Zur Validität der Herz-Kreislauf-Mortalitäts-Statistik der ehemaligen DDR

It has been known already for a long time that in the GDR the mortality rates for coronary heart disease (CHD) and cerebrovascular accidents (CVA) had been considerably underestimated. Instead of these diagnoses very often such general conditions like atherosclerosis and hypertension have been coded as underlying cause of death. We carried out, therefore, two validation studies in order to check whether and to what extent violations of the WHO coding rules were responsible for that. In the first study all hospital deaths which occurred in the GDR between 1985 and 1989 have been compared with the corresponding data of the official mortality statistics (record-linkage-database). In the second study 4.154 death certificates have been manually checked and recoded. Among the hospitalized patients who died from an acute myocardial infraction (AMI) the AMI was coded as underlying cause of death at the death certificate only in 57 % (men) and 54 % (women), respectively. Among cases of CHD these proportions were 66 % and 62 %, respectively, and among cases of CVA 46 % and 44 %, respectively. In the second study among those deaths with AMI as one of the three possible diagnoses at the death certificate AMI was coded as underlying cause of death in men in 46 % and in women in only 30 %. For CHD these proportions were 71 % and 59 %, respectively, and for CVA 44 % and 46 %, respectively. Both studies confirm that in the GDR the selection rules recommended by WHO have often been ignored when coding the death certificates of death cases from AMI, CHD and CVA. Based on the results of the two studies the following correction factors for the official mortality rates are proposed for men and women, respectively: AMI 1.8/2.3; CHD 1.5/1.6; CVA 2.2/2.3.     

Systemwechsel in der ambulanten ärztlichen Versorgung — Erklärungen aus der Perspektive der ostdeutschen ärzte

With the East German state’s accession to the FRG, the dynamic of the future development of the ambulatory medical sector was still unclear; a slow process of adaptation to the West German model was seen most likely. In fact, however, the transformation from the polyclinic system to the West German system of office based physicians took place very rapidly; although a majority of the East German doctors in the early phase after the political change in East Germany was sceptical on such a development. This article tries to offer an explanation for this rapid and ex ante unexpected dynamic of the process of transformation. The study is based on quantitative data as well as on expert interviews and a study of relevant documents. It is proposed that the dynamic is based partly on a change of preferences of doctors in comparison to the early phase after the political change in East Germany. More important, however, is the management of the legal and factual framework for the doctors decisions by governmental actors and semi-public interest groups. The most important reason for former polyclinic doctors to become office-based was their expectation, that in the long run it would not be possible to stay in the polyclinics. The activities of the local governments, who were running the polyclinics, were particularly decisive in this respect.     

Effekte der gesetzlichen Qualitätssicherung in der akutstationären Versorgung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die gesetzliche Qualitätssicherung (QS) dient der Sicherung und Weiterentwicklung der Qualität der Leistungserbringung....     

Zur Frage hypochlorämischer Erscheinungen bei Arbeitern der Veredlungsbäder

Ohne Zusammenfassung     

Indikatorensätze in der Gesundheitsberichterstattung Probleme der Kompatibilität zwischen Gesundheitsindikatoren der Gesundheitsministerkonferenz der Bundesrepublik Deutschland und der WHO

In connection with the strategy Health for All 2000 the WHO developed health targets and health indicators which are applicable to all states to measure progress in health situation. In federal countries health statistics will be set up on the basis of an indicator set, agreed on by the ministers of health care of all federal countries at the end of 1991. After having included North Rhine-Westphalia into WHO and EU projects, it became necessary to examine the compatibility of existing data sets. In conclusion, proposals for improving comparability of health indicators are submitted.     

Eckpunkte der Prävention in der Gesundheitspolitik

Zusammenfassung Seit 4 Jahren ist Prävention zur Kernaufgabe der Gesundheitspolitik geworden. Angesichts sinkender Geburtenziffern bei gleichzeitig niedrigem Renteneinstiegsalter kann gesundheitliche Prävention zur Stabilisierung der Sozialsysteme beitragen, indem Krankheiten verhindert, frühzeitig erkannt und besser bewältigt werden. Gleichzeitig können frühzeitige Verrentungen und Pflegebedürftigkeit vermieden bzw. hinausgezögert werden. Zur Ausschöpfung der vorhandenen präventiven Potenziale hat die Gesundheitspolitik in Deutschland zum einen ein Deutsches Forum Prävention und Gesundheitsförderung initiiert und zum anderen im Konsens mit den Ländern ein Präventionsgesetz erarbeitet, das sich derzeit im parlamentarischen Prozess befindet. Zur Stärkung der Prävention soll ein Präventionssystem der Sozialversicherung geschaffen werden, das von der gesetzlichen Kranken-, der Renten-, der Unfall- und der Pflegeversicherung gemeinsam finanziert wird. Als einander ergänzende Leistungen und Maßnahmen sind Kampagnen, Leistungen zur Verhaltensprävention und Settingmaßnahmen nach dem WHO-Ansatz vorgesehen. Das System wird durch gemeinsame Präventionsziele, einheitliche Qualitätssicherung und eine Berichtspflicht zur Überprüfung der Effizienz gesteuert. Auf Bundesebene wird es u. a. für Koordinierungsaufgaben eine Stiftung Prävention und Gesundheitsförderung der Sozialversicherungszweige geben. Das Deutsche Forum existiert seit 3 Jahren als freiwilliger Zusammenschluss relevanter Akteure der Prävention mit dem Ziel, Synergien herzustellen und gemeinsame Aktivitäten durchzuführen. Es arbeitet derzeit zu 4 Schwerpunkten: gesunde Kindergärten und Schulen (BZgA), betriebliche Gesundheitsförderung (BMWA), gesund Altern (BfGe) und Organisation und Recht (BMGS).S. Winter, Bundesministerium für Gesundheit und Soziale Sicherung Bonn/Berlin, Zentrum Öffentliche Gesundheitspflege, Medizinische Hochschule Hannover (MHH)     

