The reform of hospital financing in Germany: an international solution?

From 2003, each inpatient's stay at a German hospital will be reimbursed according to diagnosis related groups. The former German hospital financing system, which consisted partly of per diem rates and partly of per-case rates, was abolished in an attempt to increase efficiency in hospitals. This can be seen as the government's attempt to act on the principles of evidence-based policy. Since there is no strict global budget for inpatient treatment, it is not certain that those diagnosis related groups will actually decrease overall expenditures on hospitals. Also, it is argued that the introduction of diagnosis related groups in Germany may not be the last step in rebuilding the German health care system. The manner, scope and timing of this reform suggests that it will not succeed. Reforms lead to yet more reforms.     

Lack of significant changes in nutrition‐related parameters with tumor necrosis factor treatment of cancer

Cancer and its therapies frequently produce anorexia and cachexia. In this study, the acute (3 days) and chronic (4 wks) nutrition‐related effects of cancer therapy with recombinant human tumor necrosis factor (rHuTNF) were investigated and described. Nutritional status, as measured by body weight and body composition (body fat and lean‐to‐fat ratio) with use of bioelectrical impedance, did not appear to deteriorate. None of the serum lipids changed significantly, but triglycerides did rise modestly over four weeks of therapy. Glucose and the peptide hormones (insulin, C‐peptide, glucagon, and pancreatic polypeptide) thought to affect appetite did not change with rHuTNF therapy. Therefore, although TNF is thought to contribute to wasting in animal models, it had no negative effect on nutritional status in our small sample. The lack of adverse effect noted in this study is possibly due to the low dose level of rHuTNF or to adaptation.     

Factors associated with parental acceptance of seasonal influenza vaccination for their children – A telephone survey in the adult population in Germany

IntroductionInfluenza vaccination of children with underlying chronic diseases is currently recommended in Germany, but targeting all children constitutes an alternative approach to control seasonal influenza. To inform the modelling of vaccination impact and possible communication activities, we aimed to assess among parents the acceptance of universal childhood vaccination against seasonal influenza and possible modifiers.MethodsWe conducted a telephone survey in households in Germany using random digit dialing. We interviewed parents with children aged <18 years by constructing three hypothetical scenarios in subsequent order: (1) hearing about the influenza vaccination recommendation through the media, (2) the vaccine being recommended by a physician, and (3) being informed about the availability of the vaccine as a nasal spray. We calculated the proportion of parents who would immunize their child and used univariable and multivariable logistic regression to identify factors associated with influenza vaccination intention.ResultsResponse was between 22 and 46%. Of 518 participants, 74% were female, mean age was 41.3 years. Participants had on average 1.6 children with a mean age of 8.9 years. In scenario 1, 52% of parents would immunize their child, compared to 64% in scenario 2 (p < 0.01) and to 45% in scenario 3 (p = 0.20). Factors independently associated with vaccination acceptance in scenario 1 were previous influenza vaccination of the child or parent (adjusted odds ratio [aOR] 4.5 and 8.6, respectively), perceived severity of influenza (aOR = 5.1) and living in eastern Germany (aOR = 2.4).ConclusionIf seasonal influenza vaccination was recommended for all children, more than half of the parents would potentially agree to immunize their child. Involving physicians in future information campaigns is essential to achieve high uptake. As intranasal vaccine administration is non-invasive and easily done, it remains unclear why scenario 3 was associated with low acceptance among parents, and the underlying reasons should be further explored.     

On the relevance of parents and TV as socializers of 6–19 year-olds’ expressions of emotion: representative data from Germany

This study examines joint influences of parental socialization and socialization via mass media on children’s expression of emotions. The effect of parental approval of their child’s expression of emotions, on the child’s approval of TV characters expressing the emotion, and the influence of both on the child’s expression of emotions within the past seven days is tested for the emotions fear, sadness, anger, and happiness with a representative survey of children (N = 1458) aged 6–19 in Germany. Moderating age and gender effects were also considered. Consistent across the four emotions, results showed that socialization of emotions via mass media is driven by internalized parental socialization but has a comparably strong effect of its own on the child’s expression of emotion that adds to the variance explained, especially with regard to anger and happiness. Implications for the conceptualization of parental emotion socialization and emotional socialization via media are discussed.     

