Die Entwicklung der Präventionsgesetzgebung in Deutschland

Background

In 2015, after many years of debate, the German parliament passed a Prevention Act. This act is a milestone in establishing modern forms of health promotion and prevention.

Objectives

Central lines during the development of the prevention legislation are traced.

Discussion

With the introduction of § 20 SGB V in 1989, health promotion and prevention became part of the service of the statutory health insurance (GKV) and a comprehensive approach to prevention was established. With the Contribution Relief Act in 1996, § 20 SGB V was largely removed. The “GKV-Gesundheitsreform 2000” brought a revival of the idea. After three failed legislative initiatives (2004–2013) the “Law for strengthening health promotion and prevention” (Gesetz zur Stärkung der Gesundheitsförderung und Prävention – PrävG) came into force in 2015. The PrävG is conceived as a social-insurance-centered omnibus act and benefits law, which is financed by GKV contribution funds and focuses on a stronger orientation to living environments (setting approach).

Conclusion

Despite its existing regulatory and methodical shortcomings, the PrävG improves the operational framework. The opportunities offered by the new law, especially in the setting approach of health promotion and prevention, must be used.

     

Hospitalisationen infolge Hepatitis A, B und C in ?sterreich 1996–1998

Ziel dieser Arbeit ist die Analyse der Hospitalisationsdaten aller Österreicher, die in den Jahren 1996 bis 1998 mit der Hauptdiagnose Virushepatitis (nach ICD 9) stationar aufgenommen waren. Datenquelle ist das Minimum Basic Data Set (MBDS), das an allen-aus öffentlichen Mitteln finanzierten-österreichischen Krankenhäusern von stationären Patienten obligat erhoben wird.Hepatitis A: Die standardisierte Hospitalisationsrate (SHR) erreicht Werte zwischen 2,8/100000 (1996) und 4,7/100000 (1997). Die meisten Hospitalisationen erfolgen in der Altersklasse der Schulkinder (7-13/100000 pro Jahr); in den nachfolgenden Altersklassen nehmen die Hospitalisationen deutlich ab. Im Vergleich mit den österreichischen Bundesländern weist Wien die höchste mittlere SHR auf (6,8/100000 pro Jahr).     

Trends in Hepatitis B and Hepatitis C Virus among Blood Donors over 16 Years in Turkey

Background: We document in the present study the trends over the sixteen years in HBV and HCV seroprevalence among blood donors in Turkish populations. Methods: In this study, serologic test results of whole blood (n = 6.240.130) donors at 22 Red Crescent Centers between 1989 and 2004 were evaluated retrospectively. Results and conclusion: The overall prevalence was 4.19% for HBsAg and 0.38% for HCV antibody during the study period. The annual prevalence of HBsAg gradually increased from 4.92% in 1989 to 5.23% in 1991 (p=0.001, t=21.00, CI₉₅, 17237–22490) and gradually decreased from that to 2.10% in 2004 (p=0.001, t=17.27, CI₉₅, 12869–21342). The seroprevalence of HCV antibody gradually increased from 18 per 10.000 in 1996, to 56 per 10.000 in 1998 (p=0.073, t=3.81, CI₉₅, 459.62–5721.23), while that decreased to 34 per 10.000 in 2004 (p=0.021, t=7.49, CI₉₅, 743.98–3980.11). The seroprevalence of hepatitis B and C has decreased markedly between 1989 and 2004 in Turkey. This could be related to the significant increase in the number of volunteer blood donors that increased from 135,779 to 197,815.     

Die Einführung der elektronischen Gesundheitskarte in Deutschland

Zusammenfassung Ab 2006 erhalten alle Krankenversicherten in Deutschland eine elektronische Gesundheitskarte. Sie löst die bisherige Krankenversichertenkarte ab und wird geeignet sein, neben deren administrativen Funktionen auf freiwilliger Basis auch Gesundheitsdaten verfügbar zu machen. Detaillierte Regelungen zu den Zugriffsrechten und vom Gesetzgeber vorgegebene technische Sicherheitsanforderungen sollen eine weitgehende Patientenautonomie sowie eine größtmögliche Sicherheit der Daten gewährleisten.     

Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland

Overweight and obesity are an increasing problem: worldwide, for Germany and for children and adolescents. Until now there have been no representative and age-specific assessments of the prevalence of obesity among children and adolescents in Germany. Thus, the standardised height and weight measurements gathered in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) have, for the first time, provided national, representative data about overweight and obesity in young people. The terms 'overweight' and 'obese' are defined based on percentiles of the body mass index (BMI) of the Kromeyer-Hauschild reference system. Of children and adolescents between the ages of 3 and 17, 15% exceed the 90th BMI percentile of the reference data and are thus overweight, 6.3% exceed the 97th BMI percentile and thus suffer from obesity by this definition. The proportion of overweight rises from 9% of 3-6-year-olds to 15% of 7-10-year-olds and 17% of 14-17-year-olds. The prevalence of obesity is 2.9%, 6.4% and 8.5% for the same age groups respectively. No clear differences between boys and girls or between East and West Germany are detected. Children are at a higher risk of being overweight or obese if they have a lower socioeconomic status, have a migration background, or have mothers who are also overweight.     

Aktueller Stand der Evidenz und Entwicklung der Darmkrebsfrüherkennung in Deutschland

Colon cancer is currently the third leading cause of cancer death in men and women in Germany, with a total of about 25,000 deaths per year. Established methods for early detection of colorectal cancer include lower gastrointestinal endoscopy and fecal occult blood testing. For both procedures, there is evidence of a reduction in colorectal cancer-specific mortality and for endoscopy a reduction of colorectal cancer incidence has been shown.In Germany, the guaiac test for fecal occult blood has been offered since 1977. Additionally, screening colonoscopy has been offered since 2002 and in 2016, the guaiac test was replaced by the immunological fecal occult blood test, which has an improved diagnostic performance. Overall, participation rates have been low over the past decades and differed between men, women, and age groups.Personal invitations are expected to be sent out starting in 2019 as part of the introduction of an organized colorectal cancer screening program in Germany. The program also provides for measures to systematically monitor and improve the quality of colorectal cancer screening. It remains to be seen which effects these changes will have and whether the trend towards declining colon cancer incidence and mortality that has been observed in Germany will continue in the coming years.     

Lebensmittelsicherheit—ein Schwerpunkt der Gesundheitspolitik in Deutschland und Europa

Ohne Zusammenfassung     

Die unterschiedliche Sterblichkeit von M?nnern und Frauen, mit Beispielen aus der Bundesrepublik Deutschland

Zusammenfassung Anhand von Daten aus der Bundesrepublik Deutschland wird dargestellt und diskutiert, welche Todesursachen in erster Linie zur unterschiedlichen Sterblichkeit von Männern und Frauen beitragen. Wie in anderen Industrieländern, so liegen auch in Westdeutschland die Mortalitätsraten der Männer bei allen Haupttodesursachen, sieht man vom weiblichen Brustkrebs ab, höher als diejenigen der Frauen. Besonders eklatant sind die geschlechtsspezifischen Differenzen bei koronaren Herzerkrankungen, Lungenkrebs, Unfällen, Selbstmorden und Leberzirrhose. In den mittleren Jahrgängen (35 bis 55) liegen z.B. die altersspezifischen Mortalitätsraten der Männer beim Herzinfarkt 6 bis 7fach höher, beim Lungenkrebs 3 bis 4fach höher und bei Unfällen 4fach höher als die Mortalitätsraten der Frauen. Die Todesursachenstatistiken und die bisherigen epidemiologischen Studienergebnisse lassen darauf schliessen, dass neben der teilweise ungünstigeren genetischen Disposition der Männer, die soziale Umwelt und das individuelle Verhalten wesentlich mitverantwortlich sind für die vorzeitige Sterblichkeit. Die Ergebnisse implizieren, dass ein grosser Teil der geschlechtsspezifischen Mortalitätsdifferenzen beeinflussbar ist und nicht fatalistisch hingenommen werden muss.

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Sex differences in mortality, with examples from the Federal Republic of Germany

Summary Sex differences in mortality are described and discussed, using data from the national causes of death statistics of West Germany. As in other industrialized countries, men in the FRG, compared to women, have higher mortality rates in all leading causes of death. The sex differences are most prominent in coronary heart disease, lung cancer, fatal accidents, suicide and liver cirrhosis. For example, in the age groups 35 to 55 the male/female ratio in the mortality rates was 6 to 7 for coronary heart disease, 3 to 4 for lung cancer, and 4 for fatal accidents. The cause-specific death rates and the results from corresponding epidemiological studies indicate that genetic disadvantages of men are reinforced by factors of the social environment and deleterious individual behavior. Thus a great part of the sex differences in total mortality could be influenced and should not be judged as inevitable.