Messung der Pflegequalität in der Langzeitpflege

Introduction

From 2009, the quality of care in nursing homes in Germany is inspected, rated, and publicized. This study investigates the association between staff-perceived nursing quality, clinical quality indicators, and ratings of health insurance medical services based on the transparency of stationary care agreement (PTVS).

Methods

This was a cross-sectional study merging publicly reported data, clinical quality indicators of a national health provider system, and data from staff surveys. Data from 83 nursing homes were adjusted for sample size, age, and care level and analyzed using Kendall’s tau coefficients and scatter plots.

Results

There were pronounced differences in staff-perceived nursing quality and some of the clinical indicators between facilities that were not detected by the PTVS. There was a weak association between staff-perceived quality and care quality rated by external inspections. No associations were found between the PTVS and clinical quality indicators.

Conclusions

Differences between nursing home providers were detected to varying degrees by the three approaches and were if at all weakly associated. Given the aims followed by public reporting initiatives of nursing home providers, the results stress the importance of revising the PTVS.     

Zur Qualität der Qualitätssicherung

Ohne Zusammenfassung     

Bildgebung in der Diagnostik der Alkoholabhängigkeit

Neuroimaging provides insight into the main biological mechanisms underlying alcohol dependence. This article discusses results from brain imaging studies on neurobiological correlates of alcohol dependence. Cardinal symptoms of alcohol dependence are the development of tolerance, withdrawal symptoms, drug craving, loss of control on alcohol intake, and harmful consequences of alcohol consumption. Brain imaging studies support the hypothesis that tolerance can be understood as a neuroadaptive mechanism to ensure homeostasis during chronic alcohol intake. When alcohol consumption is suddenly interrupted during detoxification, the loss of homeostasis typically manifests as withdrawal syndrome. While tolerance reduces the effects of chronic alcohol intake, sensitization is a neuroadaptive process that increases the effects of alcohol and raises incentive salience. Brain imaging studies indicate that sensitization and drug craving are associated with neuroadaptive processes in the brain reward system. Harmful consequences of alcohol intake also include neurotoxic effects on the central nervous system characterized by local and global atrophy. These findings can be best diagnosed with neuroimaging.     

Ausgewählte Aspekte bei der mikrobiologischen Überwachung der Trinkwasserqualität

The new drinking water ordinance (TrinkwV 2001) entered into force in 2003. In this paper we report about experiences with monitoring microbiological quality of drinking water. Special problems, for instance requirements concerning the quality of raw water, new and "old" microbiological parameters, microbiological methods, assessment of parametric values, especially in the case of values higher than the imperative value, are also described. Possible developments in this field are discussed. The paper should support microbiological laboratories, public health officers and other public authorities in monitoring and assessment of drinking water quality.     

Präventionsstrategien zur Eindämmung der HIV-Epidemie

After the recognition of AIDS as a new disease entity and isolation of HIV as the causative agent in the early 1980s, a controversial debate about adequate measures to reduce the spread of HIV developed. In all developed countries a strategy based on education about modes of HIV transmission, condom promotion and harm reduction approaches to intravenous drug use finally succeeded and became instrumental for the relative containment of HIV within most at risk populations. However, in most developing countries as well as in the countries of Eastern Europe, the success of HIV pre vention remained limited for various reasons. In addition, for several years now, in the western developed countries sexual risk behaviour, newly diagnosed HIV infections, and the incidence of various other sexually transmitted infections seem to re-increase, especially among men who have sex with men (MSM). These increases coincide with a dramatic improvement of therapeutic options for the treatment of HIV infection. The relationship between improvement of therapy and changes in sexual risk behaviour has to be further defined. It is hypothesized that HIV serosorting as a predominant risk management strategy among MSM results in an accumulation of health risks in the HIV-positive MSM population. In addition to and beyond established condom promotion, additional biomedical approaches to reduce transmissibility and susceptibility for HIV will be necessary to regain control of the spread of HIV in highly sexually active populations.     

