Gesundheitswesen最新文献

The present study examines the relationship between the burnout dimension emotional exhaustion and subsequent events of work nonparticipation (long-term sickness absence, unemployment, early retirement) and their duration.The data basis was the Study on Mental Health at Work (S-MGA); a follow-up study based on a random sample of n=4511 employees subject to social security contributions aged 31-60 years at baseline and their follow-up after 5 years (n=2460). Burnout symptoms were measured at the time of the baseline survey by means of a questionnaire, while the employment and sickness absence history was recorded at follow-up by means of an interview. Associations between the burnout scale at T1 and subsequent events of inactivity were analysed using a two-part model: i. e., events were predicted using logistic regression, and their duration was predicted using generalised linear regression models (GLM).The burnout scale was associated with the events and duration of long-term sickness absence; among men with an odds ratio [OR]=1.72 (95% CI=1.31; 2.27) and among women with an OR=2.23 (95% CI=1.73; 2.88) per scale point for the occurrence of an event. Among those who experienced long-term sickness absence, the duration (in months) increased by a factor of Exp(β)=1.44 (95% CI=1.23; 1.69) for men and Exp(β)=1.29 (95% CI=1.09; 1.52) for women for each scale point on the burnout scale.From a clinical and health economic point of view, it is a relevant finding that the burnout dimension of emotional exhaustion is associated with events and duration of work nonparticipation.

The number of patients with invasive home mechanical ventilation (IHMV) in Germany is vastly increasing. Currently, only limited data is available on the characteristics of these patients. The aim of the present study was to describe the health care situation of IHMV patients living in Bavaria using routinely collected data within the project OVER BEAS.The routine data were derived from the care assessment of the Medical Service (MD) in Bavaria (years 2017-2020). In this dataset, IHMV patients were identified using specific filter variables. Patients were analysed regarding sociodemographic characteristics, diagnosis, mobility, therapeutic measures, and need for care.The dataset comprised 536 adult IHMV patients (34.5% female, median age 68, IQR 58 75); 13.1% lived in nursing homes (NH), 22.2% in home care (HC), and 64.2% in shared living communities (SLC). From 2017 to 2020 a trend in proportionally more patients living in SLC was observed. Differences between the living situations were seen in the frequency of physical (NH 91.4%; HC 76.5%; SLC 90.4%; p<0.001) and occupational therapy (NH 47.1%, HC 58.8%, SLC 69.8%, p<0.001). 69.4% of IHMV patients were classified as having the highest need for care.The routine data from the MD Bavaria could be successfully used to describe the characteristics of patients in the highly complex setting of IHMV. In order to facilitate regular monitoring of the care situation, it would be advantageous to implement more precise recording of IHMV in routine data.

Assessments in the German Public Health Service take place, among other things, in the recruitment and incapacity assessment of civil servants. This may lead to conflicts of values and norms for assessing doctors, as they have to make decisions that are not necessarily in the interests of the person being assessed. Legally, the expectations of assessing doctors in public administration are largely defined. For public health service physicians, individual normative role conflicts still appear, and questions arise as to whether conscientious decisions of physicians adhere to legal requirements.

Compared to the general population, individuals with Down syndrome carry a much higher genetic risk of developing early onset Alzheimer's dementia. This leads to unique challenges and the need for a targeted patient journey.In a qualitative interview study with medical professionals, patient organisations and formal and informal care persons, we assessed barriers within the medical care process of this patient group as well as current approaches to overcome these problems. The study is one module of a multi-method project founded by the Innovation Fund of the German Joint Commission. The results presented here focus on access to and transitions within the medical care process. 14 guided interviews were conducted by a team of moderators by video conference, recorded and transcribed. The analysis of the results was carried out as a qualitative content analysis based on the methods of Mayring.Given the varying degree of premorbid intellectual disability, difficulties recognizing dementia symptoms were reported leading to delays in initiating the diagnostic process. Limited knowledge of the special disease risk and symptom manifestation in routine medical care as well as the lack of specialized medical institutions were identified as additional hurdles. Insufficient dissemination of information about existing specialised institutions to regular physicians and caregivers was criticized. All stakeholder groups drew attention to limitations in access to occupational and speech therapy because of the inadequate number of specialized therapists. Improvements suggested by the interview partners focussed on topics such as the implementation of guidance of the patient journey to and within the medical care process by one institution, easily accessible information for patients and caregivers as well as optimised training for physicians in routine care.Barriers such as insufficient availability of specialised service providers and information deficits about the specific disease risks and symptoms of the population have also been identified in international literatur; in addition, management and coordination deficits in the fragmented German health care system represent well known additional barriers. Approaches to improve the situation can be seen, on the one hand, in improved information and training offers for caregivers and service providers, and, on the other hand, in the expansion of the range of specialized service providers, in particular the Medical Centres for Adults with Disabilities. Informed by these study results and the results of other project modules, health policy recommendations for the improvement of the patient journey of patients with Down syndrome and dementia will be developed in the last project module.

Background: There is limited data on the number and distribution of academically qualified professionals in the field of Public Health at the lower level of health authorities. The aim of this study was to analyze the distribution of Public Health Professionals in Public Health Authorities in Germany.

Method: An online survey was conducted with the directors of the 376 German Public Health Authorities regarding the presence of Public Health Professionals and their views on personnel needs. The term Public Health Professionals was operationalized. The survey took place starting in 06/2023 over a period of 14 weeks. The results were descriptively analyzed.

Results: The participation rate in the survey was 40.4% (n=152). On average, the participating Public Health Authorities employed 2.6 (SD 3.85, MD 2) Public Health Professionals. 28.3% (n=43) of directors reported not employing any Public Health Professionals. 78.3% (n=119) of the leadership reported needing more staff. Additionally, 65.1% (n=99) expressed the need for more personnel with a degree or those with additional training in the field of Public Health.

Conclusion: Personnel from the field of Public Health are not yet represented in all Public Health Authorities in Germany. Both the distribution of Public Health Professionals in the participating Public Health Authorities and the views of the department heads regarding the needs of this professional group in their own Public Health Authorities are heterogeneous. In summary, there is a clear need to strengthen collaboration between academic Public Health Professionals and the Public Health Authorities.

Introduction: Deployments abroad pose an occupational risk for mental disorders and reduced quality of life among military personnel. This study examines the question of whether a relevant predictor for the frequency of mental disorders after deployments abroad can be found. It is postulated that soldiers who experience a military-specific critical event develop more symptoms and their quality of life decreases.

Methods: This study included n=370 combat troops deployed to Afghanistan as part of the International Security Assistance Force (ISAF) operation. Using questionnaires, data on psychological symptoms and quality of life were collected before and after deployment. The discriminator was whether a critical military-specific event, defined as a type A criterion of PTSD according to ICD-10 (F43.1), was experienced during the deployment.

Results: It was shown that soldiers who experienced a critical event (n=81; 21.9%) developed significantly more depressive, somatic and stress symptoms. When evaluating the questionnaires on the quality of life, significant deteriorations were found in all areas, apart from environmental quality of life. In the study group without a critical event, there were significant improvements in stress experience and environmental quality of life after deployment. When the entire group was included, a time x group interaction effect was found with deterioration in soldiers with critical events in all of the above-mentioned areas, apart from the environmental quality of life.

Conclusion: In summary, it can be postulated that critical events during a deployment abroad have a significant impact on the mental health and quality of life of soldiers. This can be used for more specific pre- and post-operation measures as well as for de-stigmatization programs.