention (BI). Performance Expectancy and Habit emerged as significant predictors. Obtained findings were supplemented by guided interviews to gain further insight. Based on a population that habitually uses its own bicycles, it is suggested to promote BSSs as part of multimodal transportation systems. Flexible pricing models and high-quality bikes are also central aspects to the intention to use BSSs.

The usage of geospatial tools in traffic sign detection

The topic of this scientific paper is the detection of traffic signs based on the data obtained using modern geodetic methods (LiDAR, mobile laser scanning), by using geospatial tools. In a total of 100 photos taken in an urban area in Germany, in a length of 500 m, 75 traffic signs were detected. Each sign is assigned a corresponding code from the catalog of German traffic signs, after what the photos are connected to the point cloud. Then the extraction of bounding boxes and central points of traffic signs was done. The visualization was done in two softwares -Bentley MicroStation and QGIS, which completed the detection process. The accuracy of traffic sign detection in photos is 83% (62/75). The extraction of bounding boxes and central points on the point cloud was performed with a high degree of accuracy (85%).

The concept of register in heritage language retention

AbstractThis paper argues for a greater consideration of the role of register in the retention of heritage languages by analyzing data on adolescent heritage-language speakers in Germany. The study addresses the following question: Which language external factors have the greatest impact on heritage-language retention in the intimate vs formal registers? A questionnaire was filled out by 202 students (age 15–17) in an urban area in Germany, who are all heritage-language speakers of 42 different languages. The major finding of this study is that heritage-language retention is determined by different language-external factors in each register. The fact that different models of heritage-language retention can be postulated for different language registers emphasizes the need to describe the language competences of heritage-language speakers according to registers.

What is the impact of introducing a non-clinical community health advice and navigation service on the demand for primary care in socially deprived areas? Evidence from an observational panel study with difference-in-differences design

ObjectivesTo examine the effect of introducing a non-clinical community health advice and navigation service on the demand for primary care in a socially deprived area.DesignObservational panel study with difference-in-differences design....

Barriers and facilitators of purchasing from short food supply chains: evidence from consumer focus groups in Germany, Spain, Greece and Hungary

This study aimed to identify the barriers and facilitators of consumers purchasing from short food supply chains (SFSC). Eight focus groups were conducted with consumers in the rural and urban areas of Germany, Spain, Hungary and Greece. Participants generally felt that increasing the convenience of purchasing SFSC products (in terms of a proximal location and being able to purchase a wide range of produce in one place) was a prerequisite for them to buy such products. Food quality in terms of taste, freshness and organic status were also taken into account in purchase decisions, and there appears to be a greater focus on health rather than the environmental implications of organic production, although the environmental aspects are also appreciated. Some participants also like the idea of supporting their local community through purchasing from local producers and/or retailers. It was believed that small-scale production and SFSC result in better quality food, but participants had less confidence in the hygiene and food safety standards of SFSC compared to longer chains. Participants thought that consumers would purchase local food if they could more easily access a variety of local food in one place, such as through supermarkets, cooperatives, farm shops and markets, or an online platform that aggregates producers.

Nocturnal space and habitat use by Garden Dormice in an urban area in Germany

The Garden Dormouse (Eliomys quercinus) is currently disappearing from parts of its former range. While its population is declining in many parts of Germany, a stable occurrence is found in the city of Wiesbaden. A radio telemetry study was conducted to investigate nocturnal activity and habitat use. Three males and one female were tracked for six weeks from May to July 2021. Males weighed 85 ± 15 g (n = 6), females 63 ± 8 g (n = 2). Home ranges were calculated using the minimum convex polygon (MCP) method. Males had larger home range sizes (MCP100: 2.69 ± 1.8 ha, n = 3) than females (0.53 ha, n = 1). The home ranges of males overlapped. Males regularly crossed roads up to 16 m wide. Animals exhibited nocturnal behavior with sporadic activity at dusk. Garden Dormice preferred structures with more than 75 % cover from a bird's eye view and 50 % cover when viewed from the side. Broad hedges were strongly preferred over single shrubs and trees or structures without vegetation. They were used by the animals for foraging, mating, as a place for other interactions, and as protected pathways through the habitat. The smaller home range sizes compared to previous studies may be due to good food availability in the city. Animals also seem to benefit from continuous habitat and high levels of plant cover. Recommended conservation measures include maintaining and promoting broad hedges and habitat connectivity.

