Gesundheitswesen最新文献

{"title":"[An After-Action Review at Municipal Level in the Public Health Service - Lessons Learned at the Corona Unit of the Duesseldorf Public Health Authority after the end of the Covid-19 Pandemic, March 2023].","authors":"Hannah Höglund-Braun, Anne Lisa Quartey, Maya Ganter, Lutz Ehlkes, Steffen Geis, Max Skorning, Sybille Rehmet, Anna Kuehne","doi":"10.1055/a-2329-7058","DOIUrl":"10.1055/a-2329-7058","url":null,"abstract":"<p><strong>Background: </strong>After-Action Reviews (AARs) represent structured, qualitative evaluations of crisis interventions. Here, we describe the implementation of an AAR to assess the Corona Unit of the Duesseldorf Health Department.</p><p><strong>Methods: </strong>We employed an after-action review (AAR) using the working group format supplemented by structured interviews with key personnel. Our approach was guided by the guidelines for AARs provided by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC).</p><p><strong>Results: </strong>Participants identified nine relevant challenges with potential for improvement in three categories: (I) challenges in recruiting requested personnel, (II) overarching coordination issues, and (III) frequent relocations. Participants proposed solutions for these challenges: (I) 1. Routine cross-agency inquiries for voluntarily available personnel, 2. consideration of resources from municipal subsidiaries and involvement of personnel with leadership experience from other departments, 3. Better coordination of deployment and onboarding, 4. proposal for early communication regarding different compensation regulations, (II) 5. establishment of an overarching coordination authority for the crisis unit, 6. clearer delineation of responsibilities within the crisis unit with explicit job profiles, 7. establishment of a shared working platform, and 8. creation of a central dashboard for generating all situation reports. Additionally, they identified (III) 9. a facility for housing a crisis unit in case of an emergency.</p><p><strong>Conclusion: </strong>This study represents one of the first applications of an AAR for evaluating crisis structures at the level of a local Public Health Authority (LPHA) in the context of the COVID-19 pandemic. While some of the identified challenges are specific to Duesseldorf, many municipalities faced personnel recruitment and coordination challenges during the COVID-19 pandemic. Municipal crisis plans can be reviewed and adjusted concerning the identified challenges. Sharing evaluation results among LPHA stakeholders can contribute to strengthening crisis structures in the long term.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"769-775"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960275","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":"[WHO guideline on carbohydrate intake for adults and children].","authors":"Isolde Sommer, Barbara Nußbaumer-Streit, Gerald Gartlehner","doi":"10.1055/a-2364-2388","DOIUrl":"10.1055/a-2364-2388","url":null,"abstract":"<p><strong>Background: </strong>Noncommunicable diseases are the leading cause of death worldwide. Unhealthy diets are a major risk factor. Among other dietary factors, poorer quality of carbohydrates in the diet is associated with an increased risk of NCDs. The proportion of dietary fibre is a particularly important indicator of the quality of carbohydrate.</p><p><strong>Objective: </strong>The aim of this World Health Organization (WHO)guideline is to provide guidance on carbohydrate intake, including dietary fibre and healthy food sources of carbohydrates.</p><p><strong>Method: </strong>This guideline was developed following the WHO Manual for Guideline Development. The process includes a review of systematically gathered evidence by an international, multidisciplinary group of experts, an assessment of the confidence in this evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, and the consideration of additional factors when translating the evidence into recommendations.</p><p><strong>Results: </strong>The results of seven systematic reviews inform the formulation of carbohydrate intake recommendations. The WHO recommends that carbohydrate intake should consist primarily of whole grains, vegetables, fruits and legumes. It also recommends an intake of at least 400 g of vegetables and fruit per day for adults and at least 250-400 g per day for children and young people, depending on their age. With regard to naturally occurring fiber, a daily intake of at least 25 g is recommended for adults and 15-25 g per day for children and adolescents, depending on age.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"798-802"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581235","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":"[Quality Indicators Show Higher Fulfilment in Centers Certified by the German Cancer Society].","authors":"Stefanie Schulz, Christian Lange, Katharina Emrich, Christina Justenhoven","doi":"10.1055/a-2312-6116","DOIUrl":"10.1055/a-2312-6116","url":null,"abstract":"<p><strong>Aim: </strong>In 2003, a certification program was introduced by the German Cancer Society in Germany to ensure high standards of oncological care. The present study investigated whether there were differences in the concordance to guideline-based recommendations between centers certified by the German Cancer Society and medical facilities without such certification. In this context, quality indicators derived from clinical guidelines were evaluated.