Querschnittsbetrachtung Mecklenburg-Vorpommern als Beispiel für den demographischen Wandel in ländlichen Räumen Ostdeutschlands

Am Beispiel des dünn besiedelten Landes Mecklenburg-Vorpommern werden die Folgen der demographischen Entwicklung für den ländlichen Raum dargestellt. Nach den Raumkategorien des Bundesamtes für Bauwesen und Raumordnung besteht Mecklenburg-Vorpommern insgesamt aus strukturschwachen ländlichen Räumen mit starken bis sehr starken Entwicklungsproblemen. Ausnahmen sind zwei kleinere Bereiche um die Hansestadt Rostock und die Landeshauptstadt Schwerin, die in die Kategorie Verdichtungsräume eingeordnet sind. Im bundesweiten Vergleich könnten diese Gebiete guten Gewissens als „ländlich geprägte Verdichtungsräume“ bezeichnet werden. Vor diesem Hintergrund bezieht sich die vorliegende Querschnittsbetrachtung auf Mecklenburg-Vorpommern insgesamt, zum Teil mit Blick auf die Ebene von Planungsregionen oder auch Kommunen. Die demographische Entwicklung des nordöstlichen Bundeslandes ist zwar kein Sonderfall im deutschen und europäischen Kontext, jedoch keineswegs beispielhaft für alle ländlichen Räume. Insbesondere im Einflussbereich von Metropolen der westlichen Bundesländer verzeichnen die einzelnen Komponenten der Bevölkerungsentwicklung noch einen wesentlich günstigeren Verlauf. Mittel- bis langfristig betrachtet werden hier jedoch ähnliche Trends erwartet.Based on the example of the sparsely populated federal state of Mecklenburg-Western Pomerania, the author outlines the consequences of demographic change for rural areas. In terms of the spatial categories defined by the Federal Office for Building and Regional Planning, Mecklenburg-Western Pomerania is made up primarily of structurally weak, rural areas facing serious to very serious problems for development. The only exceptions are two relatively small areas around the Hanseatic city of Rostock and the state capital Schwerin: both areas are classified as high-density areas. In national terms, it would be wholly appropriate to label these as “high-density areas with a rural character”. Against this background, the present cross-sectional view is concerned with Mecklenburg-Western Pomerania in its entirety, looking to some extent also however at the level of planning regions and even municipalities. Although the demographic development taking place in the north-eastern section of the state by no means represents a special case within a German or European context, it is equally not to be seen as typical of all rural areas. Due in particular to the influence of metropolitan areas in the western part of Germany, the individual components of population growth have developed in a manner considerably more favourable than would otherwise be expected. Over the medium to long term, however, similar trends are to be expected here too

Kooperation, Bund-Länder

Kooperationen zwischen Bund und Ländern im Bereich der Raumordnung werden im Wesentlichen getragen durch die Ministerkonferenz für Raumordnung (MKRO). Wichtige räumliche Entwicklungsimpulse werden von Bund und Ländern u. a. durch die Städtebauförderung sowie die Gemeinschaftsaufgabe "Verbesserung der regionalen Wirtschaftsstruktur" gegeben

Frankreich: Großraum Lyon

Entsprechend dem auf wirtschaftliche Entwicklung ausgerichteten französischen Planungssystem hat der seit 1969 existierende Großraum Lyon (Grand Lyon) ein raumstrategisch orientiertes projekt- und freiraumbezogenes Raumentwicklungskonzept erarbeitet. Dessen Erstellung und spätere Umsetzung erfolgt in enger Zusammenarbeit mit den Stakeholdern, die in korporatistischen Governance-Regimes eingebunden werden. Die Umsetzung wird zudem über Vertragsregelungen abgesichert.In keeping with the economic orientation of the French planning system, the Lyon conurbation (Grand Lyon), in existence since 1969, has produced a strategically oriented spatial development concept that focuses on projects and open space. Preparation and later implementation of the development concept were carried out in close cooperation with stakeholders who are integrated into corporatist governance regimes. Implementation is further safeguarded by contractual provisions

