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The number of obstetric departments in German hospitals has declined in the last decades. In particular, rural hospitals are challenged to sustain their delivery services. In this paper, we analyse the role of variation and overheads of obstetric departments from the perspective of current and future German hospital financing. For this purpose, we develop a Monte Carlo simulation model that analyses the workload of the labour room and the obstetric ward. The results show that a hospital with less than 640 deliveries per year cannot break even. In order to offer services 24 h per day, 365 days per year, five nurses, five midwives, and five gynaecologists are needed. This results in high fixed costs. At the same time, the variation coefficient of the labour room and the obstetric ward declines with an increasing number of deliveries. Consequently, small hospitals have a higher risk of over- and under-utilization in the course of the year. This paper acknowledges that economics is not the only decision dimension. The quality of the institution and the transport to the hospital have to be considered, as well as the population's wish for nearby services. However, the simulations clearly demonstrate that unless the hospital financing system is changed fundamentally, the decline in the number of hospitals offering delivery services will continue. [ABSTRACT FROM AUTHOR]

The hydrogen (H2) momentum affects the aviation sector. However, a macroeconomic consideration is currently missing. To address this research gap, the paper derives a methodology for evaluating macroeconomic effects of H2 in aviation and applies this approach to Germany. Three goals are addressed: (1) Construction of a German macroeconomic database. (2) Translation of H2 supply chains to the system of national accounts. (3) Implementation of H2-powered aviation into the macroeconomic data framework. The article presents an economy-wide database for analyzing H2-powered aviation. Subsequently, the paper highlights three H2 supply pathways, provides an exemplary techno-economic cost break-down for ten H2 components and translates them into the data framework. Eight relevant macroeconomic sectors for H2-powered aviation are identified and quantified. Overall, the paper contributes on a suitable foundation to apply the macroeconomic dataset and to conduct macroeconomic analyses on H2-powered aviation. Finally, the article highlights further research potential on job effects related to future H2 demand. • The hydrogen momentum affects the aviation sector, but a macroeconomic perspective is currently lacking. • This article derives a methodology for evaluating the macroeconomic effects of hydrogen use in aviation and applies this approach to an economy-wide dataset for Germany. • The study investigates three hydrogen supply pathways, provides an exemplary cost break-down for ten hydrogen components and translates them into a national data framework. • Eight macroeconomic sectors relevant for hydrogen-powered aviation are identified and quantified by assigning the respective techno-economic cost components. • The article highlights meaningful research potential on macroeconomic analyses of hydrogen-powered aviation and employment effects related to future hydrogen demands. [ABSTRACT FROM AUTHOR]

While promoting the economic growth, energy has also brought pollution problems to the world environment, which has gradually become a bottleneck impeding sustainable economic development. In view of the rapid evolution of urbanization and industrialization, economic growth is increasingly dependent on the energy consumption, the development of the two is difficult to coordinate, and the internal contradictions are becoming increasingly serious, which hinders the sustainable development of economic growth. This study establishes the relationship between energy consumption and economic growth according to the energy Kuznets curve and studies the future trend of China's sustainable development through the comparative analysis of the energy Kuznets curve of the United States and Germany. The results show that, at the turning point of energy consumption, China's energy economic rate is higher than that of Germany and the United States. In addition, in terms of urbanization rate and industrial structure, although China's tertiary industry has made a breakthrough, it is still lower than that of the United States and Germany, but the level of urbanization rate has made significant progress. In short, China has obvious advantages in future economic development and has a late developing advantage compared with the United States and Germany. This paper makes an empirical analysis of the relationship between energy consumption and economic growth in OECD countries and finds out the turning point of energy consumption, so as to provide a theoretical basis for coordinating China's energy consumption and economic growth. [ABSTRACT FROM AUTHOR]

An increasing number of municipalities are striving for energy autonomy. This study determines in which municipalities and at what additional cost energy autonomy is feasible for a case study of Germany. An existing municipal energy system optimization model is extended to include the industrial, commercial and personal transport sectors. Multiple regression methods are benchmarked in order to identify the model best suited for the transfer of individual optimization results to a large proportion of German municipalities. The resulting levelized cost of energy (LCOE) from the optimization of representative case study municipalities are transferred using energy-relevant indicators. The study demonstrates that energy autonomy is technically feasible in 6,314 (56%) municipalities. Thereby, the LCOEs increase in the autonomous case on average by 0.41 €/kWh compared to the minimum cost scenario. Apart from energy demand, base-load-capable bioenergy and deep geothermal energy have the greatest influence on the LCOEs. Overall, it appears that municipal energy autonomy is not economically viable under current framework conditions. This study represents a starting point for defining possible scenarios in studies of future national energy system or transmission grid expansion planning, which for the first time consider completely energy autonomous municipalities. [ABSTRACT FROM AUTHOR]

In December 2019, the Digital Health Care Act ("Digitale-Versorgung-Gesetz") introduced a general entitlement to the provision and reimbursement of digital health applications (DiGA) for insured persons in the German statutory health insurance. As establishing a new digital service area within the solidarity-based insurance system implies several administrative and regulatory challenges, this paper aims to describe the legal framework for DiGA market access and pricing as well as the status quo of the DiGA market. Furthermore, we provide a basic approach to deriving value-based DiGA prices. To become eligible for reimbursement, the Federal Institute for Drugs and Medical Devices evaluates the compliance of a DiGA with general requirements (e.g., safety and data protection) and its positive healthcare effects (i.e., medical benefit or improvements of care structure and processes) in a fast-track process. Manufacturers may provide evidence for the benefits of their DiGA either directly with the application for the fast-track process or generate it during a trial phase that includes temporary reimbursement. After one year of \]reimbursement, the freely-set manufacturer price is replaced by a price negotiated between the National Association of Statutory Health Insurance Funds and the manufacturer. By February 2022, 30 DiGA had successfully completed the fast-track process. 73% make use of the trial phase and have not yet proven their benefit. Given this dynamic growth of the DiGA market and the low minimum evidence standards, fair pricing remains the central point of contention. The regulatory framework makes the patient-relevant benefits of a DiGA a pricing criterion to be considered in particular. Yet, it does not indicate how the benefits of a DiGA should be translated into a reasonable price. Our evidence-based approach to value-based DiGA pricing approximates the SHI's willingness to pay by the average cost-effectiveness of one or more established therapy in a field of indication and furthermore considers the positive healthcare effects of a DiGA. The proposed approach can be fitted into DiGA pricing processes under the given regulatory framework and can provide objective guidance for price negotiations. However, it is only one piece of the pricing puzzle, and numerous methodological and procedural issues related to DiGA pricing are still open. Thus, it remains to be seen to what extent DiGA prices will follow the premise of value-based pricing. [ABSTRACT FROM AUTHOR]

