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A Mielck

Publications and source records attributed to A Mielck.

At least 37 records · Page 2Linked to original sources
PubMed1998

Differences in self reported morbidity by educational level: a comparison of 11 western European countries.

STUDY OBJECTIVE: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. DESIGN AND METHODS: National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. MAIN RESULTS: The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. CONCLUSIONS: Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.

Adult↗
PubMed1998

[Decrease in the "healthy migrant effect": trends in the morbidity of foreign and German participants in the 1984-1992 Socioeconomic Panel].

Comparing data from three cross-sections of the German Socio-Economic-Panel (1984, 1988, 1992), migrants who had come to Germany until 1973 showed a better state of health than the German participants. This "healthy-migrant-effect" can be demonstrated for all three morbidity indicators used in this study (restriction of daily activities due to poor health, chronic illness, disablement). After controlling for age, only the indicator "restriction of daily activities" reveals higher morbidity rates for migrants than for German participants in 1984. With increasing age morbidity also increased between 1984 and 1992, but the increase was more pronounced for migrants than for the German participants. The resulting reduction of the "healthy-migrant-effect" can be seen most clearly for the indicator "chronic illness".

Adolescent↗
PubMed1997

[Income, health, and health services utilization in Germany 1992].

Data from the 1992 wave of the Socioeconomic Panel were used to analyse the relation between incomes, need for and utilisation of health care in East- and West Germany employing methods coming from the economic measurement of income distributions. "Self assessed health" and "restricted activities of daily living" were employed as need indicators. Utilisation was measured by the number of "visits to physicians" and "days in hospital". Data was available for 6435 individuals (west) and 3928 individuals (east). Income was defined as equivalent net household income with an equivalence scale derived from the german social assistance program. Compared to the concentration of income all variables in the scope of this study were only marginally concentrated (i.e. equally distributed). A slight concentration of need amongst the lower income was overcompensated by utilisation. Thus a very small impact of the German health care system favouring lower income individuals was measured. The study shows methodological problems when combining data from regions with strongly different income levels instead of analysing them separately. A combined analysis tends to underestimate concentration.

Activities of Daily Living↗
PubMed1997

Poverty and health in West Germany.

The relationship between poverty and several health-related characteristics in West Germany was investigated. Data were derived from the National and Regional Health Surveys conducted in West Germany from 1984 to 1992. 25,544 males and 25,719 females with German nationality aged 25-69 years were examined. Poverty was defined as a household income of 50% less than the mean for West Germany. Multiple logistic regression analysis was used to analyze the relationship between poverty and four health variables: individual health behavior, subjective assessment of health status, cardiovascular disease risk factors, and self-reported prevalence of lifetime chronic diseases. 10.2% of males and 12.8% of females were classified as being below the poverty line. For most but not all health parameters, less favourable results were found for the segment of the population with a household income below the poverty line. The most striking poverty-related differences were observed for lack of regular sport activities, subjective health satisfaction, obesity and myocardial infarction/stroke. Significantly lower prevalence rates for study subjects below the poverty line were observed for hypercholesterolemia in females only. Allergic disorders were the only chronic diseases reported significantly less often in males and females below the poverty line. Poverty has strong effects on individual health status and the prevalence of chronic diseases. Due to the rising unemployment rates in Germany in the last years it is very likely that the strong negative consequences of poverty for health are increasing.

Adult↗
PubMed1997

[Development of a model for explaining health inequality].

The article proposes a model for systematizing the discussion about the mechanisms of production and reproduction of health inequalities. It starts from existing explanation approaches for combining social and health inequalities in West German literature, from contributions of stress and health lifestyle research and from internationally discussed approaches. The proposed model tries to integrate possibilities of explaining different existing approaches.

Germany↗
PubMed1996

Severity of childhood asthma by socioeconomic status.

BACKGROUND: A review of studies on the association between childhood asthma and socioeconomic status (SES) in industrialized countries leads to the conclusion that there does not seem to be a clear association. A study from Aberdeen published 25 years ago, however, shows that among children with asthma, severe asthma is most prevalent in the lower social class, but this distinction between grades of asthma severity has been largely ignored since. METHODS: We screened all fourth grade schoolchildren of German nationality in Munich (4434 children, response rate 87 percent), distinguishing three severity grades in the same way as the study in Aberdeen. RESULTS: Prevalences of childhood asthma are reported by severity grade and SES. Prevalence of severe asthma was found to be significantly higher in the low as compared with the high socioeconomic group (Odds ratio = 2.37; 95 percent confidence interval: 1.28-4.41). This association could not be explained by established risk factors. CONCLUSIONS: More attention should be paid to the association between severe asthma and SES, with measures such as targeting early diagnosis and treatment towards low socioeconomic groups.

Asthma↗
PubMed1996

[Cost control in public health by rationing--what are the advantages and disadvantages?].

