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Die Arbeit thematisiert nach Erläuterungen zu den Begriffen Rechtsinformation und E-Government die heterogene Informationslandschaft der frei zugänglichen Rechtsinformation in Deutschland. Normgeber, Gerichte und Parlamente auf Ebene des Bundes und der Länder gestalten auf vielfache Weise die Internetpräsentation der Gesetze, Entscheidungen und parlamentarischen Materialien. Das Gegenmodell zu dieser auf viele Internetadressen und Webseiten verteilten Rechtsinformation stellt das österreichische Rechtsinformationssystem des Bundes (RIS) dar, das als nationale E-Government-Anwendung über eine einzige Oberfläche den Zugriff auf die Gesetze, Entscheidungen und parlamentarischen Materialien ermöglicht. Das RIS als Blaupause und unter Beachtung der Anforderungen an E-Government-Anwendungen umreißt die Arbeit Rahmenbedingungen und Ausgestaltungsmöglichkeiten für einen Portalentwurf, der als Single Point of Entry für die staatliche Rechtsinformation Deutschlands konzeptioniert ist.
Seit einigen Jahren wird zunehmend intensiver über das Angebot und den Bedarf an Fachkräften in der Pflege diskutiert. Dazu wurden bereits eine Reihe von Studien und Prognosen veröffentlicht, die allerdings zu sehr unterschiedlichen Ergebnissen kamen. In der öffentlichen wie auch in der wissenschaftlichen Diskussion sind deshalb gegenwärtig eine Vielzahl unterschiedlicher Zahlen anzutreffen. Die Unterschiede sind allerdings nicht nur auf methodische Unterschiede zurückzuführen, sondern vor allem auch darauf, dass es bislang an zuverlässigen und ausreichend differenzierten Daten amtlicher Statistiken zur Gesamtzahl der Beschäftigten in Pflegeberufen mangelt. Zwar bietet die Gesundheitspersonalrechnung (GPR) des Statistischen Bundesamtes einrichtungsübergreifende Angaben zur Gesamtzahl der Beschäftigten in Pflegeberufen, diese sind jedoch zum einen nicht ausreichend differenziert und basieren zum anderen zu einem wesentlichen Teil auf einer Hochrechnung von Ergebnissen der 1 %-Haushaltsstichprobe des Mikrozensus. Die Angaben der GPR sind darum mit dem Risiko behaftet, dass sie aufgrund von Schätzfehlern die tatsächliche Zahl der Beschäftigten über- oder unterschätzen. Zuverlässigere Angaben zur Beschäftigung in Pflegeberufen bieten Teilstatistiken des Gesundheitswesens, die ihre Daten auf dem Wege einer Vollerhebung mit gesetzlicher Auskunftspflicht der befragten Einrichtungen gewinnen. Dies sind die Krankenhausstatistik, die Statistik der Vorsorge- und Rehabilitationseinrichtungen und die Pflegestatistik. In der vorliegenden Studie werden deren Daten erstmals zu einer Gesamtstatistik der Pflegeberufe zusammengeführt. Das Ergebnis ist eine Datenaufbereitung zur Entwicklung und zum Stand der Beschäftigung in Pflegeberufen in Deutschland im Zeitraum 1999-2009, die nicht nur Zahlen zur Gesamtbeschäftigung bietet, sondern auch differenziert nach einzelnen Pflegeberufen und Versorgungsbereichen (Krankenhaus, Rehabilitationsbereich, ambulante Pflegeeinrichtungen und Pflegeheime). Die Analyse der zusammengeführten Daten führt zu einer Reihe von Ergebnissen, die insbesondere auch für die gesundheitspolitische Diskussion von Bedeutung sind.
Background:
Huntington’s disease (HD) is a rare, genetic, neurodegenerative and ultimately fatal disease with no cure or progression-delaying treatment currently available. HD is characterized by a triad of cognitive, behavioural and motor symptoms. Evidence on epidemiology and management of HD is limited, especially for Germany. This study aims to estimate the incidence and prevalence of HD and analyze the current routine care based on German claims data.
Methods:
The source of data was a sample of the Institute for Applied Health Research Berlin (InGef) Research Database, comprising data of approximately four million insured persons from approximately 70 German statutory health insurances. The study was conducted in a retrospective cross-sectional design using 2015 and 2016 as a two-year observation period. At least two outpatient or inpatient ICD-10 codes for HD (ICD-10: G10) during the study period were required for case identification. Patients were considered incident if no HD diagnoses in the 4 years prior to the year of case identification were documented. Information on outpatient drug dispensations, medical aids and remedies were considered to describe the current treatment situation of HD patients.
Results:
A 2-year incidence of 1.8 per 100,000 persons (95%-Confidence interval (CI): 1.4–2.4) and a 2-year period prevalence of 9.3 per 100,000 persons (95%-CI: 8.3–10.4) was observed. The prevalence of HD increased with advancing age, peaking at 60–69 years (16.8 per 100,000 persons; 95%-CI: 13.4–21.0) and decreasing afterwards.
The most frequently observed comorbidities and disease-associated symptoms in HD patients were depression (42.9%), dementia (37.7%), urinary incontinence (32.5%), extrapyramidal and movement disorders (30.5%), dysphagia (28.6%) and disorders of the lipoprotein metabolism (28.2%).
The most common medications in HD patients were antipsychotics (66.9%), followed by antidepressants (45.1%). Anticonvulsants (16.6%), opioids (14.6%) and hypnotics (9.7%) were observed less frequently.
Physical therapy was the most often used medical aid in HD patients (46.4%). Nursing services and speech therapy were used by 27.9 and 22.7% of HD patients, respectively, whereas use of psychotherapy was rare (3.2%).