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Différences de mortalité entre hommes et femmes: quelques exemples en République Fédérale d'Allemagne

Résumé Les causes des différences de mortalité entre hommes et femmes sont examinées à l'aide de données provenant de la République Fédérale d'Allemagne. Conformément à la situation d'autres pays industrialisés, le taux de mortalité des hommes pour toutes causes de décès — à l'exception du cancer du sein — dépasse largement celui des femmes. La surmortalité masculine est considérable pour les maladies cardiovasculaires (6 à 7 fois pour l'infarctus du myocarde), de cancer du poumon (3 ou 4 fois dans les classes d'âge de 35 à 55 ans), d'accident (4 fois pour les décès par accident de la route dans les classes d'âge de 35 à 55 ans); des différences sont également observées pour le suicide et la cirrhose du foie. Les statistiques de mortalité et les études épidémiologiques récentes montrent qu'en plus d'une disposition génétique défavorable au sexe masculin, c'est l'environnement social et le comportement individuel qui sont responsables de la surmortalité masculine. Ainsi, une grande partie de la différence observée pourrait être contrôlée par un changement des comportements individuels et sociaux.

     

Sozioökonomische Unterschiede in der Inanspruchnahme von Haus- und Facharztleistungen in Deutschland

Background

This article analyses socioeconomic differences in the use of general practitioner (GP) and specialty care services for the elderly.

Data and Methods

The analysis is based on the first two waves of German data of the Survey of Health, Ageing and Retirement in Europe (SHARE) for the years 2004 and 2006. Data from 2,861 respondents aged 50 years or more are used. The analysis distinguishes between the overall probability of a GP and specialty care visit (contact) and the frequency of contact. Probit models are used to identify the determinants of contacting a GP or specialist and count models are applied to analyze the determinants of contact frequency.

Results

The regression results show that members of lower social classes, with the same medical need, are less likely to contact a specialist compared to persons with a relatively high social status. In contrast, people with low socioeconomic status are more likely to contact a family doctor than those with a high social status. Regarding contact frequency, members of lower social classes, with the same medical need, have a significantly lower number of specialist contacts compared to persons with a relatively high social status.     

Der Rückgang des Zigarettenkonsums Jugendlicher und junger Erwachsener in Deutschland und die zunehmende Bedeutung von Wasserpfeifen,E‑Zigaretten und E‑Shishas

Background

National and international studies indicate that despite the decline in the consumption of traditional tobacco cigarettes, the consumption of other products, such as waterpipes (or hookahs), e?cigarettes or e?hookahs (a variant of e?cigarettes), may be increasing. In addition to the long-term change in smoking behaviour, this article examines how the prevalence of smoking tobacco cigarettes, waterpipes, e?cigarettes and e?hookahs in adolescents and young adults in Germany has developed between 2007 and 2016.

Methods

Data are based on representative surveys on substance use among adolescents and young adults between the ages of 12 and 25 conducted by the Federal Center for Health Education (BZgA) from 1973 to 2016. Age- and gender-specific trends of the proportion of those who describe themselves as smokers are shown. Additionally, trends of single and combined 30-day prevalence of consumption of tobacco cigarettes, waterpipes, e?cigarettes and e?hookahs are presented and tested for significance.

Results

Between 2007 and 2016, the decline in the proportion of adolescents and young adults who call themselves smokers and the decline of 30-day prevalence of consumption of tobacco cigarettes continued. At the same time, the consumption of waterpipes is rising in young adults and the consumption of e?cigarettes is rising in young men. Among adolescents, the exclusive use of waterpipes, e?cigarettes or e?hookahs was more widespread in 2016 than the exclusive consumption of tobacco cigarettes.

Discussion

In comparison to tobacco cigarettes, the consumption of waterpipes, e?cigarettes and e?hookahs is becoming increasingly important among adolescents and young adults. Thus, these products must also be considered in the planning and design of preventive measures for the prevention of smoking.