Design: A cross‐sectional study was conducted in December 2020/January 2021 in the five significant cities of Germany. Sample: 135 of 244 identified service institutions took part in the evaluation. Measurements: This evaluation included changes in institutions' operating hours as well as capacity for homeless people. Service institutions described changes in guests' characteristics, moods, and mental burden. Finally, equipment including face masks, coveralls, and gloves was investigated. In addition, the study examined how the cooperation with the health authorities works. Results: Institutions reduced their operating hours and capacity for guests (62.4%). Increased costs, which they had to cover themselves, were reported by 70.9% of institutions. Institutions reported, that guests showed more symptoms of aggression (15%), anxiety (25%), and desperation (32%) and fewer signs of being relaxed (75%). The institutions reported room for improvement in PPE supplies and collaboration with health authorities. Conclusions: Services are limited for a vulnerable population, which shows changes in moods and mental health. Health authorities are not sufficiently engaged to take over the role of institutions in caring for homeless people. In the future, in‐depth investigation to improve this is necessary. [ABSTRACT FROM AUTHOR]

Aim: To compare recent compliance cost estimates by nurses of German nursing homes who employ the new documentation approach structural model with those who use traditional documentation frameworks. Design: A cross‐sectional survey. Methods: For each documentation approach, five sub‐processes were surveyed employing standard activities. The postal and online surveys were based on the same self‐administered questionnaire. The measures addressed time investments and further costs to carry out the components of nursing documentation. Data were collected from a convenience sample of nurses (n = 264) from German nursing homes between October 2018 and June 2019. Results: The analysed sub‐processes consume between 26 min and 8 hr per fulfilment. For users of the structural model, collecting information on a new admission is the costliest part of the documentation, at €90 per case. For users of other documentation approaches, care planning requires the most expensive effort, at €130 per case. [ABSTRACT FROM AUTHOR]

Background In responding to Covid-19, governments have tried to balance protecting health while minimizing gross domestic product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain and Sweden from UK healthcare payer perspective. Methods We compared observed cases, hospitalizations and deaths under 'mitigation' to modelled events under 'no mitigation' to 20 July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared with Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses. Results The UK saved 3.17 (0.32–3.65) million QALYs, £33 (8–38) billion healthcare costs and £1416 (220–1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1455 GDP loss using Sweden as comparator and offsets 46.1 (7.1–53.2)% of total £3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes. Conclusions Our exploratory analysis indicates the benefit of government Covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency. [ABSTRACT FROM AUTHOR]

University lecturers and coordinators of business and economics courses around the world are faced with the challenge that beginning students in these courses have heterogeneous entry conditions in terms of personal characteristics. This article focuses on the economic knowledge of German and Japanese beginning students in a business and economics degree programme. The German and Japanese versions of the US-American Test of Economic Literacy were used for the assessment of the economic knowledge of German (N = 901) and Japanese (N = 571) students. The TEL consists of 45 items in two questionnaire versions and is based on 20 globally accepted core standards of economics. The analyses in this paper are based on the total score of all 45 items of the TEL as well as the subscores for the 20 standards. A special focus of this paper is on gender-specific differences in economic knowledge. While gender has a strong effect on economic knowledge in Germany, only a small number of the core standards in Japan exhibit a difference between male and female test takers. The paper concludes by applying interpretative approaches to the different findings in both countries and suggests potential methods for further research on the gender effect in economics education.

Using a network approach, we investigate the determinants of intra-EU migration flows between all 28 EU member states in the years 2001, 2005, 2008 and 2013. Our descriptive analysis of the networks of intra-EU migration flows shows that the EU migration space is dominated by two core destination countries (Germany and United Kingdom). The results of our cross-sectional exponential random graph models (ERGM) reveal that the status of Germany and the United Kingdom (UK) as core destination countries remains a robust characteristic of the network of intra-EU migration flows over time, even when controlling for GDP, unemployment rates or shared geographical borders between destination and source countries. Furthermore, our results point to the differentiated effects of national economic performance on outgoing and ingoing flows: GDP per capita mainly affects intra-EU inflows, while unemployment rates tend to influence outmigration. Lastly, regulatory linkages – measured with the accession to the EU of source countries and the opening of the labour market of destination countries – exert a moderate effect on intra-EU migration flows when taking into account the national economic performances of source and destination countries, the core status of Germany and the United Kingdom, and the shared borders between destination and source countries. [ABSTRACT FROM AUTHOR]

Background: The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China.Methods: This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist.Results: The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited.Conclusion: Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China. [ABSTRACT FROM AUTHOR]

In recent decades, financialization has reworked the ownership, organization and geographies of global brewing. However, the institutional constellations of national, regional and local markets continue to shape and mediate its processes in variegated ways. Presenting a more granular and spatially sensitive conceptualization of financialization, this article adopts a cultural political economy (CPE) framework to analyse its relationships with the German brewing industry. First, the article distils the key elements of firm-level financialization and identifies a range of core constituents which provide the foundations for observing how financialization is enacted as part of wider institutional and political economic contexts. Second, the paper explains how these core constituents unfold as part of the global brewing industry, where the growing importance of mergers and acquisitions (M&As), the cultivation of global brands and the strategic prioritization of value over volume have reconstituted mature beer markets. Analysis then turns to the brewing industry and market in Germany, where regional patterns of production, a localized culture of consumption and various forms of state intervention are shown to constrain the enactment of financialization. Building on this empirical evidence, it is argued that geographically particular social relations, cultural conditions and political economic structures intertwine to shape and mediate processes of financialization, in different ways, with geography both causal and constitutive in its uneven expression. [ABSTRACT FROM AUTHOR]

