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Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland)., (© 2021. The Author(s).)

Background: Spinal muscular atrophy (SMA) is a severe, life-limiting neurodegenerative disease. A disease-modifying and approved therapy with nusinersen has been available in Germany since July 2017. Gene therapies offer another promising treatment option through a once in a lifetime administration. In May 2019 a gene replacement therapy for the treatment of SMA was approved for the first time by the U.S. Food and Drug Administration (FDA). An application for approval in Europe has been submitted and is currently pending., Objective: This consensus paper was compiled at the invitation of the German Society for Muscular Diseases (DGM) with the participation of all potential German neuromuscular treatment centers, the German section of the Society for Pediatric Neurology (GNP) and with the involvement of the medical scientific advisory board of the DGM. The aim was to define and establish the necessary prerequisites for a safe and successful application of the new gene replacement therapy in clinical practice., Conclusion: Gene replacement therapy with onasemnogene abeparvovec has the potential to significantly influence the course of SMA. Long-term data on sustainability of effects and possible adverse effects of gene replacement therapy are not yet available. The application of this innovative therapy must be carried out in specialized and appropriately qualified treatment centers under strict safety conditions. This article makes suggestions for the necessary framework conditions and gives recommendations for a systematic pretreatment and posttreatment assessment schedule under gene therapy. The effectiveness and safety of the therapy should be systematically documented in an industry-independent and disease-specific register.

Providing expert opinion in the context of smell disorders is often challenging, not only with regard to general aspects of providing an expert opinion but particularly with regard to chemosensory testing. Currently there is no consensus which chemosensory test should be selected and how they should be executed. This positions paper from Committee on Olfaction and Gustation of the German Society of Otorhinolaryngology, Head and Neck Surgery aims to give concrete recommendations for chemosensory testing for providing expert opinion for smell disorders with regard to the selection and execution of these test., (© Georg Thieme Verlag KG Stuttgart · New York.)

Despite great advances in the pathophysiology and etiology of myocarditis, the clinical diagnosis of myocarditis in daily clinical practise remains challenging. Often the diagnosis was not clear because of the heterogeneity of clinical symptoms and the lack of guidelines for adequate diagnostic requirements and consecutive treatment options. The European Society of Cardiology (ESC) Working Group on Myocardial and Pericardial Diseases established a working group of experts to improve the diagnosis and management of myocarditis and to provide a common consensus statement as a reference for future registries and controlled trials. The goal was to bridge the gap between clinical- and tissue-based diagnosis by formulating a concept concerning essential diagnostics and treatment of these patients that would be accepted across Europe. Only in this manner is it possible to establish a basis for national and international registries and double-blind randomized treatment trials for the etiologically differentiated treatment of myocarditis, which appear promising due to numerous studies in recent years. In this paper, two members from the expert working group summarize the most important aspects of this position paper on the etiology, diagnosis, management, and treatment of myocarditis, which were published in the July 2013 issue of European Heart Joumal.

The process of reviewing the European pharmaceutical legislation resulted in a codex, which contains two new instruments related to marketing authorisation of biological medicines: Plasma Master File (PMF) and Vaccine Antigen Master File (VAMF). In the manufacture of plasma derivatives (e. g. coagulation factors, albumin, immunoglobulins), usually the same starting material, i. e. a plasma pool, is used for several products. In the case of vaccines, the same active substance, i.e. vaccine antigen, may be included in several combination vaccine products. The intention behind the introduction of PMF and VAMF was to avoid unnecessary and redundant documentation, and to improve and harmonise assessment by means of procedures for certification of master files on the community level.

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people., (© 2024. The Author(s).)

Background and Aim: Due to its strong economy and a well-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct a detailed mortality analysis by age., Methods: Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy)., Results: Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20 years. In 2000, Germany was 0.73 years behind for men and 0.74 years behind for women. By 2019, these figures had risen to 1.43 and 1.34 years, respectively. This is mainly due to mortality from non-communicable diseases., Conclusion: For Germany to catch up with other Western European countries, a stronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position., (© 2024. The Author(s).)

