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Electroconvulsive therapy in Germany: a nationwide multilevel analysis of determinants, regional patterns, and institutional variation.

Electroconvulsive therapy (ECT) is an effective treatment for severe psychiatric disorders, yet its use may be shaped not only by clinical n … adjustment for case mix and contextual factors. These findings suggest that variation in ECT use in Germany is only weakly aligned with proxies of clinical need and is shaped to a considerable extent by institutional and structural conditions, indicating potential inequities in access to ECT across regions and providers.

A comparative analysis of health technology assessment decision-making for cancer drugs in Germany and England.

IntroductionThe rising cost of cancer drugs places a heavy burden on patients and public healthcare systems, posing an ongoing challenge of balancing access with efficient resource allocation. Health technology assessment (HTA) serves as a critical basis for reimbursement decisions, evaluating both clinical and economic value. Although the Federal Joint Committee (G-BA) and the National Institute for Health and Care Excellence (NICE) have established standardized HTA frameworks, differences in their assessment methods and decision-making processes may lead to divergent outcomes. This study com

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… However, this does not imply inferior reimbursement accessibility in Germany compared with England. Rather, it reflects Germany's phased decision-making framework, in which clinical value assessment precedes economic negotiation. … Benefit assessment in Germany: implications for price discounts. Health Econ Rev. (2016) 6:33. doi: 10.1186/s13561-016-0109-3 15. Ruof J, Schwartz FW, Schulenburg JM, Dintsios CM. Early benefit assessment (EBA) in Germany: analysing decisions 18 months after introducing the new AMNOG legislation. …

The Early Childhood Curiosity Questionnaire: Development and Psychometric Properties in the United Kingdom, The Netherlands, and Germany.

Curiosity in early childhood is associated with exploration, learning, and cognitive growth, yet little is known about how trait curiosity can be reliably assessed in preschoolers. This paper reports the development and validation of a caregiver-report measure designed to assess curiosity in children aged 2-5 years across three cultural contexts: the United Kingdom, the Netherlands, and Germany. Pursuing three objectives, we (1) generated 41 age-appropriate items by adapting and extending the Infant and Toddler Curiosity Questionnaire (ITCQ; Altmann et al., 2025a), first in English, followed b…

Exploring the different models of the four-day workweek as social innovations in Germany's healthcare system.

BACKGROUND: The German healthcare system faces a persistent shortage of skilled professionals, particularly in nursing, driven by demographic change, high workloads, and challenging working conditions. In response, new working-time models such as the four-day workweek have emerged as potential solutions to improve job attractiveness, employee well-being, and staff retention. This study examines different models of the four-day workweek as social innovations within the healthcare system, focusing on their development, implementation, and implications across institutional levels. METHODS: A qua

Factors associated with mortality in older sepsis patients: a nationwide retrospective cohort study in Germany.

BACKGROUND: Sepsis is a leading cause of mortality in older adults, but large unselected cohort data on factors associated with mortality remain limited. OBJECTIVE: To examine patient characteristics and acute illness features associated with mortality among older patients hospitalised with sepsis in Germany. METHODS: We conducted a retrospective, observational cohort study using statutory health insurance data (AOK) of patients aged ≥70 years and hospitalised with sepsis between 2016 and 2019. Outcomes were in-hospital and 90-day post-discharge mortality. Multivariate blockwise logistic reg…

Clinical Characteristics and Outcomes of 1894 Women with Peripartum Cardiomyopathy Treated with and Without Levosimendan in Germany.

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This study investigated the prevalence of PPCM in Germany and evaluated outcomes associated with levosimendan use. METHODS: Using national data from the German Statistical Office, all pregnant women diagnosed with PPCM and hospitalized between 2009 and 2022 were included. Patients were categorized into groups …

Forensic investigation of pediatric homicides in the Freiburg district (Germany): A 25-year retrospective study.

