Vernünftige Existenz als Weltbewältigung. Eine Kritik der weltanschaulichen Neutralität säkularer Vernunft bei Jürgen Habermas

Since Jürgen Habermas' speech for the Peace Price of the German Book Trade in October 2001, secular reason – personified by one of its main protagonists – has been able to debate with religion anew. For the purpose of an unbiased encounter between philosophy and religion, Habermas introduced the term “postsecular” back then in order to emphasize that this dialogue was inevitably necessary, all the more in the face of religiously motivated terrorism. Nonetheless, this willingness to debate was accompanied by the conviction that secular reason itself, as a matter of fact, would be “ideologically neutral”. However, taking the necessity of accomplishing the confrontation with “world” (Weltbewältigung) seriously, the reflection on world view as a whole unveils its implied tasks of granting metaphysical and existential certainty (metaphysische Sicherheit), therefore resulting in the statement that there cannot be a neutral world view at all. Only dialogue as exchange of beliefs generates the general framework within which the discursive issues of world views are separated from their existential aspects, thus enabling a reasonably conducted debate without endangering the existential certainty of its participants. As a consequence, the neutrality of world views exclusively rests in dialogue and is no unique feature of secular reason at all. Eventually, this leads to the reconsideration of the conditions that must be given for an argument to be called “rational”. The article tries to point out that an argument in political contexts, whether given by a religious or a secular person, should only be acknowledged rational if it takes at least all living people – regardless of their group affiliations – into account

Prevention among immigrants: the example of Germany

Spallek J, Zeeb H, Razum O. Prevention among immigrants: the example of Germany. BMC Public Health. 2010;10(1): 92.Background A large and increasing part of the European population has a history of migration. Germany, for example, is home to about 15 million people with migrant background, which amounts to 19% of its population. Migrants may have differences in their lifestyle, health beliefs and risk factors compared to the autochthonous populations. Discussion As for example studies on children's participation in routine prevention activities have shown, these differences can have a relevant impact on the access of migrants to the health care system and are likely to lower their participation in prevention programs compared to the autochthonous population. To increase the uptake of prevention programs, barriers to access must be identified and approaches to reduce them must be developed. Summary Taking the example of Germany, a need exists for prevention programs that include (migrant sensitive) and specifically address (migrant specific) migrants. These should be of sufficient scale, evidence-based, sustainable and evaluated at regular intervals

The impact of the temporal sequence of cranial radiotherapy and platin-based chemotherapy on hearing impairment in pediatric and adolescent CNS and head-and-neck cancer patients: A report from the PanCareLIFE consortium.

The impact of the temporal sequence by which cranial radiotherapy (CRT) and platin-based chemotherapy (PCth) are administered on sensorineural hearing loss (SNHL) in pediatric and adolescent central nervous system (CNS) and head-and-neck (HN) cancer patients has not yet been studied in detail. We examined the ototoxic effects of sequentially applied CRT and PCth. This study included children and adolescents with CNS and HN tumors who participated in the multicountry PanCareLIFE (PCL) consortium. Audiological outcomes were compared between patients who received CRT prior to PCth and those who received it afterwards. The incidence, degree and posttreatment progression of SNHL, defined as Muenster classification grade ≥MS2b, were evaluated in 141 patients. One hundred and nineteen patients were included in a time-to-onset analysis. Eighty-eight patients received CRT prior to PCth (Group 1) and 53 patients received PCth before CRT (Group 2). Over a median follow-up time of 1.6 years, 72.7% of patients in Group 1 experienced SNHL ≥ MS2b compared to 33.9% in Group 2 (P < .01). A time-to-onset analysis was performed for 74 patients from Group 1 and 45 patients from Group 2. Median time to hearing loss (HL) ≥ MS2b was 1.2 years in Group 1 and 4.4 years in Group 2 (P < .01). Thus, audiological outcomes were better for patients who received CRT after PCth than before. This finding should be further evaluated and considered within clinical practice in order to minimize hearing loss in children and adolescents with CNS and HN tumors

