Gesundheitswesen最新文献

{"title":"[How effective are non-pharmacological interventions for family caregivers? A systematic review with meta-analyses].","authors":"Patrick Janson, Chu-Wei Hung, Kristina Willeke, Dieter Frisch, Anne Berghöfer, Peter Heuschmann, Andreas Zapf, Manfred Wildner, Carolin Stupp, Thomas Keil","doi":"10.1055/a-2340-1560","DOIUrl":"10.1055/a-2340-1560","url":null,"abstract":"<p><strong>Introduction: </strong>Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany.</p><p><strong>Method: </strong>We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany.</p><p><strong>Result: </strong>Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life.</p><p><strong>Conclusion: </strong>The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"145-160"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tuberculosis among Ukrainian Refugees in Germany - A Comparison of Screening and Reporting Data].","authors":"Vanessa Igbokwe, Ralf Otto-Knapp, Cornelia Breuer, Martin Priwitzer, Torsten Bauer, Brit Häcker","doi":"10.1055/a-2312-6270","DOIUrl":"10.1055/a-2312-6270","url":null,"abstract":"<p><p>Since the onset of the war in Ukraine until November 2022, nearly 1 million people sought refuge in Germany. Despite efforts to reduce tuberculosis (TB) cases, Ukraine had a high TB incidence in 2020, with increased rates of multidrug-resistant TB. Conflict and war have historically been associated with TB spread due to delays in diagnosis, treatment interruptions, and increased transmission risks. The World Health Organization (WHO) estimated a rise in TB cases in the EU region due to refugee movements. In Germany, screening methods used in testing individuals in communal housing involving chest X-rays or immunological tests were variable. A survey conducted by the DZK within the nationwide TB working group evaluated TB screening methods and results for Ukrainian refugees. Out of 26,196 individuals aged over 15, 48 TB cases were detected, with a higher-than-expected incidence. About 42% of cases were multidrug-resistant TB. The screening findings differed from both the WHO's estimates as well as TB cases reported to the Robert Koch Institut (RKI) in 2022. A preliminary comparison of the numbers is presented here. The differing results emphasize the need for ongoing data collection and analysis to adapt resources and interventions to the evolving TB situation among Ukrainian refugees in Germany, especially considering the ongoing conflict and potential for increased TB cases in the future.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"99-102"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effects of a One-Week Inpatient Health Programme for Family Caregivers and Persons in Need of Care (SVLFG Care Tandem) - A Quasi-Experimental Study].","authors":"Christian Hetzel, Julia Schaller, Wolfgang Michel, Ingo Froböse","doi":"10.1055/a-2305-0146","DOIUrl":"10.1055/a-2305-0146","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to assess the effect of a one-week inpatient health programme for family carers together with the persons in need of care (care tandem) on the well-being of family carers. Acceptance and subjective benefits were also assessed. The intervention was funded by the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG).</p><p><strong>Methodology: </strong>Central to the intervention are (1) the home care counselling before the seminar, (2) the one-week seminar in the setting of a rehabilitation clinic at a health resort, in particular with a care course, exercise and relaxation units and the use of local remedies, (3) the substitute care of the person in need of care in close proximity to the seminar location and (4) the low-threshold telephone aftercare by SVLFG specialists. In a controlled prospective panel study (IG n=35, VG n=67, allocation not randomised), well-being (WHO-5, range 0-100) was measured at several points in time (IG: 0, 1, 9, 17, 28 and 43 weeks after the start of the seminar; VG 0, 17, 28 and 43 weeks). Statistical analyses were performed using fixed-effects panel regression, controlling for time-varying covariates (period effects, external stress).</p><p><strong>Results: </strong>In the IG (80% women, mean age 66.5 years), 69% of family carers showed evidence of clinically relevant depression at baseline. All care levels were represented among the people in need of care, predominantly 2 and 3, with medically diagnosed dementia in 37% of the cases. The VG was similarly structured. Under the condition of stable external stress, the initial effect was very clear (delta=+19 points). The effect then flattened out, but remained fairly stable at around 10 points above the initial level. Although the last measurement (43 weeks) was no longer statistically significantly higher, it was independent of the development of external stress. Acceptance and subjective benefit were very high.</p><p><strong>Conclusions: </strong>The strength of the intervention is the dyadic approach. The intervention promotes well-being and is highly accepted. The design allows at least cautious causal conclusions. For the remaining limitations, larger case numbers and a randomised controlled trial would be necessary.