Häufigkeit der Hautschäden bei Friseuren

Zusammenfassung Zu eigenen Untersuchungen über die Kaltwellverträglichkeit wurden nahezu 1000 Personen herangezogen, die fast alle dem Friseurgewerbe angehörten. Entgegen einer Vielzahl von anderslautenden Mitteilungen, in denen die Zahl der Hautschäden als unbedeutend beziffert wurde, ergab sich, daß etwa 70% der laufend mit Kaltwellflüssigkeiten arbeitenden Personen unter toxisch verursachten Hautschäden litten. — Der untersuchte Personenkreis wird näher beschrieben. — Als toxische Hautveränderungen kommen eine bestimmte Form der Hyperhidrosis manuum (feuchte Kaltwellhände) und ein entzündliches Ödem vor, deren Morphologie und Pathogenese diskutiert wird.Mit 7 Textabbildungen, davon 3 farbigenHerrn Prof. Dr. Franz Koelsch zum 80. Geburtstag.     

Kardiovaskuläre Hochrisikokonstellationen in der primärärztlichen Versorgung

DETECT is a nationwide epidemiological cross-sectional and longitudinal study program in a random probability sample of 3,795 primary care settings (response rate: 60.2%). Based on a target day total assessment of n=55,518 consecutive patients (RR 93.5%) in these settings all patients underwent standardized diagnostic assessment, using self-reporting, clinical interview and laboratory measures. DETECT aims at describing the point prevalence and comorbidity of coronary heart disease (CHD), hyperlipidaemia, arterial hypertension and diabetes mellitus and at identifying the behavioural, clinical, laboratory and psychological risk factors associated with these conditions. A random subset of patients (n=7,519) also completed an extensive standardized laboratory screening program and a 12-month follow-up investigation. Findings reveal a high prevalence of hypertension (36.3%), dyslipidaemia (29.1%), diabetes mellitus (14.6%) and CHD (12.4%) in primary care as well as their close association among each other. The study describes for the first time in greater detail the prevalence of specific disorders and the frequency of high-risk constellations in primary care and allows for the evaluation of various risk scores.     

Die Gesundheitsverhältnisse der Gerbereiarbeiter

Ohne Zusammenfassung     

Ernährungserziehung in der Grundschule

Background

The competences are derived for the nutrition education in the setting primary school. They are based on didactical considerations and public health demands

Methods

In an intervention study the effectiveness of the teaching concepts ‘Ernährungsführerschein’ and ‘Schritt für Schritt’ was evaluated. Five hundred and eighty-three children participated in the study with intervention and control groups

Results

Regarding the desired competence nutrition behaviour one concept results in highly significant improvements and shows an important effect strength

Conclusion

In the resuming discussion it is worked out that for the concept and evaluation of instruction psychological models should be used as a fundament in order to state the connection between factors such as attitude, norm, motivation or self-effectiveness and the nutrition behaviour. In the evaluation also a direct statistic proof of a behaviour change must be given, too, since only a change of the factors referred to is not sufficient.     

Schulbasierte Prävention der Adipositas

The prevalence of obesity for children and adolescents in Germany has increased during the past 20 years. Because the success rate of therapy is low, prevention seems to be the only solution. Prevention should begin early in life. School is an ideal setting for the implementation of prevention strategies. The aim of this review was to compare results of school-based prevention programs and to identify effective methods. A systematic literature search for studies published between 1990 and 2009 was conducted. A total of 22 studies were considered for inclusion. Combined interventions including nutrition, physical activity, and television viewing modification are effective. The intervention should last for at least one year. Installation of water fountains in schools, implementation of the topics “sugar-containing drinks” and “television viewing” in the curriculum, modification of existing physical education and more physical activity during the school day are effective prevention strategies.     

Die Novelle der EU-Badegewässerrichtlinie

In an attempt to reduce the risk of infection in natural bathing waters the European Union is in the process of improving the Bathing Water Directive 76/160/EWG, which regulates the safety of such waters. The proposal contains several positive innovations which will improve the protection of the bathers: (1) health-related indicators, (2) harmonized detection methods, (3) requirements for active bathing water management, and (4) stricter standards for coastal waters. One of the most salient features of the current draft is the introduction of bacterial standards that are more stringent for coastal than for fresh waters. This decision on different standards seems unjustified: it was taken solely on the grounds that in two epidemiological studies-one carried out in coastal, the other in fresh waters-the maximum excess rate of gastroenteritis among bathers in coastal waters was higher than among bathers in fresh waters. However, it was not taken into account that the concentrations of bacterial indicators at which the gastroenteritis rate began to increase was nearly identical in both studies. The ratio between the standard concentrations of E. coli and intestinal enterococci in the draft was set at 2.5. This value does not correspond to the ratio found in German surface waters with low pollution levels, with ratios ranging from 2.7 to 4.0, and to the even higher ratios found in raw and treated sewage effluents. As a consequence in a majority of cases the non-compliance of bathing waters in Germany would be caused exclusively by a violation of E. coli standards. In assessing risks of infection it must also be taken into account that the adequacy of E. coli and intestinal enterococci for signaling the presence of viruses in water is far from optimal. The decay of viruses in water-estimated by the decay of bacteriophages-was found to be substantially slower than the die-off of indicator bacteria.