Diabetes adherence - does gender matter?

Aim: This paper aims to unobtrusively identify gender patterns in diabetics' adherence to their medication regimen. Subjects and methods: Non-adherence is a major problem in health care as it affects both the patient’s individual health as well as public health. Seen worldwide, the problem of non-adherence is even more important due to the increasing numbers of the elderly population and of chronic diseases such as diabetes, asthma, HIV, etc. It is estimated that in Germany alone, non-adherence is responsible for costs of €10 billion per year. Finding useful health behaviour patterns could be especially important for the increasing number of patients with chronic diseases such as diabetes, where costs are high and consequences such as retino-, nephro- and neuropathy severe for 180 million diabetics worldwide. This paper analyses the records of two German pharmacies, P1 and P2, regarding gender patterns in adherence to oral antidiabetics as this analysis method has a high specificity. Out of 4,474 (P1) respectively 2,650 (P2) datasets, those were selected that showed the use of medication with oral drugs for diabetes based on ATC code level A10B. The selected medication datasets were fully analysed, also the respective adherence rate for drugs used for hypertension, ATC code level C. Results: Average adherence rates for oral antidiabetic agents varied, with 25.4% (P1 women) and 34.6% (P1 men), and 27.8% (P2 women) and 26.1% (P2 men). In contrast, average adherence rates with drugs for the cardiovascular system were high, with 73.4% (P1 women) and 74.2% (P1 men), and 57.0% (P2 women) and 70.2% (P2 men). Conclusion: Adherence rates for oral antidiabetic agents showed no gender patterns. This finding is supported by varying adherence rates for medication for hypertension. In both cases, the chi-square test showed no significant correlation between gender and adherence classification, and also Cramer’s V only showed a small effect of gender on adherence behaviour

Entsolidarisierung von Führungsverhalten und mögliche Auswirkungen auf die Gesundheit

"In Heft 3/2005 von 'Industrielle Beziehungen' diskutieren Auer-Rizzi et al. (2005) Symptome der Umsolidarisierung von Governance-Strukturen und Führungsverhalten in Deutschland und Österreich. Neben den dort vermuteten Entwicklungen, wie Abnahme der Partizipation, Abnahme der Identifikation etc., zeigt ihre Diskussion eine verblüffende Ähnlichkeit mit gesundheitswissenschaftlichen Langzeitstudien, etwa mit der so genannten Roseto Story. In dem Beitrag wird die mögliche Beziehung zwischen entsolidarisierten Machtstrukturen und der Gesundheit untersucht. Obwohl immer mehr Unternehmen in Gesundheitsmanagementsysteme investieren, ist ein sich verschlechternder Gesundheitszustand zu erwarten, insbesondere dann, wenn sich die Entwicklung in Richtung Egoismus, autokratischem Führungsverhalten und abnehmender sozialer Kompetenz der Führungskräfte fortsetzt." (Autorenreferat)"Auer-Rizzi et al. outline a decrease in the solidarity of governance structures and leadership behaviour in Germane and Austria. An Americanization of values appears to be taking place, 'both in the national/ systems level and at corporate level' (Auer-Rizzi et al. 2005: 231). Beneath the anticipated decline in participation, identification, etc., their results reveal a remarkable similarin with epidemiological health studies, especially the so-called Roseto Story. The present article conceptually investigates the possible relationship between de-solidarized governance structures and health. Although more and more companies are investing in health promotion programs for their employees, a weakened health status can be expected; especially if the trend towards egoism, autocratic leadership behavior and declining social competence regarding governance systems continues." (author's abstract

Improving employee well-being through worksite health promotion? The employees' perspective

Aim: The aim of the present study was to investigate the potential of worksite health promotion to improve individual well-being from the employees' perspective, analyze benefit categories and develop suggestions for future worksite health promotion program designs. Subjects and methods: A questionnaire based on a qualitative study was distributed in four Austrian organizations to cover state-owned, private, and non-profit organizations. A total of 237 white-collar employees participated in the survey. Results: Workplace health promotion does improve individual well-being from the employees' perspective. A factor analysis of the changes in well-being reported yields a three-factor solution with a physical/ cognitive element, a social component, and an emotional factor. In the sample tested, the physical-cognitive and emotional elements of perceived benefits were felt the most. Conclusion: The current theoretical grouping of potential WHP effects requires further testing and might profit from being differentiated into more categories. Research on WHP could gain from a consideration of the employee's perspective by showing which program elements to focus on. Strengthening the emotional components of WHP information and program elements is proposed for increasing participation rates and the subsequent individual benefits derived

Health-related quality of life of family caregivers - evidence from Hesse

Aim: The aim of this study was to analyse the health-related quality of life (HRQOL) of primary family caregivers in comparison to the reference values of the average population. Subjects and methods: Data collection took place in the Werra-Meißner district in 2009 with a response rate of 102 primary family caregivers of frail elderly people. The health-related quality of life was measured with the Short Form 36 health survey (SF 36) and compared with the German reference values. Results: Compared to the health values of the normative sample, primary caregivers show significantly lower rates in all dimensions of health-related quality of life. In particular, caregivers between the ages of 53 to 61 report extremely low health values. Caregiving women compared to non-caregiving women have highly significant differences in all subscales of the SF 36. Caregiving men also report highly significant differences to non-caregiving men in all dimensions of the SF 36 except for Physical Functioning and General Health (p < 0.01). Caregivers in general and especially caregiving women aged 53 to 61 (midlife) were identified as at-risk groups for poor health. The latter report lower vitality and well-being, which may be a consequence of both social isolation and social impacts from multiple role demands. Conclusion: The identified high-risk groups of family caregivers, caregivers in midlife and especially caregiving women in midlife, should be supported by social measures, e.g., training courses for family caregivers, particularly in their home setting, and various types of respite care in order to sustain their health

