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Previous research has shown that temporary employment is negatively associated with many psychological and job-related outcomes, such as well-being, health, wages, organisational commitment, and job satisfaction. Among recent doctoral graduates, the proportion of temporary contracts is particularly high. However, research on the association between contract type and job satisfaction specifically among doctoral graduates is scarce. Therefore, whether and how obtaining permanent employment affects doctoral graduates’ job satisfaction remains a notable research gap that we intend to narrow by using panel data from a recent doctoral graduation cohort and by adopting a panel research design. We examine what effect obtaining permanent employment has on doctoral graduates’ job satisfaction and whether this effect differs by labour market sector. We use panel data that are representative of the 2014 doctoral graduation cohort in Germany and their career trajectories up to five years after graduation. We apply fixed-effects regression to approximate the within-effect of obtaining a permanent employment contract on job satisfaction. The analyses indicate that obtaining permanent employment increases doctoral graduates’ job satisfaction and that this increase is not driven by time-varying confounders. We also find that doctoral graduates’ labour market sector moderates the effect: the increase in job satisfaction is highest in the academic sector and statistically significantly different from that in the private sector. Overall, this paper offers new insights into the effect of obtaining a permanent contract on the job satisfaction of recent doctoral graduates throughout their first years after graduation, when they are often employed on temporary contracts.
Medical tourism is a rapidly growing sector of economic growth and diversification. However, data on the demographics and characteristics of the traveling patients are sparse. In this study, we analyzed the common demographic properties and characteristics of the inbound medical tourists seeking orthopedic medical care in Germany for the years 2010 to 2019 compared to a domestic group. At the same time, we examined how the COVID-19 pandemic outbreak of 2020 changed the field of medical tourism in Germany. Calculations were performed using administrative hospital data provided by the Federal Statistical Department of Germany. Data were analyzed from the years 2010 to 2020. A total of six elective orthopedic surgery codes (bone biopsy, knee arthroplasty, foot surgery, osteotomy, hardware removal, and arthrodesis) were identified as key service indicators for medical tourism and further analyzed. Factors including residence, sex, year, and type of elective surgery were modeled using linear regression analysis. Age and sex distributions were compared between patients living inside Germany (DE) or outside Germany (non-DE). Between 2010 and 2020, 6,261,801 orthopedic procedures were coded for the DE group and 27,420 key procedures were identified for the non-DE group. Medical tourists were predominantly male and significantly younger than the domestic population. The linear regression analysis of the OPS codes over the past years showed a significantly different slope between the DE and non-DE groups only for the OPS code “hardware removal”. With the COVID-19 pandemic, an overall decline in performed orthopedic procedures was observed for the non-DE and the DE group. A significant reduction below the 95% prediction bands for the year 2020 could be shown for hardware removal and foot surgery (for DE), and for hardware removal, knee arthroplasty, foot surgery, and osteotomy (for non-DE). This study is the first to quantify inbound medical tourism in elective orthopedic surgery in Germany. The COVID-19 pandemic negatively affected many — but not all — areas of orthopedic surgery. It has to be seen how this negative trend will develop in the future.
Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (−3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard.
The July 2021 heavy rainfall episode in parts of Western Europe caused devastating floods, specifically in Germany. This study examines circulation types (CTs) linked to extreme precipitation in Germany. It was investigated if the classified CTs can highlight the anomaly in synoptic patterns that contributed to the unusual July 2021 heavy rainfall in Germany. The North Atlantic Oscillation was found to be the major climatic mode related to the seasonal and inter-annual variations of most of the classified CTs. On average, wet (dry) conditions in large parts of Germany can be linked to westerly (northerly) moisture fluxes. During spring and summer seasons, the mid-latitude cyclone when located over the North Sea disrupts onshore moisture transport from the North Atlantic Ocean by westerlies driven by the North Atlantic subtropical anticyclone. The CT found to have the highest probability of being associated with above-average rainfall in large part of Germany features (i) enhancement and northward track of the cyclonic system over the Mediterranean; (ii) northward track of the North Atlantic anticyclone, further displacing poleward, the mid-latitude cyclone over the North Sea, enabling band of westerly moisture fluxes to penetrate Germany; (iii) cyclonic system over the Baltic Sea coupled with northeast fluxes of moisture to Germany; (iv) and unstable atmospheric conditions over Germany. In 2021, a spike was detected in the amplitude and frequency of occurrence of the aforementioned wet CT suggesting that in addition to the nearly stationary cut-off low over central Europe, during the July flood episode, anomalies in the CT contributed to the heavy rainfall event.
