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Biomedical subjects

A Mielck

Publications and source records attributed to A Mielck.

At least 19 recordsLinked to original sources
PubMed2006

[Quality of care and extent of complications in a population-based sample of patients with type 2 diabetes mellitus. The KORA Survey 2000].

BACKGROUND AND OBJECTIVE: The aim of this study was to analyse health care processes and outcomes in type 2 diabetes in a representative population sample of persons, aged 25-74 years, in the region of Augsburg, Germany. PATIENTS AND METHODS: Based on the KORA Survey 2000, indicators of health care services and outcomes were analysed for all study subjects with known type 2 diabetes (n=149; 80 males (54%)) , mean age 62 +/- 9 years; total random population sample: 4,261 persons). Means and prevalences were calculated, including 95% confidence intervals (CI). Associated factors were analysed using multivariate regression models. RESULTS: 57% of the patients had not received adequate drug treatment concerning hypertension and 43% concerning hypercholesterolemia. 63% (CI: 54-70 %) and 38% (CI: 30-47%), respectively, reported that their eyes or feet had been examined during the past 12 months. 47% (CI: 39-56%) had been instructed about their diabetes. 69% (CI: 61-76%) of the subjects did not know the term "HbA(1c)", the proportion being higher among subjects without diabetes education or those of a low social status. 13% (CI: 8-20%) of the subjects had been told by their medical practitioner that they had a retinopathy, 5% (CI: 2- 10%) a foot ulcer, 19% (CI: 12-28%) proteinuria. Two persons were blind, one had been on renal dialysis, and 5% (CI: 2-10%) had undergone amputation of a limb. 6% (3-12%) had at least one of the end-stage diabetic complications. The mean HbA(1c) was 7.2 +/- 1.6%, significantly higher in those with a diabetes for >10 years. CONCLUSIONS: The population-based data regarding indicators of type 2 diabetes care processes and outcome in a defined region in Germany show that the treatment of hypertension and hypercholesterolemia was highly inappropriate, as was the frequency of medical control investigations. The high proportion of subjects who did not know the term "HbA(1c)" was striking, particularly among those of a low social status. A significant proportion had severe late complications. The mean HbA(1c), however, was better than had been reported in some previous German practice-based studies.

Adult↗
PubMed2006

Knowledge about diabetes and participation in diabetes training courses: the need for improving health care for diabetes patients with low SES.

The association between socioeconomic status (SES) and health is well known, and many determinants of these health inequalities have been studied. Concerning the role of health care, the results are conflicting, though. The study adds to this discussion by focussing on health care differences for people with type 2 diabetes. The analyses are based on a study conducted in Southern Germany (WHO MONICA study, Augsburg myocardial infarction registry). The sample consists of 378 type 2 diabetic patients, divided into two clearly distinct groups: one group (n = 210) from a MI registry with clinically confirmed myocardial infarction (MI), the other (n = 168) from a population based survey, characterised by the absence of a previous MI. Ten topics are differentiated in the assessment of diabetes knowledge (diet, weight control, etc.). The analyses show that knowledge about diabetes increases with increasing educational level. Concerning "very well informed about diet", for example, the odds ratio for the high educational group is 3.45 (95 % CI: 1.34 - 8.86) as compared with the low educational group. This association is restricted to those diabetic persons with previous MI. For diet, the odds ratio for this subsample increases to 7.35 (p < 0.05). Similar results are seen for the other topics of diabetes knowledge. Also, diabetic persons with a low educational level participated in diabetes training courses least often, especially in the subsample with previous MI. Thus, taking the example of type 2 diabetes, the study adds to the evidence that the inverse care law is still present today in Germany.

Adult↗
PubMed2006

[Persons insured with the German statutory sickness funds or privately insured: differences in health and health behaviour].

This paper deals with differences in health and health behaviour between those who are insured in the German Statutory Sickness Funds (GKV) and those who are privately insured (PKV). This topic has been largely ignored in German Public Health research. The analyses are based on data from a large survey in Germany conducted in 1998 and including 6822 adults. The multivariate analyses have been performed with OLS and logistic regression, separately for men and women and controlling for age, educational level, income and region. The most important result is that PKV-insured men have fewer diseases and feel more healthy than GKV-insured men. For women, though, no significant association could be found between health and type of health insurance. The interpretation of these results is mainly based on the "selection hypothesis", stating that healthier persons are more likely to be insured in the PKV than in the GKV. This would imply that the "causation hypothesis" (stating that being privately insured has a positive effect on health) is less important. Taking into account the current discussion on the balance between GKV and PKV, it is believed that future research should focus more on these topics.

