Schrittmacher und interne Defibrillatoren mit kardiotelemedizinischer Unterstützung

Recent developments in pacemaker and ICD therapy can be characterized by a rising number of implantations (especially in the field of ICD and CRT systems) and an increasing complexity of the units involved. Problems evolving from this trend are the soaring numbers of necessary follow-up examinations, issues of patient safety and the necessity of device management by specialized physicians. Telemonitoring offers various possibilities of improvement in these areas. The manufacturers of the devices have developed applicable solutions for concepts of care including telemedical monitoring of patients with pacemakers, ICD and CRT systems. The systems commonly include an implant capable of either automatic or manual data transmission, a device for transmitting the implant's data (mobile communication or fixed line network), a server managing the information and a front-end (internet-based) platform for the physician. Multiple clinical trials have verified the stability and the security of this method of data transmission. Telemedical monitoring can be used in order to improve the monitoring of the patients' state of health (e. g., patients with CRT systems because of their CHF) and the management of arrhythmias (e. g., patients suffering from paroxysmal atrial fibrillation). Telemonitoring allows the intervals between follow-up check-ups to be individualized, thus, leading to financial savings. The telemedical monitoring of patients with ICD and CRT systems facilitates new opportunities for networked follow-up care and comprehensive medical treatment.     

E-Learning – eine wichtige Unterstützung in der medizinischen Aus-, Fort- und Weiterbildung?

There is increasing activity in the development of e-learning modules for general medical training and continuing education. One of the central advantages of e-learning is flexibility regarding time and place of its use. The quality of the available e-learning opportunities varies quite considerably. For users it is often not easy to assess the quality of e-learning modules or to find offers of high quality. This could be a reason for the fact that despite the huge number of e-learning modules still only few students and physicians are using them. This is although e-learning has proven to be as effective as and even more efficient than learning in the classroom or with paper-based materials. This article summarizes the different models of e-learning, how and where to find offers of high quality, advantages of using e-learning, and the effectiveness and efficiency of such offers. In addition problems of e-learning and possibilities to overcome these problems are shown.     

OP-Planung und OP-Unterstützung durch biomedizinische Technik

Fundamental changes were achieved with the introduction of minimally invasive surgery. In this context, innovations in microtechnology played a significant role in the deployment of new tools. Developments for further integration are still ongoing. Furthermore, decisive progress was made by the timely provision of individual patient data prior to surgery. These comprise imaging data, electrophysiological or functional recordings, and synthetic data gained by modeling and simulation of anatomical or physiological conditions. Aside from the technical aspects of supporting surgery, effective quality management and optimized workflow are essential for therapeutic success. The vision of autonomously operating robots has been dropped in favor of permanently conducted and supervised interventions with the support of intelligent tools for the surgeon. Recent advances in reconstruction and transplantation surgery by tissue engineering and molecular biology are only the beginning of new promising concepts.     

Arbeitsbedingungen, Arbeitszufriedenheit und Beschäftigtengesundheit

Background

The aim of this study was to explore differences in self-reported working conditions, work satisfaction, and self-reported health in companies of differing size.

Methods

Representative data were analysed from the survey of working conditions in Germany (n=20,000) that was conducted in 2005/06 by the Federal Institute for Vocational Education and Training (BIBB) and the Federal Institute of Occupational Safety and Health (BAuA).

Results

In small companies, a considerably higher percentage of employees are exposed to physical workload than in large ones, whereas exposure to psychological workload is less prevalent in comparison. Job control is slightly higher in small businesses, but for social support, general work satisfaction, and self-reported health, no significant differences could be found.

Conclusions

Results do not suggest that the need for occupational safety and health interventions is higher in small enterprises, but different size-specific foci of preventive action can be derived from our data. More, and methodologically refined research is needed to clarify the relationship between company size on one hand and the level of job control and social support on the other.     

Soziale Ungleichheit und chronische Rückenschmerzen bei Erwachsenen in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Rückenschmerzen sind ein häufiger Grund für Arbeitsunfähigkeit und die Inanspruchnahme von...     

Frühe Hilfen aus der Distanz – Chancen und Herausforderungen bei der Unterstützung psychosozial belasteter Familien in der COVID-19-Pandemie

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Kontaktbeschränkende Maßnahmen waren zur Eindämmung des SARS-CoV-2-Infektionsgeschehens ab Frühjahr 2020 in...     

Die Entwicklung der psychischen Gesundheit bei hochaltrigen Individuen während der COVID-19-Pandemie und die Rolle sozialer Unterstützung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die Bevölkerungsgruppe der Hochaltrigen gehört zu den Hochrisikogruppen in Bezug auf einen schweren Erkrankungsverlauf...     

Soziale Netzwerkanalyse interdisziplinärer Kooperation und Vernetzung in den Frühen Hilfen

Child protection can only be successfully solved by interdisciplinary cooperation and networking. The individual, heterogeneous, and complex needs of families cannot be met sufficiently by one profession alone. To guarantee efficient interdisciplinary cooperation, there should not be any gaps in the network. In addition, each actor in the network should be placed at an optimal position regarding function, responsibilities, and skills. Actors that serve as allocators, such as pediatricians or youth welfare officers, should be in key player positions within the network. Furthermore, successful child protection is preventive and starts early. Social network analysis is an adequate technique to assess network structures and to plan interventions to improve networking. In addition, it is very useful to evaluate the effectiveness of interventions like round tables. We present data from our pilot project which was part of "Guter Start ins Kinderleben" ("a good start into a child's life"). Exemplary network data from one community show that networking is already quite effective with a satisfactory mean density throughout the network. There is potential for improvement in cooperation, especially at the interface between the child welfare and health systems.     