BACKGROUND: Several studies have been performed on the relationship between working conditions and health. Numerous parameters still require further study, including working hours and obesity among different groups, specifically older workers in national, regional, and international levels. OBJECTIVE: Working hours have considerable effects on the socio-cultural, psychological, and economic aspects of people's lives and health. While long working hours increases income level and raises living standards, it increases the risk of certain health problems. This study investigated whether working hours are associated with obesity in upper-middle-aged workers. METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) dataset was used for the analyses. Analyses were carried out by means of a Cox regression of the panel dataset created with the data in question, surveyed by European Commission to 12,000 participants. RESULTS: The survey was performed in Austria, Belgium, Switzerland, Germany, Denmark, Spain, France, Greece, Italy, the Netherlands, Sweden, the Czech Republic, Poland, and Ireland. We found that in most countries, especially Sweden and the Netherlands, upper-middle-aged employees working > 59 hours per week are more likely to gain weight than their counterparts working < 59 hours. CONCLUSIONS: Our findings raise awareness of obesity in older workers, and highlight the need to regulate working conditions and hours in the European Union and other countries. [ABSTRACT FROM AUTHOR]

This study tests the influence of culture on group decision-making behavior among respondents in Korea and Germany. For our field experiment we are using an ultimatum game design, played among participants in Korea and in a benchmark experiment in Germany. We find evidence that taking the mosaic view of culture and making subjects aware of shared affective ties, based on age, educational-institution and regional origin, leads to differences in economic decisions, contrary to what neoclassical economic theory would suggest. Our results indicate that awareness of common group membership in some cultural contexts orients decision-makers toward upholding social norms that induces a greater preference for more selfless, in-group interested decisions, while anonymity makes personal identity salient and promotes more self-interested economic decisions. These effects are more pronounced in Korean participants compared with German participants. [ABSTRACT FROM AUTHOR]

Objectives Preparation for age-related changes has been shown to be beneficial to adjustment in later life. However, an understanding of the factors that influence such preparations is rather limited. This study examines whether perceived control and future-self views (FSV) influence preparations for old age, and if this influence varies across ages, domains of functioning, and cultures. Methods Assessments of perceived control, FSV, and preparations for old age in each of four different life domains (social relationships, finances, work, and health) were obtained from 1,813 adults (ages 35–85) from Germany, Hong Kong, and the United States. Results Future-self views partially mediated the relationship between perceived control and preparation for old age across both domains of functioning and cultures. With one exception, the association between perceived control and preparations increased with advancing age across contexts. Evidence for similar age-related moderation of the indirect effect of control through FSV was more limited. Discussion These results suggest that perceived control that is not necessarily related to aging affect FSV, which in turn influence preparing for old age. Further, our results indicate that such relationships are context- and age-specific, highlighting the importance of considering the salience and diversity of life domains and cultures. [ABSTRACT FROM AUTHOR]

Receiving information about expected costs promptly after a cancer diagnosis through psycho‐oncology care or social counselling is crucial for patients to be prepared for the financial impact. Nevertheless, less is known about financial impacts for cancer patients in countries with statutory health insurance. This study aims to explore the full scope of costs that constitute the financial impact of a cancer diagnosis in Germany and to identify the reasons for high financial decline. Semistructured interviews with 39 cancer patients were conducted between May 2017 and April 2018. Narratives were analysed via qualitative content analysis. Several factors influenced cancer patients' indirect costs and direct medical and non‐medical costs. For many patients, these changes resulted in higher indirect costs caused by income losses, especially when surcharges for shift work, travel expenses or company benefits ceased and were not reimbursed. Higher direct medical costs were caused by co‐payments and additional non‐refundable costs. Non‐medical costs were reported to increase for some patients and to decrease for others, as for example, leisure activity costs either increasing because of pampering oneself to cope with the diagnosis and undergoing therapy or decreasing because of not being able to participate in leisure activities during therapy. When analysing the financial impacts of individuals' total costs, we found that some patients experienced no financial decline or an overall financial increase. Most patients experienced overall higher costs, and income loss was the main driver of a high financial decline. Nevertheless, decreased non‐medical costs due to lower work‐related and leisure activity costs could compensate for these higher costs. Cancer patients are confronted with a variety of changes in their financial situations, even in countries with statutory health insurance. Screening for cancer patients with a high risk of financial decline should consider any effects on indirect costs and direct medical and nonmedical costs. [ABSTRACT FROM AUTHOR]

Background Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an 'ingredients-based' approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). Conclusions It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year. [ABSTRACT FROM AUTHOR]

A community outreach clinic was established in 2013 in a rural part of Germany to counsel and better integrate patients with mental health disorders or clients with psychosocial problems into the healthcare and complementary social assistance system. In a pilot study, we aimed to evaluate the costs of the integration assistance system after the outreach clinic was opened, the number of visits and the trend in the costs of the social assistance system of the federal state. Anonymised secondary cost data were used to evaluate the costs associated with the integration assistance receivers before (2010–2012) and after the establishment of the outreach clinic (2013–2015). Total costs were descriptively compared between the intervention group (consultation in the outreach clinic), the non‐referral group, and a propensity score‐matched control group for the years 2013–2015. To monitor the counselling activity, we used anonymised data on visits to the outreach clinic between 2013 and 2015. Data from 50 clients in the outreach clinic and 678 non‐referral clients were analysed. The total costs of the integration assistance for the years 2013–2015 amounted to EUR 21,516 (95% CI 14,513–28,518) and EUR 28,464 (25,789–31,140) respectively. Propensity score matching of the controls resulted in equalised total costs for the years 2013 through 2015 for clients (n = 50, EUR 21,516 (14,513–28,518)) and controls (n = 250, EUR 21,725 (18,214–25,234)). The total number of integration assistance receivers in the district was lower than the average for the federal state. The number of consultations at the outpatient clinic steadily increased from 146 in 2013 to 1,090 in 2015. Counselling in the outreach clinic might help reduce the placement of clients into integration assistance, including supported housing, and slow the expected cost trend. However, counselling failed to lower total costs in the integration assistance service, possibly due to the selection of more severe cases. [ABSTRACT FROM AUTHOR]

Summary: We propose a latent class mixture growth model with concomitant variables to study the time profiles of international remittances sent by first‐generation migrants in Germany from 1996 to 2012. The latent class approach enables us to identify homogeneous subgroups of migrants associated with different trajectories for their remitting behaviour, which can be interpreted in the light of the theoretical economic background. In addition, the inclusion of concomitant covariates allows us to uncover whether the assignment of migrants to a specific subgroup can be ascribed to their observable characteristics (e.g. their intention to return home), as conjectured by the theoretical models. The model proposed is easily estimated through an expectation–maximization algorithm. Results show that migrants can be clustered in three groups, two of which reflect the evolution of remittances predicted by economic theory. [ABSTRACT FROM AUTHOR]

Background: The inverse association between mortality and individual socioeconomic status is well-documented. Due to the lack of appropriate data, little is known about the nature of this association among individuals with long-term care (LTC) needs. Objectives: We aim to fill in this knowledge gap by estimating life expectancy (LE), life expectancy without (CFLE) and with (CLE) long-term care by education for older German men; and by assessing the trends in the education-LE/CFLE/CLE gradient over time. Data and methods: We apply survival analysis and Gompertz regression to German Socioeconomic Panel data (1997–2012) to estimate the mortality levels and to construct the life tables for three educational categories. Using the administrative data from the health insurance, we adjust mortality rates upward to account for the institutionalized population. We estimate age-specific LTC prevalence from the German Microcensus data (2004, 2012) and compute life expectancy with and without LTC by employing Sullivan’s method. Slope and Relative Indices of Inequality are computed to evaluate the magnitude of educational inequalities in CFLE. Results: There is a clear and growing educational gradient in LE and CFLE among older men in Germany. In 2004, LE at age 65 among men with low education was 14.2 years, or 3.3 years lower than among highly educated individuals. The CFLE of these two educational categories ranged from 13.6 to almost 17 years. The gradient increased over time and in 2012 the difference constituted 4.6 years. The gaps between educational groups were not pronounced for CLE. The declining health ratio of years without LTC to remaining LE suggests the expansion of LTC needs, irrespective of the educational level. Conclusions: Growing inequalities by educational status among older German men with care needs demand the attention of policy-makers. Prompt actions are needed to increase the survival chances of the most vulnerable groups. [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]

There has been a long-lasting debate over whether increasing ethnic diversity undermines support for social welfare, and whether this conflict thesis applies not only to the United States, but also to European welfare states. In their 2016 ASR article, Schmidt-Catran and Spies analyzed a panel (1994 to 2010) of regional units in Germany and concluded that this thesis also holds for Germany. We argue that their analysis suffers from misspecification: their model specification assumes parallel time trends in welfare support in all German regions. However, time trends strongly differed between Western and Eastern Germany after reunification. In the 1990s, Eastern Germans' attitudes adapted to a less interventionist Western welfare system ("Goodbye Lenin effect"). When allowing for heterogeneous time trends, we find no evidence that increasing proportions of foreigners undermine welfare support, or that this association is moderated by economic hardship (high unemployment rates). We conclude with some general suggestions regarding the conceptualization of context effects in spatial analyses. [ABSTRACT FROM AUTHOR]

How do institutional logics travel within a political economy? Employing insights from historical and ideational institutionalist theory, this article offers a novel understanding of change dynamics as driven by actors' creation of institutional interlinkages. It develops the causal mechanism of "invasion from within," consisting of a three-stage process: the progressive weakening of a policy paradigm within one institutional site coinciding with a strengthening of the policy paradigm in another; the building of a coalition within the exporting field; and the use of framing strategies to "localize" adjacent logics of action and delegitimize adversarial coalitions. The analytical purchase of the argument is corroborated through process tracing of the German pension paradigm shift during the 1990s, showing that ideas about private capital formation developed in finance were redirected toward old-age provision and strategically transferred to the pension arena by a coalition of actors from the German finance domain. [ABSTRACT FROM AUTHOR]

The German Hartz IV reform has been a far-reaching labour market reform which reduced unemployment benefit generosity. The encompassing economic evaluation tends to confirm that the reform was an initial spark for the improvement of German labour market performance. At the same time, welfare state scholars have recently expressed concerns that such reforms may have far-reaching and detrimental political effects. In this article, I contribute to this discussion and analyse the political effects of Hartz IV including decreasing satisfaction with democracy, decreasing political participation and an increase of protest voting and political polarization. To identify the effect of the reform, I rely on bi-weekly representative survey data and exploit the announcement of the Hartz reforms as natural experiment. Comparing political attitudes of persons interviewed immediately before and after the announcement in regression analyses confirms that there was a sharp drop in satisfaction with democracy and the intention to participate in the next election, as well as increasing affinity to non-established and left-wing parties. Supplementary analyses show that the effect is stronger for unemployed workers who are more directly affected by the reform. These results are robust to different model specifications and estimation techniques. Moreover, placebo tests for past and previous years refute the concern that the effect is driven by other factors such as calendar time effects. These findings indicate that the political consequences of welfare state retrenchment go far beyond electoral punishment. This is possibly more relevant today than ever before as the current increase of populist parties substantially impedes the functioning of political systems in modern democracies. [ABSTRACT FROM AUTHOR]

The paper presents the results of a research conducted in 2014–2016, aimed at characterising the milieu of the Polish academic economists with respect to their self-identification with modern schools of economic thought. Using econometric modelling, the social variables determining the theoretical choices made by the economists themselves were identified. We found that the largest group of the Polish academic economists identifies themselves with new institutional economics. Nearly half of the respondents declared their association with heterodox approaches, while only about a quarter of the respondents showed association with economic orthodoxy. Such a structure of self-identification of the Polish academic economists with schools of economic thought distinguishes it from the ones in other European countries, such as Italy and Germany. [ABSTRACT FROM AUTHOR]

Plastic, plastic waste and marine litter indisputably is one of the key environmental issues of the 21st century. The already existing amount of accumulated marine litter, the high quantity of plastic waste escaping from waste management streams every year in combination with the low recycling rates for plastic and the missing awareness of the consumer for sustainable consumption pose a permanent threat to the ecosystem, biodiversity and human health. What is more, as economic and ecological interests strongly deviate from each other, the transformation of this status quo towards a more sustainable future will take place very slowly. Against this background, this paper will shortly outline the multitude of problems connected to plastic products throughout a product's lifecycle and introduce the idea of a circular economy. On this basis, the paper will critically analyze the strategy papers and the ongoing legislation of the EU introduced to solve these problems and to realize the transformation process of the EU-economy towards a circular economy from a sustainable development point of view. On the one hand, awareness raising is one main strategy of the EU to achieve this transformation, on the other hand, educational institutions are not specifically mentioned by the EU. In order to address this shortcoming, the paper will constitute the teaching principle "global development politics/education for sustainable development" as one measure to increase consumers' awareness and sustainable consumption. In general, this paper will proof that the topical area plastics can fruitfully be implemented at German schools for primary and secondary education in order to strengthen the education for sustainable development.