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"136-144"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Effect of Service Concentration on Outcome Quality in Obstetrics Departments - An Empirical Analysis of Newborn Mortality in German Hospitals].","authors":"Fabian Kianpour","doi":"10.1055/a-2373-6769","DOIUrl":"10.1055/a-2373-6769","url":null,"abstract":"<p><p>The effect of service concentration on outcome quality of inpatient services in the hospital sector is debated, and is particularly important in the field of obstetrics. The aim of this article was to investigate the influence of volume-outcome factors and competitive economic parameters on the quality of outcomes in obstetric departments of German hospitals. In this study, structural and performance data on 412 German hospitals in 2021 were analyzed with a quantitative research approach. To test the hypotheses, a polynomial multiple regression model with a total of eleven independent variables was estimated. Newborn mortality was used as an indicator of outcome quality in obstetrics departments. Contrary to expectations, the competitive economic parameters that are important for births play a rather subordinate role, while strong empirical evidence was found for volume-outcome relationships. The results of this study suggest that positive quality effects of service concentrations also predominate in the field of obstetrics and thus provide evidence in support of the forthcoming hospital reform in Germany.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"119-130"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verleihung der Salomon-Neumann-Medaille 2024, Laudatio für Herrn Prof. Dr. med. David Klemperer.","authors":"Bernt-Peter Robra","doi":"10.1055/a-2500-7814","DOIUrl":"10.1055/a-2500-7814","url":null,"abstract":"<p><p>The German Society for Social Medicine and Prevention (DGSMP) is awarding the Salomon Neumann Medal 2024 to Prof. Dr. med. David Klemperer. He is a physician and still active in primary care today, a public health practitioner and - most importantly and effectively in terms of his public impact - an academic teacher. His work focuses on teaching in social medicine and public health, shared decision making, conflicts of interest in healthcare, and evidence-based medicine. With this medal, the DGSMP recognizes his outstanding services to teaching and evidence-based medicine, including his bringing together EbM and social medicine as well as medicine and public health.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":"87 2","pages":"96-98"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction: Access to and use of Data for better Healthcare: A Plea for a cooperative data and Research Infrastructure of Statutory and Private Health Insurers and the Network University Medicine (NUM)].","authors":"Jochen Schmitt, Peter Ihle, Olaf Schoffer, Jens-Peter Reese, Steffen Ortmann, Enno Swart, Sabine Hanß, Falk Hoffmann, Christoph Stallmann, Monika Kraus, Sebastian Claudius Semler, Ralf Heyder, Jörg Janne Vehreschild, Peter Heuschmann, Dagmar Krefting, Martin Sedlmayr, Wolfgang Hoffmann","doi":"10.1055/a-2501-9737","DOIUrl":"https://doi.org/10.1055/a-2501-9737","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Legal requirements for information and their influence on patient satisfaction].","authors":"Wolfgang Briegel, Pilar Lopez de Miguel","doi":"10.1055/a-2493-4143","DOIUrl":"https://doi.org/10.1055/a-2493-4143","url":null,"abstract":"<p><p>The German Patientenrechtegesetz defines, among other things, medical obligations in connection with the provision of information. To date, the extent to which these legal requirements also influence patient satisfaction with information has not been investigated in Germany.The study employed an anonymized patient survey on satisfaction with information, which was recorded using a validated 10-item questionnaire.189 consultations (n=105 female, n=84 male patients) were included in the analysis. 87.8% (n=166) of the patients were undergoing inpatient treatment, 12.2% (n=23) were treated as outpatients. The patients were on average 53.2 years old (standard deviation: 20.3 years, range: 15 to 97 years) and were distributed across the following treatment areas: Anesthesia: n=68; Surgery: n=60; Internal Medicine: n=56; Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy: n=5 patients. Overall, there was a high level of satisfaction with the information provided, which did not differ significantly between the genders. However, patients were more satisfied if they were informed by doctors with German as their mother tongue (p=0.005; d=0.214) or by specialists (p<0.001; d=0.288). The duration of the consultation was significantly positively correlated with patient satisfaction (p=0.002, r=0.211). It was also shown that the physician's level of training (specialist: yes/no) was the most important factor (adjusted odds ratio: 4.48).The requirements of the Patientenrechtegesetz with regard to the comprehensibility and thoroughness of the information conveyed, as well as the proficiency of the medical practitioner, have been demonstrated to foster patient satisfaction. It is thus imperative that sufficient professional competence is always ensured. For medical practitioners whose native language is not German, the utilization of translation programs, pictorial or video-based supplementary materials is recommended to facilitate comprehension and minimize any potential language barriers. Moreover, the duration of the consultation should be tailored to the specific needs of the individual patient in order to optimize satisfaction. In order to achieve this, it would be prudent to ascertain from patients in advance the level of detail they would prefer the consultation to encompass.