The challenges posed by the COVID-19 pandemic face different institutional structures and traditions of action in the European health systems. This article uses the example of the public health services in Sweden, France and Austria to address the question of the similarities and differences in the measures taken to combat the pandemic (status: November 2020).Among the countries presented in this article, Austria is the least affected by the pandemic and France is the most affected. In all analysed health systems there is a tension between national and regional responsibilities. France's healthcare system is particularly centralized, while Sweden's is strongly regional and municipal. Governments in the nation states are striving to obtain pandemic containment powers independent of parliamentary decisions. Sweden differs from Austria and France in that its pandemic containment strategy is based primarily on recommendations and appeals rather than directives and bans. The sequences of action during the pandemic and, apart from Sweden, the instruments used to contain the pandemic are similar. The course of the pandemic and the measures taken in Austria and France show clear parallels with those in Germany. The protection of particularly vulnerable groups has not been sufficiently successful in all countries and remains a challenge to be met.

Background: Traumatic eardrum perforation is a common presentation in otorhinolaryngologic practices and emergency clinics. A consistent management strategy (active intervention vs. watchful waiting) is, however, still lacking., Objective: In the following study, the outcome of watchful waiting is analyzed and presented., Materials and Methods: A collective of 272 patients presenting at two different specialist ENT practices within days of traumatic tympanic membrane perforation from June 2002 to March 2019 were analyzed. Treatment was non-surgical, with prospective monitoring. Whereas antibiotics were not given at all in one practice, they were given only upon signs of infection in the other practice. The outcome was evaluated retrospectively on the basis of patient files., Results: The collective consisted of 185 males and 87 females. Mean age was 30 years (range: 7 months to 82 years). The perforations were most commonly located in the upper anterior and lower posterior quadrants. According to Griffin grading, the size was grade I in 97%. The three most common causes were impact to the ear, barotrauma, and foreign bodies. Under a watchful waiting regimen, 95% of the patients presenting for follow-up checks showed complete closure., Conclusion: Watchful waiting can be assessed as appropriate in traumatic eardrum perforation, provided otorhinolaryngologic follow-up is ensured. An exception is blast injury, which is now much less common in Central Europe, as this is associated with a risk of secondary cholesteatomas. In these rare cases, active treatment with surgical exploration of the middle ear including relining the perforation is indicated.

Background: Measles incidence in the 53 Member States of the World Health Organization (WHO) European Region has fallen dramatically in recent decades. The European Regional Verification Commission for Measles and Rubella Elimination (RVC) verified that 43 member states had interrupted endemic measles transmission for ≥12 months by the end of 2017. However, measles incidence in the region increased sharply in 2018 compared to 2017. The purpose of this article is to assess the current status of measles in the Region in relation to its elimination goal. It also discusses challenges and actions needed to reach this goal., Methods: Measles surveillance data presented for 2017 and 2018 (as of 1 February 2019) were submitted by all 53 member states. The measles elimination status of countries was obtained from the 2018 report of the seventh meeting of the RVC., Results: In 2017, 25,863 measles cases were reported in 44 countries of the WHO European Region. In 2018, 82,596 measles cases were reported in 47 countries. Most cases were reported by Ukraine (64%) and Serbia (6%). Age was known in 82,588 cases: 8% were <1 year old, 17% were 1-4 years old, 38% were 5-19 years old and 37% were ≥20 years old. Data on vaccination status were provided for 76% of the cases, of which 62% were unvaccinated. Seventy-two measles-related deaths were reported from 10 countries., Conclusions: For the elimination of measles in the European Region, a high population immunity rate and accurate epidemiological surveillance remain essential. Long-term political commitment by all Member States in these areas is crucial to attain the elimination goal.

