Zuständigkeiten und Konzepte zur ärztlichen Ausbildung und Weiterbildung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die ärztliche Ausbildung findet an medizinischen Fakultäten der Universitäten statt. Die ärztliche...     

Fähigkeitsbeeinträchtigungen und Teilhabeeinschränkungen

Participation is defined, according to the International Classification of Functioning, Disability and Health (ICF), as inclusion in life. Participation restrictions are the result of a mismatch between capacities and context requirements. Mental disorders are more impairing than many somatic disorders.     

Ernährungswissen und Ernährungsverhalten

Background

Unfavourable nutritional behaviour is common among students in Germany, indeed in the whole German population. Intervention studies to investigate the effects of imparting nutritional knowledge to nutritional behaviour used diverse methods. Moreover the period of investigation was short and studies of this type have provided inconsistent results.

Objective

A controlled intervention study was conducted to analyze the long-term effects of nutrition-related studies on nutritional knowledge and the nutritional behaviour of female university students.

Materials and methods

Female students at the University of Education in Schwäbisch Gmünd were divided by course at the beginning of their studies: nutrition-related courses (intervention group: IG, n = 55), other courses of studies (control group: CG, n = 22). Theory- and practice-orientated nutritional knowledge and nutritional behaviour (food intake, Indicator Food Index) were assessed using a standardized questionnaire at the beginning and after two years of studies. Intervention effects were analyzed by two-way repeated measures analysis of variance.

Results

The theory- and practice-orientated nutritional knowledge of the IG increased compared to the CG (both: p < 0.001). Changes in food intake were an increased vegetable intake (p < 0.01) and a decreased fast food consumption (p < 0.01) within the IG compared to CG. The Indicator Food Index did not change.

Conclusions

Although nutrition-related studies are accompanied by a significant increase in nutritional knowledge, effects on nutritional behaviour are sparse. It can be speculated that acquired nutritional knowledge could be implemented into every day action although with a delay. Furthermore, the results show that long-term interventions have a certain health-promoting potential in sensitive phases of life.

     

Sexualpädagogik und Gewaltprävention

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die Prävention von sexualisierter Gewalt gegen Kinder und Jugendliche hat in pädagogischen Kontexten hohe...     

Lärmbedingte Belästigung und Erkrankungsrisiko

Traffic noise (road, train and flight noise, and the noise of parking cars), is the dominant source of annoyance in the living environment of many European countries. This is followed by neighbourhood noise (neighbouring apartments, staircases and noise within the apartment). The subjective experience of noise stress can, through central nervous processes, lead to an inadequate neuro-endocrine reaction and finally to regulation diseases. Within the context of the LARES-survey, noise annoyance within the everyday living environment was collected and evaluated in connection with medically diagnosed illnesses. Adults who indicated chronically strong annoyance due to neighbourhood noise were found to have an increased health risk in the cardiovascular system, the movement apparatus as well as depression and migraine. For adults with chronically strong annoyance caused by traffic noise, the risks to the respiratory system also increased. In older people, both neighbourhood and traffic noise indicated, in general, a lower risk of noise annoyance induced illness than in adults. It can be assumed that the effects of noise induced annoyance in older people is concealed by the physical consequences of age (with a strong increase in illnesses). With children, the effects of noise induced annoyance from traffic as well as neighbourhood noise is evident in the respiratory system. The increased illness risks in the respiratory system in children do not seem to be caused primarily by air pollutants but rather, as with case of neighbourhood noise, though emotional stress.     

Altern und Sexualität

This contribution describes sexual desire, activity and satisfaction of people aged 45-91 years on the basis of an empirical study conducted in the German-speaking part of Switzerland. Sexual desire and activity diminish with age but there is a great variability. Sexual satisfaction remains stable in elderly people. Physical, hormonal and neuronal changes cause a greater vulnerability for sexual problems but relationship, psychosocial and biographical factors as well as coping strategies have a strong moderating effect. The medicalization of the sexuality of aging people is critically depicted. Recommendations for health care practitioners are given.     

Verhaltensstabilität und Gewohnheitsverhalten

Background

To develop a healthy habit, various authors suggest a 6? to 9?week period of continuous practice. Despite these findings, little is known about the impact of wellbeing and mood in this process.

Objectives

The purpose of this study is to investigate the behavioural requirements for habit formation regarding continuity and temporal consistency, and to understand the impact of wellbeing and mood during this process.

Methods

In all, 48 individuals had to choose an individual, health-oriented behaviour to carry out daily for 12 weeks. During the 12 weeks the participants completed the Self-Report Habit Index (SRHI), the Profile of Mood States (POMS) and a questionnaire gathering continuity, consistency and wellbeing each week.

