Transit systems in the US and Germany - a comparison

This thesis compares German transit systems to the transit system of Atlanta, Georgia. Different performance measures are used to assess the difference in the respective rail and bus systems. The results show that the German transit systems are overall more successful and efficient than the system in Atlanta.M.S.Committee Chair: Meyer, Michael D.; Committee Member: Amekudzi, Adjo Akpene; Committee Member: Southworth, Fran

Women and men with coronary heart disease in three countries : are they treated differently?

Non-medical determinants of medical decision making were investigated in an international research project in the US, in the UK and in Germany. The key question in this paper is whether and to what extent doctors' diagnostic and therapeutic decisions in coronary heart disease (CHD) are influenced by the patients' gender. A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patient-actors of different sex, age, race and socio-economic status. The videotapes were presented to a randomly selected sample of 128 primary care physicians in each country. Using an interview with standardized and open-ended questions, physicians were asked how they would diagnose and treat such a patient after they had seen the video. Results show gender differences in the diagnostic strategies of the doctors. Women were asked different questions, a CHD was mentioned more often as a possible diagnosis for men than for women, and physicians were less certain about their diagnosis with female patients. Moreover, results indicate that gender differences in management decisions (therapy and lifestyle advice) are less pronounced and less consistent than in diagnostic decisions. Magnitude of gender effect on doctors' decisions varies between countries with smaller influences in the US. Although patients with identical symptoms were presented, primary care doctors’ behavior differed by patients' gender in all three countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men

Does socioeconomic status affect the association of social relationships and health? A moderator analysis

<p>Abstract</p> <p>Background</p> <p>Social relations have repeatedly been found to be an important determinant of health. However, it is unclear whether the association between social relations and health is consistent throughout different status groups. It is likely that health effects of social relations vary in different status groups, as stated in the hypothesis of differential vulnerability. In this analysis we explore whether socioeconomic status (SES) moderates the association between social relations and health.</p> <p>Methods</p> <p>In the baseline examination of the Heinz Nixdorf Recall study, conducted in a dense populated Western German region (N = 4,814, response rate 56%), SES was measured by income and education. Social relations were classified by using both structural as well as functional measures. The Social Integration Index was used as a structural measure, whilst functional aspects were assessed by emotional and instrumental support. Health was indicated by self-rated health (1 item) and a short version of the CES-D scale measuring the frequency of depressive symptoms. Based on logistic regression models we calculated the relative excess risk due to interaction (RERI) which indicates existing moderator effects.</p> <p>Results</p> <p>Our findings show highest odds ratios (ORs) for both poor self-rated health and more frequent depressive symptoms when respondents have a low SES as well as inappropriate social relations. For example, respondents with <it>low income and a low level of social integration </it>have an OR for a high depression score of 2.85 (95% CI 2.32-4.49), compared to an OR of 1.44 (95% CI 1.12-1.86) amongst those with a <it>low income but a high level of social integration </it>and an OR of 1.72 (95% CI 1.45-2.03) amongst respondents with <it>high income but a low level of social integration</it>. As reference group those reporting <it>high income and a high level of social integration </it>were used.</p> <p>Conclusions</p> <p>The analyses indicate that the association of social relations and subjective health differs across SES groups as we find moderating effects of SES. However, results are inconsistent as nearly all RERI scores are positive but do not reach a significant level. Also moderating effects vary between women and men and depending on the indicators of SES and social relations used. Thus, the hypothesis of differential vulnerability can only partially be supported. In terms of practical implications, psychosocial and health interventions aiming towards the enhancement of social relations should especially consider the situation of the socially deprived.</p

Med Care

Abstract Background: As physicians are pressured to deliver an increasing number of preventive services, follow guidelines, engage in evidence-based practice, and deliver patient-centered care in managerially driven organizations, they struggle with how much control they have over their time

Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany

Background The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany. Methods Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions. Results Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice. Conclusion Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process

Socioeconomic status and health among the aged in the United States and Germany: A comparative cross-sectional study

This study investigates socioeconomic status (SES) differences in health among the aged in Germany and the United States. Intra-elderly age differences in the SES-health gradient are also examined. The study uses data from two national telephone surveys conducted in Germany (N=682) and the United States (N=608) using probability samples of non-institutionalised persons 60 years or older. In addition to the traditional indicators of SES (education, income and occupational status), two alternative indicators (assets and home ownership) are utilised. Self-rated health, depression (CES-D) and functional limitations are introduced as health indicators. Results of multiple logistic regression analyses show that income is the best SES predictor of the three health measures among the aged in Germany, whereas education, occupational prestige, assets, and home ownership are not consistently related to health. Respective analyses of the US data demonstrate weaker and less consistent associations of health measures with SES indicators. Consequently, there is a higher percentage of explained variance in health by SES among the aged in Germany compared to the United States. The data also show that social inequalities in health tend to diminish at older ages in the United States, but such disparities vary only slightly by age in Germany. In conclusion, although SES health differences are observed among the elderly in both countries, they are more pronounced in Germany than in the United States where effects are restricted to younger old age. One interpretation of this finding points to higher selective mortality of middle and early old age groups with a low SES in the United States due to stronger health-related deprivation.Socioeconomic status Health Elderly population United States Germany Comparative cross-sectional study