Attitude toward second opinions in Germany – a survey of the general population

Background Second medical opinions (SOs) can assist patients in making informed treatment decisions and improve the understanding of their diagnosis. In Germany, there are different approaches to obtain a structured SO procedure: SO programs by health insurers and SOs according to the SO Directive. Through a direct survey of the population, we aimed to assess how structured SOs should be provided to fulfil patients’ needs. Methods A stratified sample of 9990 adults (≥18 years) living in the federal states of Berlin and Brandenburg (Germany) were initially contacted by post in April and sent a reminder in May 2020. The survey results were analyzed descriptively. Results Among 1349 participants (response rate 14%), 56% were female and the median age was 58 years (interquartile range (IQR) 44–69). Participants wanted to be informed directly and personally about the possibility of obtaining an SO (89%; 1201/1349). They preferred to be informed by their physician (93%; 1249/1349). A majority of participants would consider it important to obtain an SO for oncological indications (78%; 1049/1349). Only a subset of the participants would seek an SO via their health insurer or via an online portal (43%; 577/1349 and 16%; 221/1349). A personally delivered SO was the preferred route of SO delivery, as 97% (1305/1349) would (tend to) consider this way of obtaining an SO. Participants were asked to imagine having moderate knee pain for years, resulting in a treatment recommendation for knee joint replacement. They were requested to rate potential qualification criteria for a physician providing the SO. The criteria rated to be most important were experience with the recommended diagnosis/treatment (criterion (very) important for 93%; 1257/1349) and knowledge of the current state of research (criterion (very) important for 86%; 1158/1349). Participants were willing to travel 60 min (median; IQR 60–120) and wait 4 weeks (median; IQR 2–4) for their SO in the hypothetical case of knee pain. Conclusion In general, SOs were viewed positively. We found that participants have clear preferences regarding SOs. We propose that these preferences should be taken into account in the future design and development of SO programs.

The role of political parties in multi-level environmental governance in the European Union and Germany

The subject of the study is the involvement of political parties in multi-level environmental governance in the European Union, using Germany and its federal states as an example. This article describes the theoretical and practical foundations of multi-level governance. The place of European parties and their national member parties from Germany in the institutional system and decision-making process of environmental policy has been defined. For practical illustration, the climate policy guidelines of Germany’s main national parties (the Christian Democratic Union of Germany and the Christian Social Union in Bavaria, the Social Democratic Party of Germany, the Alternative for Germany, the Free Democratic Party of Germany, the Left and the Alliance 90 / The Greens) and their European affiliations (the European People’s Party, the Party of the European Socialists, the Alliance of Liberals and Democrats for Europe, the European Green Party and the Party of European Left) were compared with an emphasis on the new targets for reducing greenhouse gas emissions. The unique opportunity for parties to participate in environmental policymaking at all key levels, which is not limited to parliamentary institutions has been highlighted. Appointments to environmental positions at different levels often correlate with membership of the most environmentally oriented parties, although the level of environmental involvement may differ between national parties and their European affiliations. Among other things, this has to do with participation in governing coalitions and dependence on a senior partner in them, as shown by the examples of the Bundestag and the Landtag of Baden-Württemberg. The final decision depends heavily on the unity of the coalition at federal and state level, whereas in the European Parliament there is a great differentiation of opinions, which allows even the most influential European People’s Party to be blocked from voting.

Möglichkeiten und Grenzen der landesplanerischen Steuerung des Windenergieausbaus

The expansion of onshore wind energy is faltering. The federal states, which can control the expansion through goals and principles in state-wide spatial plans, have a share in this. The study shows that the associated restriction of the freedom to build is subject to the principle of proportionality as a content and limitation provision of property. Based on the system of spatial control of wind energy in the BauGB (Federal Building Code). and ROG (Regional Planning Act), a substance requirement for the use of wind energy in outdoor areas is derived from the privilege in § 35 para. 1 No. 5 BauGB. On the basis of the specifications in state-wide spatial development plans, it is evaluated to what extent protective goods, such as immission control or acceptance, can be used as justification.

