Das Lebensborn-Projekt als Teil der nationalsozialistischen Geburtenförderung - eine Auswertung der geburtshilflichen Ergebnisdaten der deutschen Lebensbornheime im „III. Reich“

Einleitung: Der „Lebensborn e.V.“ wurde 1935 als SS-Organisation gegründet mit dem Ziel, die Geburtenzahl der im Sinne der Rassenhygiene „wertvollen“ Bevölkerung zu steigern. Mit der Einrichtung von Entbindungsheimen sollte besonders der unverheirateten Mutter ein sicherer und geheimer Rahmen zur Geburt geschaffen werden. Die Geburtshilfe in den Heimen sollte vornehmlich nicht-operativ sein und wurde von sog. beratenden Fachärzten regelmäßig ausgewertet. Während Studien bereits den Lebensborn in den nationalsozialistischen Staatsapparat einordneten, fehlt bisher eine wissenschaftliche Analyse und kritische Einordnung der geburtshilflichen Ergebnisse der deutschen Lebensbornheime. Zielsetzung: Erstmalig erfolgte eine Auswertung der geburtshilflichen Arbeit in den Lebensbornheimen und Einordnung in den medizinhistorischen Kontext. Zudem soll die Funktion der sog. beratenden Fachärzte dargestellt werden. Methoden: Im Rahmen einer umfassenden Datenerhebung wurden Perinataldaten der Lebensbornheime digitalisiert, ausgewertet und durch anonymisierte Handeingabe der Geburten eines Lebensbornheimes ergänzt. Erfasst wurden maternale Daten, Geburtenzahlen, Geburtsmodus, geburtshilfliche Maßnahmen und peripartale Komplikationen. Als Vergleichswerte dienten Daten über Haus- und Klinikgeburten im Deutschen Reich der 1930er und 1940er Jahre. Ergebnisse und Diskussion: Insgesamt verzeichnete der Lebensborn von 1936-1945 im Großdeutschen Reich mindestens 7089 Geburten. Die Lebensbornmütter waren überwiegend ledige, erstgebärende Frauen, die durchschnittlich jünger waren als Vergleichsgruppen an Frauenkliniken der damaligen Zeit. Maternale Komplikationen (vorzeitiger Blasensprung, Wehenschwäche, Dammrisse und Uterusatonien) traten in den Lebensbornheimen insgesamt in einem vergleichbaren Prozentsatz wie in Vergleichsgruppen im Deutschen Reich auf. Die Rate mütterlicher Komplikationen im Wochenbett lag in zwei Lebensbornheimen bei 6-12% (Vergleichskliniken im Deutschen Reich 7-18%). Fetale/kindliche Asphyxien traten im Lebensbornheim „Harz“ in einem vergleichbaren Rahmen auf, wohingegen Nabelschnurkomplikationen in geringerem Ausmaß auftraten als in deutschen Frauenkliniken. Die Säuglingssterblichkeit im Lebensborn (knapp unter 4%) war geringer als im Reichsdurchschnitt (6-7%), ebenso wie die perinatale Mortalität (Lebensborn 1-2% vs. Reichsdurchschnitt 5%). Die Rate an operativ beendeten Geburten war teilweise auf dem Niveau der Vergleichsgruppen, teilweise darunter. Die häufigsten geburtshilflichen Maßnahmen waren Forcepsentbindungen, Wendungen und Extraktionen sowie manuelle Plazentalösungen. Schlussfolgerung: Die geburtshilfliche Arbeit in den Lebensbornheimen stellt sich hinsichtlich der peripartalen Komplikationsraten auf einem vergleichbaren Niveau zum Deutschen Reich dar. Die deutlich niedrigere Säuglingssterblichkeit lässt sich zum einen auf die insgesamt niedrigere Rate an Frühgeburten, zum anderen auf das geburtshilflich günstigere Patientinnenkollektiv der Lebensbornheime zurückführen, in dem weniger Risikoschwangerschaften vorhanden waren. Den Heimärzten wurden beratende Fachärzte aus der SS zur Seite gestellt, die regelmäßig die medizinische Versorgung und praktizierte Geburtshilfe in den Heimen überwachten. Im Lebensborn setzten diese überzeugten Nationalsozialisten die rassenhygienischen und bevölkerungspolitischen Ziele des NS-Staates um.Introduction: The SS organization ‘Lebensborn e.V.’ was founded in 1935 to increase the birth rate of the "valuable" population in terms of eugenics. Maternity homes were established to create a safe and secret environment for unmarried mothers in particular. Obstetrics in the facilities was to be primarily non-surgical and regularly evaluated by so-called consulting specialists. While studies already classified the role of Lebensborn in the National Socialist state, a critical analysis of the obstetric results does not exist. Objective: For the first time, an evaluation of the obstetric work in the Lebensborn facilities and classification in the medical-historical context took place. In addition, the function of the consulting specialists is to be described. Methods: Within the scope of a comprehensive data collection, perinatal data of the Lebensborn were digitized and evaluated. Maternal data, birth rates, birth mode, obstetric interventions and peripartal complications were recorded. Data on home and clinic births in the German Reich in the 1930s and 1940s served as comparative values. Results and discussion: In total, the Lebensborn recorded at least 7089 births in the German Reich from 1936-1945. The mothers were predominantly single, first-birth women, who were on average younger than comparable groups at gynaecological hospitals. Maternal complication rates (premature membrane rupture, weak contractions, perineal laceration and atonia) were comparable to those in the German Reich. Complications in the puerperium occurred in 6-12% in two facilities (hospitals in the German Reich 7-18%). Fetal/child asphyxia occurred in the Lebensborn facility ‘Harz’ to a comparable extent, whereas umbilical cord complications were fewer than in gynaecological hospitals. Infant mortality in Lebensborn (just under 4%) was lower than the German average (6-7%), as was perinatal mortality (1-2% vs. German average 5%). The rate of surgical births was partly at the level of comparable groups, partly below it. The most frequent obstetric interventions were forceps deliveries, cephalic versions, extractions and placental separations. Conclusion: Obstetric work in the Lebensborn is comparable to that of the German Reich regarding peripartal complications. The significantly lower infant mortality rate can be attributed to the lower rate of premature births as well as to the more favorable collective of Lebensborn mothers in terms of obstetrics due to fewer high-risk pregnancies. The facility doctors were accompanied by consulting specialists from the SS who regularly evaluated the medical work in the facilities. In Lebensborn, these convinced National Socialists implemented the racial-hygienic and political goals of the Nazi state