Adult↗
PubMed2006

[Egalitarian and individualistic perceptions of fairness in health care provision: results from a survey of patients and students].

OBJECTIVE: This study focuses on the following question: How are health care reform proposals accepted by different groups of insured persons? Two perceptions of justice or fairness are compared. The "egalitarian view" states that the financial burden should be distributed as equally as possible across all insured persons and that health care should be offered to all insured persons in the same way. The "individualistic view" states that health care should be provided according to the individual's willingness to pay for it, and also according to the individual health behaviour. METHODS: In 2003, a standardised questionnaire was answered by a random sample of 343 persons (175 elderly patients and 168 students). The egalitarian view was assessed by four questions and the individualistic view by five questions. The questionnaire included vignettes. Based on this method it is possible to assess if an answer depends on the "frame" that is presented as an example (framing the question as: thinking of a poor or a wealthy person). RESULTS: A bivariate analyses show that the egalitarian view is mostly present in the following groups of patients: higher age group, insured in a Statutory Sickness fund, high medication, many physician visits. Concerning students, this view is also associated with low physical activity. The individualistic view can be found mostly in the following groups of patients: male, insured in a private health insurance, higher educational level, employed, high physical activity, non-smoker. Concerning students, very similar associations can be seen. These results are largely confirmed by multivariate analyses. It can also be seen that the answers are strongly influenced by the vignettes. DISCUSSION: The insured persons seem to approve or disapprove of health care reform proposals according to their personal characteristics. The overall acceptance of health care reforms will largely depend on the ability to integrate these different perspectives.

Adolescent↗
PubMed2005

Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000.

BACKGROUND: Sex differences in the associations of socioeconomic status (SES) with prevalence of undiagnosed diabetes mellitus, impaired glucose tolerance (IGT) and known risk factors of type 2 diabetes mellitus were investigated in an elderly population. METHODS: Oral glucose tolerance tests were carried out in 1354 randomly selected subjects (697 men, 657 women) aged 55-74 years in the population-based KORA Survey 2000, Augsburg, Germany. Odds ratios (ORs) and 95% confidence intervals (CIs) for undiagnosed diabetes or IGT by education, occupation and income were estimated using logistic regression controlling for age, waist circumference, blood pressure, triglycerides, physical activity, smoking and alcohol intake. RESULTS: All three SES variables were significantly inversely related to body mass index, waist circumference and low physical activity in women (P < 0.05). In men, these associations were weaker or absent. Using the lowest category as reference, occupational status was significantly associated with undiagnosed diabetes in women (adjusted OR 0.5; 95% CI 0.3-0.8) after controlling for risk factors in multivariate regression. The OR was also reduced with higher income in women (adjusted OR, diabetes: 0.7; 95% CI 0.5-1.03). Among men, no significant relations of the SES indicators with unknown diabetes were observed. However, the odds of having IGT was lower with higher occupational status in men (adjusted OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: Undiagnosed type 2 diabetes was related to low SES defined by occupation or income in women only. In men, low occupational status was independently associated with higher IGT risk. Educational level was not related to glucose disorders in both sexes in the elderly population.

Aged↗
PubMed2005

The diabetes epidemic in the elderly population in Western Europe: data from population-based studies.

Valid epidemiologic data on type 2 diabetes in the elderly population are scarce in the European Region despite its enormous human and economic burden. The aim was to assess population-based data on type 2 diabetes and impaired glucose regulation (IGR) from surveys carried out in Western Europe since 1990 using oral glucose tolerance tests, and to discuss the possible impact of risk factors on geographic variation, in particular, obesity and physical activity. In the decade below 60 years of age, about 10 % of the population had known or newly diagnosed diabetes in European surveys. In the age group 70 to 79 years, average total diabetes prevalence was about one quarter. IGR prevalences also increased with age, reaching a maximum of 25 % (men) to 30 % (women) above 70 years of age. There was a wide variation of total diabetes prevalence in the elderly population in Western European countries, however, without clear geographical pattern. Whereas age- and sex-specific prevalences for total diabetes in the German KORA Survey S4 (1999/2001) (Augsburg) were comparable to the European average, IGR prevalences were higher in Augsburg (60-69 years: KORA: men: 30.2 %, women: 22.4 % Europe: men: 21.2 %, women: 19.0 %). Thus, there is a huge reservoir for future diabetes cases in the elderly population in Germany. Differences at the population level were found for obesity, nutrition, and sedentary lifestyle in Western Europe. Comparative studies on the predictive values of obesity, physical activity, and nutrition and possible interactions with genetic markers in European populations are of interest in the future.