Voices from the Lagers in Germany

This paper traces the everyday realities of refugees living in camps in certain federal states of Germany during the ongoing COVID-19 crisis. It provides a systematic analysis of refugees’ testimonies and demonstrates that they have not received similar levels of care and protection as German citizens, and that their movement has become increasingly regulated. Drawing on Achille Mbembe’s notion of ‘necropolitics’, I argue that the German State has treated refugees’ lives as less liveable than those of their own citizens during the pandemic, as was the case before it broke out. Much scholarship has explained the notion of refugee camps in various ways, but there has been less discussion of Lagers (camps) as a site where colonial oppression persists outside the temporal and spatial contexts of former colonies. Data are drawn from archived data sets and testimonies that refugees uploaded to websites of various refugee activist groups.

Sex-typical symptoms of depression and the importance of conditioning contexts in Austria

Background: Findings regarding the effect of sex on depression are inconclusive. The aim of this paper is to contribute to clarification concerning this effect by first disentangle the concept of depression and splitting it up into two sub-types. Second, we will address macro-level contexts as conditions of the sex-effect on depression.Methods: This study gives a comparative analysis of sex as a predictor of depression symptoms in various Austrian federal states. It offers a secondary data analysis of data collected from an online survey (CAWI) conducted in Austria as a quota sample of Austrian inhabitants (N=1229). Besides sex as a predictor of depression symptoms (measured by PHQ-9 items) we also consider four dimensions of social support, the retirement status, and the experience of a vocational gratification crisis.Results: By and large, sex is not associated with motivational deficit symptoms, but rather with somatic stress symptoms. Taking into account federal states as conditions, the sex-effect on depression symptoms turn out to be context-dependent.Limitations: Using some items from the PHQ-9 inventory for measuring depression symptoms was arbitrary, findings could be sensitive to operationalization. Furthermore, Austrian federal states are no substantial variables which could condition the sex-effect directly. The actual conditioning variables correlate with the Austrian federal states, but remain unobserved here. Conclusions: Depression symptoms are partly sex-typical, but this association is context-dependent. For diagnostics, therefore, the recommendation arises to take symptomatic sub-types of depression into account, instead of an in itself heterogeneous construct that expresses itself differently under certain conditions.

Spatial and temporal distribution patterns of tick-borne diseases (Tick-borne Encephalitis and Lyme Borreliosis) in Germany

Background In the face of ongoing climate warming, vector-borne diseases are expected to increase in Europe, including tick-borne diseases (TBD). The most abundant tick-borne diseases in Germany are Tick-Borne Encephalitis (TBE) and Lyme Borreliosis (LB), with Ixodes ricinus as the main vector. Methods In this study, we display and compare the spatial and temporal patterns of reported cases of human TBE and LB in relation to some associated factors. The comparison may help with the interpretation of observed spatial and temporal patterns. Results The spatial patterns of reported TBE cases show a clear and consistent pattern over the years, with many cases in the south and only few and isolated cases in the north of Germany. The identification of spatial patterns of LB disease cases is more difficult due to the different reporting practices in the individual federal states. Temporal patterns strongly fluctuate between years, and are relatively synchronized between both diseases, suggesting common driving factors. Based on our results we found no evidence that weather conditions affect the prevalence of both diseases. Both diseases show a gender bias with LB bing more commonly diagnosed in females, contrary to TBE being more commonly diagnosed in males. Conclusion For a further investigation of of the underlying driving factors and their interrelations, longer time series as well as standardised reporting and surveillance system would be required.

Epidemiology of Antepartum Stillbirths in Austria—A Population-Based Study between 2008 and 2020

(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22+0 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20+0/40 was 3.10, ≥22+0/40 3.14, and ≥24+0/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33+0 (27+2–37+4) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58–8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83–3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.