Messung der gesundheitsbezogenen Lebensqualität mit dem SF-8

The SF-8, a relatively new instrument for measuring health-related quality of life, was used in the German National Telephone Health Survey 2003. The SF-8 provides results which are comparable to those of the SF-36, the instrument most commonly used internationally. The German National Telephone Health Survey provides nationally representative data for the residential population in Germany aged 18 and older. In addition to the measurement of health-related quality of life, comprehensive information on chronic illnesses and complaints, health care needs, utilisation of health care, risk factors, risk behaviour and social status is also collected, making differentiated analyses possible. According to the data collected, men rate their quality of life in all dimensions higher than women. With increasing age, quality of life for both men and women decreases in the physical dimensions, while increasing in the mental health dimensions. Apart from chronic disease and pain having a negative impact on health-related quality of life, social differences are also observable, in that worse health-related quality of life is reported by respondents with lower socioeconomic status.     

Messung der motivationalen Bereitschaft zu körperlicher Aktivität

Background

The central construct of the transtheoretical model conceptualises behaviour change as a progression through a series of five stages. The aim of the current study was to examine the behavioural validity of these stages with two different physical activity (PA) recommendations.

Design and methods

Students (14–16 years; n=560) completed a self-administered questionnaire assessing stages of change for exercise and PA, PA, and sedentary behaviour. Validity was evaluated by the association between stages and PA as well as sedentary behaviour, respectively.

Results

The stages were mainly differentiated by exercise but only marginally by PA. The correct stage assignment with respect to recommended PA levels was low for PA compared with exercise. Findings for discriminant validity were acceptable.

Conclusions

The behavioural validation of two German-language scales with regard to stages of change suggests that only the exercise stage allocation is valid.     

Qualität und Ethik in der Gesundheitsversorgung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Der Begriff „Qualität“ in der Gesundheitsversorgung wird häufig verwendet, aber unterschiedlich bestimmt....     

Langzeitpflege im europäischen Vergleich

Across Europe, long-term care (LTC) is one of the most challenging areas of social policy. Despite a growing awareness of the problems and improved data, current institutional reforms are an ineffective response to demographic change. This article aims to provide an overview of the challenges of future nursing and care staff in LTC in Europe, and to discuss the German case in a wider European context. We focus on the nursing workforce and on the link between current and prospective analyses on the demand and offer of LTC services and LTC professionals/nursing staff. We draw on a secondary analysis of the literature and public statistics, especially OECD data. The European comparison shows a high variation in the future demand for LTC. In Germany, a number of problematic trends create a negative scenario: the growing demand for LTC meets with a decrease in nursing staff on the supply side. We conclude by suggesting intervention strategies that may reduce this negative scenario.     

Teilleistungsbezogene Messung der Qualitätswahrnehmung von Patienten

Unter Wettbewerbsbedingungen hat die subjektiv von Patienten wahrgenommene Dienstleistungsqualität in Krankenhäusern eine gestiegene Bedeutung. Für die Entwicklung geeigneter Messverfahren ist festzustellen, anhand welcher Dimensionen Patienten die Qualität ihres Krankenhausaufenthaltes beurteilen. Der vorliegende Bericht untersucht empirisch inwieweit dazu ein teilleistungsbezogener Ansatz für komplexe Dienstleistungen geeignet ist. Als Verfahren der Hypothesenprüfung wird die Faktorenanalyse genutzt. Der Nachweis der Übereinstimmung einer teilleistungsbezogenen Formulierung der Qualitätsdimensionen mit der Wahrnehmung der Patienten kann erbracht werden.     

Kindesmisshandlung und neue Morbidität in der Pädiatrie

The effects of child maltreatment on children’s chronic health conditions have become more visible during recent years. This is true for mental health problems as well as some chronic physical conditions, both summarized as new morbidity within pediatrics. As several Bradford Hill criteria (criteria from epidemiology for the determination of the causal nature of a statistical association) are met, the likely causal nature of underlying associations is discussed. Early family support may have the potential to modify such associations, although empirical evidence is lacking. At least for attachment-based interventions with foster carerers after child maltreatment, positive effects on child HPA axis dysregulation have been demonstrated.     

Zur Messung und Darstellung von medizinischer Ergebnisqualität mit administrativen Routinedaten in Deutschland

While internationally low-effort reporting and quality assurance systems based on routine data for hospitals were implemented a long time ago, the evaluation of the treatment quality in hospitals according to section sign 137 SGB V in Germany still relies on special data collection, which demands considerable extra time and effort for the healthcare providers. The current article starts by addressing the question whether quality analyses using primary data sources should be preferred to analyses using secondary data analyses. Subsequently, current possibilities of measuring outcome quality, using administrative routine data, will be illustrated, referring to the large collaborative project Quality Assurance of Hospital Care with Routine Data (QSR). This project was carried out in order to examine possibilities of measuring quality based on routine administrative data in Germany from 2002-2007. The objectives of this article are to present a summary of the project's current status as well as to provide perspectives of future quality assurance with routine data in Germany. In addition, some general problems in measurement of outcome quality, the volume-prevalence problem and the problem of risk adjustment are presented, and possible solutions are proposed.     

