„Prävention postoperativer Wundinfektionen“

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz -     

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.     

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)     

Weiterentwicklung der Prävention in Deutschland

Zusammenfassung Mit dem 2005 vorgelegten Entwurf für ein Präventionsgesetz wollte die Bundesregierung Prävention und Gesundheitsförderung zu einer eigenständigen Säule in der Gesundheitsversorgung ausbauen. Prävention und Gesundheitsförderung sind jedoch gesamtgesellschaftliche Querschnittsaufgaben, die weit über das System der Gesundheitsversorgung hinausweisen und die Einbeziehung aller für die Gesundheit der Bevölkerung verantwortlichen politischen Ressorts und föderalen Ebenen erfordern.Weil der Gesetzentwurf sich fast ausschließlich auf die gesetzlichen Sozialversicherungen beschränkte, haben die Krankenkassen das Gesetz abgelehnt. An der Ablehnung durch den Bundesrat ist das Gesetz schließlich gescheitert. Die gesetzlichen Krankenkassen bieten ihren Versicherten ein breites Spektrum von qualitativ hochwertigen Präventionsleistungen. Sie fordern ein Präventionsgesetz, mit dem eine gesamtgesellschaftliche Präventionskultur mit verbindlichen Zielen, besserer Koordination und Kooperation der Akteure sowie bedarfsgerechten und qualitativ hochwertigen Leistungen etabliert wird.     

Prävention der Hepatitis C bei Drogenkonsumenten

The high prevalence and incidence rates of the hepatitis C virus (HCV) infections in drug users demonstrate the urgent necessity for a coordinated national prevention strategy. In the shadow of HIV/AIDS the necessary attention to the rapid spreading of the hepatitis C in drug users was started late, without being able to reach the public attention level of HIV/AIDS. The present efforts in the primary and secondary prevention of the hepatitis C in drug users are obviously not sufficient to reduce the prevalence with long-lasting results. Substitution treatment is of central relevance in the prevention of hepatitis C in opiate-dependent subjects, but requires, as current data of the HCV incidence of substituted opiate dependents illustrate, a stronger HCV-specific accentuation. Further settings, which are relevant for the group of intravenous drug users, have to be accessed and sensitized. Furthermore structural and political efforts are necessary, in order to develop a systematic and evidence-based answer to the challenge of the HCV spreading in drug users, in particular due to the fact that a German HCV strategy is still lacking.     

Das Initiativprogramm „Allgemeinmedizin“ der Gesundheitsministerkonferenz der Länder

The number of general practitioners has clearly decreased over the last 10 years in Germany. The situation is more critical in Eastern Germany compared to Western Germany. The article shows the results of the "program initiative to secure primary care in general practice" of the Conference of the Federal Health Ministers. The authors focus on the situation in Saxony-Anhalt, where they are founders of the Institute of General Medicine at the Universities of Halle-Wittenberg and Magdeburg. They also work as general practitioners.     

Tabakprävention am Beispiel der „rauchfrei“-Kampagne

Currently, 28.7% of 18- to 64-year-olds in Germany smoke (26.1% of women/31.2% of men). Among the 12- to 17-year-olds, the smoking rate at 7.4%, is at a historic low. The smoking rate among the 18- to 25-year-olds has also fallen in recent years.The most important goal of the nationwide measures of the Federal Center for Health Education (BZgA) on tobacco prevention is to reduce the smoking rate. For this purpose, the BZgA carries out the “smoke-free” campaign, which is targeted at both adolescents and adults. With a closely interlinked and continuously reviewed and further developed mix of measures, the target groups are reached on the internet, in settings and via media and mass communication. In addition to the information on the risks of smoking and passive smoking, the motivation to quit smoking and the quality-assured support in smoking cessation play an important role here.The measures of the BZgA are reviewed and further developed on the basis of representative surveys on the smoking behavior of the 12- to 25-year-olds, which the BZgA regularly carries out. On this basis, new products, such as e?cigarettes, e?shishas or tobacco heaters, and new consumer trends, such as the trend for waterpipe smoking, are integrated. Access routes to the target groups are continuously reviewed against the background of the digitization of society and the health-promoting design of settings is supported. All in all, the smoke-free campaign offers a quality-assured range of measures that is continuously being developed.     