Pediatric homicide represents one of the most severe forms of violence against children and remains an underexplored issue in Europe. The aim of the present study was to analyze the epidemiological, criminological, and autopsy-related characteristics of pediatric homicides and to identify potential age-related differences, which are essential to guide prevention and judicial investigation. A retrospective study was conducted on all autopsies of homicide victims under 18 years performed at the Institute of Forensic Medicine of Freiburg (Germany) between January 2000 and April 2025. Demographic,…

Association of Polypharmacy and Bone Mineral Density: A Cross-Sectional Analysis of Geriatric Inpatients in Germany.

Background: Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mineral density (BMD) and increased fracture risk, particularly among older adults. While individual medications have been implicated in bone loss, the cumulative impact of polypharmacy on skeletal health remains underexplored. Methods: This cross-sectional study included 1155 geriatric inpatients undergoing routine bone mineral density assessment. Medication use, demographic characteristics, and clinical variables were extracted from electronic medical records. BMD at the lumbar spine (L1-L4) and tot

Epidemiology, therapy, and outcome of immune-mediated thrombotic thrombocytopenic purpura at population level in Germany.

BACKGROUND: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy caused by severe a disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS-13) deficiency due to autoantibodies. Although therapeutic advances have improved outcomes, data on population-level trends in epidemiology, therapy, and outcomes remain limited. OBJECTIVES: We assessed temporal trends in incidence, treatment strategies, and acute in-hospital outcomes of iTTP episodes at the population level in Germany from 2011 to 2021. METHODS: This retrospect…

[Surgical management of children with liver tumors in Germany : Evidence, care structures and future perspectives].

BACKGROUND: Liver tumors in childhood are rare and associated with high treatment demands. Over the past decades substantial progress has been achieved through effective chemotherapies and improved surgical techniques as well as international collaborations. Nevertheless, the challenges for the surgical treatment remain high. In Germany additional specific difficulties arise in this context. OBJECTIVE: To summarize the current evidence on the surgical management of pediatric liver tumors, to analyze the care structures in Germany and to develop perspectives for optimizing treatment. MATERIAL…

Predictors of in-hospital mortality in traumatic subarachnoid hemorrhage: a nationwide study of 67,684 patients in Germany.

INTRODUCTION: Population-based data on incidence and mortality risk factors, particularly in very elderly patients with traumatic subarachnoid hemorrhage (tSAH) are limited. This study analyzed epidemiology, comorbidities, complications, age-specific incidence rates, and predictors of in-hospital mortality in patients with tSAH in Germany, with a focus on those aged ≥80 years. MATERIAL AND METHODS: This retrospective cross-sectional study included all hospitalized patients with tSAH (ICD-10 S06.6) in Germany from 2019 to 2022, using nationwide administrative data from the Institute for the Ho…

Between guidelines and reality: expert neurologists' perspectives on structural resources for ALS care in Germany.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease, leading to an inexorable decline in voluntary muscle functi … fully meet these requirements. METHODS: This study assessed resources of specialized ALS centres in Germany, focusing on the structural prerequisites for the provision of multidimensional care and collaboration with specialised palliative care (SPC) providers. A mixed methods design was used, comprising remote video interviews with neurologists specialize …

Cancer prevention in Germany: awareness, beliefs, and information-seeking behaviors in a population-based survey.

INTRODUCTION: At least 40% of cancer cases could be prevented by lifestyle changes. However, despite clear recommendations, public awareness of modifiable cancer risk factors remains limited and misconceptions about cancer causes further impede prevention efforts. Understanding knowledge of preventable factors, myths, and information sources is essential for effective cancer prevention. METHODS: To address this, a total of 1,232 residents of Stuttgart, Germany (53.2% female; Mage  = 41.1; SD = 14.3) participated in the CLARO study (January-May 2025). A cross-sectional online survey assessed p…

Care of patients with Phenylketonuria (PKU) in Germany - a claims data analysis from 2013 to 2023.