This paper proposes a patent search strategy for photovoltaics which allows distinguishing patents of the photovoltaic system into sub-trajectories. Identifying and analyzing sub-trajectories is of particular importance for understanding micro patterns of technological change. The proposed search strategy is modular and replicable. It performs similar to benchmark search strategies and allows us to distinguish three cell sub-trajectories and two system components. The identified sub-trajectories allow a more detailed economic analysis previously not possible. Descriptive analyses reveal that inventive activity differs between sub-trajectories and countries. The market dominating silicon wafer cell sub-trajectory shows hardly any patented inventive activity even though it dominates the market. Furthermore, there are shifts in relative patenting activity between sub-trajectories, previously unnoticed at the trajectory level. Country comparison reveals that Asian countries focus on the emerging cell sub-trajectory, fostering their competitive advantage. The USA focuses on the established thin-film sub-trajectory, and inventive activity in Germany focuses on module components. The results have several implications for policy, for example, questioning the effectiveness of demand pull policies for inventive activity, and economic theory. The empirical assessment of sub-trajectories can increase understanding of technological change and uncover dynamics not observable at the trajectory level. [ABSTRACT FROM AUTHOR]

The recent Eurozone crisis and negotiations over bailout packages to Greece are more than a simple controversy about financial resources. They have a decidedly moralistic overtone. Giving more funds is thought by some to be unfair to hard‐working taxpayers and does not teach Greece an important moral lesson. Yet much international political economy scholarship neglects such considerations. We build on moral psychology to understand the ethical drivers of both German support and opposition to the 2015 Greek government bailout package. We analyze original survey data to show how morality is an essential factor in Germany's hard‐line approach. Our results show that caring and European attachment are associated with bailout support, while authority, national attachment, and retributive fairness drive opposition. Some morals also have boundaries: National attachment attenuates the effect of harm/care on support for foreign financial assistance but strengthens the effect of fairness on bailout opposition. Moral psychology helps us understand foreign policy but must be adapted to account for multiple potential ingroups. [ABSTRACT FROM AUTHOR]

Using a dataset of 3540 economists working in 2007 in 125 of the best academic centers in 22 countries, this paper presents some evidence on spatial mobility patterns in Spain and other countries conditional on some personal, department, and country characteristics. There are productivity and other reasons for designing a scientific policy with the aims of attracting foreign talent (brain gain), minimizing the elite brain drain, and recovering nationals who have earned a Ph.D. or have spent some time abroad (brain circulation). Our main result is that Spain has more brain gain, more brain circulation and less brain drain than comparable large, continental European countries, i.e., Germany, France, and Italy, where economists have similar opportunities for publishing their research in English or in their own languages. We suggest that these results can be mostly explained by the governance changes introduced in a number of Spanish institutions in 1975–1990 by a sizable contingent of Spanish economists coming back home after attending graduate school abroad. These initiatives were also favored by the availability of resources to finance certain research-related activities, including international Ph.D. programs. [ABSTRACT FROM AUTHOR]

Can participation in job-related training contribute to the formation and maintenance of adults’ literacy skills? Although evidence suggests that participation in training is related to higher literacy skills, it remains unclear whether this association reflects a causal effect of training participation on literacy (training effects), results from the self-selection of more high-skilled individuals into training (selection effects), or is due to other sources of endogeneity (e.g., omitted variable bias). To unravel these possibilities, we used data from the Programme for the International Assessment of Adult Competencies (PIAAC) and its German follow-up, PIAAC-Longitudinal (PIAAC-L). As these unique data offer repeated measures of literacy skills, spaced three years apart, in a large and representative sample, they allowed us to disentangle training effects from selection effects and to account for potential endogeneity. Analyses revealed that, even after taking account of formal education and a host of job characteristics, individuals with higher literacy skills were more likely to participate in training. By contrast, no evidence for effects of training on literacy skills emerged in any of our models, which comprised lagged-dependent, fixed effects, and instrumental-variable models. These findings suggest that, rather than job-related training contributing to literacy development, individuals with higher literacy skills are more likely to participate in training. [ABSTRACT FROM AUTHOR]

Being a victim of bullying is linked to various social, emotional and behavioral problems potentially leading to a reduced quality of life. Furthermore, victims of bullying may cause extensive costs for society, for example by an above-average need for healthcare services. The present study was designed to quantify the costs and the loss of quality of life attributable to bullying by comparing victims with a control group of non-bullied students. A cross-sectional sample of 1293 adolescents (mean age 14.07, SD = 1.36) and their parents reported on bullying victimization, quality of life (adolescents' self-report), and annual direct (medical and non-medical) as well as indirect costs (parents' self-report) from a societal perspective (all expressed in €, year 2014 and 2015). For frequent (20.6% of our sample; costs: €8461.80 p.a.) but not occasional (13.3%; costs: €2850.06) bullying, victimization was associated with significantly higher costs compared to non-bullied adolescents (costs: €3138.00; annual difference between frequently bullied students and controls: €5323.01 p.a.; p = 0.008). Cost drivers included increased direct medical costs, but mostly indirect costs caused by productivity losses of the parents. Self-reported quality of life of frequent victims was considerably reduced (T = − 10.96; p < 0.001); also occasional bullying showed significantly reduced values in global quality of life (T = − 5.73; p < 0.001). The present findings demonstrate that frequent bullying is associated with substantial cost to society and reduced quality of life of victims. This observation underscores the need for effective school-based bullying prevention and suggests a high potential of effective programs to be cost effective as well. [ABSTRACT FROM AUTHOR]

This article addresses the historical significance of the increasing precariousness of labor, even in the most advanced economies. Given the sterility of the mainstream approach, based on methodological individualism, we start from a Marxist critique of political economy, focusing on the laws that govern the process of capitalist accumulation and its contradictions. Within the framework of these laws, we analyze the tendency of labor exploitation to increase in a capitalist economy, linked to the exigencies of profitability due to the increasing difficulties of the valorization of capital. The precariousness of labor is studied around some of the main forms it adopts in three European economies: mini‐jobs in Germany, "zero‐hours contracts" in the United Kingdom, and false self‐employment, together with internship and training contracts, in Spain. Based on theoretical and empirical analysis, several conclusions are proposed to understand the extension and deepening of labor precariousness, built on the notions of overexploitation and destruction of productive forces, linked to current demands of capitalist accumulation. [ABSTRACT FROM AUTHOR]

Education is the core of the factors that improved people for a better lifestyle and increases the level of society' development. Quality education is one of the most vital goals of Sustainable Development Goals (SDGs) due to actualizing these factors. Using relational network data envelopment analysis (DEA), which have three interrelated substages, this current paper computes the educational economy efficiency of the Organisation for Economic Co-operation and Development (OECD) countries bearing in mind the characteristics related to SDGs. The contribution of our study is the use of a novel approach to computing the educational economy efficiency using relational network DEA with GAMS. Even though some interesting differences reveal in the efficiency of the countries, the findings show that countries with high-efficiency scores are clustered around countries like Latvia, Slovenia, and Korea.