     

Gesundheitsökonomische Aspekte chronischer Infektionskrankheiten am Beispiel der chronischen Hepatitis C

Based on the German Hepatitis C Model (GEHMO) we developed a Hepatitis C Policy Model and applied it to the heterogeneous German hepatitis C population within the German health care context. We used Markov cohort simulation to predict absolute clinical and economic outcomes for a 20-year time horizon. For the cost-effectiveness analysis, a lifelong time horizon was used. Four different strategies were compared: (1) no antiviral treatment, (2) interferon monotherapy, (3) combination therapy with interferon plus ribavirin, and (4) combination therapy with pegylated interferon plus ribavirin. Based on our model, antiviral therapy with pegylated interferon and ribavirin could prevent about 17,000 cases of cirrhosis, 580 liver transplants, and 7,600 HCV-related deaths and is expected to save about 53,000 life years at total costs of 1.3 billion Euros within the next 20 years. Pegylated interferon plus ribavirin was the most effective treatment with an incremental cost-utility ratio of 23,000 Euros per quality-adjusted life year saved.     

Leitlinienempfehlungen und Qualitätsindikatoren bei der invasiven Versorgung der peripheren arteriellen Verschlusskrankheit in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Zahlreiche Empfehlungen in den verfügbaren internationalen Leitlinien zur Diagnostik und Behandlung der peripheren...     

Hepatitis A and B seroprevalence in Macaé, Rio de Janeiro State,Brazil

Total HAV and HBc seroprevalence rates in two socioeconomic groups in Macaé, Rio de Janeiro State, Brazil, were estimated in 1,100 surplus serum samples from routine laboratory tests identified by sex, age, neighborhood, and category of medical care, i.e., the public health system or National Unified Health System (SUS) as compared to private health services (NSUS). Seroprevalence rates by age, 95% confidence intervals, and statistical significance tests for differences between SUS and NSUS are presented. Distribution of seroprevalence rates (P) for total HAV (P = 88.8%; 95% CI = 86.8-90.6) and total HBc (P = 15.3%; 13.2-17.6) by age showed an ascending curve. Prevalence rates in the SUS group were significantly higher that in the NSUS group, for both HAV (chi2 = 31.15; p < 0.0001) and HBV (chi2 = 15.41; p < 0.0001). The high prevalence rates reflect the epidemiological pattern of HAV infection in developing countries and the relevance of the social and environmental context. The proportion of susceptible individuals in the < 5 and > 20 year groups highlights the need to vaccinate for hepatitis A and the potential increase in severe cases. High HVB prevalence among adolescents underscores the importance of vaccinating this group. The results serve as a reminder to health professionals concerning biosafety norms.     

Mortalit?t der ausl?ndischen und der einheimischen Bev?lkerung in der Bundesrepublik Deutschland

Zusammenfassung Vergleichende Mortalitätsanalysen unter dem Aspekt der Staatsangehörigkeit sind für die Bundesrepublik Deutschland noch nicht umfassend präsentiert worden. Eine Sonderauswertung der Todesursachenstatistik für das Jahr 1986, differenziert nach Nationalität, weist auf ein vergleichsweise niedrigeres Mortalitätsrisiko der in der Bundesrepublik lebenden ausländischen Bevölkerung hin. Abgesehen von möglichen Fehlerquellen infolge von underreporting des Merkmals Staatsangehörigkeit bei den Todesfällen oder einer Überschätzung der Bevölkerungsgröße der ausländischen Population, muss aus sozialepidemiologischer Sicht die Möglichkeit in Betracht gezogen werden, daß Selektionsprozesse das Mortalitätsrisiko der Ausländer nachhaltig beeinflussen. Eine von der Qualität des Gesundheitszustands abhängige Aufenthaltsdauer bzw. eine bei Vorliegen chronischer Erkrankungen gehäuft vollzogene Rückwanderung könnten wichtige Einflußfaktoren darstellen, um die Sterblichkeitsdifferenzen zwischen ausländischer und deutscher Bevölkerung zu erklären.