Niederlande: Provinz Zuid-Holland und Metropolregion Rotterdam-Den Haag

Das niederländische Planungssystem hat sich mit dem neuen Planungsrecht (2004) noch stärker als bisher auf „Entwicklungssteuerung“ hinbewegt. Am Beispiel der Provinz Süd-Holland und der Metropolregion Rotterdam-Den Haag werden neuere strategische Planungsansätze herausgearbeitet. Für Deutschland von Interesse sind dabei: a) die engere Einbindung von Stakeholdern in die Planungsprozesse und vor allem Planumsetzung, b) das neue Verständnis von Planung als Management der Kooperation, c) die Umsetzung der Pläne über finanzielle Anreize, soziale Zwänge (Öffentlichkeitsbeteiligung, Medien) sowie Projektgenehmigungsvorbehalte und d) das Konsensmodell (trotz seiner Probleme).With the new Planning Act of 2004, the planning system of the Netherlands moved more strongly towards “development management”. Using the example of the province of South Holland and the metropolitan region of Rotterdam-Den Haag new strategic planning approaches are discussed. Of interest in the German context are: a) the closer involvement of stakeholders in the planning processes and particularly in the implementation of plans, b) a new understanding of planning as the management of cooperation, c) the implementation of plans using financial incentives, social pressure (public participation and media) and project approval provisos, and d) the consensus model (despite its problems)

Modell einer Strategischen Regionalplanung in Deutschland

Teil III beschreibt die Funktionsweise der Strategischen Regionalplanung mit einer Fokussierung auf die einzelnen Prozesse und Produkte. Dabei werden zur Verdeutlichung ausgewählte Beispiele aus Deutschland und Europa herangezogen. Auf der Basis des Verständnisses von Funktionen, Prozessen und Produkten der Strategischen Regionalplanung erfolgt sodann die Benennung der einzelnen Elemente als Bestandteileeines Baukastens, der so verstanden werden will, dass er eine Strategische Regionalplanung in idealtypischer Form aufzeigt, aber gleichzeitig den Regionen erlaubt, sich nach eigenen Kriterien und eigenem Verständnis einzuordnen und nach sinnvollen nächsten Schritten auf dem Weg zu einer Strategischen Regionalplanung als Motor zu einer effektiven regionalen Entwicklungsperspektive zu suchen. Außerdem wird der Mehrwert gegenüber der klassischen Regionalplanung beschrieben.Part III describes the functionality of Strategic Regional Planning, focusing on the individual processes and products. By way of illustration, selected examples from Germany and Europe are discussed. Based on an understanding of the functions, processes and products of Strategic Regional Planning, individual elements are identified as components of a building block concept. This is to be understood as an ideal-typical form of Strategic Regional Planning, which also allows the regions to use their own criteria and understandings to identify their positions in the scheme and to find appropriate next steps to lead towards Strategic Regional Planning. Strategic Regional Planning can thus become an engine for effective regional development. The advantages of Strategic Regional Planning compared to classical Regional Planning are also described

Risikobasierter Hochwasserschutz durch Regionalplanung

Neue Vorgaben verlangen von der Regionalplanung in Deutschland, dass ihre Festlegungen zum Hochwasserschutz vom Hochwasserrisiko abgeleitet werden, auch um eine ausreichende Anpassung an den Klimawandel zu erreichen. Ausgehend von dem identifizierten Hochwasserrisiko, d.h. nicht ausschließlich basierend auf Wahrscheinlichkeit bzw. Gefahr von Hochwasserereignissen, sind Vorrang- und Vorbehaltsgebietsausweisungen in Regionalplänen auf der Grundlage der Vulnerabilität von Raumnutzungen und ihrer Schutzbedürftigkeit gegenüber Überschwemmungen festzulegen. Flächennutzungen mit einem hohen Schadenspotenzial, die empfindlich auf Überschwemmungen reagieren, sind vorsorglich in Bereichen mit hohem Hochwasserrisiko auszuschließen. In deichgeschützten Bereichen darf das Risiko des Versagens von Schutzeinrichtungen nicht ausgeblendet werden. Hier ist mehr Risikovorsorge nötig, als bisher betrieben wird. Überschwemmungsbereiche mit Abfluss- und Rückhaltefunktion sind konsequent zu schützen. Neuer Retentionsraum - auch wenn die Retentionsfunktion noch nicht erbracht wird - ist durch Gebietsausweisungen in Regionalplänen vor konkurrierenden Nutzungen zu bewahren. Außerdem ist der Wasserrückhalt in der Fläche zu verbessern. Eine neue Aufgabe für die Raumordnung ist die Abstimmung ihrer Hochwasserschutzfestlegungen in Flussgebietseinheiten

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks