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Abstract This paper sheds light on the wage structure of foreign and German employees who are subject to social security contributions in fulltime employment and focuses on the experience structure. Existing evidence suggests that additional labour market experience is rewarded less for migrants than for their German counterparts. We identify and discuss reasons and explanations for migrants’ flat experience curves, which is particularly important in the light of the debate on inequality between both groups. These explanations include: the recognition of vocational training degrees, the successful passing of vocational training in Germany, German citizenship by naturalisation, and the labour market experience. After ten to 15 years in the German labour market, we identify convergence in the returns to labour market experience.

Abstract In this paper, we use a macroeconomic model to evaluate two reform proposals that, first, abolish the exemption from social security contributions for marginal employment (“mini jobs”) and, second, reduce social security contributions for low-income earners. Specifically, the first reform proposal lowers social security contributions for individuals with a gross income of less than 1,300 euro per month. The second reform proposal extends the relief to individuals who earn less than 1,800 euro per month. The main findings show that the second reform proposal leads to substantial relief for low income individuals and incentivises unemployed, marginal employed and parttime employed households to increase their labour supply. While there are already positive shortterm effects on employment, the second reform proposal increases longterm employment by 68,900 full-time equivalent units and the ensuing positive effect on employment and productivity is beneficial for the economy, the society, and for fiscal balances.

Abstract The European Union’s top climate policy objective is to fully decarbonise its member states’ economies by 2050, i. e. to achieve climate neutrality in all sectors that currently still depend on fossil fuels. This is fully reflected in the EU Commission’s political agenda under the heading “European Green Deal”. In order to achieve climate neutrality by 2050, the EU’s previous intermediate CO2 reduction target was recently tightened from a 40 % to a 55 % reduction by 2030. In its “Fit for 55 Program”, which was announced on 14 July 2021, the Commission proposed comprehensive reforms of the EU’s emissions trading system, the Renewable Energies Directive and the Energy Tax Directive to fully implement the European Green Deal. This paper provides a critical assessment of the proposed measures.

Abstract Regulatory efforts to introduce effective intramodal competition to the rail sector, in particular to the long-distance intercity market segment, have so far achieved only very limited success in most countries. Germany is a case in point. Even 25 years after the fundamental 1994 ‘rail structure reform’, which eliminated the legal network monopoly of the former Deutsche Bundesbahn (DB), the combined market share of all competitors for long-distance passenger services remains stuck at “significantly below one per cent” (Bundesnetzagentur 2018, 22). This figure stands in stark contrast to the competitors’ market shares of some 26% for short-distance (regional) services — where a competition for the market regime has been established — and around 50% of the rail cargo segment — which is governed by an open access regime. In this paper, we make the case for an alternative regulatory regime to substantially increase effective intramodal competition in the intercity rail passenger market. Our proposal addresses, and helps to overcome, the two major entry barriers faced by competitors: the massive investment needs in rolling stock on the one hand and reliable infrastructure access on the other.

Abstract This paper compares the economic programmes of 23 OECD countries with that of Germany. It focuses on monetary and fiscal policies, income support and stimulus, labour market policies and other government programmes in areas such as infrastructure, health, education and climate protection. In comparison, Germany looks well placed in protecting employment and income, albeit without a clear anti-poverty focus. However, it lacks a clear vision of the kind of post-Corona economy it wants to achieve.

Abstract This paper examines new options regarding interdisciplinary perspectives on the history of economic reconstructions in post socialist Eastern Germany after 1990, mostly connected to the muchdebated Treuhandanstalt (Trusteeship Agency). By discussing different narratives, a brief, abstract framework is presented by highlighting longterm structural changes, shortterm disruptions, midterm dynamics as well as framing cultural reflections on an individual or collective level. These patterns could help to build heuristic bridges between different disciplines (like social sciences, economics, or history) in this re-emerging scientific area and to embed this research in broader themes on a European or even global scale.

Abstract A total of 3.2 million people in Germany have been fully immunised so far. However, in order to achieve herd immunity, which is likely to require an immunisation rate of around 80 % due to the highly infectious mutants, approximately 65 million people need to be vaccinated. The current “imbalance” in the vaccination campaign is largely due to the limited supply of vaccines. Since J&J’s vaccine has recently been approved by the EU and additional production facilities are available, it is foreseeable that the capacities of the vaccination centres will no longer be sufficient. Moreover, at some point the existing unwillingness to vaccinate could become the final bottleneck in reaching herd immunity. This paper provides some calculations for these relationships. Against this background, it is questionable how well-prepared the present system is to cope with these foreseeable problems.

Background: With the introduction of tumor necrosis factor (TNF) alpha inhibitors, the treatment of inflammatory rheumatic diseases (IRD) has undergone a fundamental change. Several of the originally high-priced biologics are now accessible as lower cost biosimilars, removing a significant impediment to prescription., Objective: The present study investigated whether the availability of biosimilars is associated with an improvement in the care of IRD. Moreover, the subjective acceptance of biosimilars by physicians and patients was investigated and compared with objectifiable parameters., Material and Methods: Pseudonymized claims data of the Bavarian Association of Statutory Health Insurance Physicians from 2014 to 2019 as well as a paper and pencil survey of patients and rheumatologists formed the data basis of the study., Results: During the observation period, the proportion of diagnosed patients receiving drug therapy increased from 38.5% to 43.2%. Also, the care changed in terms of the prescribed agents. Conventional drug therapy declined overall and, in particular, glucocorticoid prescriptions decreased from 39.3% in 2014 to 34.3% in 2019. At the same time, the proportion of targeted treatments increased from 12.3% to 20.4%. The median duration of basic treatment before first-time bDMARD use dropped from 3.15 years in 2014 to 2.17 years in 2019., Conclusion: Over the observation period, in which three biosimilars entered the market, the care of patients with IRD improved both quantitatively and qualitatively. The market share of biosimilars increased in parallel with this development. With an overall high acceptance of biosimilars, the assessment of the disease course by physicians and patients indicates a slight subjectively perceived advantage of therapy with originals compared to biosimilars, which, however, is not confirmed when standardized scores are applied. A possible explanation for this might be a nocebo effect, which could be minimized by suitable communication strategies., (© 2022. The Author(s).)

Background: The number of older people living alone is constantly increasing. This group faces special challenges regarding remaining at home when their care needs increase, especially in later life. When no family is available, friends and neighbors, so called non-kin carers, are important sources of support., Objective: A literature review was conducted to evaluate existing research on the relevance of non-kin support for older people living alone, from initial limitations to the end of their lives, particularly when they wished to remain at home., Method: The literature search followed the criteria of a scoping review and was conducted in relevant databases and manually. A total of 22 studies were included in the analysis., Results: Older people living alone are often embedded in complex support networks. Living alone at an advanced age creates tensions between the desire for independence and the need for help. Non-kin carers primarily provide instrumental, emotional, and informational support. Challenges arise due to difficult interpersonal dynamics and the overburdening of non-kin carers, especially when those they support are at the end of their lives., Conclusion: It is important to understand care networks as a complex interplay of different actors. Future research should focus on the specific burdens on non-kin carers as well as on the dynamics of relationships in these care networks., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Imaging instruments, such as conventional X‑ray, ultrasound and magnetic resonance imaging (MRI) are now fully established and highly valued in the care of rheumatology patients. However, the information provided by these imaging modalities in their current form is of limited utility for the prognostic prediction of individual patient outcomes. This article illuminates an important part of the development of imaging and shows that the vision of personalized medicine is becoming increasingly more tangible due to the further development of high-resolution imaging techniques, molecular imaging and artificial intelligence., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is a clinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria., Objective: To investigate the prevalence and severity of SP in patients with RMD., Methods: A total of 141 consecutive patients over 65 years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in a cross-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP 1 and 2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as a parameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in a standardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student's T-test and the χ 2 -test were used for statistics., Results: Of the patients included 73% were female, the mean age was 73 years and 80% had an inflammatory RMD. According to EWGSOP 2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP., Discussion: This study showed a relatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in a standardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Abstract The paper at hand presents the development of offshore wind energy with a focus on the North Sea Region (NSR) and its dominant countries. The article analyses not only the shift to Asia in terms of offshore energy but also a structural shift inside the NSR that is disadvantageous to Germany. As an example of longterm planning within the market, the article quantitately examines the new challenge of decommissioning offshore wind installations embedded in two major cycles arising in the next decade. Moreover, the level of preparation in the respective countries is critically discussed. Open questions about adapting to the challenges arising from decommissioning are highlighted and potential answers are presented.

Abstract Europe is said to be in a trust crisis. The finance crisis and the euro crisis caused a wide-ranging and sustained loss of trust and the media suspected this to be the culmination of a long-term trend. This may be true for the United States but not for Europe. Trust in Europe recovered within a decade, but with significant regional differences. While trust in democracy is not at all endangered in the EU’s northern and central countries, it could be at risk in the southern and the eastern ones. The paper shows that the problems in the East are exaggerated and may turn out as transitory, while the political instability in the South is more risky. Due to the fact that almost all member countries manifest a relatively high trust in the EU and a strong resolve to remain, these problems are unlikely to put European democracy at risk.

Abstract The paper discusses the real returns of German and Austrian households of different financial wealth groups in times of ultra-low interest rates. While returns decreased across all groups, the decline is rarely claimed, at least so far. Moreover, it is shown that — contrary to popular belief — rich households are particularly affected, although their returns today are still higher than those of the poor. While the general developments are similar, the yield level in Austria is consistently lower than in Germany. Overall, the asset structure is key for the results. Economic policy should therefore aim at a higher diversification of assets, especially for the poor, by effectively improving financial education.

Abstract How do we define what technology is for humans? One perspective suggests that it is a tool enabling the use of valuable resources such as time, food, health and mobility. One could say that in its cultural history, humanity has developed a wide range of artefacts which enable the effective utilisation of these resources for the fulfilment of physiological, but also psychological, needs. This paper explores how this perspective may be used as an orientation for future technological innovation. Hence, the goal is to provide an accessible discussion of such a psychological perspective on technology development that could pave the way towards a truly human-centred digital transformation.

Background: The development of evidence-based guidelines for the prevention of infectious diseases through vaccination requires an understanding of populations that most likely may obtain an infection, severe illness or disease. Targeted vaccination recommendations are made possible by identifying risk groups, as is the case with meningococcal infections. Despite falling case numbers, meningococcal sepsis and meningococcal meningitis remain a major health problem., Method: A systematic literature search was carried out on the research platform Ovid., Results: Vulnerable groups of people whose immune system is limited by primary and secondary immunodeficiency, such as asplenia, renal failure, human immunodeficiency virus (HIV) infection, diabetes, complement deficiency, organ and stem cell transplants, or immunomodulatory therapy (e.g., in rheumatic, hematological or oncological diseases), are exposed to an increased risk of infection and more severe courses of disease. Despite adequate medical care, the mortality rate is high and patients that survived the infection are often suffering from severe long-term sequelae. In such cases, the vaccination recommendations of the Standing Committee on Vaccination (STIKO) for indication vaccinations and the application instructions for vaccination in the case of immune deficiency should be consistently implemented in Germany., Conclusions: Increased responsibility for comprehensive protection must be assumed for persons with underlying diseases. Reducing invasive meningococcal infections can be achieved through widespread education of patients and contacts, as well as practicing physicians on available vaccinations., (© 2023. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Sarcoidosis is the most common granulomatous disease in northern Europe. A distinction is made between acute forms of sarcoidosis and chronic sarcoidosis. Chronic sarcoidosis can affect practically all organs but the lungs are affected in 90-95% of patients. The clinical appearance varies between asymptomatic and oligosymptomatic courses, which are diagnosed more by chance, to courses with acute organ failure. An extensive organ work-up is necessary at the time of the initial diagnosis in order to record the extent of organ involvement and to make appropriate treatment decisions. Asymptomatic courses with purely pulmonary sarcoidosis do not require treatment and can be observed over the course of the disease, whereas courses with extensive organ involvement or organ dysfunction require treatment. The treatment consists primarily of the administration of glucocorticoids. If the effect of the glucocorticoids is insufficient or if there are side effects, various immunosuppressive agents, including biologics can be added., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Allergies are frequent and approximately 30% of the general population in Germany are affected. The specific sensitization against an allergen is asymptomatic. On renewed allergen contact the symptoms are indicative of the underlying pathomechanism. A variety of different test procedures are available to identify allergic reactions., Objective and Aim: In this review article the typical clinical symptoms of allergic reactions are assigned to mechanisms and possible test methods are presented and discussed. Current developments in recombinant serum diagnostics and cellular testing methods are presented., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