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Mortality of the migrant and the indigenous population in the Federal Republic of Germany

Summary Comparative mortality studies with respect to nationality have not yet been published in a comprehensive way for the Federal Republic of Germany. A recent special analysis of causes of death for German mortality statistics of the year 1986 indicates a lower mortality risk among the migrant compared to the indigenous population. Apart from potential biases, such as underreporting of nationality of death cases or overestimation of the size of the non-indigenous population in Germany, from the perspective of socioepidemiology the possibility arises that selection processes lastingly affect the mortality risk of migrants. The dependence of the length of stay from the quality of the state of health or rather a plausible increased likelihood of remigration in case of chronic disease may constitute important influences, which could explain the differences in mortality between indigenous and migrant population.

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Mortalité dela population étrangère et indigène en République Fédérale d'Allemagne

Résumé Des analyses de mortalité en considération de la nationalité, n'ont pas été présentées de façon étendue en République Fédérale d'Allemagne (RFA). Une exploitation spéciale de la statistique de décès de l'année 1986, différenciée selon la nationalité, indique un risque de mortalité comparativement bas parmi la population étrangère qui vit en RFA. Abstraction faite de possibles causes d'erreur par suite d'une sous-déclaration de la caractéristique de la nationalité en ce qui concerne les cas de mort ou bien d'une surestimation du nombre des étrangers, il pourrait en résulter du point de vue socioépidémilogique la possibilité que des processus de sélection exerceront une influence considérable sur le risque de mortalité de la population étrangère. La dépendance de la persistance du séjour, de la qualité d'état de la santé et une probabilité de reémigration plus élevée en cas de maladies chroniques pourraient présenter un facteur d'influence important pour expliquer les différences de mortalité entre la population étrangère et la population allemande.

     

Ausgew?hlte Aspekte einer Bürger- und Patientenorientierung in Deutschland

The growing citizen and patient orientation of the German healthcare system reflects a health policy process which aims to achieve more individual and social responsibility as well as more autonomy on the part of healthcare users. At the same time the process is regarded as an essential component of a future oriented quality development involving raising transparency, developing competence, strengthening patient rights and improving complaints management. Representative data on these parameters and on people's level of satisfaction with their most recent contact with the healthcare service were collected in the 2009 GEDA survey 'Information Behaviour and Self-determination of Citizens and Patients' by the Robert Koch Institute. It reveals knowledge deficits in the population relating to selected areas of the healthcare service and there are also deficits in people's knowledge and assertion of their rights and in the way complaints are handled. These deficits vary according to demographic and socio-economic criteria (age, sex, educational and social status, status vis à vis health insurance companies). It emerges that different population groups have different needs, which can be used for a target group orientation in the communication of knowledge and the development of competencies.     

Sexualerziehung und Sexualpädagogik in Deutschland

Sex education in Germany has a history full of conflict and ideological change between emancipatory, reforming, and repressive tendencies. As a science, sex education has only recently gained independence from its mother disciplines theology, medicine, psychology, and sociology and at the same time has taken a critically constructive position towards sexual science. Its topics range from dissemination of knowledge about biological processes and contraception to relationship concerns, sexual orientation, gender issues, sexual transgression, moral, and ethical questions. Sexual socialization happens nearly everywhere. Sexual education takes place mainly in families, elementary education, and school, but increasingly also in all other areas of education, social work, and health service. Its clientèle are no longer exclusively children and adolescents but increasingly adults of every age group. Subjects such as AIDS, sexual abuse, and teenage pregnancy have contributed to governmental funding of projects and training in sex education. Thus, sex education still reaches from mere protection from dangers to fostering or maintaining psychological health.     

Die Einführung der International Classification of Diseases (ICD-10) in Deutschland Werkzeuge und Informationen im Internet

Zusammenfassung Die allgemeine Einführung der ICD-10 für die Morbidit?tsverschlüsselung in Deutschland steht unmittelbar bevor. In dem vorliegenden Beitrag sollen die elektronischen Versionen der Klassifikation kurz vorgestellt werden. über die amtlichen Ausgaben hinaus stellt das Deutsche Institut für Medizinische Dokumentation und Information (DIMDI) weitere Hilfsmittel für die t?gliche Arbeit und die epidemiologische Forschung bereit: die ICD-10-Metadaten, die ICD-überleitungstabelle und den ICD-10-Diagnosenthesaurus. Alle Dateien k?nnen entgeltfrei über das INTERNET bezogen werden.