Bee Honey as an Environmental Bioindicator of Pesticides’ Occurrence in Six Agricultural Areas of Greece

The pollution of six agricultural areas of Greece (north, central, south) by insecticides used in crop protection has been investigated utilizing, as a bioindicator, bee honey produced in those areas. Honey samples collected randomly from apiaries located in those areas were analyzed for pesticide residues with a multianalytical method, able to determine simultaneously up to 10 organophosphorous insecticides from the same honey extract. Findings concerning the acaricide coumaphos were also included, even though it is not used in crop protection. Coumaphos is used to control the mite Varroa destructor, an external parasite of the honeybee. The above areas are cultivated in large extent with citrus trees or cotton or sunflower crops, which are good forages for honeybees. The main pests of those crops are insects; hence, insecticides are used on a large scale for crop protection. The most contaminated samples originated from citrus groves; 16 out of 19 had pesticide residues: 4 samples had chlorfenvinphos (21.05%), 10 had chlorpyrifos (52.63%) and 2 had phorate (10.53%). Out of 17 samples from cotton fields, residues were found in 8, phorate in 6 (35.29%), chlorfenvinphos in 1 (5.88%), and chlorpyrifos in 1 (5.88%). Out of nine samples from fields of sunflower, four had phorate residues (44.44%). In brief, from the 50 analyzed samples, residues of chlorfenvinphos were detected in 5 samples (10%), residues of chlorpyrifos in 11 samples (22%), and residues of phorate in 12 samples (24%). Their levels ranged between 0.70 and 0.89 μg/kg. Coumaphos residues ranged from 0.10 up to 4.80 μg/kg and were derived exclusively from beehives treated with Perizin (the commercial formulation of coumaphos) for Varroa control. This study indicates that in agricultural areas with developed apiculture, useful information about the occurrence and the distribution of pesticide residues due to crop protection treatments can be derived from the analysis of randomly collected honey samples, used as bioindicators. It also shows that, very often, the chemicals used by apiculturists inside the hives in order to control disease are the main pollutants of the produced honey.     

Impact of an online training program in hospital workers’ smoking cessation interventions in Bolivia,Guatemala and Paraguay

Objective

To examine changes in hospital workers’ interventions before and after online training.

Evaluation of reported fatality data associated with workers using respiratory protection in the United States (1990–2012)

OSHA revised the 1971 respiratory protection standard in 1998 to add guidance for selecting and maintaining respirators. Fatality reports from 1990 to 2012 were used to characterize historical trends in fatalities associated with respirators. Industry- and time-specific trends were evaluated to determine the effect of the revision to the standard on respirator-related fatalities; 174 respirator-related deaths were reported. The majority of fatalities were associated with using an airline respirator (n = 34) or the absence of using a respirator in required spaces (n = 38). Overall, 79% of fatalities were associated with asphyxia. Fatalities were associated with improper employee use or lack of employer compliance. Reductions in fatality rates over time appeared to be associated with the revisions to the respirator standard, although other variables may influence rates (eg, controls). Recommendations for employers and employees regarding maintaining safe use of respirators are provided.     

Women’s perceptions of their husband’s drinking behavior as a risk factor of their health-related quality of life in the postpartum period

Purpose  

The objective of this study is to investigate the association between women’s perceptions of their husband’s drinking behavior and their health-related quality of life (HRQOL) in the postpartum period.     

Use of Computer Access Technology as an Alternative to Writing for a Pre-School Child with Athetoid Cerebral Palsy—A Case Report

The purpose of this study was to demonstrate the use of an outcome-driven model of decision-making in the implementation of computer access technology (CAT) for a pre-school child with athetoid cerebral palsy. The child did not have the fine motor skills required to hold a pencil but had the cognitive abilities to learn to write; therefore, we explored the use of a CAT device to enable written communication. Case study methodology was used to describe the selection process, child-level outcomes, and clinical challenges faced by the therapist in the use of a consortium model that was designed for an outcome-driven model of decision-making. The critical role of an occupational therapist in this process using a family-centered approach is discussed.     

Severe hypokalemia with paralysis in a patient with distal renal tubular acidosis as an initial expression of Sjögren's syndrome

In a 33-year-old woman with a recent flaccid paralysis of the arms and legs, laboratory tests demonstrated a severe hypokalemia with hyperchloremic metabolic acidosis and abnormally acidified urine. The urinary anion gap was positive in the presence of acidosis, thus establishing the diagnosis of distal renal tubular acidosis. The patient made a full recovery after potassium and alkali replacement. Further investigation revealed Sj?gren's syndrome as the underlying cause.     

Development and validation of an instrument assessing women’s satisfaction with screening mammography in an organized breast cancer screening program

Background

Understanding dentists’ capacity to supply dental services over time is a key element in the process of planning for the future. The aim was to identify time trends and estimate age, period and cohort effects in patients’ visits supplied per dentist per year.

Methods

Mailed questionnaires were collected from a random sample of Australian private general practice dentists. The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The time trends in the mean number of patient visits supplied per dentist per year (PPY) was described by using a standard cohort table and age-period-cohort analyses applying a nested general linear regression models approach.

Results

The mean number of PPY decreased across most age groups of dentists over the time of study. The age-period model showed that younger dentists (20–29 years) and older dentists (65–74 and 80–84 years) had lower PPY than middle-aged dentists, and the age-cohort model showed higher PPY among earlier cohorts, and lower PPY among more recent cohorts.

Conclusion

The study found a period effect of declining PPY over the observation period. More recent cohorts of dentists provide lower numbers of PPY than earlier cohorts at similar ages, but the provision of PPY among these younger cohorts appeared to be stable as they moved into middle age.