When long-term care insurance was introduced in 1994, a number of conceptual decisions were made that continue to shape the system today. This discussion article examines three of these decisions. In each case, an evaluation standard is formulated against which the current situation is assessed. In the case of a negative assessment, reform options are discussed.In combination with the lack of benefit adjustments, the design of long-term care insurance as a system with capped insurance benefits and unlimited co-payments has led to co-payment levels in nursing homes that the majority of residents cannot cover from their income. Therefore, in order to fulfill its original objectives, long-term care insurance would have be turned upside down - by imposing an absolute limit on the amount and duration of the individual co-payments.The "dual insurance system" consisting of a social insurance for the majority and a private mandatory plan for a minority of the population has also proved to be a "birth defect" of the system. Since the group of privately insured persons has a much more favorable risk structure and higher average incomes, the "equal distribution of burdens" in financing required by the Federal Constitutional Court does not exist. To remedy this inequality, the dual system must be transformed into an integrated long-term care insurance system, or at least a risk structure equalization scheme between the two branches must be implemented.The introduction of long-term care insurance as a separate branch of social insurance, however, can be justified. In order to overcome interface problems, it would nevertheless be necessary to place the financing competence for geriatric rehabilitation with long-term care insurance and that for medical treatment care in nursing homes with health insurance., (© 2023. The Author(s).)

Background: General practitioners are usually responsible for the early detection of burden due to informal care and the coordination of adequate measures. Their individual perspectives and approaches for identifying and supporting caregiving relatives have hardly been examined yet., Objective: The study therefore examined subjective perspectives of general practitioners regarding the identification and care of family caregivers in general practitioners' practices. The results will help to evaluate the needs for improvement and conditions for implementation of an instrument to identify informal carers., Material and Methods: To answer the question, we conducted 12 guideline-based expert interviews with general practitioners from Saxony-Anhalt. To evaluate the interviews, we used qualitative content analysis (Mayring)., Results: With respect to the medical care and support of caring relatives, the examination of subjective attitudes and perspectives confirmed that general practitioners occupy a central position. It also showed possibilities to improve or to facilitate support of caring relatives. Time-dependent problems and a lack of communication complicate support. Home care services and regional consulting services are available but a systematic cooperation and coordination of competences is still lacking., Conclusion: A screening instrument for family caregivers (identification, measuring subjective burden) represents a meaningful intervention. The special requirements and characteristics of interventions used in general medical practice have to be researched, the burden scale for family caregivers should be adapted and implemented accordingly. The cooperation of all actors must be a central aspect of future efforts., (© 2021. The Author(s).)

This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral/injectable antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed., (© 2023. The Author(s).)

Improving patient safety is key to better health and nursing care. The Association for the Continuous Development of the National Health Target Process, health-targets.de (gesundheitsziele.de), has defined two focus areas, each with six goals, to jointly initiate significant progress in patient safety in Germany and achieve the health target of the same name. It is based on the "Global Patient Safety Action Plan 2021-2030" of the World Health Organization (WHO) and contributes to its implementation on a national level.The national health target addresses all players in healthcare and highlights the role of patients. Strengthening patient safety culture and expanding patient safety competence are at the center of the target process.For patient safety culture, a systemic approach is crucial. Individual-related factors as well as structural and process-oriented variables are looked at. A cooperation that focusses on the wellbeing of patients is essential.Patient safety competence spotlights knowledge on security related aspects in healthcare. At the same time, it focuses on the ability of all those involved to influence care in a positive way-thereby being open to the capabilities of patients., (© 2022. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

These are the guidelines for diagnosis and treatment of diabetic neuropathy and diabetic foot.The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy, including the complex situation of the diabetic foot syndrome. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided. The needs to prevent and treat diabetic foot syndrome are summarized., (© 2023. The Author(s).)