</p><p><strong>Methods: </strong>The database of the cancer registry of Rhineland-Palatinate, Germany was used to calculate fulfilment of target values for 14 quality indicators. Analysis of quality indicators followed specifications given in treatment S3-guidelines for breast, colorectal and lung cancer. Analyses were done by R and SAS.</p><p><strong>Results: </strong>All 14 quality indicators showed that concordance with guideline-based recommendations was higher in certified centers compared to uncertified medical facilities; 13 of these differences were statistically significant.</p><p><strong>Conclusion: </strong>Higher quality of oncological treatment in certified centers has widely been discussed in the WiZen study. The results of our study support this assumption with respect to concordance with quality indicators.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"783-787"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471590","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":"[Physician Numbers and Employment in Bavaria: Trends in statistics of the Bavarian Medical Association and the Association of Statutory Health Insurance Physicians of Bavaria].","authors":"Sophie Gigou, Laura Corazza, Sandra Fett, Martin Tauscher, Roman Gerlach, Ewan Donnachie, Antonius Schneider","doi":"10.1055/a-2328-4088","DOIUrl":"10.1055/a-2328-4088","url":null,"abstract":"<p><strong>Background: </strong>Although the number of places at medical schools and physicians in Germany has increased continuously over the past 25 years, there is a threat of a shortage of physicians. Based on data from the Bavarian Medical Association (BLÄK) and the Association of Statutory Health Insurance Physicians of Bavaria (KVB), an analysis of the number of physicians in Bavaria over a longer period of time was carried out in order to understand current developments and possible starting points for the future organization of medical care. The figures were analyzed with regard to the distribution of physicians by outpatient and inpatient sector as well as with regard to the development of the number of employees, the scope of employment and the gender distribution in the outpatient sector.</p><p><strong>Methods: </strong>Data were taken from the annually published and systematically compiled numbers of physicians from the BLÄK (2000 to 2022) as well as the outpatient billing data of practicing and employed physicians in Bavaria (2010 to 2022), processed by the KVB. Descriptive analyses were performed.</p><p><strong>Results: </strong>Since 2000, the number of physicians in Bavaria has risen by 83% in the inpatient setting and by 35% in the outpatient setting. As a result, more physicians have been working in hospitals than in outpatient care since 2010. In the outpatient setting the trend is moving away from establishing one's own practice and full-time work towards salaried and part-time employment. Employed physicians have lower average working hours than self-employed physicians. The proportion of women among physicians has steadily increased, with female physicians more likely to be employed and working part-time compared with male physicians. Nevertheless, part-time employment is also prominent among male physicians in some specialties today.</p><p><strong>Conclusion: </strong>The trend towards practicing in salaried and part-time positions continues unabated and is represented across all specialties, suggesting that more physicians are needed to maintain the number of working hours over time. In addition to incentives and subsidies, this reality must be taken into account when planning care. At the same time, it is questionable whether increasing medical school places without managing them according to need is the right way to address the shortage of physicians in outpatient care when an ever-increasing proportion of physicians is working in inpatient care.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"803-813"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141628075","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":"Evaluating the Usefulness of Population-Wide COVID-19 Testing in the Omicron Era: Insights from a German Model.","authors":"Afschin Gandjour","doi":"10.1055/a-2328-4165","DOIUrl":"10.1055/a-2328-4165","url":null,"abstract":"<p><strong>Background: </strong>The Omicron variant of SARS-CoV-2, which has become dominant worldwide since late 2021, presents a unique challenge due to its high rate of asymptomatic transmission. This study evaluates the efficacy and value of population-wide testing, including self-testing, in the context of COVID-19, particularly under the Omicron variant, using data from Germany.