Technological and scientific innovations in the area of gene and cell therapies, so-called advanced therapy medicinal products (ATMPs), have contributed to the steep increase in treatment options for patients with rare diseases. They offer opportunities to address the underlying genetic defect by gene addition, i.e., the delivery of the gene of interest to the target cells, or by genome editing approaches through direct repair of disease-causing mutations. This paper outlines clinical evidence requirements in the context of marketing authorisations for rare diseases. Two out of fifteen gene therapies that have been approved in the European Union since 2018 are used as case studies: Libmeldy (atidarsagen autotemcel) for the treatment of patients with metachromatic leukodystrophy, and Roctavian (valoctocogen roxaparvovec) for the treatment of patients with haemophilia A. Special aspects of the evaluation of single-arm trials with small sample size and requirements with regard to the isolation and causal attribution of the treatment effect are discussed. The role of clinical data obtained under everyday conditions (real world data) to support the generation of evidence in the pre- and post authorisation phase is critically examined. Furthermore, the paper outlines aspects related to conditional versus standard marketing authorisations as well as aspects related to registry-based non-interventional studies in the context of market and patient access to urgently needed drugs., (Copyright © 2024. Published by Elsevier GmbH.)

Skin diseases are complex and cannot be explained solely by genetic or environmental factors but are also significantly shaped by social influences. This review illuminates the bidirectional relationship between social factors and skin diseases, demonstrating how social determinants such as socioeconomic status, living environment, and psychosocial stress can influence the onset and progression of skin conditions. Simultaneously, it explores how skin diseases can affect individuals' social lives and work capability, leading to a cycle of social withdrawal and further deterioration of the condition. The paper describes the need for a holistic approach in dermatology that goes beyond the biomedical perspective and incorporates social factors to develop effective prevention and treatment strategies. The increasing prevalence of skin diseases in Europe and the expected rise in allergies due to climate change make the consideration of social determinants even more urgent. The findings of this review aim to raise awareness of the complex interconnections between social factors and skin health and contribute to reducing social disparities in skin health., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The climate crisis has serious consequences for many areas of life. This applies in particular to human health - also in Europe. While cardiovascular, pneumological and dermatological diseases related to the climate crisis are often discussed, the crisis' significant gastroenterological consequences for health must also be considered., Methods: A literature search (Pubmed, Cochrane Library) was used to identify papers with relevance particularly to the field of gastroenterology in (Central) Europe. Findings were supplemented and discussed by an interdisciplinary team., Results: The climate crisis impacts the frequency and severity of gastrointestinal diseases in Europe due to more frequent and severe heat waves, flooding and air pollution. While patients with intestinal diseases are particularly vulnerable to acute weather events, the main long-term consequences of climate change are gastrointestinal cancer and liver disease. In addition to gastroenteritis, other infectious diseases such as vector-borne diseases and parasites are important in the context of global warming, heat waves and floods., Discussion: Adaptation strategies must be consistently developed and implemented for vulnerable groups. Patients at risk should be informed about measures that can be implemented individually, such as avoiding heat, ensuring appropriate hydration and following hygiene instructions. Recommendations for physical activity and a healthy and sustainable diet are essential for the prevention of liver diseases and carcinomas. Measures for prevention and the promotion of resilience can be supported by the physicians at various levels. In addition to efforts fostering sustainability in the immediate working environment, a system-oriented commitment to climate protection is important., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: In many European countries, intercultural treatment situations are an integral part of everyday medical practice. In this context, the appearance of different interest and decision-making conflicts, which result from communication barriers, cultural practice or moral diversity, are not uncommon. In this paper, the characteristics of intercultural treatment situations with their ethical relevance are presented. Some skills and abilities of intercultural competence are also described and their function is demonstrated by a clinical ethical case. The opportunities and limitations of intercultural competence for an ethical orientation are subject of reflection., (© 2023 Aerzteverlag medinfo AG.)

Based on scientific findings, the World Health Organization (WHO) has recommended stricter guideline values for air quality in 2021. Significant reductions in the annual mean values of particulate matter (particle size 2.5 µm or smaller, PM 2.5 ) and long-term exposure to nitrogen dioxide (NO 2 ) and ozone (O 3 ) were put forward. The risk of mortality already increases above the WHO guideline values, as shown in studies investigating low concentrations of air pollutants. In Germany, the 2021 WHO guideline values for PM 2.5 and NO 2 were clearly exceeded in 2022.In this position paper we give the following recommendations for the European Air Quality Directive: (1) set binding limit values according to WHO 2021, (2) apply the limit values to the whole of Europe, (3) continue and expand the established country-based monitoring networks, (4) expand air quality measurements for ultrafine particles and soot particles, and (5) link air pollution control and climate protection measures.Stricter limits for air pollutants require societal and political changes in areas such as mobility, energy use and generation, and urban and spatial planning. Implementation according to WHO 2021 would lead to a net economic benefit of 38 billion euros per year.Ambitious limit values for air pollutants also have an impact on climate change mitigation and its health impacts. The Environmental Public Health commission concludes that more ambitious limit values are crucial to enable effective health protection in Germany and calls for air pollutant limit values in line with the 2021 WHO recommendations to become binding in Europe., (© 2023. The Author(s).)

In the European Union (EU), rare diseases (RDs) are diseases that affect no more than 5 in 10,000 people. Due to their rarity, clinical expertise and quality-assured care structures are scarce, and research is more difficult compared to other diseases. However, these problems can be overcome by means of national and transnational RD care networks. Data and expertise are pooled in these networks.In the EU, the European Reference Networks (ERNs) for Rare and Complex Diseases cooperate across borders. Important services provided by ERNs using health data include diagnostic coding of RDs, conducting virtual cross-border case conferences, and establishing European registries that are used to measure and improve the quality of care. In ERNs, local data generation and documentation combine with network-wide data infrastructures. This paper describes the data-based services in and for RD healthcare networks: (1) diagnostic coding, (2) cross-border case conferences, and (3) ERN registries for RD patient care. The final section discusses the integration of the networks into national healthcare systems.In order to achieve the best possible benefit for SE patients, ERN activities and structures need to be better integrated into national healthcare systems. In Germany, the Medical Informatics Initiative and the German Reference Networks play a central role in this regard., (© 2022. The Author(s).)

This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences. The figure of the plague doctor with the beak mask has become the symbol of the plague par excellence. It's little wonder that the plague mask in the collection of the German Museum of the History of Medicine in Ingolstadt (Bavaria) is one of the museum's most popular objects and motifs. This forum paper investigates the figure of the plague doctor on several levels: first, it analyses contemporary textual and image sources in regard to protective clothing used in times of plague and the respective role of the beak-like part of the mask. Then it takes a close look at the Ingolstadt specimen. By examining the mask's materiality and fabrication, questions of its authenticity and practicability are raised. Finally, the Ingolstadt mask is compared with the specimen at the German Historical Museum in Berlin.The conclusion: the beak mask is not mentioned before the mid-seventeenth century, and then only in Italy and Southern France. There is no proof at all of its use during plague outbreaks in Middle Europe. And the specimens in Ingolstadt and Berlin? Both masks present details which suggest that they were not used as protective clothing at all. We do not know, however, if they were produced as replicas for historic reasons or as fakes for the modern art market.

Background: Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue., Method: Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives., Results: A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards., Discussion: Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.

The profound and ongoing crisis of organ donation and transplantation medicine in Germany urges for swift and sustainable improvement. Over the last few decades, various European countries have introduced national action plans and have efficiently begun to tap into their national potential for organ donation. Our paper sheds light on a variety of measures that have proven successful in different countries. Careful evaluation and comprehensive debate in public and professional bodies may warrant a tailor-made approach towards successful, albeit fundamental, changes in Germany's organ donation system.

