Gesundheitswesen最新文献

Background: Infection with SARS-CoV-2 can lead to health impairments lasting over several months, the so-called Post-COVID syndrome (PCS). In order to better understand and assess the regional care situation with the acute COVID-19-disease/PCS, possible consequences of illness and current needs, a survey was conducted among the population of the Hanseatic City of Lübeck. The survey also analysed the distribution of PCS and the burden of disease in the sample.

Methods: Cross-sectional survey between September and November 2023 in the Hanseatic City of Lübeck using an online survey. Individuals over 18 years of age who were registered with the Lübeck residents' registration office and who had been infected with SARS-CoV-2 at least once in the past were included. Questions were asked about the number of SARS-CoV-2 infections, the last illness, vaccinations and medical services used. Quality of life, impairment of participation, comorbidity and socio-demographic data were also recorded. The presence of PCS was assessed using self-report (yes/no) and a symptom-based scale (PCS score). Treatment preferences were also collected.

Results: After checking the inclusion criteria, questionnaire data were available from 619 people; 66.2% of respondents were female and the mean age was 47 years. Most people had last contracted SARS-CoV-2 in 2022 and 2023. 54% (N=332) of respondents considered themselves to have PCS and reported more symptoms (6 vs. 2; p<0.01), higher participation limitations (39.9 vs. 7.2; p<0.01) and poorer quality of life (45 vs. 70; p<0.01) than people who did not consider themselves to have PCS. Medical services related to SARS-CoV-2 infection/PCS were used statistically significantly more by people with PCS. However, only 2.4% of people with PCS were satisfied with their current care situation. A number of wishes were expressed, such as better information from physicians (70%) or a website (67%) with information on regional care services for PCS.

Conclusion: People with PCS reported a high burden of disease and were affected by a range of symptoms at the time of the survey. The degree of restrictions in light of the wishes suggest that medical and therapeutic care should be optimised for those affected and that awareness and networking among practitioners should be strengthened.

Background: Knowledge of the epidemiology of illnesses at music festivals is limited. Music festivals challenge the medical staff and local communities providing healthcare services to the guests. Objective The aim of this study was to identify and compare reasons for medical treatment of visitors at festivals, PPTT (patients per ten thousand), TTRH (transport to hospital rates) and the time of day when treatment was carried out at one of the largest free-of-charge outdoor music festivals in Europe from 2017 to 2022. The goal was to identify the characteristics of such events.

Methods: The retrospective study used data from the medical documentation provided by the organizer of the "Pol'and Rock" festival in Poland. The correlations between PPTT, TTHR, visitor count, patient count, and time of day were examined. Important features in the organization of medical support were described.

Results: There had been 1.48 million visitors at the festival since 2017 to 2022, and 6,719 needed medical care. There were two peaks in patient count, one from 12-2 pm and another from 8-10 pm (p<0.0001). The median PPTH was 45, and the median TTRH was 0.0638.

Conclusion: There is no significant correlation between PPTT, TTRH, and the number of visitors during the study period at the events. The time of day has a significant impact on patient count. Long transportation distances from the festival grounds to the nearest hospital make it important to provide on-site high-quality care. Further investigations on the epidemiology of music festivals are necessary.

Aim of the study: Summarising the formal and substantive enrolment practice of school entry examinations (SEU) in the German Democratic Republic (GDR).

Methods: Through a systematic literature review using a conventional as well as internet-based sources, specialised literature on specific topics and original documents were made available following selected search terms to capture essential characteristics of SEU in the GDR and to present them in a general context.

Results: In the GDR, regular school enrolment took place at the age of 6, although SEU implementation practice during the 1950s and 1960s was fundamentally inconsistent in terms of form and content. On the basis of mandatory annual screening examinations for children, the medical screening examination at pre-school age of 5-6 years was formally valid as a SEU. On a case-by-case basis, the responsible paediatricians carried out supplementary, but non-standardised developmental tests. From the 1970s onwards, the increasing density of kindergarten in the GDR led to their specialist staff getting more involved in the assessment of pre-school children's competences relevant to schooling. In addition, screening at the age of 4-5 years also became more relevant for developmental diagnostic purposes. While various examination procedures were initially used, a standardised inventory of instruments for assessing learning ability, intellectual development and language development gradually emerged during the 1970s. These two staggered SEUs between the age of 4 and 6 years enabled preschool children to be supported if necessary, so that children with developmental delays could be given adequate developmental and educational opportunities. This concept also enabled an intensifying, partly informal cooperation between the specialist staff in the kindergartens, paediatricians, parents and school headmasters.

Conclusion: Overall, the SEU in the GDR was based on a professionally and a well thought-out concept from the 1970s onwards. At this time, the standardised, staggered and multidisciplinary approach was methodologically superior to school enrolment practice in West Germany.

Aim of the study: Peer support workers and recovery companions in psychiatric care represent a new professional group. The aim of this study was to explore options for classification, professional integration and appropriate remuneration for this group within the SGB V healthcare system.

Methods: Part of the ImpPeer-Psy5 project, this study provides recommendations for nationwide implementation of peer support workers in SGB V care. It is based on data from 56 interviews, supplemented by five expert interviews and a focus group, and analyzed using thematic analysis.

Results: Peer workers' services are funded and compensated inconsistently across Germany, with remuneration generally inadequate. The pay was often perceived as disconnected from the tasks and responsibilities involved, hindering the establishment of PGB as a standalone profession. Greater independence from other professions and higher classification under the TVöD pay scale are necessary.

Conclusion: Successful implementation of peer support workers requires regulated and secure funding and compensation. A national peer workers interest group would help achieve these goals. Avoiding classification in EG3 or lower is recommended.

As a corporation under public law, the federally established Medical Service (MD) is an organizationally and substantively independent socio-medical expert organization. It uses its expertise to support the health and nursing care insurance companies as well as their associations and other clients from the healthcare system nationwide in ensuring medical and nursing care within the social law solidarity community consisting of statutory health and social care insurance. In relation to the 12.000 employees, the specialist tasks are carried out by doctors (20.1 %), nursing staff (40.4 %) and members of other suitable professions in the healthcare sector (5.5 %). With a total of over 2.955.000 GKV assessments, 13.200 structural audits in hospitals, significantly more than 1.600 on-site quality controls in hospitals, almost 3.000.000 nursing assessments, almost 21.900 quality inspections in nursing facilities as well as committee work at state and federal level, the MD assumes a comprehensive constitutive-constitutional and quality-assuring expert care mandate. The social-medical service provided, which is committed to the general social law principles of quality, humanity and cost-effectiveness and is regulated by guidelines issued by the MD Bund and approved by the Federal Ministry of Health, is subject to standardized, nationwide quality assurance.

Introduction: Schools in the health sector play a significant role in the structure of the German education system. In addition to public schools, there are numerous schools, either substitute or supplementary, in the private sector. Many schools are directly attached to a hospital, in contrast to others operating financially independently having cooperation agreements with corresponding facilities for practical training. This article explains the differences between public, substitute and supplementary schools in the health care sector, with particular emphasis on their financing. It also shows the impact of the integration of a school at a hospital.

Methods: The information regarding the types of schools was generated through expert interviews and by reviewing current laws. A schematic illustration is intended to promote further understanding of school financing in the health care sector, thus contributing to more transparency.

Results: The legal framework conditions for the professions of physiotherapy, occupational therapy and speech therapy are elaborated, as well as basic German Law forming the legal basis for the Hospital Financing Act (KHG). The financing of public schools is regulated by law and is carried by the respective state or municipality. This also applies to public schools in the health care sector. Uniform regulations are also applicable to replacement and supplementary schools falling under the KHG. Trainees receive a salary if their schools cooperate with hospitals with which corresponding funding agreements are in place. However, private schools not affiliated with the KHG training fund must rely on alternative sources of funding, ultimately leading to the necessity to charge tuition fees.

Conclusion: Different federal/state-specific regulations contributing to the financing of health care education is often unclear and incomprehensible. Due to current laws, tuition-free education cannot be guaranteed in every federal state or at every school. It remains to be seen if or to what extent changes will take place leading to uniform, transparent and comprehensible financing of the training landscape in the health professions in the German education system.

The rapidly advancing digital transformation is opening up innovative opportunities for disease prevention and health promotion, particularly through sociotechnical innovations. Digitally-enabled interventions serve as augmentative tools for disseminating health-related information and promoting individual empowerment and self-efficacy. Despite their potential, digital media in community-based disease prevention and health promotion face challenges, such as the need for low-threshold design and consideration of technological acceptance factors. People in precarious life situations, who often face limited access and lower literacy towards digital technologies, could benefit from targeted measures geared to their specific needs. At the same time, it is important to highlight the risks of insufficient digital health literacy, which can have a negative impact on health. Promoting digital health literacy therefore appears to be an essential tool for improving the health situation of people in precarious living circumstances. This article argues for evidence-based and targeted further development of digital interventions for health promotion that are tailored to the needs of people in precarious living conditions and emphasizes the central role of digital health literacy in this process. In this contribution, the area of early childhood intervention is considered for exemplification.