Results

The findings show a significant increase in SRHI score over time, indicating that participants began to develop a habit, particularly in the initial weeks. Significant differences were found in continuity, consistency and regarding the mood state, but not with regard to comfort.

Conclusions

It has been proven that continuity and consistency play an important role in developing habits and that mood potentially influences this process.

     

Berufliche Tätigkeit und Arbeitsunfähigkeit

The use of sickness absence data of the health insurance funds for health reporting and health research has a long tradition in Germany. The data are especially used for work-related health monitoring. Work-related health reporting describes sickness absenteeism with respect to selected occupational populations and exposures and thereby provides valuable information pointing to needs in worksite prevention and health promotion. However, despite the routine use, different standards for the keeping, selection and evaluation of data have become established. Furthermore, in Germany there are a great number of statutory health insurances which traditionally were open to certain occupations only. A nationwide work-related health reporting therefore requires methods to account for these differences and to adjust for selective memberships in health insurance institutions. The BKK health report has established a specific standardisation approach which allows analysis with respect to occupations adjusted for economic sectors and vice versa.     

Ernährung und Arteriosklerose

International Journal of Public Health -     

HIV-Prävention und Sexualverhalten

The essay reflects practically and pragmatically the discourse regarding HIV/AIDS prevention in the light of current challenges. The authors argue that the potential for future quality improvement of prevention activities lies within the principles of "best practice" developed and approved during recent years. These principles are presented in an overview and discussed in detail.     

Telematik und Qualität

Since the end of the year 2000 a group of interested people has been working on the subject of quality improvement in breast cancer. Within this framework the project "improvement of breast cancer treatment by telemedicine" was started. Based on a workflow analysis and interviews with patients as well as health professionals, it turned out that there are gaps and flaws in the communication process. These problems occurred between health professionals involved in the treatment of patients and between health professionals and patients as well. As a result a telemedicine network has been developed which is based on MPLS technology. Within this network a central communication unit facilitates optimization of the workflow for the treatment of breast cancer. It will also be possible to set up groups for integrated care. Currently the system is being evaluated in specific breast centres in Hamburg. As the net is based on a positive business plan, it can be foreseen that a broad implementation will follow.     

Sexualität und Pharmakotherapie

This contribution addresses two different areas of the complex relationship between pharmacotherapy and sexual function and dysfunction in men and women. As many impairments of sexual function are caused by side effects of medications, particularly psychotropic drugs, the first part of the paper describes substances and mechanisms often related to sexual dysfunction with a special focus on antidepressants and neuroleptics. While serotonin reuptake inhibitors entail a high risk of sexual dysfunction, it is often difficult to differentiate the negative impact of the drug from the impairment caused by the mental disorder itself. Ways to deal with these dysfunctions and remedial measures are discussed. In the second section, current pharmacological treatments for female and male sexual dysfunctions are reviewed. While there is no approved pharmacotherapy with established efficacy for female sexual dysfunction with the possible exception of the transdermal testosterone patch for surgically menopausal women, effective pharmacological therapies are available for male erectile disorders. In addition, testosterone substitution is the treatment of choice for hypoactive sexual desire disorders caused by hypogonadism. As sexual dysfunctions are often caused by a mixture of psychological and organic factors, treatment strategies combining pharmacological options and sex therapy are advocated.     

Krankenhaushygiene und Infektionsprävention

Ohne Zusammenfassung     

Morbidität und Gesundheitsversorgung bei GKV- und PKV-Versicherten

Background

It has rarely been analyzed whether there are differences in Germany concerning morbidity and healthcare between insured by statutory health insurance (Gesetzliche Krankenversicherung, GKV) and insured by private health insurance (Private Krankenversicherung, PKV). In addition, the available studies are very scattered and no review has been published yet. The study presented here aims at closing this gap and at discussing recommendations for future analyses.

Methods

By searching for publications in the Medline and PubMed databanks, only a very few studies could be identified in this manner Thus, our search was extended to include a number of German institutes and organizations working in the field of public health and health systems research. In addition, we checked all references listed in the relevant publications.

Results

A total of 18 relevant publications could be identified; however, just four of them were found via Medline and PubMed. The empirical analyses show that the GKV insured are often less healthy than the PKV insured, and that they more often go to primary care physicians. A potential disadvantage of GKV insured concerning healthcare can be seen in regard to new, innovative drugs, organ transplantations, financial burden due to co-payments, waiting times, and communication between patient and physician.

Conclusion

Most studies show that there are large differences between GKV-insured and PKV-insured, concerning health status as well as healthcare. However, due to methodological weaknesses, some of these results are difficult to interpret. More studies focusing on specific age groups (e.g., children) are needed, and the methodological standard (e.g., statistical control for other factors such as income, distinction between different subgroups of insured) must also be raised. Finally, systematic differences between GKV and PKV should be considered in all analyses comparing these two schemes, such as differences in the availability of data concerning healthcare.     

Personale, familiäre und soziale Schutzfaktoren und gesundheitsbezogene Lebensqualität chronisch kranker Kinder und Jugendlicher

INTRODUCTION: The present publication describes chronic conditions of children and adolescents (asthma, ADHD, obesity) in relation to personal, familial and social resources and to health-related quality of life (HRQOL). A database of these investigations is the German health interview and examination survey of children and adolescents (KiGGS), which is representative for 0 to 17 year-olds. The above mentioned chronic conditions occur frequently in this age group and are assumed to have an influence on quality of life and to be related to a lower level of protective factors. METHODS: The investigations used the data of 6813 children and adolescents within the age group of 11 to 17 who participated in the KiGGS study. Information about diagnosed chronic conditions was given by the parents within the framework of the computerassisted medical interview (CAPI) and by completing questionnaires. The personal, familial and social protection factors as well as the quality of life were assessed by the questionnaires, filled in by the adolescents themselves. Instruments used were the Social Support Scale, the Family Climate Scale and KINDL-R. RESULTS: Children and adolescents with asthma seem to have no deficits in the health-related quality of life and in the field of protective factors. This differs from the situation of the obese children as well as from the children with ADHD. Both groups show significant deficits in the health-related quality of life and protection factors. DISCUSSION: The chronic conditions investigated show remarkable differences in the scale values for measuring protective factors and health-related quality of life. Possible explanations are: For asthma as a chronic disease with somatic manifestation effective treatments and therapies exist, so that it has nearly no influence on the self-assessed quality of life. ADHD and obesity result in a decrease of quality of life and in the field of protective factors, possibly caused by social stigmatisation, isolation and demotivation of the concerned children and adolescents. Therefore it is important to support those children and adolescents to cope with their disease-related problems. The results illustrate that in addition to the immediate effects of chronic conditions on the concerned children and their families, it is the quality of life and the familial and social environment that should be specifically addressed in further studies.     

HIV: Prävention und Aufklärung

Ohne Zusammenfassung     

Qualitätsmanagement und -entwicklung in der Primärprävention und Gesundheitsförderung: Stand,Herausforderungen und Perspektiven

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - In den vergangenen 3&nbsp;Jahrzehnten nahm die Qualitätsentwicklung in der Primärprävention und...     

Anwendungsorientierung und Qualitätssicherung in der Krankheitsprävention und Gesundheitsförderung

Zusammenfassung   Lebensstilbedingte Erkrankungen nehmen in den Industrienationen, teils sogar weltweit zu. Zu diesen z?hlt z. B. die Adipositas. Krankheitspr?vention und Gesundheitsf?rderung gewinnen daher zunehmend an Bedeutung bzw. werden in verschiedenen Teilbereichen auch bereits seit Jahrzehnten durchgeführt. H?ufiger handelt es sich dabei um zwar gut gemeinte Ans?tze, die aber nicht selten ohne theoretischen Hintergrund konzipiert und auf Nachhaltigkeit ausgelegt sind, d. h., oft werden wesentliche Entscheidungstr?ger nicht involviert und personelle sowie finanzielle Ressourcen verschwendet. Das hier vorgelegte Strukturmodell zur Planung und Umsetzung pr?ventiver und gesundheitsf?rdernder Ma?nahmen verfolgt eine Verzahnung verschiedener Ans?tze zur Krankheitspr?vention und Gesundheitsf?rderung (verh?ltnis- und verhaltensbezogen) mit politischen und wirtschaftlichen Strukturen, den daraus resultierenden Programmen und darauf basierenden einzelnen Projekten auf Makro-, Meso- und Mikrolevel. Diese Verknüpfung wird durch einen erweiterten Public-Health-Handlungszyklus vervollst?ndigt. Das Ziel dieses neuen Modells ist es, Anwendern einerseits einen systematischen Ansatz zur Verfügung zu stellen, der die Planung von Ma?nahmen zur Pr?vention und Gesundheitsf?rderung strukturiert, andererseits die einzelnen qualit?tssichernden Schritte zu verdeutlichen.