Screening studies on conventional chest X‑rays and on sputum cytology did not show a reduction in lung cancer mortality. However, screening by low-dose computed tomography (LDCT) is more promising because it allows tumor detection in early stages at fairly low radiation levels. No reduction of lung cancer mortality was found in two small, randomized clinical studies on LDCT screening in Europe. However, in the by far largest LDCT trial, the National Lung Screening Trial (NLST) in the USA, a relative reduction of lung cancer mortality by 20.0% (95% confidence interval: 6.8-26.7%), and a relative reduction of total mortality by 6.7% (95% CI: 1.2-13.6%) was reported. According to the NLST, an important disadvantage of LDCT is the low positive predictive value of abnormal screening results: lung cancer was confirmed in only 4 of 100 abnormal screening results.In this paper, benefits and disadvantages of LDCT screening and related open questions are systematically discussed. A possible reduction of lung cancer specific and total mortality must be weighed against false positive results, overdiagnoses, and radiation exposure. In NLST, the proportion of overdiagnoses is estimated to be 11.0 to 18.5%, depending on the strategy of analysis; radiation exposure is about 1.5 mSv per scan, and thus much lower than radiation exposure in chest X‑ray, which is about 8 mSv per scan. Open questions refer to who should be offered the screening, how long the time intervals between screening rounds should be, and which algorithms should be used to clarify screen-detected nodules.

The paper addresses possible perspectives for the future of psychiatry in Europe over the next 30 years. Initially, an historical overview over the history of psychiatry since the Enlightenment suggests that significant changes did not primarily originate in psychiatry itself but were rather the result of the given societal contexts. The paper then describes five different potential scenarios for psychiatric care in 30 years time. Following that, the current situation of psychiatrists and possible signs of a crisis are outlined, and specific aspects that characterize the job of psychiatrists, as compared to other medical disciplines and other professional groups in mental healthcare, are considered. Finally, suggestions are made to make psychiatry more attractive, effective and relevant in society, which may make the profession better equipped for future changes.

Surveys show that noise in its various forms is among the most severe environmental burdens. According to estimates of the World Health Organization (WHO), there is a loss of one million healthy life years per year in Europe due to the effects of environmental noise. This paper discusses the harmful effects of noise with the example of traffic noise, for which the highest number of environmental noise effect studies are available. An increasing number of studies show associations between traffic noise and vascular, metabolic and psychic diseases. Too little is still known about the causal mechanisms, even though a number of explanatory models are available. However, it is clear that today it is no longer a question of whether noise is responsible for extra-aural diseases, but under what conditions and to what extent are the risks.The high degree of noise nuisance shows that more action is needed with regard to noise control policy.Over the past few years, federal, regional and local governments have taken countless initiatives on traffic noise control - for instance, within the framework of action plans. Especially notable are the innovative measures, instruments and programs regarding railway noise. In the most important source of nuisance, road traffic noise, less progress has been made. In air traffic noise, too, the revision and development of important laws are still lacking. To promote inner urban development, the level of protection against industrial and sports noise has been reduced.Significant health-related reductions in noise pollution (except regarding the railways), therefore, cannot be expected in the near future.