Vesico-vaginal fistulae: illustrated by the details of 14 cases operated on by the author

The vesico-vaginal fistula is an old disease, but only in the last century has treatment been undertaken with any confidence and with a fair chance of success. The developments which I am going to write about are, therefore, comparatively recent, and well worth critical examination and careful scrutiny.The woman with a vesico-vaginal fistula leads a miserable existence. She deserves the best that modern surgery can offer her.The repair of a vesico -vaginal fistula, though often easy, can be extremely difficult and laborious. The degree of difficulty is well illustrated in the extensive literature on the subject.Unless there has been severe damage to the urethra, she should be cured of her incontinence by vaginal surgery.The most favourable occasion to cure the patient is the first operation.Cure is most likely if attention is paid to the smallest details of the case. In particular, there should be most careful pre- operative examination and re- examination, until the nature of the injury is clearly and completely understood.Because of the great variety of injuries seen, there is no such thing as a routine method of closure. The operation must be fitted to each case. Three principles, however, learnt painfully and slowly, have stood the test of time. Firstly, a depth of healthy, vascular tissue must be exposed around the fistula. Secondly, the closure of the opening must be without tension. Thirdly, so far as possible the wound should be kept at rest during the process of healing by continuous bladder drainage

Biomarkers to improve functional outcome prediction after ischemic stroke:Results from the SICFAIL, STRAWINSKI, and PREDICT studies

