COVID-19 fatality in Germany: Demographic determinants of variation in case-fatality rates across and within German federal states during the first and second waves

With the federalism reform of 2006, the German federal states gained legislative power over their civil servants. This did not only lead to a substantial difference in pay levels but also to fragmented civil service regulations with different degrees of attractiveness. Requests to move to another state have created various problems in the different areas of the civil service. They are partly caused by the fragmented regulations and partly by an informal agreement between the states. By making use of an online survey among human resource managers in the different areas of public administration and 32 case studies of civil servants who either aspire to move to or have moved to another state, this book systematically identifies and analyses civil servants’ motivations for and hindrances to doing so. In this way, it reveals both obstructive and conducive factors which explain mobility. Moreover, the authors put forward some reform proposals.

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Regional differences in reasons for consultation and general practitioners’ spectrum of services in Northern Germany – Results of a cross-sectional observational study

10.21203/rs.2.16496/v3 ◽

2019 ◽

Author(s):

Ingmar Schäfer ◽

Heike Hansen ◽

Thomas Ruppel ◽

Dagmar Lühmann ◽

Hans-Otto Wagner ◽

...

Keyword(s):

Observational Study ◽

Rural Areas ◽

Urban Areas ◽

Medical Training ◽

Practice Trial ◽

Cross Sectional ◽

Federal States ◽

German Federal States ◽

Number Of Patients ◽

Individual Consultation

Abstract Background Among other factors, the patients’ consultation reasons and GPs’ spectrum of services determine the process and outcome of the medical treatment. So far, however, there has been little information on differences in reasons for consultation and GPs’ services between urban and rural areas. Our study’s goal was thus to investigate these factors in relation to the regional location of GPs’ practices. Methods We conducted a cross-sectional observational study based on standardised GP interviews in a quota sampling design. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban area, environs, rural area) and stratified proportionally to the population size. Differences in the number of reasons for consultation and services were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the German federal states and administrative districts. Differences in individual consultation reasons and services were identified by logistic regression via stepwise forward and backward selection. Results Primary care practices in 34 of the 37 selected administrative districts (91.9%) were represented in the dataset. In total, 211 GPs were personally interviewed. On average, GPs saw 344 patients per month with a slightly higher number of patients in rural areas. They reported 59.1 ± 15.4 different reasons for consultation and 30.3 + 3.9 different services. There was no statistically significant regional variation in the number of different consultation reasons, but there was a broader service spectrum by rural GPs (ß=-1.42; 95% confidence interval -2.75/-0.08; p=0.038) which was statistically explained by a higher level of medical training. Additionally, there were differences in the frequency of individual consultation reasons and services between rural and urban areas. Conclusion GPs in rural areas performed more frequently services usually provided by medical specialists in urban areas. This might be caused by a low availability of specialists in rural areas. The association between medical training and service spectrum might imply that GPs compensate the specific needs of their patients by completing advanced medical training before or after setting up a medical practice. Trial registration The study was registered in ClinicalTrials.gov (NCT02558322).

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The German Federal States, the Federation and European Integration: The Historical Dimension of German History in Europe, Problems and Perspectives (1949–2008)

Transylvanian Review ◽

10.33993/tr.2021.1.01 ◽

2021 ◽

Vol 30 (1) ◽

pp. 3-19

Author(s):

Wolf D. Gruner

Keyword(s):

European Integration ◽

German History ◽

Federal States ◽

German Federal States

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Report of the D-A-CH geoid and height unification project and prospects for the extension to the European Alps and beyond

10.5194/egusphere-egu21-7567 ◽

2021 ◽

Author(s):

Joachim Schwabe ◽

Christian Ullrich ◽

Urs Marti ◽

Gunter Liebsch ◽

Andreas Hellerschmied ◽

...