Collective training systems are based on the cooperation of multiple public and private stakeholders in order to work. However, such cooperation is not self-sustaining and depends, for instance, on public policies, capable intermediary organisations and shared logics of action. In this conceptual paper, we first review the political economy literature on cooperation in collective skill formation and find that it has given insufficient attention to the systematic comparative analysis of cooperation at the decentralised level as well as the actual social practices of cooperation. The paper then develops a multidisciplinary analytical framework that allows future research to examine decentralised cooperation at the regional, sectoral and occupational levels more systematically. This framework is grounded in a synthesis of three strands of empirical research on vocational education and training, namely the comparative political economy literature on governance, corporatism and coordination, institutional labour and societal economics as well as the educational science literature.

INTRODUCTION The availability of lower-cost cigarettes in neighboring countries provides price-sensitive smokers with incentives to purchase cheaper out-of-country cigarettes. This study estimates the prevalence of and factors associated with cross-border purchasing of cheaper cigarettes among smokers from Germany, Greece, Hungary, Poland, Romania, and Spain. The prevalence of cross-border purchasing was estimated by residential location, defined as living in regions bordering a lower-price country (where prices were at least €1/pack lower), regions bordering a similar- or higher-price country, and internal non-border regions. METHODS Data were from a survey of nationally representative samples of adult smokers (n=6011) from Germany, Greece, Hungary, Poland, Romania, and Spain. The primary outcome was purchasing cheaper out-of-country cigarettes in the previous six months. Residential location was defined using The Nomenclature of Territorial Units for Statistics (NUTS2 in Germany and NUTS3 in the other countries). Multivariable logistic regression tested differences in purchasing cheaper out-of-country cigarettes by country and residential location. RESULTS Residential location was associated with purchasing cheaper out-of-country cigarettes in Germany and Poland (p<0.05): 31% of German and 11% of Polish smokers living in regions bordering lower-price countries reported purchasing cheaper out-of-country cigarettes in the previous six months. Smokers living in regions bordering lower-price countries had 4.21 times greater odds of purchasing cheaper out-of-country cigarettes compared to smokers living in non-border regions. CONCLUSIONS Overall, only a minority of smokers in the six countries purchased cheaper cigarettes outside their country. However, smokers living in regions bordering countries where cigarettes were at least €1/pack lower than their home country had significantly higher odds of purchasing cheaper out-of-country cigarettes. This effect was especially prominent among German smokers. Tax harmonization policies designed to minimize crossborder price differentials can eliminate lower-priced alternatives for price-sensitive smokers. [ABSTRACT FROM AUTHOR]

In this paper we examine differences in access to finance and business value by gender. Using recent data from the German Socio-Economic Panel, instrumented linear probability models show that an increase in personal wealth substantially affects the probability of being a business owner only among females. This is indicative of differential access to finance by gender. Among business owners, fixed-effects regressions reveal that obtaining a bank loan increases mean total business value more for females than for males. Thus, possession of a bank loan appears to be a critical factor in explaining the business value gender gap. [ABSTRACT FROM AUTHOR]

We estimated numbers of hospitalizations for norovirus gastroenteritis (NGE) and associated medical costs in Germany, where norovirus testing is high because reimbursement is affected. We extracted aggregate data for patients hospitalized with a primary or secondary code from the International Classification of Diseases, 10th Revision (ICD-10), NGE diagnosis during 2007-2012 from the German Federal Statistics Office. We assessed reliability of the coding system in patient records from a large academic hospital. Approximately 53,000-90,000 NGE hospitalizations occurred annually in Germany (21,000-33,000 with primary and 32,000-57,000 with secondary ICD-10-coded NGE diagnoses). Rates of hospitalization with NGE as primary diagnosis were highest in children <2 years of age; rates of hospitalization with NGE as secondary diagnosis were highest in adults >85 years of age. The average annual reimbursed direct medical cost of NGE hospitalizations was €31-43 million. Among patients with a NGE ICD-10 code, 87.6% had positive norovirus laboratory results. [ABSTRACT FROM AUTHOR]

Background: The city of Wrocław in Poland represents one of Central Europeans oldest capitals of science with numerous Nobel laureates. Due to a long history of political suppressions with Nazi Germany and Communism from 1933 until 1989, its scientific community was suppressed for more than half a century. Methods: The present study assessed scientific activities in the field of social and neighbouring sciences using density equalizing mapping. On the basis of the NewQIS (New Quality and Quantity Indices in Science) platform and the Social Sciences Citation Index (SSCI) of the Web of Science database, a total of 1787 articles originating from Wrocław were identified between 1966 and 2017. Results: In total, 549 research collaborations of Wrocław with 96 different countries were present (30.7%). Among the 107 research areas the highest activity was found for the field of Business and Economics with n = 272 articles (average citation rate (AVR) of 12.54), followed by Psychology (n = 252 articles, AVR = 9.06), Psychiatry (n = 205 articles, AVR = 4.74) and Public, Environmental and Occupational Health (n = 145 articles, AVR = 7.96). The highest AVR was found for Operations Research (25.36 with n = 87 articles). Density equalizing mapping procedures revealed a global pattern of social sciences research collaborations with scientists from Germany, the UK and the US as the primary cooperating partner of Wrocław. The different countries had major differences in the area of research collaborations. Conclusions: This is the first study that depicts the global network of Wrocław scientific activities in the field of social sciences. The exorbitant increase in research activity from 2006 onwards can lead to the assumption that Wrocław social sciences encounter a fruitful future. [ABSTRACT FROM AUTHOR]