Age Distribution↗
PubMed2005

Health inequalities among persons with type 2 diabetes: the example of intermittent claudication.

In Germany, high quality health care is offered to just about all socio-economic groups. The question is rarely asked, though, if there are social differences in the utilisation and quality of health care among those with similar needs. These differences are analysed by looking at a group of persons with type 2 diabetes mellitus. Another group of persons without diabetes is included as well. The data are taken from the KORA-A Study in Augsburg, southern Germany. KORA-A is a case-control study based on patients with type 2 diabetes from the MONICA surveys S2 (1989/90), S3 (1994/95) and the Myocardial Infarction Registry, and controls, matched by age and sex to the cases. In 1997/98, these persons were contacted for the KORA-A study. The dataset includes data from 378 type 2 diabetic patients. The group without diabetes comprises 438 persons. The results indicate that the prevalence of "pain while walking" increases with decreasing educational level, and that this association is stronger for persons with type 2 diabetes (OR 3.53; 95 % CI 1.32 - 9.44) than for persons without diabetes (OR 2.02; 95 % CI 0.97 - 4.23). The prevalence of intermittent claudication can serve as an indirect assessment of the quality of health care received by diabetic persons. It is concluded that health care should be improved especially for those persons with type 2 diabetes who belong to the group with low socioeconomic status.

Adult↗
PubMed2002

Undiagnosed diabetes mellitus among patients with prior myocardial infarction.

OBJECTIVE: To determine the prevalence of undiagnosed diabetic subjects in a group of long-term myocardial infarction (MI) survivors and to investigate their cardiovascular risk factors and medical care. METHODS: Glucose tolerance (OGTT WHO 1985), cardiovascular risk factors (blood pressure, lipids, urinary albumin), and primary medical care during the previous year were assessed among 244 patients without previously known diabetes (mean age +/- SD: 70.5 +/- 6.9 yrs; 75% males; time since incident infarction: 6.5 years (median), inter-quartile range: 4-9 years) from the population-based MONICA myocardial infarction registry in Augsburg (Germany). RESULTS: Proportion of undiagnosed diabetes among MI registry patients was 29/244, 12% (95%CI: 8-17%); impaired glucose tolerance was found in 27% (22-34%). Using fasting glucose according to ADA 1997 criteria, 11% (7-16%) had diabetes and 17% (12-22%) impaired fasting glucose. MI registry patients with newly detected diabetes (WHO or ADA) showed a more adverse risk factor profile (higher triglycerides, lower HDL-cholesterol, increased urinary albumin) than subjects with normal glucose tolerance after controlling for possible confounders (age, sex, time since MI, antihypertensive and lipid-lowering medication). No significant differences were observed for self-reported medical care during the previous year among diabetic compared to non-diabetic subjects (number of physician visits and basic investigations). CONCLUSIONS: There was a high prevalence of undiagnosed diabetes mellitus among the selected elderly long-term MI survivors. Because mortality rate after MI has been previously shown to be increased in diabetic patients, screening for glucose intolerance appears to be as essential as for standard cardiovascular risk factors.

Aged↗
PubMed2002

[Social inequalities and distribution of the environmental burden among the population (environmental justice)].

The paper deals with the following question: How are the environmental risks distributed across different social groups? Using the term 'environmental justice', it has been discussed in the USA for more than 15 years already that environmental risks are not distributed evenly (i.e., justly). Public attention concentrates on the high environmental burden of the black community, but differences by social status are also addressed. In Germany, there is as yet no comparable discussion. In order to contribute to its development, we focus mainly on the following topics: empirical data from Germany on socio-economic differences in environmental risks concerning the home and the home environment, combination with the discussion on environmental justice, recommendations for research and health policy. The results indicate that also in Germany the lower status groups are exposed to greater environmental risks, and that regional measures of health promotion provide a good chance of reducing this inequality.

Air Pollution, Indoor↗
PubMed2002

[Knowledge of "Hardship Exemptions" in statutory sickness insurance].