Keyword(s):

Specific Area ◽

European Alps ◽

Reference Surface ◽

Federal States ◽

Height Determination ◽

Virtual Meeting ◽

German Federal States ◽

Gravity Field Modeling ◽

Cooperation Partners ◽

Regional Authorities

The D-A-CH geoid project was initiated in 2017 between the national mapping agencies of Germany (BKG), Austria (BEV) and Switzerland (swisstopo), as well as the regional authorities of the German federal states of Bavaria (LDBV) and Baden-W&#252;rttemberg (LGL), with the motivation to better harmonize the basis for height determination.In these countries, the official national height reference systems that are still in use apply different definitions of the height and the zero levels refer to different tide gauges and epochs. Additionally, the treatment of the permanent tide is not fully consistent. This causes differences at the decimeter scale which also vary along the national borders. At the same time, Austria and Switzerland do compute and store also EVRS-compatible geopotential numbers that are valuable for height system unification.The ambitions of the initiative therefore mirror the situation as described above &#8210; to foster and to intensify the cooperation between the partners regarding regional gravity field modeling and to provide better information about the transformations between the national height systems.It was agreed that the cooperation should first focus on a case study area around Lake Constance, with envisaged extension to the complete territories of the &#8220;D-A-CH countries&#8221; and/or, ideally, to the most of the European Alps. The following achievements have been reached for the focus area:In view of these developments, and taking into account that these challenges are not unique for this specific area, it is planned to extend this initiative to the computation of the entire European Alps (and surrounding lowland areas) and rename the project to &#8220;European Alps Geoid (EAlpG)&#8221;.We believe that this project can contribute to a better understanding of height differences across borders. Such height differences are for instance of great interest for ground water level investigations or flood protection. Other crucial applications for cross-border height unification are engineering projects such as tunnels, bridges, supply lines, etc.What is more, these activities shall be embedded in a pan-European geoid initiative within EUREF. Contributing to the upcoming EUREF Working Group &#8220;European Height Reference Surface&#8221;, the European Alps Geoid will be one of many cornerstones to build an official EVRS height reference surface.Potential cooperation partners have been contacted. Nevertheless, the initiative shall be open to interested parties. A virtual meeting is planned to be held shortly after the vEGU2021.

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IWRM through WFD Implementation? Drivers for Integration in Polycentric Water Governance Systems

Water ◽

10.3390/w11051063 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1063 ◽

Cited By ~ 2

Author(s):

Nadine Jenny Shirin Schröder

Keyword(s):

Power Relations ◽

Integrated Management ◽

Water Governance ◽

Integrated Water Resources Management ◽

Detailed Knowledge ◽

Local Policy ◽

Federal States ◽

Governance Systems ◽

German Federal States ◽

Planning Processes

This paper uses an empirical approach to explore what motivates the adoption of integrated water resources management (IWRM). The study compares cases of local implementation of the EU Water Framework Directive (WFD) from five German federal states representing various types of local policy addressees. Data were collected using policy analysis methods, including participatory observation and interviews with planners who had implemented WFD measures and conducted integration attempts of various types throughout the planning processes. The planning narratives on integration were analysed iteratively and its characteristics, drivers, and hampering factors were identified. It was found that policy addressees attempt integration due to the incentives for reaching their goals rather than according to their paradigms. Depending on the power relations, incentives result in the integration of different actors during different planning phases. The findings suggest that in order to strategically induce integration, it would be necessary to enhance the incentives based on a detailed knowledge of power relations. The WFD as a general regulatory framework was found not to be a driver for local integration, but the WFD did induce increased integrated management through setting goals.

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Seroprevalences of Newly Discovered Porcine Pestiviruses in German Pig Farms

Veterinary Sciences ◽

10.3390/vetsci6040086 ◽

2019 ◽

Vol 6 (4) ◽

pp. 86 ◽

Cited By ~ 3

Author(s):

Michelitsch ◽

Dalmann ◽

Wernike ◽

Reimann ◽

Beer

Keyword(s):

New Species ◽

Disease Outbreaks ◽

State Level ◽

Test System ◽

Control Measures ◽

Federal States ◽

Diarrhea Virus ◽

German Federal States ◽

Pig Farms ◽

Chimeric Construct

Several novel porcine pestiviruses that are linked to disease outbreaks in commercial pig farms were discovered during recent years. Bungowannah pestivirus (BuPV; new species Pestivirus F) causes sudden death in young pigs, but has only ever been isolated in the Australian region Bungowannah. Atypical porcine pestivirus (APPV; new species Pestivirus K) on the other hand has been found in multiple countries worldwide and is potentially linked to congenital tremor, a disease that causes considerable production problems in pig farms. To assess the seroprevalences of both viruses in German commercial farms during the years 2009/10 and 2018, two approaches were selected. Antibodies against Pestivirus F were detected by a traditional in-house indirect immunofluorescence test against the culture-grown virus isolate, while for the detection of Pestivirus K-specific antibodies, a newly developed test system utilizing a chimeric construct of bovine viral diarrhea virus 1 (BVDV1; species Pestivirus A) containing the E1 and E2 encoding sequences of APPV was established. A total of 1115 samples originating from 122 farms located in seven German federal states were investigated. Antibodies against Bungowannah virus could not be detected, confirming the absence of this virus in other regions than the initially affected Australian pig farm complex. In contrast, antibodies against APPV were highly prevalent throughout Germany at both investigated time points. The seroprevalence at the state level fluctuated to some degree, but the overall percentage remained stable, as is to be expected for an endemic pestivirus lacking any form of control measures.