Background: Specialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs. In Germany, palliative care patients are classified based on their primary diagnosis to determine reimbursement despite findings that other factors describe patient needs better. To facilitate adequate resource allocation in this setting, in Australia and in the UK important steps have been undertaken towards identifying drivers of palliative care resource use and classifying patients accordingly. We aimed to pioneer patient classification based on determinants of resource use relevant to specialist palliative care in Germany first, by calculating the patient-level cost of specialist palliative care from the hospital's perspective, based on the recorded resource use and, subsequently, by analysing influencing factors. Methods: Cross-sectional study of consecutive patients who had an episode of specialist palliative care in Munich University Hospital between 20 June and 4 August, 2016. To accurately reflect personnel intensity of specialist palliative care, aside from administrative data, we recorded actual use of all involved health professionals' labour time at patient level. Factors influencing episode costs were assessed using generalized linear regression and LASSO variable selection. Results: The study included 144 patients. Mean costs of specialist palliative care per palliative care unit episode were 6542€ (median: 5789€, SE: 715€) and 823€ (median: 702€, SE: 31€) per consultation episode. Based on multivariate models that considered both variables recorded at beginning and at the end of episode, we identified factors explaining episode cost including phase of illness, Karnofsky performance score, and type of discharge. Conclusions: This study is an important step towards patient classification in specialist palliative care in Germany as it provides a feasible patient-level costing method and identifies possible starting points for classification. Application to a larger sample will allow for meaningful classification of palliative patients. [ABSTRACT FROM AUTHOR]

Background: Migraine is a distinct neurological disease that imposes a significant burden on patients, society, and the healthcare system. This study aimed to characterize the incremental burden of migraine in individuals who suffer from ≥4 monthly headache days (MHDs) by examining health-related quality of life (HRQoL), impairments to work productivity and daily activities, and healthcare resource utilization (HRU) in the EU5 (France, Germany, Italy, Spain, United Kingdom).Methods: This retrospective cross-sectional study used data from the 2016 National Health and Wellness Survey (NHWS; N = 80,600). Short-Form 36-Item Health Survey, version 2 (SF-36v2) physical and mental component summary scores (PCS and MCS), Short-form-6D (SF-6D), and EuroQoL (EQ-5D), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire (WPAI), and HRU were compared between migraine respondents suffering from ≥4 MHDs (n = 218) and non-migraine controls (n = 218) by propensity score matching using sociodemographic characteristics. Chi-square, T-tests, and Mann-Whitney tests were performed to determine significant differences between the groups after propensity score matching.Results: HRQoL was lower in migraine individuals suffering from ≥4 MHDs compared with non-migraine controls, with reduced SF-36v2 PCS (46.00 vs 50.51) and MCS (37.69 vs 44.82), SF-6D health state utility score (0.62 vs 0.71), and EQ-5D score (0.68 vs 0.81) (for all, p < 0.001). Respondents with migraine suffering from ≥4 MHDs also reported higher levels of absenteeism from work (14.43% vs 9.46%; p = 0.001), presenteeism (35.52% vs 20.97%), overall work impairment (38.70% vs 23.27%), and activity impairment (44.17% vs 27.75%) than non-migraine controls (for all, p < 0.001). Additionally, HRU was significantly higher for individuals with ≥4 MHDs compared to their matched controls. Consistently, migraine subgroups (4-7 MHDs, 8-14 MHDs and CM) had lower HRQoL, greater overall work and activity impairment, and higher HRU compared to non-migraine controls.Conclusions: Migraine of ≥4 MHDs was associated with poorer HRQoL, greater work productivity loss, and higher HRU compared with non-migraine controls. The findings of the study suggest that an unmet need exists among individuals suffering from ≥4 MHDs in the EU5 suggesting the need for effective prophylactic treatments to lessen the humanistic and economic burden of migraine. [ABSTRACT FROM AUTHOR]

This is the first study to use stochastic frontier analysis to simultaneously estimate the technical, cost and profit efficiency of physician practices for different physician specialist groups. We base our analysis on a unique panel data set of 4964 physician practices in Germany for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician characteristics and practice characteristics. Additionally we consider a wide range additional variables not previously analyzed in this context (e.g. sub-specialization of physician groups and environmental factors such as physician density in the area). We investigate differences in cost, technical and profit efficiency utilizing production-/cost- and profit-functions with a translog functional form. We estimated the stochastic frontier using the comprehensive one-step approach for panel data following Battese and Coelli (Empir Econ 20(2): 325-332, 10). Overall findings indicate that participation in disease management programs and the degree of specialization are associated with significantly higher technical- cost-, and profit-efficiency for most physician specialist groups, e.g. due to the standardization of processes. In addition, our analyses show that group practices perform significantly better than single practices. This may be due to indivisibilities in expensive technical equipment, which can lead to different health care services being provided by different practice types. A more thorough look at specialist groups suggests that it is important to investigate all efficiency types for different physician groups, as results may depend on the type of efficiency analyzed as well as the physician group in question. [ABSTRACT FROM AUTHOR]

Background: According to James Fries morbidity compression is present if morbidity rates are decreasing to a larger extent than mortality rates. Compression also occurs if age at onset is increasing at a faster pace than age at death. These two variants of the compression hypothesis were formulated as a population concept. Compression has seldom been studied with a specific disease as application. Methods: Morbidity compression was examined in terms of myocardial infarction (MI) by using German claims data covering the years 2006 to 2015. The findings are based on an annual case number of about 2 m women and men aged 18 years and older. Analyses were performed by means of proportional hazards regression and by using linear regression. Results: Decreases of morbidity rates were more pronounced than those of mortality. For men, the hazard ratio for contracting MI in 2015 as compared to 2006 was hr = 0.66 and hr = 0.71 for the female population. The respective results for mortality were hr = 0.75 in men and hr = 1.0 in women. They can be interpreted in favor of morbidity compression. For the subgroup of women and men with MI, changes of onset age revealed marked gender differences. For 2015 as compared with 2006, age at MI-occurrence in men increased by 10.5 months as compared to an increase of 10.4 months for age at death. In women changes were smaller and statistically not significant. The findings referring to women have to be interpreted against the backdrop of higher onset age and higher age at death than in men. Conclusions: Taken together, morbidity compression has occurred in terms of decreasing MI-rates as well as in terms of increased onset age in men. It can be concluded that both processes have led to an improvement of healthy lifetime. Decreasing morbidity rates in women are also pointing towards morbidity compression, a finding that is not complemented by changes of onset age. Our data are demonstrating that morbidity rates and age at onset may vary independently. From this perspective morbidity compression is a multi-faceted phenomenon. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To date, there is still no IFDH approved dental hygienist (DH) education model in Germany. Nevertheless, opportunities to complete vocational DH education courses have substantially increased within the last two decades. However, the content and quality of these courses vary greatly and are difficult to survey. The purpose of this article therefore was to present an overview of the education programmes offered in Germany as of March 2017. Methods: A formal request was sent to all education establishments for details of such courses, and a systematic internet search was performed covering the DH education topic in Germany. Results: Ten vocational education programmes were found, most of them organized by local dental chambers. One private provider offers a Bachelor Degree in Dental Hygiene on completion of a course which runs over 2 or 3 ys. Details of contents, objectives and concise ratings or comparisons of the various courses are scarce, although in principle all should meet the same quality standards. Conclusion: For dental hygiene students, patients and dentists, it is hard and unsatisfactory to get a clear overview of the types and the quality of DH education which can be achieved in Germany. A solution for this dilemma would appear to be essential. However, due to the peculiarities of German legislation as well as the complex sphere of vested interests, it is impossible to predict if or when the situation will change for the better. [ABSTRACT FROM AUTHOR]