</p><p><strong>Methods: </strong>A decision-analytical model and secondary data was used for assessing the impact of systematic screening and testing for COVID-19. Various scenarios were taken into consideration including seasonal patterns of COVID-19 transmission and the potential for annual waves. The model assessed the clinical benefits of testing against the backdrop of vaccine effectiveness, transmission rates, and the potential to prevent severe clinical events, including death, ICU admission, and long COVID syndrome.</p><p><strong>Results: </strong>The study found that the value of mass testing and self-testing for private use was highly contingent on the transmission rate and the scenario of COVID-19 waves (seasonal vs. continuous). For winter waves, a very high incidence rate was required to justify testing, while for continuous waves, testing could be valuable for those in contact with individuals in their last decade of life. The analysis highlighted the limitations of mass testing when community transmission rates were low and the potential value of testing in high-risk contacts or amidst new outbreaks.</p><p><strong>Conclusion: </strong>The findings suggest that the resumption of testing during winter waves is unlikely to provide significant clinical benefits given the current understanding of Omicron's transmission and immunity waning. This study underscores the need for a nuanced approach to COVID-19 testing policies, considering both the epidemiological context and the practical implications of testing strategies.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"776-782"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761683","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":"COVID-19 Aufarbeitung: Wahrheit, Versöhnung und Entwicklung, nicht Abrechnung.","authors":"Manfred Wildner","doi":"10.1055/a-2418-2896","DOIUrl":"10.1055/a-2418-2896","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":"86 12","pages":"757-760"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786603","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: Quality Indicators Show Higher Fulfilment in Centers Certified by the German Cancer Society].","authors":"Stefanie Schulz, Christian Lange, Katharina Emrich, Christina Justenhoven","doi":"10.1055/a-2379-0670","DOIUrl":"10.1055/a-2379-0670","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"e6"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037349","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":"[Regional Healthcare Situation and Needs of Former SARS-CoV-2 Infected Persons in the Hanseatic City of Lübeck - Results of a Population Survey].","authors":"Mercedes Rutsch, Alexander Mischnik, Alexander Katalinic, Ruth Deck","doi":"10.1055/a-2452-4166","DOIUrl":"https://doi.org/10.1055/a-2452-4166","url":null,"abstract":"<p><strong>Background: </strong>Infection with SARS-CoV-2 can lead to health impairments lasting over several months, the so-called Post-COVID syndrome (PCS). In order to better understand and assess the regional care situation with the acute COVID-19-disease/PCS, possible consequences of illness and current needs, a survey was conducted among the population of the Hanseatic City of Lübeck. The survey also analysed the distribution of PCS and the burden of disease in the sample.</p><p><strong>Methods: </strong>Cross-sectional survey between September and November 2023 in the Hanseatic City of Lübeck using an online survey. Individuals over 18 years of age who were registered with the Lübeck residents' registration office and who had been infected with SARS-CoV-2 at least once in the past were included. Questions were asked about the number of SARS-CoV-2 infections, the last illness, vaccinations and medical services used. Quality of life, impairment of participation, comorbidity and socio-demographic data were also recorded. The presence of PCS was assessed using self-report (yes/no) and a symptom-based scale (PCS score). Treatment preferences were also collected.</p><p><strong>Results: </strong>After checking the inclusion criteria, questionnaire data were available from 619 people; 66.2% of respondents were female and the mean age was 47 years. Most people had last contracted SARS-CoV-2 in 2022 and 2023. 54% (N=332) of respondents considered themselves to have PCS and reported more symptoms (6 vs. 2; p<0.01), higher participation limitations (39.9 vs. 7.2; p<0.01) and poorer quality of life (45 vs. 70; p<0.01) than people who did not consider themselves to have PCS. Medical services related to SARS-CoV-2 infection/PCS were used statistically significantly more by people with PCS. However, only 2.4% of people with PCS were satisfied with their current care situation. A number of wishes were expressed, such as better information from physicians (70%) or a website (67%) with information on regional care services for PCS.