Infectious diseases before and after German unification: trends in mortality and morbidity

After the fall of the Berlin Wall in 1989 the former communist countries of central and eastern Europe underwent substantial social and economic changes that had a major impact on health. The situation of the former German Democratic Republic was unique in that its existing institutions were replaced rapidly and it was quickly integrated economically with the West. This study describes recent trends in morbidity and mortality from infectious diseases in East and West Germany before and after unification using routine data from 1980 onwards. Substantial differences in morbidity and mortality resulting from infectious diseases were observed between East and West Germany. These seem to be the complex result of societal and health system differences in both parts of Germany before unification, differing population dynamics and health behaviours, and an increasing westernisation in the eastern part of Germany during recent years.     

German dental and postgraduate education in the European context

The dental curriculum in Germany is still based on a concept from 1955 with some revisions in certain aspects. All groups involved are interested in a new and more current version. In doing this, the compatibility with European concepts should be a main goal. The Association for Dental Education in Europe (ADEE), to which about 160 of the 200 European dental education associations are members, is in charge of coordinating projects to create a network of European universities, which intends to harmonize higher education in Europe and to create a core curriculum for the dentistry program. Based on a visitation and evaluation program at more than 50 oral and maxillofacial surgery centers, a paper for the profiles and competencies for future European dentists was formulated for the creation of a modular curriculum, for the integration of the ECT (European Credit Transfer) system, and for quality assurance of the dentistry curriculum. Especially for the situation in Germany, consequences must be drawn for further dentistry and postgraduate educational concepts, which are not completely identical with the ADEE concepts, but which can use elements of the basic Bologna concepts.     

Healthcare for a new Germany: the West and East German health systems and their unification process

One of the new Germany's many challenges will be merging a socialist, centralized healthcare system with a decentralized network much like our own. Both Germanys' health services have clear pluses and minuses, and while preserving the best of each may not be completely possible, it is not as remote a goal as one might think. With a summary of the pre-unification East and West health systems, the authors map out Germany's healthcare options.     

European Public Health Association: One year of German presidency

The European Public Health Association (EUPHA) has existed for 12 years. The reasons why this scientific society has grown considerably over the years are its yearly conferences and the publication of the European Journal of Public Health (EJPH). The journal is renowned and has an impact factor of 1.15. Most journals from the field of social medicine in its broadest sense have lower values. The interest in the annual meetings of EUPHA rose steadily. For the Rome congress, which took place November 20–22, 2003 with more than 900 scientists attending 638 abstracts were submitted of which 415 were accepted for oral or poster presentation (rejection rate, approximately 30%), indicating that scientific quality is EUPHAs main purpose. This is apparently in contrast to many so-called European or World Congresses at which often nearly every abstract is accepted in order to have the largest number of participants possible. Over the years it has paid off that EUPHA always has emphasized scientific quality. Thus EUPHA has a remarkable scientific database and a comprehensive network of experts working in the field of public health in research, practice and policy. This makes the cooperation with EUPHA attractive. The society has close relationships with the European Commission, specifically EU SANCO in Luxembourg (European Health Ministry), WHO/Euro in Copenhagen, the OECD in Paris and ASPHER—the European Society for Public Health teaching. In 2003, a book entitled Public Health in Europe—10 years EUPHA was published by EUPHA in cooperation with the European Commission and WHO/Euro (Springer, Heidelberg).In conclusion, from my point of view, the favourable development of a scientific society—as it is the case with EUPHA—is determined by three relevant factors:

European integration and health policies: repercussions of the internal European Market on access to health services

This article explores the health policy repercussions of countries' regional integration into the European Union. The aim is to review the regulation of access in other countries, with the conclusion of the single European market and the free circulation of persons, services, goods, and capital. The article begins by reviewing the various forms of integration and describes the expansion and institutionalization of Community agencies. The repercussions of European integration on health policies and regulation of access are analyzed. Market impacts on health result from Treaty directives and internal policy adjustments to free circulation. Health services access is gradually regulated and granted by rulings. Projects along borders illustrate the dynamics where differences are used to achieve comprehensive care. In the oldest integration experience, the market regulation has generated intentional and non-intentional impacts on the health policies of member states, regardless of the organizational model. Knowledge and analysis of this experience signals challenges for the Southern Cone Common Market (Mercosur) and adds to future debates and decisions.     

临床思维过程中的辩证统一

临床思维是临床医生透过疾病表象，揭示疾病本质的理性认识过程，掌握科学的临床思维方法是医生提高专业技术水平的必要条件。通过对临床思维过程中，坚持形象思维与逻辑思维的辩证统一、分科思维与整体思维的辩证统一、理论思维和经验思维的辩证统一关系进行阐述，指导临床医生用理论正确地解释疾病现象之间的联系，探索疾病过程规律，避免任何单一的临床思维模式自身的局限性，降低在治疗实践中不同程度的误诊误治。     

Odontology in Spain: towards the integration to the European high education space

The European Higher Education Space (EHES) is a project to harmonize all the European University systems in order that all of them will posses a homogeneous structure of undergraduate, graduate and post graduate studies. The time period established to implement this project is year 2010. The present paper describes the establishment of a new career degree model in Spain, the degree in Dentistry that started twenty years ago. Also it has been stated the number of the present Departments and Schools, the access system to Public University Schools of Spain, the evaluation system, and which are the new mechanisms incorporated in the Spanish University system to implement this integration to the EHEE. This is the moment to design the new master guidelines to obtain homogeneous career degrees that may imply more accessibility and mobility of students and professionals.     