Study Objective: Patients expect a lot from doctors. They expect doctors to be trustworthy and competent, to discuss all treatment options with them, to inform them about mistakes made during the treatment and to put their interests before their own interests. This paper examines how the population of Europe assesses doctors in this respect and whether there are countries where the assessments are similar., Methods: In the "International Social Survey Programme - ISSP" the population in 32 countries was asked to assess the doctors in their respective countries. For this paper, data of 27,772 respondents from 18 European countries were analysed. The respondents were asked to rate 5 statements about doctors on a 5-point scale, with 1 indicating a positive assessment and 5 indicating a negative assessment. For each country, the mean values for the statements were calculated and grouped using cluster analysis to identify countries with similar assessments., Results: "Doctors can be trusted" is the statement with the highest approval across all countries, with means ranging from 2.0 in Denmark to 2.7 in Russia. In most countries, the means of the following statements were close to each other: "Doctors discuss all treatment options with their patients", "The medical skills of doctors are as good as they should be", and "Doctors do not care more about their earnings than about their patients." In almost all countries, respondents were particularly skeptical about the statement "Doctors would tell their patients if they had made a mistake during treatment". Four clusters were identified, but there was no cluster that rated among the best for all five statements. With regard to trust, the discussion of treatment options and the pursuit of self-serving interests, doctors in Germany were not rated particularly well or particularly badly. In Germany, the population was more likely to think that doctors would not inform their patients about mistakes during the treatment., Conclusions: Trust in doctors seems to reflect the general level of trust in a country. The question arises why trust in doctors is high across countries if the respondents are much more skeptical regarding the other statements., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The aim of this paper was to present the legal framework as well as previous experience in transnational collaboration regarding the assessment of medical devices for reimbursement decisions. Furthermore, the possible benefit of transnational collaboration for various stakeholders will be discussed., Methods: Experiences gathered with the compilation of overall 6 joint rapid assessments of medical devices within the completed European Network for Health Technology Assessment (EUnetHTA) Joint Action 2 (JA2) are summarised and discussed. Benefits, aims and opportunities of the ongoing EUnetHTA Joint Action 3 (JA3) are described., Results: Challenges in joint European assessment of medical devices encompass the choice of topics and the time point of assessments, the non-transparency of the medical devices market as well as the lack of European standards for systematic patient involvement. Characteristics of medical devices such as incremental changes and learning curves call for monitoring of medical devices through their whole lifecycle. The concrete benefit of European collaboration for stakeholders is manifold: uncertainties with regard to the actual added value of a technology, caused by a lack of evidence, may be reduced by Early Dialogues; harmonized and transparent assessment processes throughout Europe increase the reproducibility and quality of reports; the division of work among the health technology assessment (HTA) organisations allows a resource efficient assessment of a larger amount of technologies; patient involvement facilitates consideration of patient-relevant endpoints. The importance of cross-border collaboration in the field of HTA is shown in the continuation of the EUnetHTA project, which aims to further strengthen international collaboration even after expiration of EU funding., Conclusion: A sustainable transnational collaboration in the assessment of medical devices can ensure cross-border health care as well as efficient collaboration of national health systems. The focus should be on a wide implementation of jointly established methods and quality standards. The European collaboration can lead to a concrete benefit for patients, physicians, HTA organisations and national decision makers., Competing Interests: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (Eigentümer und Copyright ©Georg Thieme Verlag KG 2018.)

Female and male adolescents in Germany are increasingly using the Internet to find information about sexuality and sexual health. This review paper summarizes what we know about the status quo of online sexuality education in Germany.Based on a systematic literature review including 40 papers from international, peer-reviewed journals spanning 2010-2017, this paper first describes different aspects of the sexuality-related online search behavior of adolescents: its prevalence, predictors, topics and contexts. One main finding is the fact that adolescents use a computer or smartphone to type their sexuality-related questions into the search engine Google or the search engine of the video platform YouTube.Based on 54 online searches, this paper subsequently presents the kind of sexuality-related online content adolescents find if they ask "Dr. Google" for sexual advice; a collection of 1236 authentic sexuality-related questions of adolescents was used for this analysis. It turned out that online sexuality education offered by leading professional organizations like the BZgA ("Bundeszentrale für gesundheitliche Aufklärung") or pro familia was nearly invisible, while numerous other providers of online sex education consistently appeared in the top Google search results. Among them were the "Dr. Sommer" team of the youth magazine Bravo; online healthcare and advice portals; online forums; the online encyclopedia Wikipedia and, above all, sex education channels on YouTube. In this paper, the latter are presented in more detail for the first time.The third part of the paper addresses the quality of online sexual education over four main areas of quality evaluation. The presentation of the status quo ends with some recommendations both for future research and for sexuality education in practice.

Images have always played an important part in neurology. From the early days of the discipline, images, in the form of drawings and photographs, are included in textbooks and travel all around the Western world. They have a role to play in the diffusion, authority and standardization of the neurological discipline. This paper describes the world-wide circulation of a medical image through textbooks.

It has been shown that socio-economic status (SES) and health are closely linked to one another. Now we focus on further questions, and one of the most important ones is whether these "health inequalities" increase with time. In Germany, there is little discussion about this question and no review summarising the empirical evidence is available.This review focuses on 4 dimensions: time trends of health inequalities concerning mortality (or, respectively, life expectancy), self-rated health, smoking and obesity. First we included all empirical analyses from Germany, and all analyses from other European countries published between 2008 and 2012. Then, step-wise, 44 studies (including 5 from Germany) were selected by predefined criteria for a detailed -description of empirical results and methods.The number of publications has strong-ly increased in recent years, illustrating the growing interest in time trends of health inequalities. The empirical results of the 44 studies could be summarised in the following way: All in all, 184 empirical results are reported about time trends in health inequalities and 112 of them show increasing inequalities; decreasing inequalities are shown in 13 reports. The studies from Germany point in the same direction (i. e., most results indicate increasing health inequalities). It is also important to stress that there is great -heterogeneity concerning the methodical approaches. Some studies analyse health inequalities by individual socio-economic status (e. g., educational level), others by regional deprivation. Sometimes changes in the extent of health inequalities over time are not calculated explicitly. Some papers do not include absolute and relative measures of inequalities, but just one of them.In Germany, there is a need for more empirical studies looking at time trends of health inequalities; the available datasets should be used more often for this type of analysis. If possible, further studies should include individual SES and regional deprivation, measures of absolute and relative inequality (stratified by sex, with significance tests for time trend), and they should cover as many points in time as possible. Also, it would be important to relate the chang-es in health inequalities to the other changes in the society., (© Georg Thieme Verlag KG Stuttgart · New York.)

Patient safety is an important issue in European healthcare policy. Given the fact that healthcare falls within the competence of the EU Member States, this paper highlights the capabilities of the European Commission to promote patient safety. The potential added value for the topic that can arise at the EU level is critically discussed.

Introduction: The standardisation of European HTA and thus the reduction of redundancies require clearly defined processes and methods. The HTA Core Model®, a tool developed by the European Network EUnetHTA, is intended to ensure the transparent production of standardised and high-quality assessments in international collaboration., Methods: The present paper describes the experience with already published EUnetHTA assessments as well as possibilities for national/local adaptations of these assessments. The integration of jointly developed methods in routine processes of individual HTA agencies will be explained on the basis of a selected example. Further methodological initiatives in Europe will be presented., Results: So far, EUnetHTA has published four rapid assessments conducted through European cooperation between 6-9 HTA institutes during Joint Action 2 (2012-2015). Two assessments dealt with pharmaceuticals and two with non-pharmaceutical interventions. The overall duration of these assessments ranged from 7 to 9 months. There is initial information about the frequency and manner in which these assessments have been used for national/local HTA reports. According to a survey, a total of 28 HTA institutes have indicated that they want to make use of these assessments in their own context. In Austria, the Ludwig Boltzmann Institute for Health Technology Assessment (LBI-HTA) has produced two reports based on EUnetHTA assessments. A further step towards cross-border collaboration and harmonisation is the implementation of these tools in a national and regional context. Beginning in 2015 the LBI-HTA will adjust two programme lines to the format of the HTA Core Model® in order to increase the transferability of HTAs and to reduce redundancies., Discussion: Barriers to European collaboration include the relevance of topics for individual HTA institutes and the timing of joint assessments. Implementing commonly developed methods as standard practice in local/national HTA institutes is mainly impeded by legislative requirements., Conclusion: Despite the initial positive experiences with international collaboration on specific topics and methods, the coming years will have to prove whether existing barriers can be overcome effectively., (Copyright © 2015. Published by Elsevier GmbH.)

The aim to 'civilize' warfare accompanied Medicine and International Law ever since the mid-19th century. However, the entanglement of Medicine and Law, crucial for such an endeavour, has not been taken into consideration so far; likewise, the huge importance of medical knowledge for the perception of wars and their ramifications did not garner much attention in historical research. Hence, by focusing on the 'long' 19th century, this paper shows, firstly, that the production of surgical knowledge during warfare aimed at measuring the effects of combat on human bodies in order to develop prognostic medical knowledge for future wars, as well as maintaining the combat strength of soldiers. Moreover, this knowledge production during warfare strived for the enhancement of medical competence in the diagnosis and treatment of wounds in general. Secondly, I show that this medical knowledge was not only relevant for warfare, but also crucial for the design of International Law: it served to nourish the debates among the so called 'civilized' nations about legitimate and illegitimate weaponry and warfare.