Prävention im Jugendsport

Background

A number of important findings from the evaluation study of “cool and clean”—a Swiss prevention programme aimed at young athletes and their coaches—are presented. Training groups participating in “cool and clean” pledge to adhere to a number of commitments regarding fairness, doping and substance abuse. The programme thus aims to enhance the generally supposed positive impact of sport on the development of adolescents.

Methods

“cool and clean” is based on the national sport promotion programme “Jugend+Sport” (Youth+Sport, J+S) and targets coaches who are responsible for training groups, offer courses or organise sport camps. A total of 1289 J+S coaches were interviewed with an online-questionnaire concerning their response to problems in connection with substance abuse, violence, lack of fair play and doping.

Results

The evaluation shows that the prevention programme is well received, positively evaluated and implemented with a high degree of motivation by coaches. Experienced coaches with a longer career in sport and an above-average dedication to their sport tend to participate more often in “cool and clean” than other coaches. Participating coaches have a better knowledge of how to behave in case of problems and they know coping strategies or experts they may consult. In addition, they more often perceive themselves as role models.

Conclusions

Our results do not render possible an assessment of whether “cool and clean” has the desired impact on adolescents. Yet, the successful integration of coaches into the programme shown in the article is an important and necessary condition if a programme such as “cool and clean” is to work.

     

Prävention von Hautkrebs

In recent decades the numbers of cases of skin cancer have been increasing worldwide in light skinned populations. In Germany skin cancer is the most common form of cancer. To reduce the burden of skin cancer protection from ultraviolet radiation (primary prevention) and early detection (secondary prevention) of the disease play a decisive role. In this context information to the population about preventive behavior and the support of informed decision-making in skin cancer screening are important aspects in communication. This paper gives an overview about communicational aspects in the promotion of skin cancer prevention. In the development of communicational interventions it is important to identify the relevant target groups. Relevant key opinion leaders have to be included in the information process. Additionally, interventions should be based on a theoretical framework and be designed for the respective target group. Furthermore, different forms of communication and communication tools are provided for the realization of an information intervention. To appraise the intervention elements of summative and formal evaluation are available. The current results provide important findings about different effects of communicational aspects on knowledge and behavior of the population; however, due to the complexity of information interventions a particular effect cannot be explained by a single communicational element.     

Prävention chronischer Herz-Kreislauf-Krankheiten

Background

For some years now, the German government has been discussing the introduction of a prevention bill (“Präventionsgesetz”) in order to structurally and financially strengthen the preventive efforts that have been outlined by many public health experts for decades. The main aim of this venture is to make the German health system and even physicians more responsive to the needs of socially disadvantaged citizens, less vulnerable to economic constraints and generally more efficient in the long term. Such a bill touches core interests of many actors in various social, political, medical and economic sectors and so far it has proved impossible to reach a compromise acceptable to all interest groups involved.

Aim

The difficulties surrounding this contentious bill arguably have roots in the structures and concepts of the German health system, which this paper sets out to analyse in a historical comparison of the health systems in West Germany, East Germany and the UK. Emphasis is put on the prevention of cardiovascular disease because according to the WHO it represents the ‘number one cause of death’ on a global and on the national level.

Result

The historical analysis shows that political action is needed: prevention should be understood in broad terms, focus on the reduction of social inequality and be grounded in law.     

Klassifikationsmodelle in der Gesundheitsförderung und Prävention

Background

Various health classification models are used, particularly in the English-speaking world, to plan and evaluate projects and programs in the health sector. In this article, we critically examine two such models, which are currently being used in Switzerland.

Methods

We use the Model for Results Classification (by Health Promotion Switzerland) and the Program Logic Model (by Sue Funnell) as two types of classification models in order to examine their application for planning and evaluating health projects and programs. In addition, we clarify the various implications of classification systems within the health field and show, on the basis of two case studies, problems arising from their application.

Results

The models differ in their implicit assumptions and the extent to which they structure health-related categories, as well as in the degree of explication of causal reasoning with regard to health outcomes. An application of one or the other model will bring with it different advantages and disadvantages.

Conclusion

With regard to their limitations and inherent logic, classification models are nevertheless useful instruments to reduce complexity in planning and evaluating health projects and programs. Beyond that, they impose a negotiation between stakeholders with regard to making explicit health-related assumptions and goals.