Unintended effects of immigration policies for government and migrants

In this chapter, we draw empirical and theoretical conclusions based on the various analyses contained in this volume that focus on the European and U.S. migration regimes. We conclude that immigration policies have a multitude of unintended effects which affect both migrants and governments in the countries of origin, transit, and arrival. This chapter begins with an overview of the interest policies inside and outside the ‘defended’ territories. In the U.S. a lucrative internal market of border control has emerged, whereas the EU’s externalized border control includes the neighboring countries. The second part describes the unintended effects arising due to inconsistent general policies of the countries of arrival and origin, which often contradict the official immigration policies. Following this, the limited effect of border control measures on immigrants and their journeys are discussed. In the fourth section we explore in more detail the unintended effects in the form of new areas of cooperation, including new forms of self-organization, local interest groups, and sanctuary movements. The final section summarizes the various unintended effects and offers recommendations for decision makers in the field of migration policy

Compliance with recommended immunizations in adolescents

Introduction: Little is known about the completeness and timely administration of recommended standard immunizations in Germany. The goal of this study was to determine compliance with official standard immunization recommendations in adolescents attending secondary schools in the city of Erlangen, Germany. Methods: Adolescents who were attending 5th grade (at approximately 11years of age), 8th grade (14years), or 10th and 11th grade (16-17years) classes at any of the 13 of 14 schools that had agreed to participate were eligible to be enrolled. Results: While coverage for the primary series of diphtheria, tetanus and poliomyelitis immunizations was satisfactory (98%), coverage for measles-mumps-rubella immunizations (dose 1: 89-96%; dose 2: 60-76%) and hepatitis B (doses 1-3: 61%) was suboptimal. Of note, 39% of students had not received any immunization against pertussis. Completion of immunization series generally was significantly delayed. Furthermore, rates for recommended booster doses in adolescence were disappointingly low with 21% for tetanus component vaccines and <10% for the fifth dose of pertussis. Conclusions: Significant immunization gaps for all recommended standard immunizations in adolescents were detected. This puts individuals at risk for serious vaccine-preventable diseases, contributes to suboptimal herd immunity in the population under study leaving the potential for future epidemics, and impedes national and international targets of disease reduction or eliminatio

Hospital Incidence, Treatment, and Outcome of 885 Patients with Thoracoabdominal Aortic Aneurysms Treated in Switzerland over 10 Years-A Secondary Analysis of Swiss DRG Data

Despite the development of fenestrated and branched endovascular aortic repair (f/bEVAR), the surgical management of thoraco-abdominal aortic aneurysms (TAAAs) remains a major challenge. The aim of this study was to analyse the hospital incidence and hospital mortality of patients treated for TAAAs in Switzerland. Secondary data analysis was performed using nationwide administrative discharge data from 2009-2018. Standardised incidence rates and adjusted mortality rates were calculated. A total of 885 cases were identified (83.2% nonruptured (nrTAAA), 16.8% ruptured (rTAAA)), where 69.3% were male. The hospital incidence rate for nrTAAA was 0.4 per 100,000 women and 0.9 per 100,000 men in 2009, which had doubled for both sexes by 2018. For rTAAA, there was no trend over the years. The most common procedure was f/bEVAR (44.2%), followed by OAR (39.5%), and 9.8% received a hybrid procedure. There was a significant increase in endovascular procedures over time. The all-cause mortality was 7.1% with nrTAAA and 55% with rTAAA. The mortality was lower for rTAAA when f/bEVAR or hybrid procedures were used. A ruptured aneurysm and higher comorbidity were associated with higher hospital mortality. This study demonstrates that the treatment approach has changed significantly over the observed period. The use of f/bEVAR nearly tripled in nrTAAA and doubled in rTAAA during this decade

Correction to: Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement

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Inter-hospital transfer of patients with ruptured abdominal aortic aneurysm in Switzerland

Objectives: To analyse the association of inter-hospital transfer on hospital mortality in patients with ruptured abdominal aortic aneurysms (rAAA) in Switzerland. Design: Secondary data analysis of case-related hospital discharge data from the Swiss Federal Statistical Office for the years 2009-2018. All cases with rAAA as primary or secondary diagnosis were included. Cases with rAAA as a secondary diagnosis without surgical treatment and cases that had been transferred to another hospital without surgical treatment at the referring hospital were excluded. Methods: Logistic regression models for hospital mortality were constructed with age, sex, type of admission, van Walraven comorbidity score, type of treatment, insurance class, hospital level, and year of treatment as independent variables. Results: From 1 January 2009 to 31 December 2018, 1798 cases with rAAA were treated either surgically (62.5%) or palliatively (37.5%) in Switzerland. 72.9% of the cases were directly treated (surgically or palliative) at the hospital of first presentation, whereas 27.1% of all cases with rAAA were transferred between hospitals. The overall crude hospital mortality was 50.3%; in the surgically treated cohort it was 23.1%, in the palliative treated cohort it was 95.7%.Inter-hospital transfer was associated with better survival compared to patients directly admitted (OR 0.52, 95%-CI: 0.36-0.75, p<.001). Treatment in major hospitals was associated with a significantly higher mortality compared to treatment in university hospitals (OR 1.98, 1.41-2.79, p<.001). There was no evidence for an association of open repair with hospital mortality, OR 1.06, 0.77-1.48, p=.722, compared to endovascular repair. Conclusions: In a healthcare system such as Switzerland with a highly specialised rescue chain, transfer of haemodynamically stable patients with rAAA is probably safe. In this setting, a centralised medical care might outweigh the potential disadvantages of a limited delay due to patient transfer. Further studies are needed to address potential confounding factors such as hemodynamic and anatomical features. Keywords: "DRG"; "aortic aneurysm; "aortic rupture"; "patient transfer"; "secondary data analysis"; abdominal"