Intensity modulated radiation therapy or stereotactic fractionated radiotherapy for infratentorial ependymoma in children: a multicentric study

This study was to evaluate the treatment dosimetry, efficacy and toxicity of intensity modulated radiation therapy (IMRT) and fractionated stereotactic radiotherapy (FSRT) in the management of infratentorial ependymoma. Between 1999 and 2007, seven children (median age, 3.1years) with infratentorial ependymoma were planned with either IMRT (3 patients) or SFRT (4 patients), the latter after conventional posterior fossa irradiation. Two children underwent gross total resection. Median prescribed dose was 59.4Gy (range, 55.8-60). The median follow-up for surviving patients was 4.8years (range, 1.3-8). IMRT (median dose, 59.4Gy) and FSRT (median dose, 55.8Gy) achieved similar optimal target coverage. Percentages of maximum doses delivered to the cochleae (59.5 vs 85.0% Gy; P=0.05) were significantly inferior with IMRT, when compared to FSRT planning. Percentages of maximum doses administered to the pituitary gland (38.2 vs 20.1%; P=0.05) and optic chiasm (38.1 vs 14.1%; P=0.001) were, however, significantly higher with IMRT, when compared to FSRT planning. No recurrences were observed at the last follow-up. The estimated 3-year progression-free survival and overall survival were 87.5 and 100%, respectively. No grade>1 acute toxicity was observed. Two patients presented late adverse events (grade 2 hypoacousia) during follow-up, without cognitive impairment. IMRT or FSRT for infratentorial ependymomas is effective and associated with a tolerable toxicity level. Both treatment techniques were able to capitalize their intrinsic conformal ability to deliver high-dose radiation. Larger series of patients treated with these two modalities will be necessary to more fully evaluate these delivery technique

Incidence of and survival from childhood cancer : the role of social and family factors in childhood cancer

Introduction: Social inequalities, both within countries and between countries, influence the occurrence of and survival from cancer, including childhood cancer. This dissertation aimed to gain further insight into social inequalities in childhood cancer â on the national level within a country and also between countries with different levels of socioeconomic development. The first objective was to obtain a better understanding of the reported geographical differences in childhood cancer worldwide by studying incidence patterns in a Sub-Saharan African country (with a diverse racial/ethnic population) and comparing the findings to the incidence patterns of a representative high-income country (Germany). The second objective was to investigate survival from childhood cancers in relation to social and family factors within high-income countries. Methods: The two objectives were addressed by seven conceptually independent but topic-wise interrelated studies. Four studies provided the core manuscripts for this thesis: i) childhood cancer incidence patterns by race in South Africa, and in comparison to Germany; ii) survival from acute lymphoblastic leukaemia (ALL) in relation to socio-demographic background in Germany; iii) survival from ALL in relation to family factors in Germany; iv) survival from childhood haematological malignancies in relation to family factors in Denmark. Data from the South African National Cancer Registry, the German Childhood Cancer Registry, a former German case-control study, as well as from the Danish registries served as the basis for these studies. The incidence data were analysed by applying descriptive epidemiological methods. Kaplan-Meier curves and Cox proportional hazard models were used for the survival analyses. Results: Substantial differences in the reported incidence rates were observed within South African racial groups, with lowest rates among Black children and highest among White children. There were also considerable differences between White children in South Africa and in Germany, but the differences varied markedly by cancer type and by age at diagnosis. Social and family characteristics were found to be associated with survival from childhood cancers, although not consistently between Germany and Denmark and not across cancer types. An impact of socioeconomic factors on survival from ALL was not observed for either Germany or Denmark, however a beneficial effect of higher maternal education among children with non-CNS solid tumours in Denmark was observed. Higher birth order and having siblings was associated with poorer survival among childhood haematological cancer patients in Denmark, with associations being suggestive for ALL and non-Hodgkin lymphoma but stronger and statistically significant for acute myeloid leukaemia. Similarly, most associations with family factors were suggestive for survival from ALL in German children. Highest survival in Germany was seen for second-born children. Patterns of associations between parental age and survival from childhood cancers were diverse across studies. Discussion: Findings of this dissertation highlight social inequalities in childhood cancer with respect to reported incidence differences between racial groups in South Africa and compared to Germany. Furthermore, survival differences between social groups in Germany and Denmark were observed, although not consistently across cancer types. To reduce those observed social inequalities in childhood cancer, a thorough understanding of the underlying mechanisms and pathways is needed. Observed incidence differences in South Africa might be, at least to some extent, due to socio-cultural factors related to access and utilization of health care services rather than reflecting actual differences in cancer risks. Under-ascertainment of cases may not only drive the findings for South Africa but the global reported geographical patterns of childhood cancer incidence. Despite highly specialized and standardised treatment and free health services for all children in Germany and Denmark, not all children benefit equally from improvements in childhood cancer survival. Further studies are warranted to gain knowledge on the impact of social and family factors on childhood cancer survival in other populations and to identify underlying pathways