Background: Dementia is increasingly perceived as a terminal illness due to disease progression with a shortened life expectancy and often a lack of therapeutic options. In the context of palliative care, the preferred place of death is considered a quality indicator for needs-based patient care. The aim of this study was to describe the distribution of places of death of older patients with dementia., Material and Methods: Death certificates from the years 2001, 2011 and 2017 were evaluated from the most comprehensive study on places of death in Germany to date, conducted in selected regions of Westphalia. Medical information on the cause of death was also analyzed. In this way, deceased patients with dementia ≥ 65 years (ICD-10: F01, F02, F03, G30) were identified and the distribution of their places of death statistically determined., Results: Dementia was present in 4720 out of 31,631 (14.9%; 95% CI: 14.5-15.3%) deceased patients ≥ 65 years. The distribution of places of death was as follows (%; age-standardized; 2001/2011/2017): home environment 24.0/19.7/15.8, hospital 40.4/29.0/24.3, palliative care unit 0.0/0.3/1.8, hospice 0.4/0.9/0.9, nursing home 35.2/49.5/57.1 and other places 0.0/0.0/0.0., Conclusion: The majority of older patients (≥ 65 years) with dementia die in nursing homes, followed by hospitals and the home environment. Palliative care units and hospices play a subordinate role as places of death for patients with dementia., (© 2021. The Author(s).)

The concept of frailty describes an older at-risk population, which has a higher probability for the occurrence of unfavorable health outcomes. It is in the interest of frail individuals as well as the healthcare system to improve the prognosis of these people by targeted interventions. Several systematic reviews and meta-analyses are now available comparing very different interventions in frail older adults. These studies came to the conclusion that training interventions were found to be the most effective. Compared to exercise interventions delivered at participants homes, exercise in groups was found to be more effective. The case finding for such interventions should be carried out with frailty instruments that focus on strength, endurance and/or physical activity. Particularly suitable for this are the frailty criteria of Fried, gait speed or the short physical performance battery (SPPB). From a geriatrics perspective, a comprehensive offer of group training seems to be urgently necessary; however, the implementation requires a large expansion of existing structures and new ways to reach older people with frailty., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background and Objective: The digital transformation of healthcare requires changed competences in the nursing professions. The reform of nursing education opens up the opportunity to anchor the requisite content in vocational education. The framework curricula of the expert commission ("Rahmenpläne der Fachkommission nach § 53 Pflegeberufegesetz") form the basis for the federal states to create their own framework curricula. This paper examines to what extent and in what form the framework curricula take up digitalisation., Material and Methods: The framework curricula were investigated in an explicative-qualitative content analysis between August and October 2021. First, the frequency of previously defined keywords was determined. This was followed by a systematic context analysis., Results: Merely six federal states had created their own framework curriculum; the others used the federal framework curriculum, which only addresses the acquisition of competences in the field of digitalisation to a small extent. Digitalisation was addressed to varying degrees in the federal state's own framework plans but only selectively overall. Recommendations for practical exercise formats were hardly given., Discussion: The acquisition of competences in the area of digitalisation forms the foundation for later professional life and is an important component of the digital transformation. In the context of the possibility of modifying nursing education until 2024, the topic should be taken into focus more strongly. Improvements can also be made directly at technical and vocational schools as well as universities since the framework curricula are sometimes only of a recommendatory nature., (© 2022. The Author(s).)