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.     

Die kartografische Darstellung regionaler Unterschiede in der Morbidität

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die Krebsregistrierung in Deutschland erhebt flächendeckend kleinräumige Daten, zu deren Veranschaulichung thematische...     

Auswirkungen der Liberalisierung des Internethandels in Europa auf den Phänomenbereich der Arzneimittelkriminalität

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Der Handel mit illegalen und gefälschten Arzneimitteln ist ein Wachstumsmarkt. Zu den Einflussfaktoren, die diesen illegalen...     

Zur Qualität der Qualitätssicherung

Ohne Zusammenfassung     

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.     

Geschlechtsunterschiede in der Prävalenz depressiver Symptomatik: Ein Resultat differentieller Validität der Erhebungsinstrumente?

Zusammenfassung  In dieser Studie wurde die prädiktive Validität der 20 Items der deutschen Version der Center for Epidemiological Studies-Depression Scale (CES-D, ADS) geschlechterbezogen untersucht. Mit den Antworten von 516 Teilnehmerinnen und Teilnehmern der Berliner Altersstudie (70- bis 103-jährige Frauen und Männer) wurden Itemanalysen durchgeführt. Für Männer waren die meisten Items schwieriger und weniger trennscharf als für Frauen. Darüber hinaus wurden die Itemwerte zu psychiatrischen Depressionsdiagnosen nach DSM-III-R in Beziehung gesetzt, um deren Sensitivität und Spezifität für beide Geschlechter zu ermitteln. Die Itemsensitivitäten fielen eher niedrig aus und unterschieden sich für Frauen und Männer sehr stark. Diese Unterschiede spiegelten sich in der Sensitivität des Gesamtwerts (Cut-Off: 16) wider, die Konfidenzintervalle der Schätzungen überlappten jedoch. Mit Regressionsanalysen wurden die Itemantworten durch das Geschlecht der Person, die Depressionsdiagnose und die Interaktion dieser Prädiktoren vorhergesagt. Die Items 8 und 15 standen in keinem Zusammenhang zur psychiatrischen Depressionsdiagnose. Die Werte von sieben Items wurden signifikant durch die psychiatrische Diagnose und das Geschlecht bzw. die Interaktion von Diagnose und Geschlecht vorhergesagt. Auch wenn auf der Ebene des Gesamtwerts keine statistisch signifikanten Unterschiede in der Validität gefunden wurden, kann es von praktischer Bedeutung sein, dass einzelne CES-D Items nicht die gleiche diagnostische Qualität für Frauen und Männer aufwiesen.

Messung des sozioökonomischen Status in der KiGGS-Studie

This article describes the measurement of socioeconomic status in the first follow-up of the KiGGS study (KiGGS Wave 1) conducted from 2009 to 2012. A multidimensional index score was used. The score is the sum of three metric components: Education and Occupational Qualification, Occupational Status, and Net Income. Compared with the approach in the KiGGS baseline study, some modifications were made in accordance with changes in the other components of the health-monitoring program at the Robert Koch Institute, i.e., the German Health Update (GEDA) and the German Health Interview and Examination Survey for Adults (DEGS1). These changes facilitate the analysis of temporal developments and trends, ensure international comparability of the data, and support the transfer of the results into politics and practice. In order to demonstrate the application of the revised instrument, we report on exemplary results of KiGGS Wave 1 regarding the relationship between socioeconomic status and the general health status of children and adolescents aged 3–17 years.     

Messung der Kapazitätsentwicklung als Ansatz für Quartiersbeteiligung

Background

Community participation is a key domain of capacity building and is also an essential element of participatory quality development. Both concepts are largely based on the knowledge of the participants and help to use this knowledge in health promotion.

Aims

In a long-term prevention programme for children and their parents in the Hamburgian neighbourhood “Lenzsiedlung” a new evaluation tool for measuring capacity building was developed and applied. Through the involvement of both professional actors and residents in the evaluation, our knowledge on the state of health promotion in the neighbourhood was to be enlarged and further developed.

Results

Overall, the surveys of professional actors revealed positive results in capacity building over time, although there might be the risk of subjective bias. The inclusion of residents in the evaluation has to be assessed differently and shows limits of community participation in research. A positive result is the reception and further processing of the participative evaluation by the Round Table “Lenz Health”.