Relevance of Type II Endoleak After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Retrospective Single-Center Cohort Study

Introduction: Endovascular aortic repair (EVAR) is widely used as an alternative to open repair in elective and even in emergent cases of ruptured abdominal aortic aneurysm (rAAA). One of the most frequent complications after EVAR is type II endoleak (T2EL). In elective therapy, evidence-based therapeutic recommendations for T2EL are limited. Completely unclear is the role of T2EL after EVAR for rAAA (rEVAR). This study aims to investigate the significance of T2ELs after rEVAR. Patients and methods: This is a retrospective single-center data analysis of all patients who underwent rEVAR between January 2010 and December 2020 with primary T2EL. The outcome criteria were overall and T2EL-related mortality and reintervention rate as well as development of aneurysm diameter over follow-up (FU). Results: During the study period between January 2010 and December 2020, 35 (25%) out of 138 patients with rEVAR presented a primary postoperative T2EL (age 74±11 years, 34 males). At rupture, mean aneurysm diameter was 73±12 mm. Follow-up was 26 (0–172) months. The reintervention-free survival was 69% (95% confidence interval [CI]: 55%–86%) at 30 days, 58% (95% CI: 43%–78%) at 1 year, and 52% (95% CI: 36%–75%) at 3 years. In 40% (n=14), T2ELs resolved spontaneously within a median time of 3.4 (0.03–85.6) months. The overall and T2EL reintervention rates were 43% (n=15) and 9% (n=3), respectively. Within 30 days, 11 patients (31%) required reintervention, of which 2 were T2EL related. Aneurysm sac growth by ≥5 mm was seen in 3 patients (9%), and aneurysm shrinkage rate was significantly higher in sealed T2EL group (86% vs 5%, p<0.0001). The overall survival was 85% (95% CI: 74%–98%) at 30 days, 75% (95% CI: 61%–92%) at 1 year, and 67% (95% CI: 51%–87%) at 3 years. Six deaths were aneurysm related, while 1 was T2EL related within the first 30 days due to persistent hemorrhage. During FU, one more patient died due to a T2EL-related secondary rupture (T2EL-related mortality, 5.7%, n=2). Multivariable analysis revealed that arterial hypertension was associated with an increased risk for reintervention (hazard ratio [HR]: 27.8, 95% CI: 1.48–521, p=0.026) and age was associated with an increased risk for mortality (HR 1.14, 95% CI: 1.04–1.26, p=0.005). Conclusion: T2ELs after rEVAR showed a benign course in most cases. In the short term, the possibility of persistent bleeding should be considered. In the mid term, a consequent FU protocol is required to detect known late complications after EVAR at an early stage and to prevent secondary rupture and death

Carbon taxation, carbon subsidies and ETS payments in Luxembourg (integrated report). An Environmentally Extended Input-Output Analysis

This study is an analysis of current energy and transport taxation and carbon relevant subsidies in Luxemburg, utilizing an Environmentally Extended Input-Output model. The method allows to not only calculate direct taxation and emissions that are produced and paid by a sector, but also indirect emissions and taxation that is paid and produced indirectly because of the interconnectedness of the value chains. Besides current carbon-related taxation, we also ran the model for four fictional taxation scenarios, with further versions including a sensitivity analysis for selected scenarios with a varying ETS price. The analysis is based on Eurostat data on greenhouse gas emissions, taxation and sectoral connections of international economies (FIGARO-tables). Descriptive statistics show that Luxembourg had the highest GHG emissions per capita of all EU countries in 2019, while a relatively large share of energy and transport taxes was paid by non-residents. Therefore, we extended the model and introduced non-resident corporations and non-resident households in addition to the usual units, such as (resident) households and industries, in the model. In one of the fictional scenarios, we analyzed the effects of the planned carbon tax in Luxembourg in 2023 (30 Euros per ton of CO2). In the short run, this tax would generate almost 295 million Euros of revenues, in addition to already existing carbon-related taxation (1 billion Euros in 2019) if emissions stayed at their 2019 levels. In all scenarios, non-resident corporations would bear the brunt of carbon taxation, as these produced around one third of greenhouse gas emissions in Luxembourg in 2019. Energy and transport taxation in 2019 was very unevenly distributed in Luxembourg, when considering the emissions of the respective economic unit. While sectors such as agriculture paid only one Euro per emitted ton of CO2, construction and mining paid around 300 Euros for the same pollution. Moreover, we found that a selected list of carbon subsidies in Luxembourg amount to 417 million Euros, whereas entities not located in Luxembourg (foreign households and corporations) profit the most of these, while households located in Luxembourg profit the least. We suggest that policy makers in Luxembourg should come up with a taxation scheme that is stronger connected to GHG and CO2 emissions and carbon-related subsidies should be abolished to a large extent