Gesundheitswesen最新文献

Periods of heat lead to increased mortality and morbidity. The aim of the present study was to investigate whether a trend of rescue deployments on heat days (Tmax≥32°C) from 2014 to 2024 is recognizable, whether morbidity already increases at lower temperatures (Tmax≥30°C or≥28°C) and whether an exposure-response curve is recognizable - for all patients and separately for different age groups.All 250,507 deployments from June to August 2014-2024 in Frankfurt am Main and weather data from the German meteorological Service at the Frankfurt weather station were used for the study. For each year, the deployments on heat days were compared with those on non-heat days (difference and ratio). Using the pairs of values (year, additional number of rescue missions on heat days with Tmax≥32°C), a linear regression model was adapted for the years 2014 to 2024 and the trend in the additional number of missions per year was estimated. Additional analyses were carried out for Tmax≥30°C and≥28°C. For the calculation of the exposure-response curve, the exposures over all years were calculated according to daily Tmax in 2°C steps, with Tmax<18°C as reference. These analyses were carried out for all patients and for age groups up to 59 years, 60-79 years and 80 years and older.Between 2014 and 2024, the additional deployments on heat days with Tmax≥32°C decreased significantly from+25 in 2014 to - 6.6 in 2024 (- 2.9; 95% CI - 3.5 - - 2.4). Overall, 6.2% (ratio=1.062 (95% CI: 1.050-1.075)) more deployments were required on heat days with Tmax≥32°C than on days without this definition, comparable to days with Tmax≥30°C (+6.3%; ratio=1.063 (95% CI: 1.053-1.073)), or≥28°C (+6.1%; ratio=1.061 (95% CI: 1.052-1.069)). The largest increase was seen in patients under 60 years of age, The dose-response curve showed a linear increase of 27% in those under 60 and 16% in those over 80, with the latter reaching a plateau at Tmax 28°C and above.The decreasing additional need for deployments at Tmax≥32°C could indicate an adaptation of the population, but requires further investigation. Morbidity already increases on days with lower Tmax. As people≤60 y are particularly affected, prevention measures should be strengthened and extended to younger, working people.

Introduction: Climate change is the greatest threat to human health in the 21^st century. Climate change poses a significant threat to human health in Germany, with increasing heatwaves causing high mortality rates. In recent years, the German medical profession has become increasingly concerned with the consequences of climate change, particularly extreme temperatures and heat, for human health.

Suggestions: Although the Deutscher Wetterdienst (DWD) issues heat warnings, there is a lack of comprehensive heat action plans (HAPs). Initiatives such as the "Berlin Heat Protection Action Alliance" offer sector-specific plans for healthcare facilities. There is an urgent need for action in the healthcare sector, as doctors play a key role in implementing heat protection measures and advocating for action against climate change. In addition to initiatives such as signing the "Climate Pact for Health" and raising awareness among stakeholders in the healthcare sector, increased education about heat-related health risks is essential.

Conclusion: The results emphasise the urgency of measures in the healthcare sector in the face of advancing climate change. The medical profession plays a key role in the implementation of heat protection measures and should be actively involved in the planning and implementation of HAPs. Education and training on heat and health is essential in the health sector. Registration for heat warnings from the DWD (www.hitzewarnungen.de) is recommended, followed by sensitisation of decision-makers and employees in healthcare facilities. The medical profession has a crucial responsibility in the implementation of heat protection measures and should actively position itself and contribute to the political discussion on heat and climate change.

Changes at German universities, such as an increasing workload and a shift towards competition, require investments in health promotion. University Health Management (UHM) aims to support the development of a health-promoting setting. While conceptual considerations emphasize promising success factors for UHM, empirical studies are lacking. The aim of this qualitative study is therefore to identify facilitators and barriers to the implementation of UHM from the perspective of experts.We interviewed 26 experts in guideline-based interviews regarding facilitators and barriers to implementing UHM. Data were analysed using content-analytical methods following Kuckartz, assisted by MAXQDA 2020 software.We identified eight factors that can be both supportive and inhibiting in the implementation of UHM: university leadership, health as a topic within universities, networks, collaboration and exchange, structural organization, target groups, financial resources, collaboration with health insurance providers, and state university laws. Additionally, individual supporting factors, such as adherence to guidelines for a healthy university, or barriers, such as a heterogeneous understanding of UHM and time constraints, influence the implementation.Various facilitators and barriers can be found when introducing UHM. These factors need to be considered within the diverse structures, historical backgrounds, and sizes of universities. Thus, there is no universal blueprint for the development and implementation of UHM. A uniform understanding of UHM and the integration of health into state-level university seem fundamental for the successful implementation of UHM.

Despite efforts towards intercultural opening in all health sectors, the care of people with (flight) migration histories remains inadequate. The aim of the study was to explore how healthcare professionals deal with language barriers while treating patients in hospital and general practitioners' offices in Baden-Württemberg.Guideline-based expert interviews were conducted with six general practitioners, six physicians working in an emergency department and four representatives of migrant self-organisations and evaluated using thematic analysis. Results of a concurrently conducted structured online survey in various hospital care departments were embedded into the dominant qualitative analysis.All interviewees reported that the language barrier was the main problem in the care of people with a (refugee) migration history. Trained language mediation was rarely used. Lay interpreters, lists of staff with non-German language skills and translation apps were common compromise solutions, but they harbour various pitfalls. As a result, employees described poorer access and a lower quality of treatment for people with a (refugee) migration history. For employees themselves, this could lead to excessive demands and borderline legal situations. The respondents preferred to see low-threshold language mediation services and rely on the recruitment of foreign specialists. The online survey supported the descriptions of the expert interviews. In rural compared to urban areas, professional language mediation was more rarely implemented.The results suggest a need for clear financial and structural regulation of professional language mediation in order to ensure adequate care for population groups without sufficient knowledge of German and to relieve the burden on employees.

The primary care prevention program INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg) is intended to prevent stroke and dementia through systematic detection and evidence-based treatment of modifiable vascular risk factors. The study reports on the results of an eight-year evaluation phase.Longitudinal study with non-randomized control group. AOK-insured patients over the age of 50 from the Bavarian district of Ebersberg were invited to participate in the project. The control group consisted of AOK-insured individuals of the same age-group from the district of Dachau. Primary clinical endpoints (mortality and long-term care dependency) and secondary endpoints (inpatient treatment due to cerebrovascular diseases) were based on the administrative data from the AOK. Analyses were carried out according to the principle "intention to treat".The intervention group (n=10,663) included 39.7% of insured persons who had enrolled in the program. Significant advantages were observed in the intervention group compared to the control group (n=13,225). Mortality was reduced by 6%, the incidence of long-term care by 10% and the prevalence of long-term care by 18.6%. There were about 190 fewer deaths and 260 fewer new cases of long-term care dependency than expected over a period of eight years. The prevalence of care dependency decreased by 1,600 years. The frequency of hospital treatment for cerebrovascular diseases, however, did not differ between the groups.Our results suggest that a real-life practice-based prevention program aimed at better control of vascular risk factors can possibly contribute to a reduction of care dependency and an increase in life expectancy.