Several scholars have concluded that ethnic diversity has negative consequences for social trust. However, recent research has called into question whether ethnic diversity per se has detrimental effects, or whether lower levels of trust in diverse communities simply reflect a higher concentration of less trusting groups, such as poor people, minorities, or immigrants. Drawing upon a nationally representative sample of the German population (GSOEP), we make two contributions to this debate. First, we examine how ethnic diversity at the neighborhood level–specifically the proportion of immigrants in the neighborhood–is linked to social trust focusing on the compositional effect of poverty. Second, in contrast to the majority of current research on ethnic diversity, we use a behavioral measure of trust in combination with fine-grained (zip-code level) contextual measures of ethnic composition and poverty. Furthermore, we are also able to compare the behavioral measure to a standard attitudinal trust question. We find that household poverty partially accounts for lower levels of trust, and that after controlling for income, German and non-German respondents are equally trusting. However, being surrounded by neighbors with immigrant background is also associated with lower levels of social trust. [ABSTRACT FROM AUTHOR]

Abstract: Mainstream nursing history often positions itself in opposition to philosophy and many nursing historians are reticent of theorizing. In the quest to illuminate the lives of nurses and women current historical approaches are driven by reformist aspirations but are based on the conception that nursing or caring is basically good and the timelessness of universal values. This has the effect of essentialising political categories of identity such as class, race and gender. This kind of history is about affirmation rather than friction and about the conservation of memory and musealization. In contrast, we will focus on how we imagine nursing history could be used as a philosophical, critical perspective to challenge the ongoing transformations of our societies. Existing reality must be confronted with strangeness and the historically different can assume the function of this counterpart, meaning present and past must continuously be set in relation to each other. Thus, critical history is always the history of the present but not merely the pre‐history of the present – critique must rather present different realities and different certainties. In this paper, we use this approach to discuss the implementation of the nursing process (NP) in Germany. The nursing process appears to be a technology that helped to set up an infrastructure ‐ or assemblage ‐ to transform nursing interventions into a commodity exchangable between consumers and nurses in a free market. In our theoretical perspective, we argue that NP was a step in the realization of the German ordoliberal program, a specific variety of neoliberalism. In order to implement market‐orientation in the healthcare system it was necessary to transform hospitals into calculable spaces and to make all performances in the hospital calculable. This radically transformed not just the systems, but the ways in which nurses and patients conveived of themselves. [ABSTRACT FROM AUTHOR]

Background and Objectives: Since 1995, Germany has operated one of the longest-running public programs providing universal support for the cost of long term services and supports (LTSS). Its self-funding, social insurance approach provides basic supports to nearly all Germans. We discuss its design and development, including recent reforms expanding the program and ensuring its ongoing sustainability. Research Design and Methods: The study reviews legislative and programmatic changes, using program data, as well as legislative documents and program reports. Results: The program is widely accepted among citizens and has achieved many of its original goals: ensuring access to LTSS and reducing reliance on the locally-funded safety-net social assistance program, which can be used to cover nursing home costs. It also strengthened the LTSS provider infrastructure and expanded access to home care. Recent reforms have addressed some of the program's key issues: the benefit's decreasing value, the eligibility and benefit structure that largely excluded cognitive impairment, and the program's longer-term financial sustainability--particularly its ability to sustain newly expanded benefits, which provide stronger protections to caregivers, index-link benefits, and more systematically incorporate cognitive impairment via a new assessment system. It has addressed financing issues by increasing premiums, introducing subsidies for the purchase of private insurance, and creating a "demographic reserve fund." Discussion and Implications: The reforms constitute a significant strengthening of the program, remarkable in an era of retrenchment. Overall, the program provides evidence for the financial viability of a social insurance model, although longer-term challenges may yet arise. [ABSTRACT FROM AUTHOR]

This paper analyses the relationship between the German Kiel Institute of World Economics and the Rockefeller Foundation in the years 1925-1950. It focuses on the role of politics in the promotion of science and shows the great difficulties the foundation had in developing a strategy to react to the Nazi’s seizure of power in 1933. The Kiel Institute disguised itself as an unpolitical and “objective” institute and managed to regain support after 1934. During the Second World War, the Rockefeller Foundation abandoned the idea of science as an area detached from politics by definition. In the late 1940s, it carefully reassessed the German academic landscape and, in the case of the Kiel Institute, came to the conclusion not to resume a significant amount of support. [ABSTRACT FROM AUTHOR]

Background: There is a research gap concerning the evaluation of the oral healthcare of refugees. Therefore, the aim of this study was to evaluate the oral health of refugees and to estimate the costs of oral care. Methods: The study was conceptualized as a pilot study. The study participants were refugees who lived either in collective living quarters or at a reception center in a region of the federal state of Schleswig-Holstein, Germany. The cross-sectional design was complemented by dental screening. Data were collected from August 2016 until July 2017. The basic condition of the teeth was evaluated using a convenience sample by a single dentist. The assessment of caries was carried out visually in accordance with the International Caries Detection and Assessment System from code 3 and higher. The DMF-T (decayed, (D), missing, (M), filled (F), teeth (T)) index was calculated. The costs of oral care were analyzed for conservative treatment (filling or extraction) and for prosthetic treatment (missing teeth) in the form of a bridge or crown. Results: The dental screening was attended by 102 refugees, with a mean age of 28 years. A total of 49% of the study sample suffered from toothache, and the DMF-T index had a mean of 6.89. For 92% of the study sample, treatment was indicated, and a cost estimate of the treatment could be calculated. The average cost of conservative treatment was estimated to be 205.86 EUR, and the average cost of prosthetic treatment was estimated to be 588.0 EUR. The oral healthcare costs of the different treatment procedures were higher for refugees that presented with toothache than for those without toothache, with the exception of prosthetic treatment procedures. Conclusions: There is a lack of population-based data that survey the oral health status of refugees. Therefore, the current study presents an initial overview regarding the oral health status and the potential costs of oral healthcare of refugees. [ABSTRACT FROM AUTHOR]