Neonatal and postneonatal mortality in Germany since unification

BACKGROUND—After unification, the gap in infant mortality rates between the two parts of Germany widened until 1996 before converging. The reasons for these changes have not, so far, been apparent.
OBJECTIVES—To investigate trends in neonatal and postneonatal mortality in the eastern (the new Länder) and western (the old Länder) part of Germany after unification in 1990 and to identify the scope for further improvement.
DESIGN—Examination of trends in birth weights, birth weight specific neonatal mortality and cause specific postneonatal mortality in the two parts of Germany from 1990 to 1996 and 1997 by analysing routinely available vital statistics data.
RESULTS—In both parts of Germany, neonatal mortality fell considerably, by 33 per cent in the east and 17 per cent in the west, from 4.5 and 3.5 per thousand live births in 1990 to 3.0 and 2.9 in 1997, respectively. This was attributable to an improvement in survival of infants at all birth weights but especially among those with very low birth weights, accounting for an estimated 83 to 85 per cent of the overall improvement. The birth weight distribution showed a slight worsening in the new and the old Länder with an increase in the proportion of those under 1500 g and, in the east, a 24 per cent increase in the proportion of high birthweight infants of 4000 and more grams. Trends in postneonatal mortality revealed a worsening of about 32 per cent in the east from 1990 to 1991 followed by a decline of over 50 per cent up to 1997, leading to comparable mortality rates of 1.8 per thousand live births in the east and 2.0 in the west. While both parts experienced a decrease of 40 to 48 per cent in deaths from all diseases, the decline in deaths because of accidents and injuries was markedly higher in the new Länder although they are still exceeding the western rate by 3.7 per 100 000 live births in 1997.
CONCLUSIONS—Since unification, the two parts of Germany underwent a complex process that has led finally to convergence of parameters of infant health that are most likely to have been because of improvements in the quality of perinatal care. To improve infant mortality in Germany, policy measures should focus on preventive rather than curative measures as the proportion of very low birthweight babies is increasing in both parts of Germany.


     

系列化广告－－寓变化于统一之中

系列化广告是组合的系列,又是功能的系列,既有重复的变迁,又有渐变的规律,在统一的基调下有规律地变化着. 系列化广告"寓变化于统一之中",在对比中见和谐,增强艺术感染力和震撼力.     

Healthcare worker-related MRSA cluster in a German neonatology level III ICU: A true European story

Here we investigated a cluster of eight newly Methicillin-resistant Staphylococcus aureus (MRSA)-colonized neonates at an ICU, and present data on molecular strain characterization as well as the source identification process in which we analyze the impact of MRSA-colonized HCWs.Molecular strain characterization revealed a unique pattern which was identified as spa-type t 127 – an extremely rare strain type in Germany. Environmental sampling and screening of parents of colonized neonates proved negative. However, staff screening identified one healthcare worker (HCW; 1/134) belonging to a group of recently employed Romanian HCWs who was colonized with the spa 127 strain. Subsequent screening also detected MRSA in 9/51 Romanian HCWs (18%) and 7/9 (14% of all) isolates showed the same molecular pattern as the index case (spa/PFGE type). All carriers were successfully decolonized, after which no new patient cases occurred.As a result, we have now implemented a universal screening programme of all new employees as part of our infection control management strategy.MRSA-colonized HCWs can act as a source for in hospital transmission. Since HCWs from high endemic countries are particular prone to being colonized, they may pose a risk to patients.     

Principles of the unification of medical instruments]

Taking as a basis the calculation of the unification level index made according to the formula adopted in general machine building industry the need for determining the principle underlying the approach to unification of medical instruments is demonstrated. The paramount methodical prerequisite for unification of medical instruments is outlined and the unification of not only structural elements of the latter, but also of their mutual disposition is substantiated.     