Conclusions:
Based on a representative sample, this study provides new insights into the epidemiology and routine care of HD patients in Germany, and thus, may serve as a starting point for further research.
Rezension zu:
Rösch, Hermann et al.: Bibliotheken und Informationsgesellschaft in Deutschland : eine Einführung / Hermann Rösch, Jürgen Seefeldt, Konrad Umlauf ; unter Mitarbeit von Albert Bilo und Eric W. Steinhauer ; mitbegründet von Engelbert Plassmann. – 3., neukonzipierte und aktualisierte Auflage. – Wiesbaden: Harrassowitz Verlag, 2019. – XIII, 329 Seiten. – ISBN 9783447066204 : EUR 39.80 (auch als EBook verfügbar)
Aim:
To characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.
Subject and methods:
The study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.
Results:
The incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).
Conclusions:
In Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.
Background:
Hereditary angioedema (HAE) is a rare genetic disease and characterized by clinical features such as paroxysmal, recurrent angioedema of the skin, the gastrointestinal tract, and the upper airways. Swelling of the skin occurs primarily in the face, extremities and genitals. Gastrointestinal attacks are accompanied by painful abdominal cramps, vomiting and diarrhea. Due to the low prevalence and the fact that HAE patients often present with rather unspecific symptoms such as abdominal cramps, the final diagnosis is often made after a long delay. The aim of this German-wide survey was to characterize the period between occurrence of first symptoms and final diagnosis regarding self-perceived health, symptom burden and false diagnoses for patients with HAE.
Results:
Overall, 81 patients with HAE were included and participated in the telephone-based survey. Of those, the majority reported their current health status as “good” (47.5%) or “very good” (13.8%), which was observed to be a clear improvement compared to the year before final diagnosis (“good” (16.3%), “very good” (11.3%)). Edema in the extremities (85.2%) and in the gastrointestinal tract (81.5%) were the most currently reported symptoms and occurred earlier than other reported symptoms (mean age at onset 18.1 and 17.8 years, respectively). Misdiagnoses were observed in 50.6% of participating HAE patients with appendicitis and allergy being the most frequently reported misdiagnoses (40.0 and 30.0% of those with misdiagnosis, respectively). Patients with misdiagnosis often received mistreatment (80.0%) with pharmaceuticals and surgical interventions as the most frequently carried out mistreatments (65.6 and 56.3% of those with mistreatment, respectively). The mean observed diagnostic delay was 18.1 years (median 15.0 years). The diagnostic delay was higher in older patients and index patients.
Conclusions:
This study showed that self-perceived status of health for patients is much better once the final correct diagnosis has been made and specific treatment was available. Further challenge in the future will still be to increase awareness for HAE especially in settings which are normally approached by patients at occurrence of first symptoms to assure early referral to specialists and therefore increase the likelihood of receiving an early diagnosis.
As noted by Roman poet Virgil already more than 2,000 years ago: “The greatest wealth is health.”. Without health, there is no happiness, no peace, and no success according to the Reflections Recovery Center from Arizona, United States (USA, U.S.). The goal of the Healthy People 2020-project (HP2020), which is led by the Office of Disease Prevention and Health Promotion (ODPHP), was to “promote quality life, healthy development, and health behaviors across all life stages” among the U.S. population. HP2020 measures progress by using so-called Leading Health Indicators (LHI), reliable data sources, baseline values as well as targets for LHI-individual improvements for every measurable objective to be achieved by 2020 and each following decade. In the further course, these values were compared to student populations from the U.S., Germany, and Poland. The goal of this master's thesis was to obtain more data on international health, particularly among student populations. For the statistical analysis, data were obtained from an online survey that was distributed to students in at least one university in each of the three countries. In total, data from 380 students were analyzed in terms of HP2020 goal attainment. To determine if statistically significant differences were present, the z-test was used. The biggest differences emerged on the following topics: access to healthcare, environmental quality, obesity as well as reproductive and sexual health.
During the European debt crisis, German and Greek media frequently reported on the political conflict between the two countries. This article examines to what extent the media coverage in one country about the other is considered by German and Greek citizens to be hostile (‘hostile media perception’) and influential (‘influence of presumed influence’). Data from a comparative survey in Germany (n = 492) and Greece (n = 484) show that news coverage by foreign media on the European debt crisis is perceived by respondents as hostile against their own country and as influential. Moreover, both media-related perceptions are linked with intensified perceptions of hostility, such as assumptions that an individual’s country is not respected in the other country or that the other country’s citizens are demanding that the individual’s country be punished. Based on these results, it is discussed whether media-related perceptions can have a conflict-intensifying effect in international crises.
Im Zuge des Zweiten Weltkrieges wurden zahlreiche sowjetische Museen, Archive und Bibliotheken ausgeraubt oder zerstört. Als Antwort auf diese Schäden wurden im Februar 1945 seitens der Sowjetregierung die sog. Trophäenbrigaden gegründet, die mit der Ausfuhr der deutschen Kulturgüter als Kompensation für entstandene Verluste beauftragt waren. Entgegen der Vereinbarungen der Potsdamer Konferenz, die solche Konfiskationen nur in Ausnahmsfällen erlaubte, organisierten die sowjetischen Besatzer flächendeckende Beschlagnahmungen und Abtransporte der deutschen Kulturgüter als Kriegsbeute in die UdSSR. Die vorliegende Arbeit untersucht den sowjetischen Kunst- und Kulturraub im besetzten Deutschland. Eine besondere Aufmerksamkeit wird den Konfiskationen der deutschen Bücher und deren Verteilung in die sowjetischen Bibliotheken gewidmet. Am Ende der Arbeit soll ein Überblick über die komplizierten deutsch-russischen Restitutionsverhandlungen, die bis heute zu keinem Ergebnis geführt haben, gegeben werden.