Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

The medical care of prisoners in the German correctional system has traditionally taken place within a parallel structure, characterized by specific actors, regulations, and conditions. In light of the serious challenges in recruiting medical personnel for correctional facilities, cooperation with the public health system is becoming increasingly important. This is evident, for example, in the growing reliance on private (specialist) physicians and in the establishment of specially secured hospital rooms for the inpatient treatment of prisoners in public hospitals.International frameworks such as the European Convention on Human Rights (ECHR), the European Prison Rules (EPR), and the Nelson Mandela Rules, as well as the reports of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), also contribute to aligning healthcare in prisons with societal standards. Nevertheless, the generally poor health status of many inmates requires special efforts to achieve a standard of care equivalent to that of the public health system.This article first provides an overview of the legal foundations of medical care in correctional facilities. It then explains in more detail the duties and responsibilities of prison physicians, describes the care structures and various medical specialties involved, and concludes by emphasizing the importance of a qualified, comprehensive assessment of deficiencies in prison healthcare.

The aging of society is also leading to a growing number of elderly prisoners in the prison system. The challenges associated with this relate not only to the treatment and medical care of prisoners in accordance with legal requirements with the prospect of release from prison. The prison system must also find an appropriate way of dealing with prisoners who are spending the end of their lives in a correctional facility. So far, the prison system has only begun to address this issue. This primarily concerns the material and personnel requirements for a prison system that is suitable for the elderly. If possible, prisoners should not have to die in prison, and there are also legal options that open the possibility of dying in liberty. However, if release at the end of life is not an option, appropriate conditions must be created for dignified age- or illness-related dying in prison. From a legal perspective, the judgement of the Federal Constitutional Court on the fundamental right to a self-determined death has raised the question of whether prisoners who wish to die must be given access to means of suicide. Although this cannot be categorically ruled out, the special features of the prison situation must be taken into account-for example, through a particularly careful examination of whether the decision to commit suicide was made freely and responsibly.

Introduction: Dementia is already one of the leading causes of death in Germany. Due to the demographic change, the number of dementia-related deaths will continue to rise in the future. The diversity of "dementia" and the increasing importance of multimorbidity require all diseases listed on the death certificate to be included in the analyses. The aim of this article is to analyse all persons deceased "from" and "with" dementia in Bavaria (= dementia-associated deaths) with regard to their socio-demographic characteristics and to group them based on their comorbidities.

Method: Since 2020, multiple causes of death statistics have been available in Bavaria. This allows for the inclusion of all other diseases contributing to death to be used in the analyses. The Bavarian dementia-related deaths from 2020 to 2022 were grouped into clusters based on their comorbidities using latent class analysis.

Results: Approximately 19% of all deaths were dementia related. Among these, seven clusters were found: one multimorbidity cluster, one cardiovascular cluster, two infection clusters, two clusters with neurodegenerative diseases and one vascular cluster. The deceased of the clusters differed significantly in terms of age, gender, underlying cause and comorbidities.

Discussion: The results of the multiple cause of death analysis indicated a possible underestimation of more specific types of dementia such as vascular dementia. In addition, identifying different combinations of diseases in dementia-related deaths can provide information on suitable treatment methods, preventive measures and possibilities to adapt care structures.

School nurses have an important contribution to make in promoting and protecting the health of children and adolescents in schools. They are specialized healthcare professionals with additional qualifications who act as a link between the school and the healthcare system. Their responsibilities include providing medical care for chronically ill children and adolescents, early detection of mental health problems, talking with parents, providing health-related information and support in accessing health and welfare services, and filling the role of a trusted confidant.Healthcare in German schools is still inadequate. The extent to which school nurses can close this supply gap was examined in selected pilot projects. For this purpose, school nurses were deployed in mainstream schools and their impact on students' health outcomes was evaluated. Although results from these projects are promising, there is still no nationwide implementation of school nurses in the German school system.This article provides an overview of the current status of school nurses deployed in German schools. The presented study results show that model projects have been carried out in eight federal states to date, some of which will be continued. The article highlights the central role of school nurses in meeting the diverse health-related needs of children and adolescents and presents international evidence demonstrating the effectiveness of their use. Finally, it discusses why school nurses have not yet been established across the board despite their potential and how they can be successfully integrated into the German school system.

At first glance, research and quality management (QM) could hardly be more different. Research is characterized by freedom, creativity, and flexibility. QM often appears rigid, strict, and bureaucratic. Nevertheless, research laboratories can benefit significantly from the principles of QM, especially when it comes to increasing the quality and efficiency of research and thus making the best possible use of resources that are constantly limited.High research quality depends on various factors. These different influencing factors were examined in detail and implemented in a specific research quality management system (QMS) in pilot laboratories of the Robert Koch Institute (RKI) and at a university institution. The research QMS is based on the requirements of good scientific practice. It was shown that many laboratories have already established processes that can be further optimized and made more efficient by a QMS.A self-assessment tool for laboratory managers was developed to assess the maturity level of laboratory processes. This report provides an overview of the quality in research and shows ways in which this can be improved at the level of the working groups, tailored to their individual framework conditions. For this purpose, a QMS is proposed and a tool for the self-assessment of one's own processes is presented. The report is based on a comprehensive literature review and a cross-departmental and cross-institutional project of the RKI.