Behaviour in therapeutic medical care: evidence from general practitioners in Austria

Aim: The present study examines monetary effects of general practioners’ behaviour in therapeutic medical care to identify sample characteristics that allow differentiating between the individual general practitioner and the basic population. Subjects and methods: Medical services, provided by 3,919 general practitioners in Austria, were operationalized by means of the dependent variable “costs per patient”. Statistical outliers were identified using Chebyshev’s inequality and categorized by investigating bivariate correlations between the dependent variable and the personal characteristics of each physician. Results: Variables that relate to the size of the customer base such as number of consultations (r = 0.385) and office days (r = 0.376), correlate positively with the costs for medical services. By analyzing the portfolio of the general practitioners, we found a correlation of 0.451 between this coefficient and the costs. Statistical outliers feature an average portfolio of 44.5 different services, compared to 30.45 among non-outliers. Laboratory services especially were identified as cost drivers (r = 0.408). Statistical outliers generate at least one laboratory parameter for 44.34% of their patients, opposed to 27.2% within the rest of the sample. Consequently outliers produce higher laboratory costs than their counterparts. Conclusion: We found some evidence that physicians have influence in the provision of their services. Considering entrepreneurial objectives, the extension of the portfolio can increase their profit. Our findings indicate supplier-induced demand for several groups of services. We assume that the effect is consolidated by the fee for service system and could be compensated by adequate reform

The relationship between glucose and the liver-alpha cell axis – A systematic review

Until recently, glucagon was considered a mere antagonist to insulin, protecting the body from hypoglycemia. This notion changed with the discovery of the liver-alpha cell axis (LACA) as a feedback loop. The LACA describes how glucagon secretion and pancreatic alpha cell proliferation are stimulated by circulating amino acids. Glucagon in turn leads to an upregulation of amino acid metabolism and ureagenesis in the liver. Several increasingly common diseases (e.g., non-alcoholic fatty liver disease, type 2 diabetes, obesity) disrupt this feedback loop. It is important for clinicians and researchers alike to understand the liver-alpha cell axis and the metabolic sequelae of these diseases. While most of previous studies have focused on fasting concentrations of glucagon and amino acids, there is limited knowledge of their dynamics after glucose administration. The authors of this systematic review applied PRISMA guidelines and conducted PubMed searches to provide results of 8078 articles (screened and if relevant, studied in full). This systematic review aims to provide better insight into the LACA and its mediators (amino acids and glucagon), focusing on the relationship between glucose and the LACA in adult and pediatric subjects

COVID-19 in Multimorbid Patients—A Controlled Microcost Description Analysis of Diagnosis Related Group (DRG)-Case Series in Acute Care without Non-Invasive Ventilation

Diagnosis-related cost analyzes are important for health economic planning and decision-making. They form the basis for further developing of remuneration systems for health services. The rapid increase in hospital stays by COVID-19 patients requires a valid and exact calculation of the treatment costs. COVID-19 patients with many accompanying illnesses increase the requirements for a cost calculation. The focus of this work is to carry out a DRG-related micro-cost analysis, considering the age, length of stay and comorbidities of COVID-19 patients. So far, there is little information about treatment costs for multimorbid patients with COVID-19 who have not received invasive ventilation. The method is based on a standardized cost unit calculation for determining the treatment costs in a German hospital. The costs (€) of inpatients treated with COVID-19 were compared with a control group of the same DRGs of patients without COVID-19. The average total costs for inpatient treatment were €2866. The highest share of costs falls on nursing, personnel, and material costs of the non-medical infrastructure. Frequent comorbidities were heart failure, diabetes mellitus, other respiratory diseases, dizziness, and impairment of the musculoskeletal system

Applied Change Management in Interventional Radiology&mdash;Implementation of Percutaneous Thermal Ablation as an Additional Therapeutic Method for Small Renal Masses

Interventional radiology (IR) has the potential to offer minimally invasive therapy. With this potential, new and arising IR methods may sometimes be in competition with established therapies. To introduce new methods, transformational processes are necessary. In organizations, structured methods of change management, such as the eight-step process of Kotter&mdash;(1) Establishing a sense of urgency, (2) Creating the guiding coalition, (3) Developing a vision and strategy, (4) Communicating the change vision, (5) Empowering employees for broad-based action, (6) Generating short-term wins, (7) Consolidating gains and producing more change, and (8) Anchoring new approaches in the culture&mdash;are applied based on considerable evidence. In this article, the application of Kotter&rsquo;s model in the clinical context is shown through the structured transformational process of the organizational implementation of the percutaneous thermal ablation of small renal masses. This article is intended to familiarize readers in the medical field with the methods of structured transformational processes applicable to the clinical setting

COVID-19 Patient with Severe Comorbidity in Multimodal Acute Care Setting with Non-Invasive Medical Ventilation: A Clinical Outcome Report

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, depression, and other comorbidities in an isolation ward without mechanical ventilation