'Know before you go': information-seeking behaviour of German patients receiving health services abroad in light of the provisions of Directive 2011/24/EU

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.Objective While Directive 2011/24/EU on cross-border patient mobility makes specific provisions in relation to information availability and accessibility, little empirical evidence exists to guide best practice. This paper explores the information-seeking behaviour of German patients who received planned care abroad. Methods A postal survey among German patients treated in other European countries was carried out by Techniker Krankenkasse, a major German sickness fund. The influence of certain predictors on whether patients informed themselves before travelling for care was investigated using multiple logistic regression. Types and sources of information were analysed using descriptive statistics. Results Information activity was contingent on patients' level of education, type of service, regularity of treatment abroad and awareness of entitlement to cross-border services. Respondents most frequently enquired about elements of reimbursement, entitlement to services and cost-saving, and consulted their sickness fund for information. Differences in both content and medium of choice were observed between patient groups. Conclusion A structured and inclusive approach to information provision should be adopted. National Contact Points should collaborate with a range of stakeholders, who will vary depending on the health care system; however, patient organizations, health professionals and third-party payers should always be represented. Dynamically monitoring cross-border movements can help determine the range, medium and language of relevant information.EC/FP7/242058/EU/European Cross Border Care Collaborations Short Title: CrossEurope/EUCBC

Reappearance of old growth elements in lowland woodlands in northern Belgium : do the associated species follow?

The forest cover of the western European lowland plain has been very low for centuries. Remaining forests were intensively managed, and old-growth elements like veteran trees and coarse woody debris became virtually absent. Only over the last decades have these old-growth elements progressively redeveloped in parks, lanes and forests, and have now reached their highest level over the last 500-1000 years. Biodiversity associated with these old-growth elements makes up an important part of overall forest biodiversity. The ability of species to recolonise the newly available habitat is strongly determined by limitations in their dispersal and establishment. We analyse the current status and development of old-growth elements in Flanders (northern Belgium) and the process of recolonisation by means of specific cases, focussing on saproxylic fungi and saproxylic beetles. Our results show that 'hotspots' of secondary old growth, even isolated small patches, may have more potential for specialised biodiversity than expected, and may provide important new strongholds for recovery and recolonisation of an important share of old-growth related species

Qualität und Effizienz der Gesundheitsversorgung im internationalen Vergleich

Gesundheit ist sowohl individuell als auch gesamtwirtschaftlich eine wichtige Determinante der Produktivität sowie der Lebensqualität und der Wohlfahrt. Die Gesundheitsversorgung erfolgt in den meisten Ländern nicht ausschließlich über private Märkte, sondern ist staatlich reguliert und teilweise öffentlich finanziert. Die Gründe hierfür sind einerseits Marktversagen auf privaten Krankenversicherungsmärkten und andererseits normativ begründete Ziele der Gesundheitspolitik, wie z. B. der gleiche Zugang zu gleicher Gesundheitsversorgung für alle Menschen. Somit werden im Gesundheitswesen nicht nur wirtschaftliche Effizienzziele, sondern auch Verteilungs- und Umverteilungsziele verfolgt. Qualität und Effizienz lassen sich daher nur unter Berücksichtigung dieser Ziele bewerten

Costs and treatment patterns of incident ADHD patients - a comparative analysis before and after the initial diagnosis -

Background and objectives: The costs and treatment patterns of attention deficit hyperactivity disorder (ADHD) are subjects of health services research in Germany and worldwide. Previous publications focused mainly on prevalent patients and thus research gaps were identified regarding costs and treatment patterns of incident patients before and after the first diagnosis. Methods: Analyses were conducted using claims data obtained from a large German sickness fund (Techniker Krankenkasse). Inclusion criteria consisted of patients with at least two secured outpatient or one inpatient ADHD diagnosis in 2007. Incidence was ensured by defining a baseline period without ADHD-diagnosis in 2006. In addition to diseaserelated cost analyses compared to a control group including age group comparisons, comorbidities, the proportion of multimodal treatment and medication treatment patterns were described. Results: In total, 9083 newly diagnosed ADHD patients were identified (73 % male; mean age: 12.9 years (SD: 10.3)). The mean total cost of ADHD patients during the year after the first diagnosis exceeded the mean total cost of the year before by 976 € (Differencein-Difference-estimator: 1006 €). Our analyses have shown that 10 % of ADHD patients have been treated with multimodal therapy. In addition, 11 % of the investigated ADHD population have received methylphenidate or atomoxetine preceeding the date of diagnosis in the relevant observation period. Discussion: This study provides important insights into the costs as well as the treatment patterns of incident ADHD patients. ADHD-related costs and medications can be identified prior to the date of the first ADHD diagnosis. Although, multimodal therapy is presented as an optimal treatment option by many international guidelines and experts, its proportion for treatment is low (10 %). Further research is necessary to identify reasons for the low proportion of multimodal therapy and (cost-)effectiveness has to be evaluated in comparison to other treatment options. In addition, ADHD-related costs could be identified before the first diagnosis is documented. The reasons for medication prior to diagnosis have to be further investigated.BMB