OBJECTIVES: The German Statutory Sickness Fund comprises about 90 % of the total population. There are special relief or 'hardship' regulations in the Statutory Sickness Fund (the 'Härtefallregelungen') exempting those insured persons from co-payment for whom the co-payments would be an undue financial burden. The most important research questions are: How many of the insured persons do actually know about the possibility of being exempted? How did this group learn about the possibility? How many insured are not exempted from co-payment although they are entitled to be exempted? Why didn't they apply? According to our knowledge there is no comparable national or international study in this field of research. METHODS: The data for the empirical study are collected in a Statutory Sickness Fund in the city of Augsburg (Southern Germany). 18 238 insured (pre-selected as not being exempted from co-payments, but probably entitled to be exempted) were addressed with a very short questionnaire in September 2000. They were asked about their household income, the number of the household members and the money spent for co-payments for medicaments, dental prostheses and other health-related services, in order to identify those entitled to be exempted, and a control group. Among those who responded 1.002 persons were interviewed by CATI (Computer Assisted Telephone Interview). RESULTS: Within the study group interviewed by CATI there was only limited knowledge about the "Härtefallregelungen". About two-thirds of the respondents (61.58 %) were unfamiliar with the possibility of getting an annual reimbursement of the co-payments. Less than one-third (27.78 %) knew nothing about the regulation of being totally exempted from co-payments. Most persons learnt about the regulations from friends and relatives, but few from physicians and other health professionals. One of the reasons most frequently mentioned for not applying for the "Härtefallregelungen" was a presumably too high income. Reasons which lie within the formalities of the application or refer to the potentially embarrassing situation were reported less often. CONCLUSION: Knowledge about the possibilities of being exempted from co-payments for medicaments and other health-related services and goods should be increased. With most of the respondents having learnt about the "Härtefallregelungen" from friends and relatives, patients could get relevant information from physicians and other health professionals more frequently. As financial aspects are the reasons reported most for not applying for the "Härtefallregelungen", the information policy could be enhanced e. g. by simplified examples for calculating the relevant income for being entitled. This way there is a chance that all insured persons who are entitled will actually benefit from the "Härtefallregelungen".

Eligibility Determination↗
PubMed2001

[Reducing income inequity and boosting social capital: new responsibilities in social epidemiological research].

This paper focuses on the fact that there are not only large inequalities in health between but also within countries. The question is raised as to whether these two types of health inequalities are caused by similar processes, and whether understanding these processes could lead to new strategies for reducing such differences. Many studies in Germany have demonstrated that mortality and morbidity are much higher for low-status as compared to high-status population groups. These health inequalities are usually explained by differences in working and living conditions, in health behaviour and in health services utilisation. For some years there has been an extensive discussion in the international Public Health community on health inequalities between countries and on how they can be explained by income inequalities, with the term "social capital" becoming a central issue. This debate has been largely neglected in Germany, but such groundwork now offers an important opportunity for a more comprehensive discussion in this country as well.

Adult↗
PubMed2001

[Accidents in preschool children in the Boblingen district--accident causes and risk groups].

The characteristics of childhood accidents including their socio-demographic distribution were analysed using a cross-sectional design. In December 1999, questionnaires were sent to 50 kindergartens in the 'Landkreis Böblingen' (Southern Germany). 2,963 children went to these kindergartens, and the parents of the children were asked to fill in the questionnaire which was then analysed anonymously by the local health authority of Böblingen. The parents of 1,866 children sent back the questionnaire; the response rate was 72.0% for children with German nationality and 31.6% for the other children. On the average the parents reported 26 'accidents leading to a physician contact' per 100 child-life-years. Four indicators were used for characterising the socio-economic status of the parents (per capita income, occupational status of the father, school education of the mother, summary index), and three groups (low, medium and high socio-economic status) were constructed with each including about 1/3 of the children. Children from the low status group had about 13% fewer accidents than children from the high status group; for severe accidents, however, a contrary association was found (OR of the low as compared with the high status group: 4.1; Conf. Inter.: 1.12-14.96). The children with another nationality than German had severe accidents more often than German children (OR: 4.63; Conf. Inter.: 2.24-9.52). Boys had 33% more accidents than girls. About 3/4 of all accidents took place at home or in its direct environment. Concerning the age distribution, a peak was seen at age 2. The following accidents occurred particularly often: falling from stairs (10.2% of the accidents), falling from a playground equipment (9.5%), falling from a bicycle (8.9%), falling from a high bed (6.0%), stabs or cuts (4.9%), burns or scalds (4.4%), falling from a high chair (3.9%), falling from a nursery table (3.2%). The results are used by a regional working group which is asked to develop a strategy aimed at reducing accidents of pre-school children in the 'Landkreis Böblingen' until 2006 by 10%.