A school-based educational on-site vaccination intervention for adolescents in an urban area in Germany: feasibility and psychometric properties of instruments in a pilot study

BackgroundVaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting.MethodsThe study covered 863 students from 41 classes of four schools. The optimization and feasibility of access to schools, recruitment strategies, intervention, and assessment procedures were examined. The course and content of the educational unit were evaluated with a mixed-methods approach. A pre-post measurement design was tested for the vaccination rate in all schools. Additionally, at two schools, improvement in vaccination-related knowledge and perceived self-efficacy were measured by questionnaire pre-educational unit (n=287) and post-educational unit (n=293). The remaining two schools provided only postintervention data. Finally, we evaluated the psychometric properties (i.e., reliability, retest reliability, and change rates) of the questionnaire, applying Cronbach’s alpha, factor analyses, generalized estimating equations and linear mixed models.ResultsThe findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had M=2.84 (95% CI [2.69, 3.10]) correct answers before and M=4.45 (95% CI [4.26, 4.64]) after the class. Ranging from 1 to 4, the self-efficacy scale changed by 0.3 points (p <.001); Cronbach’s alpha was 0.67 and 0.76 pre- and post-educational unit, respectively, and a one-factor solution was found. Content analysis of the five semistructured group interviews (n=12, 58.3% female) showed that all students found the length of the intervention to be appropriate. The teaching methods, including interactive and social media components, were perceived as very good.ConclusionsA school-based educational and on-site vaccination intervention appears to be feasible in terms of procedures and the adequacy of the instruments for the adolescent target group.Trial registrationISRCTN, ISRCTN18026662. Pilot study for main trial registered 8 December 2017.

Socioeconomic Differences in Walking Time of Children and Adolescents to Public Green Spaces in Urban Areas-Results of the German Environmental Survey (2014-2017).

Public green spaces have a high potential for a positive impact on people’s health and wellbeing, especially in urban areas. Studies on environmental justice indicate socially unequal access possibilities to urban green spaces. This article presents results on associations between individual socioeconomic position (SEP) and walking time from home to public green spaces in young people living in urban areas with more than 20,000 inhabitants in Germany. Data were derived from the German Environmental Survey for Children and Adolescents 2014–2017 (GerES V), the environmental module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2). The sample comprises 1149 participants aged 3 to 17 years. A total of 51.5% of the participants reach a public green space on foot within five and 72.8% within ten minutes from home. The lower the participant’s SEP, the longer the walking time. Logistic regression models controlling for age group, sex, migration background, and region of residence show that participants with a low SEP have a significantly higher risk (odds ratio = 1.98; 95% confidence interval: 1.31–2.99) of needing more than ten minutes to walk from home to a public green space than participants with a high SEP. GerES V data indicate that young people living in urban areas in Germany do not equally benefit from the health-promoting potential of green spaces, which is an important aspect of environmental health inequalities.

Impact‐Based Forecasting for Pluvial Floods

AbstractPluvial floods in urban areas are caused by local, fast storm events with very high rainfall rates, which lead to inundation of streets and buildings before the storm water reaches a watercourse. An increase in frequency and intensity of heavy rainfall events and an ongoing urbanization may further increase the risk of pluvial flooding in many urban areas. Currently, warnings for pluvial floods are mostly limited to information on rainfall intensities and durations over larger areas, which is often not detailed enough to effectively protect people and goods. We present a proof‐of‐concept for an impact‐based forecasting system for pluvial floods. Using a model chain consisting of a rainfall forecast, an inundation, a contaminant transport and a damage model, we are able to provide predictions for the expected rainfall, the inundated areas, spreading of potential contamination and the expected damage to residential buildings. We use a neural network‐based inundation model, which significantly reduces the computation time of the model chain. To demonstrate the feasibility, we perform a hindcast of a recent pluvial flood event in an urban area in Germany. The required spatio‐temporal accuracy of rainfall forecasts is still a major challenge, but our results show that reliable impact‐based warnings can be forecasts are available up to 5 min before the peak of an extreme rainfall event. Based on our results, we discuss how the outputs of the impact‐based forecast could be used to disseminate impact‐based early warnings.

