Chipkarten im Gesundheitswesen: Nutzungsmöglichkeiten für Prävention und Gesundheitsförderung

Das Papier basiert auf einem für die Senatsverwaltung für Gesundheit Berlin erstellten Gutachten. Ihm lagen als Fragestellungen zugrunde, ob eine elektronische Gesundheitskarte (Gesundheitspaß) auch für die Bereiche Prävention und Gesundheitsförderung anwend- und nutzbar sei und welche erwünschten oder auch unerwünschten Wirkungen hierbei anzunehmen wären. Es werden im Anschluß an eine allgemeinere Einleitung zunächst Ergebnisse einer Kurzrecherche zum gegenwärtigen Stand und den bestehenden Problemen von Chipkarten als Patientenkarten dargelegt (Kap. 2). Im folgenden Kapitel werden die acht für die Untersuchung entwickelten Prüfkriterien Verfügbarkeit von Indikatoren, Konsensfähigkeit von Indikatoren, Individuelle Zuschreibbarkeit von Indikatoren, Individuelle Erhebbarkeit von Indikatoren, Organisatorischer, politischer, finanzieller und rechtlicher Regelungsbedarf, Abschätzung von Nutzenpotentialen für die individuelle Prävention, Abschätzung von Nutzenpotentialen für die bevölkerungsbezogene Prävention sowie Ethische Aspekte begründet. Diese Prüfkriterien werden in Kap. 4 auf die erfragten Indikatorenbereiche Angeborene Risiken, Erworbene Risiken, Risiken des Lebensstils, Risiken der Arbeitswelt, Risiken der natürlichen und technischen Umwelt, Soziale Risiken, Ressourcen, Teilnahme an Gesundheitsförderung sowie Gesundheitszustand bezogen, indem der diesbezügliche Wissenstand dargelegt wird. Aus einer Perspektive bevölkerungs-bezogenen Nutzens, welche die Autoren einnehmen, müßte gefordert werden, daß jeweils alle acht Kriterien ein positives Urteil nahelegen. Dem steht meist bereits ein Fehlen standardisierter, konsensfähiger und individuell zuschreibbarer Indikatoren entgegen (Kap. 5). Individuelle Zuschreibmöglichkeiten gibt es jedoch bei präventivmedizinischen Daten; etliche davon fallen heute bereits in der medizinischen bzw. der präventivmedizinischen Versorgung an. Für sie gilt wie für die Versorgungsdaten, daß sie oft nicht (rechtzeitig) verfügbar sind. Ein diesbezüglich erwarteter Nutzen von Patientenkarten müßte auch für präventivmedizinische Daten gelten. Erweiterungsoptionen von Patientenkarten in den präventiven Bereich hinein werden daher für Indikatoren aus solchen Versorgungsprogrammen prinzipiell unterstützt, für die grundsätzlich eine Effektivität des Programms anzunehmen ist (wenngleich die Programme oft Inanspruchnahmeprobleme haben, bei denen die Autoren skeptisch sind, ob sich diese durch einen Gesundheitspaß würden verringern lassen). In diesem Sinne wird empfohlen, modellhaft den Aufbau einer Kinder(vorsorge)karte, die Einbeziehung des Mutterpasses sowie des öffentlichen Gesundheitsdienstes in nähere Erwägung zu ziehen (Kap. 6). Auch zur Dokumentation eines Teils der arbeitsbedingten Gesundheitsrisiken könnte ein individuelles Informationssystem nutzbar sein, wobei im Vorfeld von Modellversuchen allerdings Akzeptanzprobleme zu lösen wären, die sich bei bisherigen Modellversuchen in Papierform aus der Befürchtung des Datenmißbrauchs durch die Unternehmen ergeben haben. --

Debate: Are surrogate end-point studies worth the effort?