Accidental Falls↗
PubMed2001

[Health Status of German and Foreign Children: Why is Mehmet healthier than Maximilian?].

At least in Germany social epidemiologists have practically never studied the association between the health status of children on one hand and their social status and nationality on the other. The census data from 1995 analysed here include data on social status (employment, social security, per capita income, school education) and nationality; and the 1 % sample of the population living in Germany covers all nationalities and all members of the families interviewed. The analysis includes 50,908 children aged 0-18 years and focuses on the health status and the smoking behaviour of the children and their parents. The result is somewhat surprising: In the age group 0-9 years foreign children seem to be more healthy than German children, despite the fact that their families more often belong to the lower status group and that their parents smoke more than the parents of the German children. It is hypothesised that social support in foreign families is stronger than in German families, and that this protective effect is stronger than the disadvantages of foreign children concerning social status of their families and smoking behaviour of their parents.

Adolescent↗
PubMed2000

Educational differences in smoking: international comparison.

OBJECTIVE: To investigate international variations in smoking associated with educational level. DESIGN: International comparison of national health, or similar, surveys. SUBJECTS: Men and women aged 20 to 44 years and 45 to 74 years. SETTING: 12 European countries, around 1990. MAIN OUTCOME MEASURES: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.

Adult↗
PubMed2000

Social inequality and environmentally-related diseases in Germany: review of empirical results.

A literature search was conducted aiming at all empirical studies from Germany till mid 1997 containing data on the association between environmentally-related diseases and the socio-economic status (education, occupation, income, social class) and/or on the association between the exposure to harmful substances and the socio-economic status. With respect to the exposures, a clear picture becomes visible: the concentration of harmful substances in the ambient air as well as indoors is considerably higher with regard to the lower social class as compared with the higher social class. This applies to children as well as to adults and to West Germany as well as to East Germany. However, with respect to environmentally-related diseases, no such clear picture becomes visible. For example, several studies indicate that allergies, atopic eczema and croup occur less frequently in the lower social class than in the higher social class. Malignant tumours (lung cancer, kidney cancer or bladder cancer), however, seem to occur more frequently in the lower social class than in the higher social class. Environmental-epidemiological studies should increasingly integrate socio-epidemiological study approaches and explicitly present their results.

Adolescent↗
PubMed1999

[Realm and goals of social epidemiology. A contribution to determining current status in relation to German language discussion].

A first approach to the word "social epidemiology" is provided by the two components social and epidemiology. They suggest that the social dimension of the distribution of morbidity and mortality should be analysed by means of epidemiological methods. The interest in this topic has risen considerably in recent years, but it is difficult to exactly specify the questions "social-epidemiologists" are analysing or should be analysing. That is why the "Social Epidemiology Working Group" is now reviewing the state of the art of social epidemiology discussions in the German-speaking countries. The overview shows the broad spectrum of social epidemiology topics, but also the difficulties in providing a clear definition. In a brief description of the Anglo-American discussion it is pointed out that social epidemiology have to deal with similar problems there, and that they classify their work as epidemiology rather than social epidemiology. The paper concludes with recommendations by the Working Group concerning the main topics and objectives of current socio-epidemiological research.

Epidemiologic Factors↗
PubMed1998

Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme.

BACKGROUND: This paper describes morbidity differences according to occupational class among men from France, Switzerland, (West) Germany, Great Britain, the Netherlands, Denmark, and Sweden. METHODS: Data were obtained from national health interview surveys or similar surveys between 1986 and 1992. Four morbidity indicators were included. For each country, individual-level data on occupation were recorded according to one standard occupational class scheme: the Erikson-Goldthorpe social class scheme. To describe the pattern of morbidity by occupational class, odds ratios (OR) were calculated for each class using the average of the population as a reference. The size of morbidity differences was summarized by the OR of two broad hierarchical classes. All OR were age-adjusted. RESULTS: For all countries, a lower than average prevalence of morbidity was found for higher and lower administrators and professionals as well as for routine nonmanual workers, whereas a higher than average prevalence was found for skilled and unskilled manual workers and agricultural workers. Self-employed men were in general healthier than the average population. The relative health of farmers differed between countries. The morbidity difference between manual workers and the class of administrators and professionals was approximately equally large in all countries. Consistently larger inequality estimates, with no or slightly overlapping confidence intervals, were only found for Sweden in comparison with Germany. CONCLUSIONS: Thanks to the use of a common social class scheme in each country, a high degree of comparability was achieved. The results suggest that morbidity differences according to occupational class among men are very similar between different European countries.

Adult↗