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Over the past decades, plagiarism has been classified as a multi-layer phenomenon of dishonesty that occurs in higher education. A number of research papers have identified a host of factors such as gender, socialisation, efficiency gain, motivation for study, methodological uncertainties or easy access to electronic information via the Internet and new technologies, as reasons driving plagiarism. The paper at hand examines whether such factors are still effective and if there are any differences between German and Slovene students’ factors influencing plagiarism. A quantitative paper-and-pencil survey was carried out in Germany and Slovenia in 2017/2018 academic year, with a sample of 485 students from higher education institutions. The major findings of this research reveal that easy access to information-communication technologies and the Web is the main reason driving plagiarism. In that regard, there are no significant differences between German and Slovene students in terms of personal factors such as gender, motivation for study, and socialisation. In this sense, digitalisation and the Web outrank national borders. [ABSTRACT FROM AUTHOR]

Introduction: Opioids are one of the most important and effective drug classes in pain medicine with a key role in most medical fields. The increase of opioid prescription over time has led to higher numbers of prescription opioid misuse, abuse and opioid-related deaths in most developed OECD (Organisation for Economic Co-operation and Development) countries around the world. Whilst reliable data on the prevalence of opioid treatment is accessible for many countries, data on Germany specifically is still scarce. Considering Germany being the largest country in the European Union, the lack of evidence-based strategies from long-term studies is crucial. The aim of this work is to review and summarise relevant published literature on the prevalence of opioid prescription in Germany to adequately inform health policy strategies. Methods: A systematic review of the epidemiology of opioid prescription in Germany was conducted, searching PubMed and Web of Science. Eligibility criteria were defined prior to conducting the search. Literature concerning Germany, published in English and German was included and the search was replicated by three independent researchers. Two levels of screening were employed. Disagreement was resolved by face-to-face discussion, leading to a consensus judgement. Results: Our electronic search yielded 735 articles. Reviewing titles and abstracts yielded 19 relevant articles. Three authors examined each article’s full text more closely and determined that twelve papers should be included. Of the twelve identified studies—with publication dates ranging from 1985 to 2016—six were retrospective cross-sectional studies and six were retrospective repeated-measures cross-sectional studies. Sample sizes ranged from 92,842 to ≈ 11,000,000 participants. Data sources of included studies showed vast heterogeneity. The reviewed literature suggested an increase in the number of patients with opioid prescriptions and defined daily doses of opioids per recipient in Germany over time. The majority of opioid prescriptions was used for patients with non-cancer pain. Opioid use was more common in older people, women and in the north of Germany. Fentanyl was shown to be the most prescribed strong opioid in outpatient settings in Germany, despite not being the first-line choice for chronic pain conditions. All data published before 2000—but none of the more recent studies—suggested an insufficient treatment of pain using opioids. There were no signs for a current opioid epidemic in Germany. Conclusions: Despite some limitations of the review and the heterogeneity of studies, it can be stated that the number of opioid prescriptions overall as well as the number of people receiving opioid treatment have increased over time. Most prescriptions were found to be for strong opioids and patients with non-cancer pain. Even though patterns of opioid prescription follow trends observed in other developed countries, there are no signs of an opioid epidemic in Germany. Therefore, this review could currently not find a need for urgent health policy interventions regarding opioid prescription practices. However, critical gaps in the literature remain and more research is needed to make more reliable judgements. [ABSTRACT FROM AUTHOR]