BACKGROUND AND AIMS: Acute ischemic stroke (AIS) outcome prognostication remains challenging despite available prognostic models. We investigated whether a biomarker panel improves the predictive performance of established prognostic scores.METHODS: We investigated the improvement in discrimination, calibration, and overall performance by adding five biomarkers (procalcitonin, copeptin, cortisol, mid-regional pro-atrial natriuretic peptide (MR-proANP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) to the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and age/NIHSS scores using data from two prospective cohort studies (SICFAIL, PREDICT) and one clinical trial (STRAWINSKI). Poor outcome was defined as mRS &gt; 2 at 12 (SICFAIL, derivation dataset) or 3 months (PREDICT/STRAWINSKI, pooled external validation dataset).RESULTS: Among 412 SICFAIL participants (median age 70 years, quartiles 59-78; 63% male; median NIHSS score 3, quartiles 1-5), 29% had a poor outcome. Area under the curve of the ASTRAL and age/NIHSS were 0.76 (95% CI 0.71-0.81) and 0.77 (95% CI 0.73-0.82), respectively. Copeptin (0.79, 95% CI 0.74-0.84), NT-proBNP (0.80, 95% CI 0.76-0.84), and MR-proANP (0.79, 95% CI 0.75-0.84) significantly improved ASTRAL score's discrimination, calibration, and overall performance. Copeptin improved age/NIHSS model's discrimination, copeptin, MR-proANP, and NT-proBNP improved its calibration and overall performance. In the validation dataset (450 patients, median age 73 years, quartiles 66-81; 54% men; median NIHSS score 8, quartiles 3-14), copeptin was independently associated with various definitions of poor outcome and also mortality. Copeptin did not increase model's discrimination but it did improve calibration and overall model performance.DISCUSSION: Copeptin, NT-proBNP, and MR-proANP improved modest but consistently the predictive performance of established prognostic scores in patients with mild AIS. Copeptin was most consistently associated with poor outcome in patients with moderate to severe AIS, although its added prognostic value was less obvious.</p

Outcome van NMa-optreden: Een beschrijving van de berekeningsmethode

Sinds een aantal jaren bericht de NMa in haar jaarverslag over de welvaartseffecten van haar optreden. Deze jaarlijkse rapportages concentreren zich op de geschatte welvaartswinsten voor consumenten/afnemers, aangeduid als de Outcome van het handelen van de NMa. De Outcome wordt berekend als het 3-jaars voortschrijdend gemiddelde van de eerstejaarseffecten van de NMa-ingrepen. In dit rapport wordt de wijze waarop de Outcome wordt bepaald gepresenteerd. De methode voorde bepaling van de Outcome bestaat er uit dat op een relatief eenvoudige wijze het effect van NMa activiteiten op het consumentensurplus wordt geschat

Future-proofing plural antitrust enforcement models:Lessons from the United States and the European Union

The paper illustrates how the EU and U.S. antitrust systems are coming closer to each other in their extent of federalism or decentralization. It explores how plural antitrust enforcement models can be made future-proof, also considering the involvement of courts and legislators as evaluators in antitrust matters. The paper’s insights focus on considerations that are relevant in balancing experimentation and consistency. The starting point is that some extent of federalism or decentralization is welcome to allow for learning by doing when antitrust authorities reach different outcomes. The paper argues that stronger coordination among the different actors in the EU and U.S. antitrust systems is needed to make the learning more structural and to ensure effective enforcement. Insights from experimentalist governance are used to propose ex ante and ex post coordination mechanisms to achieve this

The review of the law on abuse of a dominant position through soft law in the European Union and Turkey: the Commission’s guidance on article 102 TFEU and implications for the guidelines on Art.6 in Turkey