Fall Risk Increasing Drugs: The Effect on Injuries of the Frail Elderly Estimated from Administrative Data

Society benefits on a large scale from improved medical care and pharmaceuticals. The prescription of pharmaceuticals, however, also carries risks such as the possibility of an increased risk of falls, which may lead to severe injuries and increased health expenditures associated with these injuries. This study investigates the influence of several fall risk increasing drugs (FRIDs) on the number of injuries of elderly persons using multivariate regression models. Routine data from the Techniker Krankenkasse (TK) of frail elderly persons aged Ï 65 years is analyzed for the year 2009 by estimating count data models, in order to take the data generating process of the number of injuries into account. The results of the count data model are compared to those from logistic regressions, which is the default regression model in this fi eld of research. The empirical results suggest that antidepressants, anxiolytics, hypnotics and sedatives, antiarrhythmics, and drugs from the Priscus-list have a signifi cant positive effect on the number of injuries, while antihypertensives and anti-parkinsonian agents show no and neuroleptics a significant negative eff ect. As recurrent injuries are common, the analysis of the number of injuries rather than just the probability of having an injury provides a more informative analysis of FRIDs.Flächendeckende medizinische Versorgung und eine verbesserte Pharamkotherapie haben dazu geführt, dass die Lebenserwartung in den vergangenen Jahrzehnten stetig gestiegen ist. Dennoch ist die Einnahme von Medikamenten nicht ausschließlich nutzenbringend, sondern kann für gewisse Personengruppen mit Risiken und hohen Nachbehandlungskosten einhergehen. Deshalb verwendet diese Studie Routinedaten der Techniker Krankenkasse, um den Einfluss von sturzrisikofördernden Medikamenten, auf die Anzahl von Verletzungen bei älteren Menschen ab einem Alter von 65 Jahren zu untersuchen. Für die Schätzung werden im Gegensatz zur existierenden Literatur anstelle von Logit Modellen, Count Data Modelle verwendet, die die besondere, hier vorliegende Datenstruktur berücksichtigen. Die empirischen Ergebnisse zeigen, dass bestimmte Medikamentengruppen, wie Antidepressiva, Anxiolytika, Hypnotika und Sedativa, Antiarrhythmika sowie Medikamente der Priscus-Liste einen positiv signifikanten Einfluss auf die Anzahl von Verletzungen haben, wohingegen der Einfluss von Antihypertensiva und Antiparkinson Mittel insignifikant ist. Demnach ist vor allem bei der Verschreibung der erstgenannten Medikamentengruppen besondere Vorsicht geboten und eine Abwägung der Risiken und des Nutzen von Nöten

Mitigating the impact of microbial pressure on great (Parus major) and blue (Cyanistes caeruleus) tit hatching success through maternal immune investment

he hatching success of a bird’s egg is one of the key determinants of avian reproductive success, which may be compromised by microbial infections causing embryonic death. During incubation, outer eggshell bacterial communities pose a constant threat of pathogen translocation and embryo infection. One of the parental strategies to mitigate this threat is the incorporation of maternal immune factors into the egg albumen and yolk. It has been suggested that habitat changes like forest fragmentation can affect environmental factors and life-history traits that are linked to egg contamination. This study aims at investigating relationships between microbial pressure, immune investment and hatching success in two abundant forest bird species and analyzing to what extent these are driven by extrinsic (environmental) factors. We here compared (1) the bacterial load and composition on eggshells, (2) the level of immune defenses in eggs, and (3) the reproductive success between great (Parus major) and blue (Cyanistes caeruleus) tits in Belgium and examined if forest fragmentation affects these parameters. Analysis of 70 great tit and 34 blue tit eggshells revealed a similar microbiota composition (Enterobacteriaceae, Lactobacillus spp., Firmicutes and Bacteroidetes), but higher bacterial loads in great tits. Forest fragmentation was not identified as an important explanatory variable. Although a significant negative correlation between hatching success and bacterial load on the eggshells in great tits corroborates microbial pressure to be a driver of embryonic mortality, the overall hatching success was only marginally lower than in blue tits. This may be explained by the significantly higher levels of lysozyme and IgY in the eggs of great tits, protecting the embryo from increased infection pressure. Our results show that immune investment in eggs is suggested to be a species-specific adaptive trait that serves to protect hatchlings from pathogen pressure, which is not directly linked to habitat fragmentation

Salmonella Typhimurium DT193 and DT99 are present in great and blue tits in Flanders, Belgium