Background: The news media is a key source for health and medical information, and relies to a large degree on material from press releases (PR). Medical universities are key players in the dissemination of PRs. This study aims to 1) explore the relation between the quality of press releases (PRs) from medical universities and their corresponding news stories (NSs) and 2) to identify the likelihood that specific scientific and interest-raising measures appear or are omitted in PRs and NSs. Methods and findings: In this retrospective study using quantitative content analysis, PRs (n = 507) from 21 medical universities in Germany, the Netherlands, Sweden, the USA and the UK were retrieved. Of all PRs, 33% had media coverage, resulting in 496 NSs. With two codebooks, 18 scientific (e.g. reporting the study design of the study correctly) and 7 interest-raising measures (e.g. words like ‘ground-breaking’) were evaluated in the PRs and NSs. For all measures the percentage of presence in NSs and PRs was calculated, together with a Mean PR Influence Factor. Quality of PRs and NSs was defined as a score, based on 12 of the 18 scientific measures. Mean (SD) NS quality score was 6.5 (1.7) which was significantly lower than the PR score of 8.0 (1.5). The two quality scores were significantly correlated. Quality measures that were frequently omitted included reporting important study limitations (present in 21% of PRs, 21% of NSs), funding (59% of PRs, 7% of NSs) and conflicts of interest (16% of PRs, 3% of NSs). We did not evaluate the quality of the scientific papers (SPs), and can therefore not determine if the quality of PRs and NSs is associated with the quality of SPs. Conclusions: This large study of medical university press releases and corresponding news stories showed that important measures of a scientific study such as funding and study limitations were omitted to a very large extent. The lay public and health personnel as well as policy makers, politicians and other decision makers may be misled by incomplete and partly inaccurate representations of scientific studies which could negatively affect important health-related behaviours and decisions. [ABSTRACT FROM AUTHOR]

Cities are major drivers of environmental change at all scales and are especially at risk from the ensuing effects, which include poor air quality, flooding and heat waves. Typically, these issues are studied on a city-by-city basis owing to the spatial complexity of built landscapes, local topography and emission patterns. However, to ensure knowledge sharing and to integrate local-scale processes with regional and global scale modelling initiatives, there is a pressing need for a world-wide database on cities that is suited for environmental studies. In this paper we present a European database that has a particular focus on characterising urbanised landscapes. It has been derived using tools and techniques developed as part of the World Urban Database and Access Portal Tools (WUDAPT) project, which has the goal of acquiring and disseminating climate-relevant information on cities worldwide. The European map is the first major step toward creating a global database on cities that can be integrated with existing topographic and natural land-cover databases to support modelling initiatives. [ABSTRACT FROM AUTHOR]

Using a standardized instrument to evaluate patients’ stress reactions has become more important in daily clinical routines. Different signs or symptoms of stress are often unilaterally explored: the physiological, psychological or social aspects of stress disorders are each viewed on a single dimension. However, all dimensions afflict patients who have persistent health problems due to chronic stress. Therefore, it is important to use a multidimensional approach to acquire data. The ‘Psycho-Physiological-Stress-Test’ (PPST) was established to achieve a comprehensive understanding of stress and was further developed at the Charité—Universitätsmedizin Berlin in collaboration with the Psychological Department of Freie Universität Berlin. The PPST includes a series of varying stress phases, embedded in two periods of rest. Physiological and psychological parameters are simultaneously measured throughout the test session. Specifically, the PPST activates the sympathetic stress axis, which is measured by heart rate, blood pressure, respiration depth and rate, electro dermal activation and muscle tension (frontalis, masseter, trapezius). Psychological data are simultaneously collected, and include performance, motivation, emotion and behavior. After conducting this diagnostic test, it is possible to identify individual stress patterns that can be discussed with the individual patient to develop and recommend (outpatient) treatment strategies. This paper introduces the PPST as a standardized way to evaluate stress reactions by presenting the results from a sample of psychosomatic inpatients (n = 139) who were treated in Charité—Universitätsmedizin Berlin, Germany. We observed that the varying testing conditions provoked adjusted changes in the different physiological parameters and psychological levels. [ABSTRACT FROM AUTHOR]