Changing health inequalities in east and west Germany since unification

The unification of Germany in 1990 brought about substantial social and economic changes in its eastern part, with new uncertainties and, despite increasing overall income, rising inequality. This paper explores the potential impact on health of these changes during the 1990s, looking specifically at income-related health inequalities in east and west Germany and its modulation by psychosocial factors. We used data from the German Socio-Economic Panel (GSOEP) for the years 1992 and 1997, including individuals aged 25+. We investigated changes in self-perceived health in the two parts of Germany and its socio-economic and psychosocial determinants. Analyses estimated odds ratios of less than good health using logistic regression.In 1992, 47% of east Germans rated their health worse than good compared with 54% in the west. By 1997, the east-west gap in self-rated health had disappeared, with the prevalence of poor health increasing to 56% in both parts. Income and education were important determinants of health in east and west, with, in the age-sex-adjusted model, those having available less than 60% of median equivalent income being at increased risk of poor health in 1992 (OR(east) 2.39, 1.45-3.94; OR(west) 2.04, 1.65-2.52). Addition of education reduced the strength of this relationship only slightly. In the west, income-related health inequalities widened between 1992 and 1997 yet the initially stronger gradient declined in the east, despite an overall increase in income inequality (OR(east) 1.63, 1.04-2.56; OR(west) 2.65, 2.19-3.21). The impact of education remained stable. Psychosocial variables were important determinants, mediating the effects of income, with leisure-cultural social involvement exerting the strongest effect in both east and west.The results show that, unlike in the west, the overall increase in income inequality in east Germany between 1992 and 1997 was not accompanied by a simultaneous increase in income-related health inequalities. This suggests that mechanisms involved in the association of socio-economic factors and health possibly behave differently in east and west.     

Temporal and spatial pattern of infant mortality in Germany after unification

SummaryObjectives After unification in 1990 the two parts of Germany underwent a complex process that has led to convergence of infant mortality. The pattern of change did, however, differ in east and west. This study investigates whether these differences conceal a complex pattern of heterogeneity at the regional level.Methods Examination of routine data on infant, neonatal and postneonatal mortality. Time trends in the 16 federal states of Germany (Länder) from 1991 to 1997 were studied using a log-linear model.Results In 1991, infant mortality was higher in almost all eastern Länder than in the west. By 1997, this east-west gap had disappeared. Over this period, infant mortality fell in all Länder but one. The decline was steepest in the east, ranging from 31% to 52%. Improvements were largely due to steep declines in both neonatal and postneonatal mortality.Conclusions This study shows that, at the time of unification, there was an almost complete demarcation between east and west, a pattern that disappeared by 1997. There is, however, still a substantial regional variation in infant mortality that is largely determined by postneonatal mortality.

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Regionale Variation der Säuglingssterblichkeit in Deutschland Fragestellung

ZusammenfassungFragestellung Seit der Vereinigung im Jahr 1990 haben die beiden Teile Deutschlands einen komplexen Prozess in Bezug auf Säuglingssterblichkeit durchlaufen, wobei das Muster dieses Wandels in Ost und West verschieden war. Die vorliegende Studie untersucht, inwieweit diese Unterschiede Heterogenität auf regionaler Ebene maskieren.Methoden Analyse von Routinedaten zur Säuglings-, neonatalen und postneonatalen Sterblichkeit in den 16 Bundesländern im Zeitraum 1991 bis 1997. Als Analyseinstrument kommt ein log-lineares Regressionsmodell zur Anwendung.Ergebnisse Im Jahr 1991 war die Säuglingssterblichkeit in fast allen neuen Bundesländern höher als in den alten Ländern. Dieser Ost-West-Gradient hat sich jedoch zum Jahr 1997 aufgelöst, wobei die Säuglingssterblichkeit mit einer Ausnahme in allen Ländern über den genannten Zeitraum zurückgegangen ist. Mit einer Verminderung um 31% bis 52% war dieser Prozess in den in den neuen Ländern am deutlichsten ausgeprägt. Rückgänge der Säuglingssterblichkeit waren bedingt durch Verbesserungen der neonatalen wie auch der postneonatalen Sterblichkeit.Schlussfolgerungen Zum Zeitpunkt der Vereinigung bestand ein deutlicher Ost-West-Gradient in der Säuglingssterblichkeit, 1997 jedoch nicht mehr. In Deutschland besteht nach wie vor eine deutliche regionale Variation in der Säuglingssterblichkeit, die vor allem durch Unterschiede in der postneonatalen Sterblichkeit bedingt ist.

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Variations temporelles et régionales du taux de mortalité infantile après l'unification allemande

RésuméObjectifs Après leur réunification en 1990, les deux parties de l'Allemagne ont subit un processus complexe qui a fait convergé leurs taux de mortalité infantile. Les types de changements ont toutefois varié entre l'Est et l'Ouest. Cette étude investigue si ce phénomène dissimule un modèle complexe de différences régionales.Méthodes Examination de statistiques de routine de mortalité infantile, néonatale, postnéonatale. Les variations observées entre 1991–1997 dans les 16 états fédéraux d'Allemagne (Länder) ont été étudiées par régression linéaire.Résultats En 1991, la mortalité infantile était plus élevée dans presque tous les Länder de l'Est que dans ceux de l'Ouest. En 1997, cet écart avait disparu. Pendant cette période, la mortalité infantile avait chuté dans 15 Länder. Le déclin était plus marqué dans l'Est (31–51%). Les améliorations s'expliquent principalement par une diminution marquée de la mortalité néonatale et postnéonatale.Conclusions Au moment de l'unification, il existait une démarquation Est-Ouest importante, mais celle-ci a disparu avant 1997. Toutefois, des variations régionales importantes dans la mortalité infantile demeurent et s'expliquent par des différences au niveau de la mortalité postnéonatale.