Administrative Data from Germanys Statutory Health Insurances for Social, Economic and Medical Research

"This article gives a short description of administrative data sources from Germany’s statutory health insurances which are of potential interest for social, economic and medical research. After an introduction, the underlying legal regulations as well as the structure and contents for the most interesting databases are shortly described.Current and future accessibility of this data sources are discussed in the context of legal and data privacy protection issues.Aspects of data validity and completeness are provided for the different data sources. Additionally an up-to-date example from health care research using administrative data is given. Finally potentials and limitations of research using administrative data medical data from Germanys Statutory Health Insurances are put into perspective.[author's abstract

Monitoring hillslope moisture dynamics with surface ERT for enhancing spatial significance of hydrometric point measurements

Besides floodplains, hillslopes are basic units that mainly control water movement and flow pathways within catchments of subdued mountain ranges. The structure of their shallow subsurface affects water balance, e.g. infiltration, retention, and runoff. Nevertheless, there is still a gap in the knowledge of the hydrological dynamics on hillslopes, notably due to the lack of generalization and transferability. This study presents a robust multi-method framework of electrical resistivity tomography (ERT) in addition to hydrometric point measurements, transferring hydrometric data into higher spatial scales to obtain additional patterns of distribution and dynamics of soil moisture on a hillslope. A geoelectrical monitoring in a small catchment in the eastern Ore Mountains was carried out at weekly intervals from May to December 2008 to image seasonal moisture dynamics on the hillslope scale. To link water content and electrical resistivity, the parameters of Archie's law were determined using different core samples. To optimize inversion parameters and methods, the derived spatial and temporal water content distribution was compared to tensiometer data. The results from ERT measurements show a strong correlation with the hydrometric data. The response is congruent to the soil tension data. Water content calculated from the ERT profile shows similar variations as that of water content from soil moisture sensors. Consequently, soil moisture dynamics on the hillslope scale may be determined not only by expensive invasive punctual hydrometric measurements, but also by minimally invasive time-lapse ERT, provided that pedo-/petrophysical relationships are known. Since ERT integrates larger spatial scales, a combination with hydrometric point measurements improves the understanding of the ongoing hydrological processes and better suits identification of heterogeneities

The Choir Invisible: zur Analyse der gesundheitsbezogenen Panelmortalität im Sozio-Ökonomischen Panel SOEP

Die Panelmortalität ist ein zentrales Problem bei der Durchführung und Beurteilung von Panelstudien. Bisherige Analysen des Nonresponse im SOEP berücksichtigen den möglichen Effekt von Krankheit oder Gesundheit auf die Panelmortalität nicht. Weder das Kontaktverlustmodell noch das Verweigerungsmodell erlauben zufriedenstellende Prognosen des individuellen Ausfalls. Die Verfasser zeigen, dass es in den ersten fünf Wellenübergängen des SOEP deutliche Hinweise auf eine relevante gesundheitsbedingte Panelmortalität gibt. Die bisherige Gewichtung des SOEP führt zu einer systematischen Überschätzung des Gesundheitszustandes der Grundgesamtheit. (ICE

Impacts of a capillary barrier on infiltration and subsurface stormflow in layered slope deposits monitored with 3-D ERT and hydrometric measurements

Identifying principles of water movement in the shallow subsurface is crucial for adequate process-based hydrological models. Hillslopes are the essential interface for water movement in catchments. The shallow subsurface on slopes typically consists of different layers with varying characteristics. The aim of this study was to draw conclusions about the infiltration behaviour, to identify water flow pathways and derive some general interpretations for the validity of the water movement on a hillslope with periglacial slope deposits (cover beds), where the layers differ in their sedimentological and hydrological properties. Especially the described varying influence of the basal layer (LB) as an impeding layer on the one hand and as a remarkable pathway for rapid subsurface stormflow on the other. We used a time lapse 3-D electrical resistivity tomography (ERT) approach combined with punctual hydrometric data to trace the spreading and the progression of an irrigation plume in layered slope deposits during two irrigation experiments. This multi-technical approach enables us to connect the high spatial resolution of the 3-D ERT with the high temporal resolution of the hydrometric devices. Infiltration through the uppermost layer was dominated by preferential flow, whereas the water flow in the deeper layers was mainly matrix flow. Subsurface stormflow due to impeding characteristic of the underlying layer occurs in form of "organic layer interflow" and at the interface to the first basal layer (LB1). However, the main driving factor for subsurface stormflow is the formation of a capillary barrier at the interface to the second basal layer (LB2). The capillary barrier prevents water from entering the deeper layer under unsaturated conditions and diverts the seepage water according to the slope inclination. With higher saturation, the capillary barrier breaks down and water reaches the highly conductive deeper layer. This highlights the importance of the capillary barrier effect for the prevention or activation of different flow pathways under variable hydrological conditions