A fuzzy classification scheme that results in physically interpretable meteorological patterns associated with rainfall generation is applied to classify homogeneous regions of boreal summer rainfall anomalies in Germany. Four leading homogeneous regions are classified, representing the western, southeastern, eastern, and northern/northwestern parts of Germany with some overlap in the central parts of Germany. Variations of the sea level pressure gradient across Europe, e.g., between the continental and maritime regions, is the major phenomenon that triggers the time development of the rainfall regions by modulating wind patterns and moisture advection. Two regional climate models (REMO and CCLM4) were used to investigate the capability of climate models to reproduce the observed summer rainfall regions. Both regional climate models (RCMs) were once driven by the ERA-Interim reanalysis and once by the MPI-ESM general circulation model (GCM). Overall, the RCMs exhibit good performance in terms of the regionalization of summer rainfall in Germany; though the goodness-of-match with the rainfall regions/patterns from observational data is low in some cases and the REMO model driven by MPI-ESM fails to reproduce the western homogeneous rainfall region. Under future climate change, virtually the same leading modes of summer rainfall occur, suggesting that the basic synoptic processes associated with the regional patterns remain the same over Germany. We have also assessed the added value of bias-correcting the MPI-ESM driven RCMs using a simple linear scaling approach. The bias correction does not significantly alter the identification of homogeneous rainfall regions and, hence, does not improve their goodness-of-match compared to the observed patterns, except for the one case where the original RCM output completely fails to reproduce the observed pattern. While the linear scaling method improves the basic statistics of precipitation, it does not improve the simulated meteorological patterns represented by the precipitation regimes.
Introduction
Low-grade appendiceal mucinous neoplasms (LAMN) are semi-malignant tumors of the appendix which are incidentally found in up to 1% of appendectomy specimen. To this day, no valid descriptive analysis on LAMN is available for the German population.
Methods
Data of LAMN (ICD-10: D37.3) were collected from the population-based cancer registries in Germany, provided by the German Center for Cancer Registry Data (Zentrum für Krebsregisterdaten—ZfKD). Data was anonymized and included gender, age at diagnosis, tumor staging according to the TNM-classification, state of residence, information on the performed therapy, and survival data.
Results
A total of 612 cases were reported to the ZfKD between 2011 and 2018. A total of 63.07% were female and 36.93% were male. Great inhomogeneity in reporting cases was seen in the federal states of Germany including the fact that some federal states did not report any cases at all. Age distribution showed a mean age of 62.03 years (SD 16.15) at diagnosis. However, data on tumor stage was only available in 24.86% of cases (n = 152). A total of 49.34% of these patients presented with a T4-stage. Likewise, information regarding performed therapy was available in the minority of patients: 269 patients received surgery, 22 did not and for 312 cases no information was available. Twenty-four patients received chemotherapy, 188 did not, and for 400 cases, no information was available. Overall 5-year survival was estimated at 79.52%. Patients below the age of 55 years at time of diagnosis had a significantly higher 5-year survival rate compared to patients above the age of 55 years (85.77% vs. 73.27%).
Discussion
In this study, we observed an incidence of LAMN in 0.13% of all appendectomy specimen in 2018. It seems likely that not all cases were reported to the ZfKD; therefore, case numbers may be considered underestimated. Age and gender distribution goes in line with international studies with females being predominantly affected. Especially regarding tumor stage and therapy in depth information cannot be provided through the ZfKD-database. This data analysis emphasizes the need for further studies and the need for setting up a specialized registry for this unique tumor entity to develop guidelines for the appropriate treatment and follow-up.
Eine pentaploide Sippe aus der Pilosella macranthela-Verwandtschaft wurde in Unterfranken/Bayern entdeckt, die hier als P. macranthela subsp. sylvae-pici neu beschrieben wird. Sie wächst hauptsächlich im bayerischen Buntsandstein-Spessart und kommt mit drei kleinen, isolierten Wuchsorten auch in den Kalkgebieten des Maintals und Tauberbereichs vor. Die Wuchsform steht zwischen dem Furcata- und Laxicephala-Typus von Pilosellinen mit ober- und teils unterirdischen Ausläufern und zeigt Neigung, Horste zu bilden. Die Ober- und Unterseiten der Rosettenblätter besitzen Sternhaare. Die Korbstiele und Hüllblätter sind dicht mit dunkel gestielten Drüsenhaaren mit gelblichen Drüsenköpfen besetzt. Die seitlichen Zähne der Blütenzungen sind oft durch Einschnitte abgetrennt. Tetra- und pentaploide Zwischenarten zwischen P. macranthela subsp. sylvae-pici und P. officinarum werden als P. ottonis neu beschrieben. P. ottonis ist tetra- und pentaploid mit bis zu 7 Körben, ist an den Hüllblättern mit dunklen Stieldrüsen besetzt und ähnelt vom Habitus Formen von P. acutlifolia. Die Hüllen von P. ottonis besitzen wie die von P. macranthela subsp. sylvae-pici und P. glomerata zahlreiche, ca. 10–20 μm dicke Epidermispapillen, die stets bei P. officinarum fehlen. Heterogene P. marcanthela-Sippen (tetra- und heptaploid) kommen als Spontanhybride zwischen P. glomerata und P. officinarum auch außerhalb des Spessartgebiets vor und wurden auch ohne benachbarte P. glomerata gefunden.