“Do You Think the Angels Will Speak Spanish?”: Nurses’ Experiences of Death in Pediatric Oncology

Caring for children dying of cancer and families experiencing immense suffering is challenging complex work. Pediatric oncology nurses attend to the physical and emotional needs of children and their families during the illness progression, at the moment of death, and beyond, however, little is known about how they themselves are affected, and how this influences the care they give. Our intent with this philosophical hermeneutic research was to add to understandings of these effects on pediatric oncology nurses and to support them in this challenging component of their work. This is a part of the doctoral research of the first author which is published online (Morck, 2014), and was supervised by the second author. Fifteen pediatric oncology registered nurses were interviewed to expand our understanding of this topic. These data were then analyzed according to hermeneutic tradition as guided by the philosophical hermeneutics of Hans-Georg Gadamer. Findings from this research revealed nurses struggled to navigate the ideals of nursing versus the realities of practice when working with children who may die. This called for them to maintain a fine balance between the personal and the professional. This ontological struggle is not absolute but premised on a shifting continuum based on a complexity of personal and professional beliefs, experiences, and expectations. There needs to be a reminder that death continues to be an unfortunate constant in the work of these nurses - - a reality, that in many ways, society has turned away from and hidden, a reality that has shaped the way death is experienced within pediatric oncology. This common middle ground is what nurses called for in order to be sustained and remain in their work. Research and transformative education that specifically addresses the tension created by insufficient end of life and death education is required for nurses to feel more comfortable and competent within the ontology of death and dying. This necessitates a re-conceptualization of how death is processed in pediatric oncology

Methodology of the DCCSS later fatigue study:a model to investigate chronic fatigue in long-term survivors of childhood cancer

Background: A debilitating late effect for childhood cancer survivors (CCS) is cancer-related fatigue (CRF). Little is known about the prevalence and risk factors of fatigue in this population. Here we describe the methodology of the Dutch Childhood Cancer Survivor Late Effect Study on fatigue (DCCSS LATER fatigue study). The aim of the DCCSS LATER fatigue study is to examine the prevalence of and factors associated with CRF, proposing a model which discerns predisposing, triggering, maintaining and moderating factors. Triggering factors are related to the cancer diagnosis and treatment during childhood and are thought to trigger fatigue symptoms. Maintaining factors are daily life- and psychosocial factors which may perpetuate fatigue once triggered. Moderating factors might influence the way fatigue symptoms express in individuals. Predisposing factors already existed before the diagnosis, such as genetic factors, and are thought to increase the vulnerability to develop fatigue. Methodology of the participant inclusion, data collection and planned analyses of the DCCSS LATER fatigue study are presented. Results: Data of 1955 CCS and 455 siblings was collected. Analysis of the data is planned and we aim to start reporting the first results in 2022. Conclusion: The DCCSS LATER fatigue study will provide information on the epidemiology of CRF and investigate the role of a broad range of associated factors in CCS. Insight in associated factors for fatigue in survivors experiencing severe and persistent fatigue may help identify individuals at risk for developing CRF and may aid in the development of interventions.</p