Capturing modelled and perceived spatial access to ambulatory health care services in rural and urban areas in Germany.

Studies on social and regional inequalities in access to health care often use spatial indicators such as physician density to measure access to health care. However, the concept of access is more complex, comprising, among others, patient perceptions. In this study, we evaluate the association between different spatial measures of access (i.e. physician density, distance to the nearest provider, and measures based on floating catchment area methods) and measures of perceived spatial access to ambulatory health care in rural and urban areas in Germany. Using correlation and regression analysis, we found that the significance and strength of the relation between perceived and modelled spatial access depends on the type of area and the physician group. The distance to the nearest physician is associated with perceived spatial access to GPs only in rural areas but not in urban areas. More sophisticated measures of spatial access seem not to explain perceived access better than the simpler indicators.

Perceptions of time constraints among primary care physicians in Germany

BackgroundTime constraints during patient visits play a major role for the work stress of primary care physicians. Several studies suggest that there is a critical situation in terms of time constraints in primary care in Germany. Therefore, the following research questions are addressed: (1) What is the time allocated and needed for different types of consultations among primary care physicians in an urban area in Germany? (2) What is the extent of time stress? (3) Are there differences in time stress according to physician characteristics (gender and length of experience) and practice type (single vs. group/shared practice)?MethodsData stem from a face-to-face survey of primary care doctors in Hamburg and adjacent regions. A sample of 128 physicians stratified by a combination of physicians’ gender and length of experience (≤15 years or > 15 years) was used. Physicians were asked about the time needed (in minutes) to provide high quality of care for patients regarding six types of consultations: (1) new patient appointment, (2) routine consultation, (3) complete physical examination, (4) symptom-oriented examination, (5) check-up, and (6) home visit (without drive). Afterwards, they were asked about the average minutes allocated for the six consultations. Time stress was measured by calculating minutes needed minus minutes available.ResultsAverage perceived time needed was higher than time allocated for all six types of consultation. However, there were differences in the magnitude of time stress between the consultation types. Time stress was most pronounced and most prevalent in case of a new patient visit. No significant differences in time stress between male and female primary care physicians were found, while less experienced physicians reported more time stress than those with more experience (> 15 years). Physicians working in a single practice had less time stress than those working in a group or shared practice in case of a check-up visit.ConclusionsPerceived time needed is higher than time allocated for various types of consultation among primary care physicians in Germany. Time stress in primary care is particularly pronounced in case of new patient appointments. Early-career physicians are particularly affected by time stress.

Conflicts about Urban Green Spaces in Metropolitan Areas under Conditions of Climate Change: A Multidisciplinary Analysis of Stakeholders’ Perceptions of Planning Processes

Under conditions of climate change, land-use conflicts are a significant challenge for spatial planning, especially in densely populated metropolitan regions. By using a multi-methodological approach, this study aims to identify different stakeholders’ perceptions of these spaces in planning processes within urban areas in Germany. We use an ecosystem service analysis to evaluate the ecological potential of each selected study area and conducted a household survey to gauge how the local population and administration perceive them. The perceptions of these two groups of stakeholders regarding each area’s spatial qualities often differed from their actual ecological potential. We conducted interviews to identify possible conflicts between politicians and administration staff. While cooperation between politicians and the administration staff takes place and works well, the stakeholders involved often evaluate and perceive the cooperation processes in planning differently. Therefore, the authors argue that an integrative and methodologically multi-layered approach is useful for understanding complex perceptions in spatial planning.