Issuing soft law instruments on the enforcement of abuse of a dominant position in different competition law systems has never been a global trend in the last decade than before. In the European Union (EU), the European Commission published the “Guidance on the Commission’s Enforcement Priorities in Applying Article 82 of the EC Treaty to Abusive Exclusionary Conduct by Dominant Undertakings” (the Guidance) in February 2009 as yet the final formal stage during the “modernisation” of Art.102 TFEU. As an official candidate for EU membership, Turkey is unlikely to distance itself from the developments in the EU. Within this context, “Guidelines on the Assessment of Abusive Exclusionary Conduct by Dominant Undertakings” (the Guidelines on Art.6) were published on April 7, 2014. Evident from their structure and substantive content, the Guidelines on Art.6 are closely modelled on the Guidance. Although the transposition of the Guidance into Turkish competition law seems prima facie desirable in terms of the harmonisation of Turkey’s domestic competition law with the EU acquis, the question as to whether the Guidelines on Art.6 have suited to Turkey’s own needs gains significance. Despite being the first secondary legislation on Art.6 of the Act on the Protection of Competition 1994 in Turkey, a lack of much-needed guidance on the problematic areas in the enforcement of Art.6 may well result in the Guidelines on Art.6 being a missed opportunity to establish a coherent policy on Art.6. This thesis explores whether there is a need for adopting Guidelines in relation to Art.6 in Turkish competition law, examines whether the Guidance can or should be used as a model, and finally gives reflections on how the legal regime and content of these Guidelines can be best tailored to the enforcement of Art.6 in Turkey

Effective Road To Quantification Of Damages In EU Antitrust Law : Actions For Damages: A Hinder Or A Facilitator?

The competitiveness in and of the internal market of the EU is one of the main objectives of the Treaty of the European Union. In the EU, private enforcement is seen as a complimentary mechanism of public enforcement to attain the goals of competition law policy. Following the publication of Regulation 1/2003, the private enforcement of EU competition law has gained steady pace for development. During the past decade multiple legal instruments have been produced by the EU legislators to facilitate actions for damages, however, with limited accuracy and clarity for the victims of competition law infringements. The latest legislative piece, the Damages Directive, does not provide harmonization of the procedures leading up to the quantification phase or the methods for quantification .The procedural elements of the actions for damages are greatly left to the discretion of the national courts as long as the application of the twin EU principles of effectiveness and equality are ensured. The lack of clear guidelines in these aspects of the damages actions often create ambiguity and contrasting outcomes in different member states. Furthermore, the interplay between the tasks assigned to EU competition law combined with the application of “concept of effectiveness” often puts the parties in confusing situations in the hands of the national courts. This study focuses on the possibility of a victim of competition law infringement to effectively bring an action for damages by demonstrating the shortcomings of the various elements of the claim process and assesses whether the legal instruments and applicable other sources of law provide sufficient relief for the claimants. Furthermore, the policy choices of the EU are assessed to their compatibility from the potential victim’s and defendant’s perspective. The methods of quantification, which is the last phase of the claim is also reviewed from both economic and legal perspective. regarding The claim friendliness of the processes is also reviewed through its application, which remains in the hands of recent national case law. The study concludes that the policy choices are the main reason behind the inefficiencies and that effective application of competition law can be found by a more concentrated approach between the deterrence and corrective tasks assigned to private enforcement and advises the claimants to pursue a number of procedural reliefs

Future-proofing plural antitrust enforcement models:Lessons from the United States and the European Union

The paper illustrates how the EU and U.S. antitrust systems are coming closer to each other in their extent of federalism or decentralization. It explores how plural antitrust enforcement models can be made future-proof, also considering the involvement of courts and legislators as evaluators in antitrust matters. The paper’s insights focus on considerations that are relevant in balancing experimentation and consistency. The starting point is that some extent of federalism or decentralization is welcome to allow for learning by doing when antitrust authorities reach different outcomes. The paper argues that stronger coordination among the different actors in the EU and U.S. antitrust systems is needed to make the learning more structural and to ensure effective enforcement. Insights from experimentalist governance are used to propose ex ante and ex post coordination mechanisms to achieve this