Food supplements play an important role in the everyday lives of many consumers, whose desire for a healthy lifestyle is supposedly fulfilled by a growing market of a variety of preparations. Although they often resemble medicinal products in their presentation, food supplements are also foodstuffs and are subject to the same legal provisions as other foodstuffs. However, the demarcation between medicinal products and foodstuffs-especially food supplements-poses a complex regulatory and practical challenge. Both product groups can be similar in terms of composition, dosage form, and effect, but they differ fundamentally in their regulatory requirements. Placing medicinal products on the market is preceded by a strict authorization procedure with proof of efficacy, safety and quality. In contrast, food supplements, which often contain identical substances in lower dosages, are subject only to a notification procedure without prior authorisation. In some cases, products are incorrectly marketed as food supplements even though they should be classified as medicinal products due to their effects or presentation. The classification as a medicinal product is always based on a case-by-case assessment of various factors, with the pharmacological effect usually being the key criterion. Despite the dynamic and diverse market, however, the authorities succeed in classifying such products in a legally compliant manner and in the interests of consumer protection.

In Germany, around two thirds of adults and 5-20% of children take food supplements, many hoping to improve their health or performance. Consumption data show that with a few exceptions the intake of micronutrients through conventional foods is adequate in Germany. Food supplements are thus generally not considered necessary for healthy people who follow a varied and balanced diet. There are thus only a few situations in which a food supplement can be useful. Routine use of high-dose supplements, above all by people with adequate nutrient supply, increases the risk of harm to health, especially if products also contain 'other substances' with a nutritional or physiological effect, such as omega‑3 fatty acids or caffeine.Micronutrients or 'other substances' may also be added to conventional foods. Discretionarily fortified foods can-often without being noticed-contribute significantly to the overall exposure. In the European Union (EU), food supplements (as well as fortified foods) are legally defined as food, not as medicine. According to the Food Law, food shall not be placed on the market if it is unsafe. It is the responsibility of the food business operator to safeguard this, while in Germany the federal states (Länder) are responsible for food control and inspection. This is increasingly challenging due to the fact that a significant proportion of food supplements is marketed via the internet. In order to facilitate monitoring and ensure consumer protection, existing regulatory gaps must be closed, for example by setting EU-harmonised maximum amounts for vitamins and minerals and by improving the regulation of 'other substances'.

Social media is an important and popular source of information related to dietary supplements (DSs); at the same time, social media also spreads potentially harmful misinformation and disinformation. Content on DSs is usually economically motivated without this being transparently recognizable to users. This situation is highly problematic in terms of consumer health protection. Nevertheless, social media offers excellent opportunities for evidence-based education of the population about DS-related benefits and risks.While the effects of social media information on users' health behavior, health, and nutrition have been well studied, there is a lack of specific data on DSs. This article therefore summarizes the data available on DS-related information on social media and identifies specific risks and opportunities from the perspective of consumer health protection. On this basis, concrete recommendations for action are derived that should serve to shape DS-specific structures in the context of social media that benefit both consumers and reputable DS manufacturers.

Introduction: Routine data from statutory health insurance (SHI) are to be used for the surveillance of non-communicable diseases (NCDs) at the Robert Koch Institute (RKI), including for the estimation of administrative incidences of mental disorders. The aim of the study is to identify a methodology that is as sensitive and practicable as possible.

Methods: Using data available from 2005 onwards from the BARMER health insurance fund, with which approximately 10% of the German population was insured, cumulative incidences were determined for the years 2006 to 2022 after gradual exclusion of persons with previous diagnoses in 1 to 17 previous years for depression, anxiety disorders, schizophrenia spectrum disorders, and mental disorders with uniform population-based standardization by gender, age, and region of residence.

Results: With an extension of the prior observation period, a similar relative decline in the incidence estimates can be observed for all four diagnostic groups in different observation years. From a prior observation period of two years, the values of the incidence estimators differ with further extension of the prior observation period, but relative changes and thus trends are depicted almost identically. A large proportion of the persons identified as incident already had diagnoses of other mental disorders in previous years.

Discussion: For the estimation of administrative incidence rates, the exclusion of persons with a previous diagnosis in two previous years appears to be sufficient to depict trends. Comparisons and interpretations of incidence estimates should only ever be made with similar prior observation and methodology. Further methodological aspects and results for the four diagnosis groups are discussed.