Introduction: A broad range of self-tests (testing for e.g. HIV, cancer, hepatitis B/C) have become available and can be conducted by lay consumers without the help of a health professional. The aims of this study were to (a) investigate the prevalence of self-testing, (b) identify the most frequently used self-tests, and (c) explore the associations between socio-demographic, health-related and individual factors with self-testing. Methods: A face-to-face plus paper-pencil cross-sectional survey was conducted. The sample consisted of 2.527 respondents who were representative of the German population in terms of the age, sex, and residence. Basic descriptive statistics and univariate logistic regression analyses were performed. Results: 8.5% of the participants reported having used one or more self-tests in the past, totalling 363 self-tests, with a mean of 1.7 (min. = 1, max. = 6). The three self-tests most frequently indicated were for detecting diabetes, bowel cancer, and allergies. Self-testers were older (Nagelkerke R2 = .006, p < .01), had a higher BMI (Nagelkerke R2 = .013, p < .001) and displayed more physical and mental fatigue (Nagelkerke R2 = .031, p < .001) than non-testers. Self-testers also reported higher global life satisfaction values (Nagelkerke R2 = .008, p < .01) and a higher educational level (Nagelkerke R2 = .015, p < .01). Conclusions: Self-testing is fairly prevalent in Germany Given the current shortage of physicians in Germany, especially in rural areas, and recent studies on the use of self-medication, the topic of self-testing has a great practical and socio-political relevance. Future studies should investigate further predictors of self-testing (e.g. contextual, situational and individual factors) as well as the emotional consequences of testing as a layperson without the attendance of a health professional. [ABSTRACT FROM AUTHOR]

Background: In August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI). Objective: To describe the reported HAI-outbreaks and the surveillance system’s structure and capabilities. Methods: Information on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed. Results: Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%). Conclusion: The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation. [ABSTRACT FROM AUTHOR]

Germany has been officially free of bovine tuberculosis since 1996. However, in the last years there has been an increase of bovine tuberculosis cases, particularly in the southern part of Germany, in the Allgäu region. As a consequence a one-time tuberculosis surveillance program was revisited with different premortal and postmortal tests. The aim of this paper was to estimate diagnostic sensitivities and specificities of the different tests used within this surveillance program. In the absence of a perfect test with 100% sensitivity and 100% specificity, thus in the absence of a gold standard, a Bayesian latent class approach with two different datasets was performed. The first dataset included 389 animals, tested with single intra-dermal comparative cervical tuberculin (SICCT) test, PCR and pathology; the second dataset contained 175 animals, tested with single intra-dermal cervical tuberculin (SICT) test, Bovigam® assay, pathology and culture. Two-way conditional dependencies were considered within the models. Additionally, inter-laboratory agreement (five officially approved laboratories) of the Bovigam® assay was assessed with Cohen's kappa test (21 blood samples). The results are given in posterior means and 95% credibility intervals. The specificities of the SICT test, SICCT test, PCR and pathology ranged between 75.8% [68.8–82.2%] and 99.0% [96.8–100%]. The Bovigam® assay stood out with a very low specificity (6.9% [3.6–11.1%]), though it had the highest sensitivity (95.7% [91.3–99.2%]). The sensitivities of the SICCT test, PCR, SICT test, pathology and culture varied from 57.8% [48.0–67.6%] to 88.9% [65.5–99.7%]. The prevalences were 19.8% [14.6–26.5%] (three-test dataset) and 7.7% [4.2–12.3%] (four-test dataset). Among all pairwise comparisons the highest agreement was 0.62 [0.15–1]). In conclusion, the specificity of the Bovigam® assay and the inter-laboratory agreement were lower than expected. [ABSTRACT FROM AUTHOR]

Using the InCites tool of Thomson Reuters, this study compares normalized citation impact values calculated for China, Japan, France, Germany, United States, and the UK throughout the time period from 1981 to 2010. InCites offers a unique opportunity to study the normalized citation impacts of countries using (i) a long publication window (1981 to 2010), (ii) a differentiation in (broad or more narrow) subject areas, and (iii) allowing for the use of statistical procedures in order to obtain an insightful investigation of national citation trends across the years. Using four broad categories, our results show significantly increasing trends in citation impact values for France, the UK, and especially Germany across the last thirty years in all areas. The citation impact of papers from China is still at a relatively low level (mostly below the world average), but the country follows an increasing trend line. The USA exhibits a stable pattern of high citation impact values across the years. With small impact differences between the publication years, the US trend is increasing in engineering and technology but decreasing in medical and health sciences as well as in agricultural sciences. Similar to the USA, Japan follows increasing as well as decreasing trends in different subject areas, but the variability across the years is small. In most of the years, papers from Japan perform below or approximately at the world average in each subject area. [ABSTRACT FROM AUTHOR]