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The burnout dimension emotional exhaustion and impairment of work participation: A prospective study of 2308 employees subject to social security contributions in Germany].","authors":"Uwe Rose, Friederike Buchallik, Hermann Burr, Norbert Kersten","doi":"10.1055/a-2505-9011","DOIUrl":"https://doi.org/10.1055/a-2505-9011","url":null,"abstract":"<p><p>The present study examines the relationship between the burnout dimension emotional exhaustion and subsequent events of work nonparticipation (long-term sickness absence, unemployment, early retirement) and their duration.The data basis was the Study on Mental Health at Work (S-MGA); a follow-up study based on a random sample of n=4511 employees subject to social security contributions aged 31-60 years at baseline and their follow-up after 5 years (n=2460). Burnout symptoms were measured at the time of the baseline survey by means of a questionnaire, while the employment and sickness absence history was recorded at follow-up by means of an interview. Associations between the burnout scale at T1 and subsequent events of inactivity were analysed using a two-part model: i. e., events were predicted using logistic regression, and their duration was predicted using generalised linear regression models (GLM).The burnout scale was associated with the events and duration of long-term sickness absence; among men with an odds ratio [OR]=1.72 (95% CI=1.31; 2.27) and among women with an OR=2.23 (95% CI=1.73; 2.88) per scale point for the occurrence of an event. Among those who experienced long-term sickness absence, the duration (in months) increased by a factor of Exp(β)=1.44 (95% CI=1.23; 1.69) for men and Exp(β)=1.29 (95% CI=1.09; 1.52) for women for each scale point on the burnout scale.From a clinical and health economic point of view, it is a relevant finding that the burnout dimension of emotional exhaustion is associated with events and duration of work nonparticipation.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Description of the characteristics of invasive home mechanical ventilated patients in Bavaria using routine data from the MD Bavaria].","authors":"Lilly Sophia Brandstetter, Martha Schutzmeier, Anna Grau, Jutta Ahnert, Hanna Klingshirn, Bernd Reuschenbach, Maximilian Kippnich, Tobias Skazel, Thomas Wurmb, Katja Lehmann, Peter U Heuschmann, Kirsten Haas","doi":"10.1055/a-2504-0513","DOIUrl":"https://doi.org/10.1055/a-2504-0513","url":null,"abstract":"<p><p>The number of patients with invasive home mechanical ventilation (IHMV) in Germany is vastly increasing. Currently, only limited data is available on the characteristics of these patients. The aim of the present study was to describe the health care situation of IHMV patients living in Bavaria using routinely collected data within the project OVER BEAS.The routine data were derived from the care assessment of the Medical Service (MD) in Bavaria (years 2017-2020). In this dataset, IHMV patients were identified using specific filter variables. Patients were analysed regarding sociodemographic characteristics, diagnosis, mobility, therapeutic measures, and need for care.The dataset comprised 536 adult IHMV patients (34.5% female, median age 68, IQR 58 75); 13.1% lived in nursing homes (NH), 22.2% in home care (HC), and 64.2% in shared living communities (SLC). From 2017 to 2020 a trend in proportionally more patients living in SLC was observed. Differences between the living situations were seen in the frequency of physical (NH 91.4%; HC 76.5%; SLC 90.4%; p<0.001) and occupational therapy (NH 47.1%, HC 58.8%, SLC 69.8%, p<0.001). 69.4% of IHMV patients were classified as having the highest need for care.The routine data from the MD Bavaria could be successfully used to describe the characteristics of patients in the highly complex setting of IHMV. In order to facilitate regular monitoring of the care situation, it would be advantageous to implement more precise recording of IHMV in routine data.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Between Hippocrates and the Oath of Office: Tensions between legal, moral and role expectations with regard to Public Health Service Physician assessments of (future) public servants].","authors":"Peter Schröder-Bäck, Kerstin Brixius","doi":"10.1055/a-2505-2011","DOIUrl":"https://doi.org/10.1055/a-2505-2011","url":null,"abstract":"<p><p>Assessments in the German Public Health Service take place, among other things, in the recruitment and incapacity assessment of civil servants. This may lead to conflicts of values and norms for assessing doctors, as they have to make decisions that are not necessarily in the interests of the person being assessed. Legally, the expectations of assessing doctors in public administration are largely defined. For public health service physicians, individual normative role conflicts still appear, and questions arise as to whether conscientious decisions of physicians adhere to legal requirements.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}