Why dynamos are prone to reversals

In a recent paper (Phys. Rev. Lett. 94 (2005), 184506; physics/0411050) it was shown that a simple mean-field dynamo model with a spherically symmetric helical turbulence parameter alpha can exhibit a number of features which are typical for Earth's magnetic field reversals. In particular, the model produces asymmetric reversals, a positive correlation of field strength and interval length, and a bimodal field distribution. All these features are attributable to the magnetic field dynamics in the vicinity of an exceptional point of the spectrum of the non-selfadjoint dynamo operator. The negative slope of the growth rate curve between the nearby local maximum and the exceptional point makes the system unstable and drives it to the exceptional point and beyond into the oscillatory branch where the sign change happens. A weakness of this reversal model is the apparent necessity to fine-tune the magnetic Reynolds number and/or the radial profile of alpha. In the present paper, it is shown that this fine-tuning is not necessary in the case of higher supercriticality of the dynamo. Numerical examples and physical arguments are compiled to show that, with increasing magnetic Reynolds number, there is strong tendency for the exceptional point and the associated local maximum to move close to the zero growth rate line. Although exemplified again by the spherically symmetric alpha^2 dynamo model, the main idea of this ''self-tuning'' mechanism of saturated dynamos into a reversal-prone state seems well transferable to other dynamos. As a consequence, reversing dynamos might be much more typical and may occur much more frequently in nature than what could be expected from a purely kinematic perspective.Comment: 11 pages, 10 figure

Impacts of a capillary barrier on infiltration and subsurface stormflow in layered slope deposits monitored with 3-D ERT and hydrometric measurements

Identifying principles of water movement in the shallow subsurface is crucial for adequate process-based hydrological models. Hillslopes are the essential interface for water movement in catchments. The shallow subsurface on slopes typically consists of different layers with varying characteristics. The aim of this study was to draw conclusions about the infiltration behaviour, to identify water flow pathways and derive some general interpretations for the validity of the water movement on a hillslope with periglacial slope deposits (cover beds), where the layers differ in their sedimentological and hydrological properties. Especially the described varying influence of the basal layer (LB) as an impeding layer on the one hand and as a remarkable pathway for rapid subsurface stormflow on the other. We used a time lapse 3-D electrical resistivity tomography (ERT) approach combined with punctual hydrometric data to trace the spreading and the progression of an irrigation plume in layered slope deposits during two irrigation experiments. This multi-technical approach enables us to connect the high spatial resolution of the 3-D ERT with the high temporal resolution of the hydrometric devices. Infiltration through the uppermost layer was dominated by preferential flow, whereas the water flow in the deeper layers was mainly matrix flow. Subsurface stormflow due to impeding characteristic of the underlying layer occurs in form of organic layer interflow and at the interface to the first basal layer (LB1). However, the main driving factor for subsurface stormflow is the formation of a capillary barrier at the interface to the second basal layer (LB2). The capillary barrier prevents water from entering the deeper layer under unsaturated conditions and diverts the seepage water according to the slope inclination. With higher saturation, the capillary barrier breaks down and water reaches the highly conductive deeper layer. This highlights the importance of the capillary barrier effect for the prevention or activation of different flow pathways under variable hydrological conditions

Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with anxiety disorders

<p>Abstract</p> <p>Background</p> <p>The EQ-5D is a generic questionnaire which generates a health profile as well as index scores for health-related quality of life that may be used in cost-utility analysis.</p> <p>Aims of the study</p> <p>To examine validity and responsiveness of the EQ-5D in patients with anxiety disorders.</p> <p>Methods</p> <p>389 patients with anxiety disorders completed the EQ-5D at baseline and 6-month follow-up. Subjective measures of quality of life (WHOQOL-BREF) and psychopathology (BAI, BDI-II, BSQ, ACQ, MI) were used for comparison. Validity was analyzed by assessing associations between EQ-5D scores and related other scores. Responsiveness was analyzed by calculating effect sizes of differences in scores between baseline and follow-up for 3 groups indicating more, constant or less anxiety. Meaningful difference scores for shifting to less or more anxiety were derived by means of regression analysis.</p> <p>Results</p> <p>88.4% of respondents reported problems in at least one of the EQ-5D dimension at baseline; the mean EQ VAS score was 63.8. The EQ-5D dimension most consistently associated with the measures used for comparison was 'anxiety/depression'. EQ VAS and EQ-5D index scores were highly correlated (|r|>0.5) with scores of the WHOQOL-BREF dimensions 'physical', 'mental' and 'overall' as well as BAI and BDI-II. The EQ-5D index tended to be the most responsive score. Standardized meaningful difference scores were not significantly different between EQ VAS, EQ-5D index and measures used for comparison.</p> <p>Conclusions</p> <p>The EQ-5D seems to be reasonably valid and moderately responsive in patients with anxiety disorders. The EQ-5D index may be suitable for calculating QALYs in economic evaluation of health care interventions for patients with anxiety disorders.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN15716049</p

The Investigation of Structure Heterogeneous Joint Welds in Pipelines

Welding joints of dissimilar steels don’t withstand design life. One of the important causes of premature destructions can be the acceleration of steel structural degradation due to cyclic mechanical and thermal gradients. Two zones of tube from steel 12H18N9T, exhibiting the structural instability at early stages of the decomposition of a supersaturated solid austenite solution, were subjected to investigation. Methods of x-ray spectral and structure analysis, micro hardnessmetry were applied for the research. Made the following conclusions, inside and outside tube wall surfaces of hazardous zones in welding joint have different technological and resource characteristics. The microhardness very sensitive to changes of metal structure and can be regarded as integral characteristic of strength and ductility. The welding processes are responsible for the further fibering of tube wall structure, they impact to the characteristics of hot-resistance and long-term strength due to development of ring cracks in the welding joint of pipeline. The monitoring of microhardness and structural phase conversions can be used for control by changes of mechanical properties in result of post welding and reductive heat treatment of welding joints

Prevalence and Infant Mortality of Major Congenital Malformations Stratified by Birthweight

Background: Low birthweight and major congenital malformations (MCMs) are key causes of infant mortality. Objectives: The aim of this study was to explore the prevalence of MCMs in infants with low and very low birthweight and analyze the impact of MCMs and birthweight on infant mortality. Methods: We determined prevalence and infant mortality of 28 life-threatening MCMs in very-low-birthweight (75% (10,316) had severe congenital heart disease. The prevalence (per 10,000) of any/cardiac MCM was increased in VLBW (286/176) and LBW (244/143), as compared to NBW infants (38/32). Infant mortality rates were significantly higher in infants with an MCM, as opposed to infants without an MCM, in each birthweight group (VLBW 28.5% vs. 11.5%, LBW 16.7% vs. 0.9%, and NBW 8.6% vs. 0.1%). For most MCMs, observed survival rates in VLBW and LBW infants were lower than expected, as calculated from survival rates of VLBW or LBW infants without an MCM, and NBW infants with an MCM. Conclusions: Infants with an MCM are more often born with LBW or VLBW, as opposed to infants without an MCM. Many MCMs carry significant excess mortality when occurring in VLBW or LBW infants

The course of pain intensity in patients undergoing herniated disc surgery: a 5-year longitudinal observational study

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support