This paper uses individual-level data from the German Socio-Economic Panel to model trends in population health in terms of cognition, physical fitness, and mental health between 2006 and 2012. The focus is on the population aged 50–90. We use a repeated population-based cross-sectional design. As outcome measures, we use SF-12 measures of physical and mental health and the Symbol-Digit Test (SDT) that captures cognitive processing speed. In line with previous research we find a highly significant Flynn effect on cognition; i.e., SDT scores are higher among those who were tested more recently (at the same age). This result holds for men and women, all age groups, and across all levels of education. While we observe a secular improvement in terms of cognitive functioning, at the same time, average physical and mental health has declined. The decline in average physical health is shown to be stronger for men than for women and found to be strongest for low-educated, young-old men aged 50–64: the decline over the 6-year interval in average physical health is estimated to amount to about 0.37 SD, whereas average fluid cognition improved by about 0.29 SD. This pattern of results at the population-level (trends in average population health) stands in interesting contrast to the positive association of physical health and cognitive functioning at the individual-level. The findings underscore the multi-dimensionality of health and the aging process. [ABSTRACT FROM AUTHOR]

Objective: Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany. Research Design and Methods: The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases. Results: Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955–0.992]; p = 0.006) arterial hypertension (1.90 [1.190–3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504–7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068–1.114]; p<0.0001 and 1.18 [1.137–1.222]; p<0.0001, respectively). Conclusions: Our calculations suggest that more than a quarter-million persons have vision-threatening diabetic retinal disease in Germany. Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the study design, methodology, cohort profile and self-reported diseases in the ophthalmological branch of the Gutenberg Health Study (GHS). Methods: The GHS is an ongoing, prospective, interdisciplinary, single-center, population-based cohort study in Germany. The main goals of the ophthalmological section are to assess the prevalence and incidence of ocular diseases and to explore risk factors, genetic determinants and associations with systemic diseases and conditions. The eye examination at baseline included a medical history, self-reported eye diseases, visual acuity, refractive errors, intraocular pressure, visual field, pachymetry, keratometry, fundus photography and tear sampling. The 5-year follow-up visit additionally encompassed optical coherence tomography, anterior segment imaging and optical biometry. The general examination included anthropometry; blood pressure measurement; carotid artery ultrasound; electrocardiogram; echocardiography; spirometry; cognitive tests; questionnaires; assessment of mental conditions; and DNA, RNA, blood and urine sampling. Results: Of 15,010 participants (aged 35-74 years at the time of inclusion), ocular data are available for 14,700 subjects (97.9%). The mean visual acuity (standard deviation), mean spherical equivalent, median decimal visual acuity, and mean intraocular pressure were 0.08 (0.17) logMar, -0.42 (2.43) diopters, 0.9 and 14.24 (2.79) mm Hg, respectively. The frequencies of self-reported strabismus, glaucoma, surgery for retinal detachment and retinal vascular occlusions were 2.7%, 2.3%, 0.2% and 0.4%, respectively. Conclusions: The GHS is the most extensive dataset of ophthalmic diseases and conditions and their risk factors in Germany and one of the largest cohorts worldwide. This dataset will provide new insight in the epidemiology of ophthalmic diseases and related medical specialties. [ABSTRACT FROM AUTHOR]

Population aging is an inevitable global demographic process. Most of the literature on the consequences of demographic change focuses on the economic and societal challenges that we will face as people live longer and have fewer children. In this paper, we (a) briefly describe key trends and projections of the magnitude and speed of population aging; (b) discuss the economic, social, and environmental consequences of population aging; and (c) investigate some of the opportunities that aging societies create. We use Germany as a case study. However, the general insights that we obtain can be generalized to other developed countries. We argue that there may be positive unintended side effects of population aging that can be leveraged to address pressing environmental problems and issues of gender inequality and intergenerational ties. [ABSTRACT FROM AUTHOR]