Psychosoziale Versorgung durch schulische Unterstützungssysteme

Background

To support students with personal, often health-related problems, and also to prevent these problems, there are six support systems available in the Austrian school system: school psychologists, school physicians, school counsellors, personal and vocational consultants, school social workers and youth coaches.

Objectives

In this article, we show supply gaps and redundancies of services provided by these support systems and identify hindering factors for their successful collaboration and coordination.

Methods

Data are based on 26 expert interviews that were on average about 1 h in length. The interviews were transcribed and assessed by means of a qualitative content analysis.

Results

The identified supply gaps were: ambiguous legal norms for the support of chronically ill students, a lack of school psychologists and school social workers, a lack of cost-free psychotherapy and supply of child and youth psychiatrists, as well as too little awareness of the problem of child and adolescent poverty. Redundancies can be seen for vocational consultancy and uncoordinated interventions to prevent mobbing and violence in schools. Hindering factors for collaboration and coordination in the Austrian school system are: a high fluctuation of staff, varying sponsorships, obligation to confidentiality and data privacy, lacking time resources for networking and too little mutual respect amongst the different professional groups.

Conclusions

Based on the results, conditions for better collaboration and coordination of these support systems are framed.

     

Parlamentarische Technikfolgenabschätzung und Risikokommunikation

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Mit der parlamentarischen Technikfolgenabschätzung (TA) hat sich in vielen Ländern weltweit ein eigener Typus...     

Soziale Ungleichheit, Migrationshintergrund, Lebenswelten und Übergewicht bei Kindern und Jugendlichen

This study aimed at studying the relationships between different social determinants, overweight, migration background, lifestyle factors, and neighborhood characteristics in children and adolescents aged 6–14 years. Data were collected within the Kiel Obesity Prevention Study (KOPS). The lower the social status, the higher the prevalence of overweight (e.g., parental education low/middle/high,%: 18.4/13.6/7.9). Non-German children are twice as often overweight as German children (20.2% versus 11.7%) with a social gradient in overweight (%: 26.0/28.2/17.2). There are social differences in health-related behavior between the social groups and also between German and non-German children of the same social group. The social gradient in overweight is, in part, independent of lifestyle factors. Neighborhood characteristics like high food supply and traffic density add to the development of overweight. To summarize, overweight is a social issue; direct prevention has to address the social determinants of health as well as families with migration background. In addition, the development of “healthy” neighborhoods may support the prevention of overweight.     

Soziale Unterschiede in der ambulanten und stationären Versorgung

There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.     

Soziale Lebenssituation und Gesundheit von M��ttern in Deutschland

This paper reports findings from a population sample of mothers with underage children living in Germany (n=3,129). The objective of the study was to analyze whether social and familiar living conditions are associated with enhanced health risks for mothers. The sample is representative with respect to German federal states, school education, marital status, age of mothers, and number of children. Health problems were assessed in terms of physical disabilities and discomforts, anxiety and depression, and self-rated health. About 27% of mothers perceived physical disabilities and discomfort, 21% reported high levels of anxiety, and 22% high levels of depression. About 6% assessed their health as poor or very poor. Particularly single motherhood, unemployment, sole responsibility for household and family as well as low income and low school education increased the risk of poor health. The findings suggest that for specific subgroups of mothers parenting may be a vulnerable phase of life reflecting the need for a life stage orientation in health inequality research.     

Epidemiologische und statistische Methoden der Risikoabschätzung

Risk assessment offers a variety of methods which comprise different risk concepts to assess population-based or individual risks. A central epidemiological measure of risk is incidence which is used to derive the relative risk as the ratio between the incidence among subjects exposed and the incidence among subjects unexposed to a certain risk factor. The excess risk quantifies the risk of an exposed population that exceeds the background risk of a non-exposed population. In environmental epidemiology the latter is frequently based on a constant exposure dose over a certain period and is expressed as unit risk. Since the application of different risk concepts depends on the respective study type, we first discuss the different epidemiological study designs. Next, methods to derive the different risk concepts are evaluated and the corresponding statistical measures are presented. Finally, an example illustrates the application of the discussed concepts for individual risk assessment.     

Soziale Determinanten des täglichen Frühstücksverzehrs bei Schülern in Deutschland

Background

A balanced breakfast is an important element of a healthy diet and in childhood and adolescence it is associated with better health status and improved school performance. This analysis examined potential differences in breakfast behavior among primary and secondary school pupils in Germany according to age, sex, family form, socioeconomic status (SES) and migration background.

Methods

The analysis was based on data from the first follow-up of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009–2012). The proportion of pupils aged 6–17 years (n = 7547) who reported having breakfast at home every weekday was analyzed. Family form distinguished between nuclear, single-parent and step-families. The SES was based on data on parental education, occupation and income. Migration background refers to country of birth and nationality of both parents and child.

Results

Approximately two thirds of the girls (65.7%) and boys (70.3%) have breakfast at home every weekday. With increasing age the respective proportions gradually decrease. Children in nuclear families have daily breakfast at home more often than children in step-families and single-parent families. A higher SES corresponds to a higher percentage of children having breakfast at home every weekday. Children with a two-sided migration background have breakfast every weekday at home less often than children without a migration background.

Conclusion

The results may help to conceptualize activities that promote healthy nutrition in families and schools. When interpreting the presented results it has to be taken into account that out-of-home breakfast was not assessed and the data do not allow conclusions about the nutritional quality of the breakfast.