Endemic infections with the common avian pathogen Salmonella enterica subspecies enterica serovar Typhimurium (Salmonella Typhimurium) may incur a significant cost on the host population. In this study, we determined the potential of endemic Salmonella infections to reduce the reproductive success of blue (Cyanistes caeruleus) and great (Parus major) tits by correlating eggshell infection with reproductive parameters. The fifth egg of each clutch was collected from nest boxes in 19 deciduous forest fragments. Out of the 101 sampled eggs, 7 Salmonella Typhimurium isolates were recovered. The low bacterial prevalence was reflected by a similarly low serological prevalence in the fledglings. In this study with a relatively small sample size, presence of Salmonella did not affect reproductive parameters (egg volume, clutch size, number of nestlings and number of fledglings), nor the health status of the fledglings. However, in order to clarify the impact on health and reproduction a larger number of samples have to be analyzed. Phage typing showed that the isolates belonged to the definitive phage types (DT) 193 and 99, and multi-locus variable number tandem repeat analysis (MLVA) demonstrated a high similarity among the tit isolates, but distinction to human isolates. These findings suggest the presence of passerine-adapted Salmonella strains in free-ranging tit populations with host pathogen co-existence

Wafer-level vacuum sealing for packaging of silicon photonic MEMS

Silicon (Si) photonic micro-electro-mechanical systems (MEMS), with its low-power phase shifters and tunable couplers, is emerging as a promising technology for large-scale reconfigurable photonics with potential applications for example in photonic accelerators for artificial intelligence (AI) workloads. For silicon photonic MEMS devices, hermetic/vacuum packaging is crucial to the performance and longevity, and to protect the photonic devices from contamination. Here, we demonstrate a wafer-level vacuum packaging approach to hermetically seal Si photonic MEMS wafers produced in the iSiPP50G Si photonics foundry platform of IMEC. The packaging approach consists of transfer bonding and sealing the silicon photonic MEMS devices with 30 μm-thick Si caps, which were prefabricated on a 100 mm-diameter silicon-on-insulator (SOI) wafer. The packaging process achieved successful wafer-scale vacuum sealing of various photonic devices. The functionality of photonic MEMS after the hermetic/vacuum packaging was confirmed. Thus, the demonstrated thin Si cap packaging shows the possibility of a novel vacuum sealing method for MEMS integrated in standard Si photonics platforms

Phylogeography and cryptic diversity of the solitary-dwelling silvery mole-rat, genus Heliophobius (family: Bathyergidae)

Alongside the eusocial naked mole-rat, Heterocephalus glaber, Heliophobius argenteocinereus represents the second oldest lineage within the African mole-rat family Bathyergidae, and phylogenetically intermediate between the East African Het. glaber and the South African genera Bathyergus and Georychus. Across its geographic range, Hel.. argenteocinereus is widely distributed on both sides of the East African Rift System (EARS), and is a key taxon for understanding the phylogeographic patterns of divergence of the family as a whole. Phylogenetic analysis of 62 mitochondrial cyt b sequences, representing 48 distinct haplotypes from 26 geographic locations across the range of Heliophobius, consistently and robustly resolved six genetically divergent clades that we recognize as distinct evolutionary species. Early species descriptions of Heliophobius were synonymized into a monotypic taxonomy that recognized only Hel. argentocinereus. These synonyms constitute available names for these rediscovered cryptic lineages, for which combined morphological and genetic evidence for topotypical populations endorses the recognition of six to eight distinct taxa. Bayesian estimates of diver- gence times using the fossil Proheliophobius as a calibration for the molecular clock suggest that the adaptive radiation of the genus began in the early Miocene, and that cladogenesis, represented in the extant species, reflects a strident signa- ture of tectonic activity that forged the principal graben in the EARS.SYNTHESYS grant (BE-TAF-289), grants from the National Research Foundation, the University of Pretoria South Africa (to NCB) and the ERANDA and Bay Foundations (FC).http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1469-7998ab201

Season as a discriminating factor for faecal metabolomic composition of great tits (Parus major)

The microbiome of wild birds has been associated with health status and risk of disease development, but underlying metabolomic mechanisms are still unknown. Metabolites produced by microbial organisms may affect host metabolic processes and by doing so influence host health. Here we provide for the first time data on the faecal metabolome of wild great tits (Parus major) by analyzing metabolites associations with age, sex, season and body condition. Using untargeted metabolomics, we analyzed faecal samples from 112 great tits that were caught in a deciduous forest fragment in Flanders (Belgium) during late autumn and 19 animals that were re-captured during early spring. In this study, no significant associations between the faecal metabolites and age, sex and body condition were observed. However, season was shown to be a discriminating factor for the metabolomic composition of great tits, suggesting an impact of environmental factors