For the continued existence of the specialty of internal medicine and rheumatology and the assurance of a qualitative patient care, attractive further education for motivated resident physicians is of central importance. Continuing training in rheumatology takes place primarily in the inpatient setting, although reliable figures on outpatient and inpatient further education positions are not yet available. Further training in rheumatology is predefined by the model further training regulations (Musterweiterbildungsverordnung; MWBO) 2018, which have now been implemented by most state medical associations, in some cases with state-specific changes. Based on the MWBO of 2018, a model curriculum was developed by the German Society of Rheumatology (DGRh) for further training in the specialty of internal medicine and rheumatology. This model curriculum is intended to provide orientation for trainees and trainers as well as to facilitate structured rheumatology training in inpatient and outpatient settings., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Standardised surveillance of COVID-19 infections among healthcare personnel during the current pandemic was and is not available. In particular, the proportion of occupational infections among healthcare personnel and which workers among them are most at risk remains unclear., Objectives: The aim of this study was to analyse the reported COVID-19 cases among healthcare personnel in Frankfurt/Main during the first six months of the pandemic, to determine the number of occupational infections and thus to allow a better interpretation of the data published by the Robert Koch Institute., Methods: Data from the Frankfurt/Main Health Protection Authority was analysed for the period from 1 March to 31 August 2020, and healthcare personnel were recruited for a cross-sectional survey. Three subgroups were defined and analysed according to whether the infectious contact occurred at work, in private or in an unknown setting., Results: Healthcare personnel accounted for 11.8% (319/2700) of all reported COVID-19 cases in Frankfurt/Main during the period studied. In the survey, 47.2% of respondents reported that their infection was acquired in the workplace. There was an association of contact with COVID-19 patients as well as employment in the internal medicine ward and a reported work-related infection. Also apparent was an association between suspected occupational infections and consequently filed reports for alleged occupational disease., Discussion and Conclusion: Health protection authorities are in a position to collect relevant data on work-related transmissions in healthcare occupations and workplaces and should generate standardised data on infected healthcare personnel. This data is necessary to take targeted infection control and prevention measures that protect healthcare personnel and their patients., (© 2022. The Author(s).)

In addition to locomotion, mobility also includes any motor performance that serves other purposes and movements that are unplanned. This article presents the instruments mentioned in the S1 guideline "Geriatric assessment level 2, living guideline", as well as additional ones that are less known. The classification is into three categories: instruments that focus on the upper extremities, instruments without performance, which mainly focus on the functions and capabilities of the lower extremities, and those that do this using performance tests., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Osteopathy in rheumatology can either be primary a condition as a consequence of inflammatory rheumatic diseases but can also be drug induced. The most severe clinical manifestations are insufficiency fractures and osteonecrosis. The risk of fractures is highest for patients treated with glucocorticoids depending on the daily intake, the cumulative glucocorticoid dosage and the duration of administration. An incidence rate of nearly 13% was reported after administration of glucocorticoids lasting > 1 year. Cases of osteonecrosis under glucocorticoids are, in contrast, less frequent and not associated with glucocorticoid-induced osteoporosis. The antiresorptive substances bisphosphonates and denosumab, as well as romosumab are effective and important in treating osteoporosis; however, they can also cause atypical fractures, particularly of the femur as well as osteonecrosis of the jawbone. According to the most recent guidelines the benefits of bisphosphonate treatment have only been verified for 3-5 years and for denosumab for 3 years. There are clear preventive recommendations to avoid osteonecrosis of the jaw. Ultimately, the disease-modifying antirheumatic drugs (DMARD) methotrexate and leflunomide also affect the metabolism of bones. There is a rare but very characteristic form of osteopathy associated with methotrexate, mainly occurring in cases of long-term treatment. The typical manifestations are insufficiency fractures, particularly of the distal tibia, which persist for many years under continuous methotrexate administration. The treatment is the discontinuation of methotrexate and in most cases the fractures will heal within 3-4 months. Leflunomide has been associated with cases of persisting pseudarthrosis that only disappeared after a wash-out of the active metabolite., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Chronic pain in older adults should be explained and treated on the basis of the biopsychosocial model. With its interdisciplinary and interprofessional approach, multimodal pain therapy is the method of choice. In old age freedom from pain is usually not the primary goal. It is more important to restore the quality of life of those affected and to maintain independence and autonomy with a versatile treatment offer. This article explains the basics of multimodal pain therapy and its special features in old age., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Only the correct diagnosis enables an effective treatment of rheumatic diseases. Digitalization has already significantly accelerated and simplified our everyday life. An increasing number of digital options are available to patients and medical personnel in rheumatology to accelerate and improve the diagnosis. This work gives an overview of current developments and tools for patients and rheumatologists, regarding digital diagnostic support in rheumatology., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background and Aim: Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks"., Method: In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated., Previous Results: The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC., Conclusion: Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)