In Unterfranken/Nordbayern wurde eine gut abgegrenzte Unterart der Hieracium maculatum-Gruppe festgestellt, die auf die Hänge des Maintals zwischen Würzburg und Hasloch beschränkt ist mit einem Hot Spot (>90% des Gesamtbestandes) zwischen den Orten Thüngersheim und Retzbach. Aufgrund einiger Ähnlichkeiten mit H. glaucinum subsp. prasiophaeum (Syn.: subsp. gougetianum) wird die Unterart als H. maculatum subsp. pseudogougetianum beschrieben. Diese Subspecies wächst bevorzugt auf Muschelkalk-Schotter und beginnt bereits Mitte April zu blühen, hat weißlich behaarte Kopfhüllen mit dunklen Stieldrüsen. Die Grundblattrosette besteht aus eiförmigen bis elliptischen, gezähnten bis gesägten, oberseits kahlen, glauken und dunkel gefleckten Blättern. Die Stängel tragen 1-3(4) gestielte Laubblätter und bilden meistens lange blühende Seitenäste aus den Blattachseln. H. maculatum subsp. pseudogougetianum ist wie ein Teil der H. maculatum-Sippen tetraploid mit einem Genomgewicht (2C-Wert) von 14,5 pg und unterscheidet sich damit von der H. glaucinum-Gruppe, deren untersuchte Taxa ausnahmslos triploid sind (10,1 pg).
Hieracium rotundatum subsp. silvae-bavaricae wird als neu für die Wissenschaft beschrieben und abgebildet. Die neue Unterart gehört zu einem Formenkreis von Arten (H. rotundatum, H. transylvanicum), dessen Hauptverbreitung auf dem Balkan liegt. Die wechselvolle nomenklatorische Geschichte des Artnamens wird nachgezeichnet. Diagnostische Merkmale zur Unterscheidung der in der Wuchsform ähnlichen Arten H. murorum, H. rotundatum und H. transylvanicum werden diskutiert. Dabei wird auf die Bedeutung der Ausbildung des Grundblattzyklus besonders hingewiesen. Entgegen bisheriger Kenntnis reicht die nordwestliche Verbreitungsgrenze von H. rotundatum nun bis Südost-Bayern. Bei der Suche nach H. rotundatum konnte auch eine morphologisch auffällige Unterart von H. rotundatum nachgewiesen werden, die hier als neu beschrieben wird.
Background and objectives
Bullous pemphigoid (BP) is associated with neuropsychiatric disorders. Other comorbid diseases are discussed controversially. We evaluated the prevalence of comorbidity in BP patients in a representative area of Germany.
Patients and methods
Medical files of all BP patients treated at the Department of Dermatology, University Hospital Würzburg, Germany, between June 2002 and May 2013 were retrospectively reviewed. Bullous pemphigoid was diagnosed based on established criteria. For each patient, two controls were individually matched. Records were evaluated for age, sex, laboratory values, concomitant medication and comorbidity. Conditional logistic regression, multivariable regression analysis and complex regression models were performed to compare results.
Results
300 BP patients were identified and compared to 583 controls. Bullous pemphigoid was associated with neuropsychiatric disorders as well as laboratory abnormalities including leukocytosis and eosinophilia. Importantly, a highly significant association of BP with anemia (OR 2.127; 95 % CI 1.532–2.953) and renal impairment (OR 2.218; 95 % CI 1.643–2.993) was identified. No association was found with malignancy and arterial hypertension.
Conclusions
Our data revealed an increased frequency of anemia and renal impairment in BP patients. In accordance with previous studies the strong association for neuropsychiatric disorders was confirmed (p < 0.0005).