</p><p><strong>Conclusion: </strong>People with PCS reported a high burden of disease and were affected by a range of symptoms at the time of the survey. The degree of restrictions in light of the wishes suggest that medical and therapeutic care should be optimised for those affected and that awareness and networking among practitioners should be strengthened.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689212","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":"[Care dynamics of \"Free & Open Air\" Music Festivals in Rural Communities using the example of the Pol'and Rock Festival: an epidemiological, retrospective study 2017-2022].","authors":"Philipp Humbsch, Maja Studzinska, Izabela Jastrzebska, Robert Gintrowicz","doi":"10.1055/a-2422-4252","DOIUrl":"10.1055/a-2422-4252","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of the epidemiology of illnesses at music festivals is limited. Music festivals challenge the medical staff and local communities providing healthcare services to the guests. Objective The aim of this study was to identify and compare reasons for medical treatment of visitors at festivals, PPTT (patients per ten thousand), TTRH (transport to hospital rates) and the time of day when treatment was carried out at one of the largest free-of-charge outdoor music festivals in Europe from 2017 to 2022. The goal was to identify the characteristics of such events.</p><p><strong>Methods: </strong>The retrospective study used data from the medical documentation provided by the organizer of the \"Pol'and Rock\" festival in Poland. The correlations between PPTT, TTHR, visitor count, patient count, and time of day were examined. Important features in the organization of medical support were described.</p><p><strong>Results: </strong>There had been 1.48 million visitors at the festival since 2017 to 2022, and 6,719 needed medical care. There were two peaks in patient count, one from 12-2 pm and another from 8-10 pm (p<0.0001). The median PPTH was 45, and the median TTRH was 0.0638.</p><p><strong>Conclusion: </strong>There is no significant correlation between PPTT, TTRH, and the number of visitors during the study period at the events. The time of day has a significant impact on patient count. Long transportation distances from the festival grounds to the nearest hospital make it important to provide on-site high-quality care. Further investigations on the epidemiology of music festivals are necessary.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336972","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":"[School entry examinations in the former German Democratic Republic (GDR) from 1949 to 1989 - An overview of formal and content-related implementation].","authors":"Clara Maria Knüppel, Heribert Stich","doi":"10.1055/a-2451-9501","DOIUrl":"10.1055/a-2451-9501","url":null,"abstract":"<p><strong>Aim of the study: </strong>Summarising the formal and substantive enrolment practice of school entry examinations (SEU) in the German Democratic Republic (GDR).</p><p><strong>Methods: </strong>Through a systematic literature review using a conventional as well as internet-based sources, specialised literature on specific topics and original documents were made available following selected search terms to capture essential characteristics of SEU in the GDR and to present them in a general context.</p><p><strong>Results: </strong>In the GDR, regular school enrolment took place at the age of 6, although SEU implementation practice during the 1950s and 1960s was fundamentally inconsistent in terms of form and content. On the basis of mandatory annual screening examinations for children, the medical screening examination at pre-school age of 5-6 years was formally valid as a SEU. On a case-by-case basis, the responsible paediatricians carried out supplementary, but non-standardised developmental tests. From the 1970s onwards, the increasing density of kindergarten in the GDR led to their specialist staff getting more involved in the assessment of pre-school children's competences relevant to schooling. In addition, screening at the age of 4-5 years also became more relevant for developmental diagnostic purposes. While various examination procedures were initially used, a standardised inventory of instruments for assessing learning ability, intellectual development and language development gradually emerged during the 1970s. These two staggered SEUs between the age of 4 and 6 years enabled preschool children to be supported if necessary, so that children with developmental delays could be given adequate developmental and educational opportunities. This concept also enabled an intensifying, partly informal cooperation between the specialist staff in the kindergartens, paediatricians, parents and school headmasters.</p><p><strong>Conclusion: </strong>Overall, the SEU in the GDR was based on a professionally and a well thought-out concept from the 1970s onwards. At this time, the standardised, staggered and multidisciplinary approach was methodologically superior to school enrolment practice in West Germany.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510414","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}