BACKGROUND: Phenylketonuria (PKU) is a rare inherited metabolic disorder requiring lifelong management to prevent neurological, psychiatric, and physical complications. Although early detection through newborn screening has improved outcomes, real-world evidence on long-term care and healthcare utilisation remains limited. This study assessed the epidemiology, comorbidities, treatment practices, rehabilitation and healthcare resource utilisation (HCRU) of individuals with PKU in Germany, using nationwide statutory health insurance (SHI) claims data over ten years. RESULTS: Based on anonymised…

Clinical Course, Viral Load, and (Sub)Type of Influenza in Hospitalized Children in Southern Germany.

This study aimed to assess the relationship between clinical course and influenza virus characteristics by quantifying viral load and performing phylogenetic analyses in hospitalized children. Children aged 0-3 years presenting with an acute respiratory tract infection (RTI) at the Childrens' Hospital Heidelberg/Germany were included and nasopharyngeal swabs were collected. Viral load was quantified by real-time polymerase chain reaction and influenza virus (sub)type was identified by haemagglutinin gene sequencing. Among 1464 respiratory samples collected, 139 were positive for influenza viru…

The Current Status of Herpesviridae as Major Human Pathogens: A 10-Year Diagnostic Evaluation in Germany.

Herpesvirus infections belong to major pathogens in the human population. This study aimed at evaluating diagnostic data for eight human herpesviruses, based on datasets derived from a large European tertiary care center. Specifically, we analyzed 118,692 herpesvirus submittals to the Diagnostic Division of the Virological Institute, University Hospital Erlangen (UKER), Germany, between July 2014 and June 2024. Our points of focus were the following: (i) the frequencies of herpesvirus diagnostic results with positivity rates, (ii) departments representing main sample submitters, (iii) the spec…

Incorporating vertical transmission into mechanistic modeling of West Nile virus for optimized control in Germany.

West Nile virus is an arbovirus transmitted by infected Culex mosquitoes to birds, horses, and humans. Since its first recorded case in Germany in 2018, WNV has been endemic in several parts of Germany. Globalization, ecosystem modification and climate change have been identified as significant drivers of the arbovirus spread. However, vertical transmission of pathogens from adult female to their progeny might alter the transmission dynamics. In this study, we designed a process-based epidemic model incorporating climatic variables and epidemiological parameters that replicated mosquito popula…

[Awareness of human papillomavirus (HPV) vaccination for girls and boys in Germany-results of the LIEBESLEBEN study].

BACKGROUND: Despite the current recommendation of human papillomavirus (HPV) vaccination for girls and boys, vaccination rates in Germany remain low. Vaccination awareness is essential for vaccination behaviour and thus for an increase in vaccination rates. The aims of the present work were to investigate HPV vaccination awareness among the general population in Germany and to identify potential factors (sociodemographic, family and relationship characteristics, regional context) associated with HPV vaccination awareness. The results will help to conceptualize, manage, optimize and evaluate me…

Coping strategies of neurosurgeons in response to major surgical complications: A nationwide questionnaire assessment in Germany.

INTRODUCTION: This study aimed to explore the emotional and psychological impact of major surgical complications on neurosurgeons in Germany, focusing on identifying coping strategies, perceived barriers to support, and the influence of institutional culture - particularly in the context of the "second victim" phenomenon. RESEARCH QUESTION: How do neurosurgeons in Germany handle major complications, and which barriers limit access to psychological support? MATERIAL AND METHODS: In this cross-sectional study, a nationwide, anonymous online survey was conducted among neurosurgeons working at u…

[The doctoral regulations of the medical faculties in Germany : What has changed in the last 9 years?].

BACKGROUND: The doctoral degree regulations at German faculties partially show fundamental differences. Against this background in 2016 the Medical Faculty Association (MFT) published a position paper on teaching scientific competence in medical studies. This study project aims to analyze the quality of doctoral degree regulations in Germany 9 years later. METHODS: In this study 39 current doctoral degree regulations (PromO) from German medical faculties with the right to award doctorates were analyzed along with the supervision agreements, if available. The standard of the statutes was asses…