INFLUENCE OF BENZO(A)PYRENE ON ENVIRONMENTAL QUALITY AND POPULATION HEALTH (BY EXAMPLE OF IVANOVO)

The paper presents the results of measurements of the content of benzo(a)pyrene (BaP) in the snow cover in the territory of the Ivanovo city. It was revealed that the concentration of BaP at the controlled points is 2.7 times higher than the background level on average. The degree of pollution of the snow cover in Ivanovo is much less than in Moscow (the level of excess varies in the range 2.3 - 89 times). The intake levels (from 0.02 μg/m2 to 3.76 μg/m2) and deposition density (0.02 - 1.88 ng/m2 · day-1) of BaP are estimated that are commensurate with the values typical for such areas, as urban areas of Germany and Canada. Interpolation the BaP concentrations in snow is allowed to reveal anomalies in the city with BaP content of 35 ng/l, which is 7 times higher than the average value for the whole city. The obtained data made it possible to estimate the BaP concentration in atmospheric air, which on the average is 0.7· 10-6 mg/m3, which is 0.7 fraction of the maximum permissible concentration. The values of individual carcinogenic risk for public health were calculated, which amounted to 0.6·10-6 and 1.6·10-6, which corresponds to negligible individual risk (for the adult population) or corresponds to the maximum allowable level (for children), respectively. The obtained results allowed to evaluate the environmental risk from pollution of the snow cover with BaP, the level of which corresponds to a moderate one, however, indicates a potential public health hazard related to the ability of the BаP to accumulate in environmental objects. It is established that the most likely source of BaP is automobile transport. The contribution of the fuel and energy complex should be much less.

The size ranking of cities in Germany: caught by a MAUP?

A long standing question in urbanisation studies queries whether an empirical regularity known as Zipf's law applies to the size ranking of cities within countries or regions. Part of the debate addresses the statistical attributes of the size distribution. More recently, the definition of the territories assigned to cities has become a matter of concern in this context. Since the shape of administrative boundaries may not represent economic entities, analysis of the size ranking among cities defined by municipal territories may be affected by a considerable modifiable areal unit problem. Following a methodical approach that relates to current research on natural cities, we study the extent to which variation in the territory assigned to urban areas in Germany affects basic features of the size ranking. We define urban areas according to variable thresholds of population density across 1 km2 grids by a clustering algorithm. We find a systematic but moderate deviation from Zipf's law suggesting scale economies among urban agglomerations if peripheral zones are included.

Microscopic Demand Modeling of Urban and Regional Commercial Transport

Commercial transport is an intrinsic part of the evaluation of traffic volumes. However, it is often limited to freight transport, and while this is a significant element, it disregards the share of trips contributed by plumbers, electricians, care services, and the like. These businesses add a significant part to the commercial traffic volume, especially in urban areas. The reasons, commercial passenger transport lacks behind are wide-ranging, one of the leading causes being difficulties in gathering sufficient data.In this paper, we present a microscopic approach to model commercial travel demand, including but not limited to freight traffic, based on data from a national survey and open data. We differentiate between vehicles of businesses that have a fixed daily schedule, with only small variations of their trip purposes and vehicles of businesses that can predict their daily schedules only to a certain degree. The latter have varying trip purposes and decide on a short-term base if and what sort of trip is to be pursued. Vehicles with fixed daily schedules include plumbers, electricians, care services, and delivery trucks. Due to our database, we produced a model for these vehicles exemplary for delivery by determining the number of trips for a day and assigning destinations to those trips afterward. We also take the number of private trips into account, laying the foundation of being able to incorporate the commercial transport model into a passenger transport model.We show that our model can overcome the lack of regional data. Based on generic data, the application of our approach shows promising results for the urban and regional commercial travel demand of a model region. By basing our model on generic data, we introduced an opportunity to model commercial travel demand not only in one model region but also for other urban areas in Germany and possibly in various areas in Europe, assuming that structural data is similar.