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Declining regional disparities in mortality in the context of persisting large inequalities in economic conditions: the case of Germany

International Journal of Epidemiology ◽

10.1093/ije/dyz265 ◽

2020 ◽

Vol 49 (2) ◽

pp. 486-496

Author(s):

Alyson A van Raalte ◽

Sebastian Klüsener ◽

Anna Oksuzyan ◽

Pavel Grigoriev

Keyword(s):

Life Expectancy ◽

State Level ◽

Economic Conditions ◽

Future Research ◽

German State ◽

Federal States ◽

German Federal States ◽

Regional Mortality ◽

East West ◽

Economic Inequalities

Abstract Background Subnational regional mortality inequalities are large and appear to be mostly increasing within industrialized countries, although comparative studies across high-income countries are scarce. Germany is an important country to examine because it continues to experience considerable economic disparities between its federal states, in part resulting from its former division. Methods We analyse state-level mortality in Germany utilizing data from a newly constructed regional database based on the methodology of the Human Mortality Database. We compare time trends (1991–2015) in the German state-level standard deviation in life expectancy to that of other large, wealthy countries and examine the association between mortality and economic inequalities at the regional level. Finally, using contour-decomposition methods, we investigate the degree to which age patterns of mortality are converging across German federal states. Results Regional inequalities in life expectancy in Germany are comparatively low internationally, particularly among women, despite high state-level inequalities in economic conditions. These low regional mortality inequalities emerged 5–10 years after reunification. Mortality is converging over most ages between the longest- and shortest-living German state populations and across the former East–West political border, with the exception of an emerging East–West divergence in mortality among working-aged men. Conclusions The German example shows that large regional economic inequalities are not necessarily paralleled with large regional mortality disparities. Future research should investigate the factors that fostered the emergence of this unusual pattern in Germany.

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Estimating vaccine effectiveness against laboratory-confirmed influenza among children and adolescents in Lower Saxony and Saxony-Anhalt, 2012–2016

Epidemiology and Infection ◽

10.1017/s0950268817002709 ◽

2017 ◽

Vol 146 (1) ◽

pp. 78-88 ◽

Cited By ~ 2

Author(s):

A. MÖHL ◽

L. GRÄFE ◽

C. HELMEKE ◽

D. ZIEHM ◽

M. MONAZAHIAN ◽

...

Keyword(s):

Influenza A ◽

Respiratory Illness ◽

Vaccine Effectiveness ◽

Federal State ◽

Influenza B ◽

Surveillance Systems ◽

Lower Saxony ◽

Federal States ◽

German Federal States ◽

Influenza A H1n1

SUMMARYInfluenza vaccine effectiveness (VE) has to be estimated anew for every season to explore vaccines’ protective effect in the population. We report VE estimates against laboratory-confirmed influenza A(H1N1)pdm09, A(H3N2) and influenza B among children aged 2–17 years, using test-negative design. Pooled data from two German federal states’ surveillance systems for acute respiratory illness from week 40/2012 to 20/2016 was used, yielding a total of 10 627 specimens. Odds ratios and 95% confidence intervals (95% CIs) for the association between laboratory-confirmed influenza and vaccination status were calculated by multivariate logistic regression adjusting for age, sex, illness onset and federal state. VE was estimated as 1-Odds Ratio. Overall adjusted VE was 33% (95% CI: 24·3–40·7). A strong variation of VE between the seasons and subtypes was observed: highest season- and subtype-specific VE of 86·2% (95% CI: 41·3–96·7) was found against A(H1N1)pdm09 in 7–17-year-olds in 2015/16. Low estimates of VE were observed against A(H3N2) in any season, e.g. 1·5% (95% CI: −39·3–30·3) in 2014/15. Estimates showed a tendency to higher VE among 7–17-year-old children, but differences were not statistically significant. Although our findings are common in studies estimating influenza VE, we discussed several explanations for observed low VE.

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