Surrogate end-points of cardiovascular disease can provide useful information in cross-sectional, prospective and interventional studies. They provide information on association with risk factors, natural history and factors associated with disease progression. Because every participant can reach an end-point, sufficient power can be attained with much smaller numbers of subjects in surrogate end-point studies than in studies that use clinical endpoints, so that the costs are likely to be substantially less. Measures of carotid intima-media thickness (IMT) by B-mode ultrasonography and of coronary calcification by electron beam computed tomography (EBCT) appear to be the most promising surrogate end-points

Health care in and outside a DMP for type 2 diabetes mellitus in Germany: results of an insurance customer survey focussing on differences in general education status

Aim: The Disease Management Programmes (DMPs) introduced in Germany since 2003 are intended to improve health care for the chronically ill. Whether they do this is currently being investigated in various evaluation settings. In order to assess possible changes in the process quality from the point of view of patients, the BARMER health insurance company conducted a national postal survey in Germany in 2007 of its customers with diabetes mellitus type 2 in order to compare programme participants and non-participants. This evaluation is a sub-analysis intended to clarify whether the utilisation, acceptability and perceived benefits of the programme differ as a result of educational status. Subjects and Methods: A nationally representative random sample was drawn from BARMER insurance customers with type 2 diabetes, aged 45–79 years. Questionnaires were evaluated from 38.5% of the sample (DMP-participant respondents: n = 2,158; non-participant respondents: n = 2,182). Results: A lower educational status was related among other things with increased morbidity, a poorer level of information and also a less well-developed “preventive attitude” to the disease. The finding that 49% of participants had a higher school qualification compared with 45% of non-participants, although significant, is less pronounced than the differences found between DMP participants and non-participants for other values analysed. A social influence could be found concerning the differences in treatment provided within the programme. A multivariate analysis shows that both the participation in the programme and higher levels of education have independent positive effects on the satisfaction with health status, with the effect of programme participation being stronger. Conclusions: It can be assumed that the clear differences established between the groups of DMP participants and non-participants can in no way be explained solely by the comparatively small difference related to school education. Patients obviously appreciate the fact that the health personnel and the insurance company are paying increased interest to their disease, and this is true to an increased degree for participants with only basic schooling. Although overall this group is significantly under-represented among the participants, they reported to an increased degree that they were profiting from the programme

Dielectrophoretic Equilibrium of Complex Particles

In contrast to the commonly used spherical Janus particles, here we used engineered Janus particles that are fabricated using photolithography technique for precise control over their geometry and coated regions. Specifically, we studied a lollipop-shaped complex particle where its head is coated with gold while its tail is left bare. Due to their distinct electrical properties (i.e. electrical polarizability) the particle exhibits force equilibrium where opposite dielectrophoretic forces acting on its head and tail exactly cancel each other to yield a stable equilibrium position. This was realized in a quadrupolar electrode array where the equilibrium position of the engineered particle could be tuned by the frequency. This stands in contrast to the standard dielectrophoretic behavior where the particle shifts positions from either the center of the quad to the very edge of the electrodes when shifting from a negative to positive dielectrophoretic response, respectively. This opens new opportunities for positioning control of such complex particles for self-assembly, biosensing, biomimetic spermatozoa and more.Comment: 10 pages, 4 figure

Dissection of a DNA-damage-induced transcriptional network using a combination of microarrays, RNA interference and computational promoter analysis

BACKGROUND: Gene-expression microarrays and RNA interferences (RNAi) are among the most prominent techniques in functional genomics. The combination of the two holds promise for systematic, large-scale dissection of transcriptional networks. Recent studies, however, raise the concern that nonspecific responses to small interfering RNAs (siRNAs) might obscure the consequences of silencing the gene of interest, throwing into question the ability of this experimental strategy to achieve precise network dissections. RESULTS: We used microarrays and RNAi to dissect a transcriptional network induced by DNA damage in a human cellular system. We recorded expression profiles with and without exposure of the cells to a radiomimetic drug that induces DNA double-strand breaks (DSBs). Profiles were measured in control cells and in cells knocked-down for the Rel-A subunit of NFκB and for p53, two pivotal stress-induced transcription factors, and for the protein kinase ATM, the major transducer of the cellular responses to DSBs. We observed that NFκB and p53 mediated most of the damage-induced gene activation; that they controlled the activation of largely disjoint sets of genes; and that ATM was required for the activation of both pathways. Applying computational promoter analysis, we demonstrated that the dissection of the network into ATM/NFκB and ATM/p53-mediated arms was highly accurate. CONCLUSIONS: Our results demonstrate that the combined experimental strategy of expression arrays and RNAi is indeed a powerful method for the dissection of complex transcriptional networks, and that computational promoter analysis can provide a strong complementary means for assessing the accuracy of this dissection