Objective: The aim of this study was to measure the acceptance of a telemedical, inpatient-outpatient care concept by physicians, patients and the relatives of patients. Based on a quantitative survey of acceptance, both the potential and success factors influencing the use of telemedicine were to be highlighted.

Methods: The TELnet@NRW study is a national, multicenter, cluster-randomized study in stepped-wedge design conducted from February 2017 to January 2020 for the purpose of documenting changes in the quality of care through telemedicine in an inpatient-outpatient network. Consultations were focused on intensive care medicine and infectious diseases. This current study used questionnaires for specific groups of patients to determine acceptance of the telemedical care concept practiced in the main study. The survey was anonymously conducted once in either digital or paper-based form during the reporting period.

Results: The answers of 126 questionnaires from physicians and 1686 questionnaires from patients and their relatives were evaluated. The physicians of both sectors attributed high potential (up to 88.4%) for telemedicine to improve guideline-adherent treatment. A trustworthy and appreciative communication during the telemedical consultation represented a positively reinforcing success factor. The additional workload generated by telemedicine inhibited acceptance, especially in the inpatient sector. A continuation of telemedicine beyond the end of the project was supported by the majority of surveyed physicians (inpatient 60.6%, outpatient 82.1%) as well as in patients and their relatives (inpatient 79.7%, outpatient 57.4%) in both sectors.

Conclusion: There is widespread acceptance of telemedical, inpatient-outpatient care concepts among physicians, patients and their relatives. Low-effort processes and user-centered technology are crucial to increase the rate of use. Telemedicine has the potential to improve the quality of care and can serve as a robust component of sustainable healthcare in Germany.

Objectives: The tasks of the Public Health Service include, amongst others, health promotion and disease prevention, health reporting and health planning. In many places, local or district health conferences (HCs) have been established to network and coordinate municipal stakeholders. HCs have been defined in the laws of the German states of Baden-Wurttemberg, Berlin, Hamburg, Hesse, and North Rhine-Westphalia. As systematic and comprehensive studies of HCs are not available, a descriptive analysis of the characteristic features, key topics and activities of HCs in selected states was performed.

Methods: Based on a non-reactive survey of the activities from 2013 to 2022, all HCs in four states (n=110) were covered. Data on structural features, topics and HC activities were gathered in a systematic approach. The topics these conferences dealt with were matched against the health objectives of the states. Following an internal verification of the results, univariate and bivariate analyses were performed for individual states, districts, and the year of establishment.

Results: Overall, topics frequently covered by the HCs are primary care, children's and adolescent health, health at old age, infection prevention and control, physical exercise and diet as well as addiction; in some cases, frequencies of these topics differed heavily among the states and municipalities. The topics covered by the HCs showed a strong association with the health objectives of the respective states. Health care is addressed more often in administrative districts (Landkreise) than in independent cities (kreisfreie Städte). Conferences established more recently (after 2011) exhibited greater activities than older ones in terms of plenary sessions and press releases.

Conclusion: HCs are marked by a wide range of key topics which are based on health objectives of the respective states; however, noticeable differences exist between rural and urban areas. Conferences established more recently show a higher level of activity than older ones, which might point to sustainability issues under the current constraints. Whereas differences between rural and urban areas had already been noted for health-reporting activities, this was not the case for HC activities. The hypotheses derived from this descriptive analysis warrant further examination in order to ensure that the HCs create a sustainable impact.

Background: With the beginning of the Covid-19 vaccinations in primary care, a new and work-intensive responsibility arose for medical assistants (MA). In addition to their existing duties and the challenges posed by Covid-19, they had to organize, plan, and in some cases carry out the vaccinations and follow up on the documentation.

Methods: A total of 21 semi-structured interviews were conducted with MA between April and September 2021. Particularly considering the timing of the interview, questions were asked about the daily work routine and the associated vaccine organization. The interviews were then analyzed using MAXQDA software based on Kuckartz's qualitative content analysis.

Results: The MA criticized a lack of organization and transparency in the planning and implementation of vaccinations. Each vaccination had to be pre- and post-processed, resulting in an immense bureaucratic effort. Additional work and stress were the results. Also, MA had to deal with difficult patients.

Conclusion: The experience of MA must be taken into consideration in the future to create guidance for dealing with an increased demand for vaccinations. The guidelines for the future must ensure that MA are relieved and supported by a meaningful organization during such events.