Inequalities in therapeutic treatment during cardiac inpatient rehabilitation in Germany

Objective Cardiac patients of low socio-economic status (SES) display low health status and increased need for rehabilitation. This study’s objective was to examine whether and to what extent inequalities in the provision of rehabilitative health care occur in Germany. Methods We conducted an observational study with two points of measurement on 543 patients in cardiac inpatient rehabilitation. We used logistic regression and analysis of covariance to explore whether patients experience unequal therapeutic rehabilitative treatment. Results Patients of low SES were less frequently physically active, more likely to smoke and displayed a higher number of physical and psychological symptoms when entering rehabilitation. They were less likely to receive a number of therapies with differences being significant for core therapies of cardiovascular rehabilitation. Patients of higher SES received fewer hours of dietary counselling on average. Conclusions While the latter difference might be in line with the needs of different socio-economic groups, most differences are unlikely to be tailored to patients’ needs. Potential causes of inequalities in service provision like structural factors and aspects of the doctor–patient encounter should be further investigated

Forschen mit und für Communities - Wissenschaft diversitätssensibel gestalten

Im vorliegenden Kapitel werden Besonderheiten, Herausforderungen und Spannungsfelder hinsichtlich der Gestaltung von Community-Health-Forschung beleuchtet und methodische Herangehensweisen reflektiert. Die zentrale Frage lautet hierbei, wie eine Kohärenz zwischen dem Anspruch und den Leitkonzepten von Community Health (vgl. den Beitrag zu Leitkonzepten) und der Umsetzung wissenschaftlicher Forschung gelingen kann - angefangen bei der Identifikation von Forschungsbedarfen und der Formulierung von Fragestellungen, über die Gestaltung von Forschungsbeziehungen, die Wahl der Methoden, die Analyse und Interpretation der Daten bis hin zur Nutzung und Veröffentlichung der Erkenntnisse. Es ist nicht der Anspruch dieses Beitrags, einen umfassenden Blick über Methoden zu geben; hierfür sei verwiesen auf die einschlägige Literatur zur Community-Health-Forschung. Vielmehr möchten wir zur Reflexion darüber anregen, welche Aspekte bei der Gestaltung des Forschungsprozesses zu bedenken sind, sowie zwei exemplarische methodische Ansätze vorstellen. Nicht zuletzt möchten wir dazu einladen, bewährte methodische Rezepte den Anforderungen des jeweiligen Forschungsgegenstands anzupassen und sie mutig weiterzuentwickeln.In the present chapter, special features, challenges and areas of tension with regard to the design of community health research are highlighted, and methodological approaches are reflected. The central question is how a coherence between the claim and the guiding concepts of community health (cf. the contribution on guiding concepts) and the implementation of scientific research can be achieved - starting with the identification of research needs and the formulation of questions, through the creation of research relationships, the choice of methods, the analysis and interpretation of data to the use and publication of findings. This contribution does not aim to provide a comprehensive overview of methods; for this purpose, we would like to refer to the relevant literature on community health research. Rather, we would like to encourage reflection on which aspects need to be considered when designing the research process, and present two exemplary methodological approaches. Last but not least, we would like to invite the reader to adapt well-established methodological recipes to the requirements of the respective research object, and to courageously develop them further

Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with substantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated in a nationwide multicentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the original data used for allocation and graft acceptance. Methods. A nationwide deidentified multicenter study-database was created of data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ procurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance level 5%, hazard ratio [95% CI]) was conducted (n=4411, isolated KTX). Results. Risk factors associated with graft-survival were donor age (1.020 [1.013–1.027] per year), donor size (0.985 [0.977–0.993] per cm), donor’s creatinine at admission (1.002 [1.001–1.004] per µmol/L), donor treatment with catecholamine (0.757 [0.635–0.901]), and reduced graft-quality at procurement (1.549 [1.217–1.973]), as well as recipient age (1.012 [1.003–1.021] per year), actual panel reactive antibodies (1.007 [1.002–1.011] per percent), retransplantation (1.850 [1.484–2.306]), recipient’s cardiovascular comorbidity (1.436 [1.212–1.701]), and use of IL2-receptor antibodies for induction (0.741 [0.619–0.887]). Conclusion. Some donor characteristics persist to impact graft-survival (e.g., age) while the effect of others could be mitigated by elaborate donor-recipient match and care

Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007

Reeske A, Kutschmann M, Razum O, Spallek J. Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007. BMC Pregnancy and Childbirth. 2011;11(1): 63.Background: Stillbirth is a sensitive indicator for access to, and quality of health care and social services in a society. If a particular population group e. g. migrants experiences higher rates of stillbirth, this might be an indication of social deprivation or barriers to health care. This study examines differences in risk of stillbirth for women of different regions of origin compared to women from Germany in order to identify high risk groups/target groups for prevention strategies. Methods: We used the BQS dataset routinely compiled to examine perinatal outcomes in Germany nationwide. Participation of hospitals and completeness of data has been about 98% in recent years. Data on all live births and stillbirths were obtained for the period 2004 to 2007 (N = 2,670,048). We calculated crude and stratified mortality rates as well as corresponding relative mortality risks. Results: A significantly elevated stillbirth rate was found for women from the Middle East and North Africa (incl. Turkey) (RR 1.34, CI 1.22-1.55). The risk was slightly attenuated for low SES. An elevated risk was also found for women from Asia (RR 1.18, CI 1.02-1.65) and from Mediterranean countries (RR 1.14, CI 0.93-1.28). No considerable differences either in use and timing of antenatal care or preterm birth and low birthweight were observed between migrant and non-migrant women. After stratification for light for gestational age, the relative risk of stillbirth for women from the Middle East/North Africa increased to 1.63 (95% CI 1.25-2.13). When adjusted for preterm births with low birthweight, women from Eastern Europe and the Middle East/North Africa experienced a 26% (43%) higher risk compared with women from Germany. Conclusions: We found differences in risk of stillbirth among women from Middle East/North Africa, especially in association with low SES and low birthweight for gestational age. Our findings suggest a need for developing and evaluating socially and culturally sensitive health promotion and prevention programmes for this group. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with migrant backgrounds

Methodological considerations concerning the development of oral dental erosion indexes: literature survey, validity and reliability

Within the context of preventing non-communicable diseases, the World Health Report (2002) and the WHO Global Oral Health Program (2003) put forward a new strategy of disease prevention and health promotion. Greater emphasis is placed on developing global policies in oral health promotion and oral disease prevention. The Decayed, Missing, Filled Teeth (DMFT) index does not meet new challenges in the field of oral health. Dental erosion seems to be a growing problem, and in some countries, an increase in erosion of teeth is associated with an increase in the consumption of beverages containing acids. Therefore, within a revision of the WHO Oral Health Surveys Basic Methods, new oral disease patterns, e.g. dental erosion, have to be taken into account. Within the last 20 years, many studies on dental erosion have been carried out and published. There has been a rapid growth in the number of indexes quantifying dental erosion process in different age groups. However, these indexes are not comparable. This article discusses quality criteria which an index intended for assessing tooth erosion should possess

Forschen mit und für Communities : Wissenschaft diversitätssensibel gestalten

Im vorliegenden Kapitel werden Besonderheiten, Herausforderungen und Spannungsfelder hinsichtlich der Gestaltung von Community-Health-Forschung beleuchtet und methodische Herangehensweisen reflektiert. Die zentrale Frage lautet hierbei, wie eine Kohärenz zwischen dem Anspruch und den Leitkonzepten von Community Health (vgl. den Beitrag zu Leitkonzepten) und der Umsetzung wissenschaftlicher Forschung gelingen kann – angefangen bei der Identifikation von Forschungsbedarfen und der Formulierung von Fragestellungen, über die Gestaltung von Forschungsbeziehungen, die Wahl der Methoden, die Analyse und Interpretation der Daten bis hin zur Nutzung und Veröffentlichung der Erkenntnisse. Es ist nicht der Anspruch dieses Beitrags, einen umfassenden Blick über Methoden zu geben; hierfür sei verwiesen auf die einschlägige Literatur zur Community-Health-Forschung. Vielmehr möchten wir zur Reflexion darüber anregen, welche Aspekte bei der Gestaltung des Forschungsprozesses zu bedenken sind, sowie zwei exemplarische methodische Ansätze vorstellen. Nicht zuletzt möchten wir dazu einladen, bewährte methodische Rezepte den Anforderungen des jeweiligen Forschungsgegenstands anzupassen und sie mutig weiterzuentwickeln.In the present chapter, special features, challenges and areas of tension with regard to the design of community health research are highlighted, and methodological approaches are reflected. The central question is how a coherence between the claim and the guiding concepts of community health (cf. the contribution on guiding concepts) and the implementation of scientific research can be achieved – starting with the identification of research needs and the formulation of questions, through the creation of research relationships, the choice of methods, the analysis and interpretation of data to the use and publication of findings. This contribution does not aim to provide a comprehensive overview of methods; for this purpose, we would like to refer to the relevant literature on community health research. Rather, we would like to encourage reflection on which aspects need to be considered when designing the research process, and present two exemplary methodological approaches. Last but not least, we would like to invite the reader to adapt well-established methodological recipes to the requirements of the respective research object, and to courageously develop them further.AlternativeReviewe