In Germany, the discussion on the pros and cons of rationing health care services in the statutory health insurance funds has just begun, but it will probably be of great importance in the years to come. Until now, it is mainly a political discussion with only very few researches participating. In order to enhance the matter-of-factness in this controversial debate, the experiences in the USA with rationing health care services are summarised, and in the second part a more general discussion is added on different forms and consequences of rationing. The present discussion in Germany is outlined in the third part of the paper. In our own evaluation two arguments are stressed: Firstly, the central argument that rationing of health care services is inevitable because health care costs are "exploding", has as yeb no firm empirical and theoretical basis. Secondly rationing by taking medically useful benefits from the schedule of benefits in the statutory health insurance funds is not compatible with the ethical principles governing these funds.

Cost Control↗
PubMed1993

The role of childbirth in smoking cessation.

BACKGROUND: Many women abstain from smoking during pregnancy, but relapse rates in the first year postpartum are high. The impact of childbirth on long-term abstinence from smoking is unknown for both women and men. METHODS: We assessed the impact of childbirth on long-term abstinence from smoking (minimum: 17 months, much longer in most cases) in a retrospective cohort analysis of 925 women and 1,494 men who were interviewed in 1984 to 1986 in the national baseline survey of the German Cardiovascular Prevention Study. RESULTS: Among women, smoking cessation rates resulting in long-term abstinence were about three times higher during the year of childbirth and the year before than in other years (adjusted rate ratio, 2.98; 95% confidence interval, 2.21-4.03). Childbirth was also associated with increased cessation rates among better educated men (adjusted rate ratio for this subgroup, 1.84; 95% confidence interval, 1.16-2.92), but not among less educated men. Nevertheless, childbirth led to long-term abstinence from smoking only in a small minority of smoking mothers and fathers. CONCLUSION: Despite increased cessation rates around childbirth, more effective measures are needed to promote sustained abstinence after childbirth among both parents.

Adult↗
PubMed1993

[Social inequality in myocardial infarct and stroke in West Germany].

It is examined to which extent social inequalities exist in West-Germany (old federal states) regarding myocardial infarction and stroke in the general population. Databases were the regional and national health surveys which were conducted in the framework of the German Cardiovascular Prevention Study (GCP) from 1984 to 1991. 12.445 males and 13,335 females aged 40-69 years were included in this analysis. The assessment of myocardial infarction and stroke was done by a self administered questionnaire. 648 (5.2%) males and 252 (1.9%) females reported a myocardial infarction. 209 (1.7%) males and 143 (1.1%) females reported a stroke. Social class was measured using an additive index comprising the dimensions income, occupational status and education. For both genders it was found that the prevalence of myocardial infarction and stroke increased significantly with decreasing social class. This association remained significant also under control for age and the cardiovascular disease risk factors cigarette smoking, hypertension, hypercholesterolemia and overweight. The results clearly demonstrate that in West-Germany--as was shown already for many other western industrialized nations--social factors independently from the classical risk factors have a significant effect on the incidence of myocardial infarction and stroke.

Adult↗
PubMed1993

[Satisfaction with ambulatory medical care: Differences according to education in Görlitz].

Whereas in East Germany patient satisfaction has been the subject of scientific research already for some years, there are hardly any comparable studies from West Germany. But today, based on the present discussion on quality assurance, interest in patient satisfaction increases in West Germany, too. Studies dealing with socioeconomic differences in patient satisfaction (most studies are from the USA and Great Britain, none from Germany) show very inconsistent results. The data for the present study are taken from a survey that has been conducted 1986/1987 in an East German town. The analyses indicate that satisfaction is greatest among those patients with the longest school education.

Adult↗
PubMed1993

Children's exposure to parental smoking in West Germany.

In this study, we derive national estimates of the prevalence of children's exposure to parental smoking in West Germany. The estimates are based on a national health survey conducted in 1987 and refer to those parents living in the same household as the child. Estimated prevalences of maternal smoking range from 18.9% among children aged < 2 years to more than 30% among 2-5 and 6-13 year old children. Estimates of paternal smoking prevalence are considerably higher: 33.7% among children < 2 years old and 43.1% and 46.8% among 2-5 and 6-13 year old children, respectively. The prevalence of at least one smoking household member was 49.9% among 2-5 year old children, while a clear majority of children aged < 2 years (58.8%) and 6-13 (67.5%) were living in a household with at least one smoker. For all age groups, prevalence of maternal and paternal smoking was considerably higher among children of less-educated parents than among children of better-educated parents. Given the high prevalence of parental smoking and the association of parental smoking with a variety of respiratory diseases in children, a large proportion of these diseases could be prevented by efforts to reduce smoking among parents.

Adolescent↗
PubMed1992

[Restrictions to smoking at the workplace and smoking habits: a literature review].

Based on a critical review of the literature, we assess the consequences of restrictive smoking policies at the worksite on smoking habits of active smokers. The majority of the fourteen studies reported to date (eleven studies from the United States, one study from Canada, one from Australia and one from the FRG) suggest that restrictive smoking policies might have a major impact on reduction of cigarette smoking and eventual smoking cessation of active smokers. However, most of the studies suffer from serious methodologic limitations, and more stringent scientific investigations should be carried out. Nevertheless, implementation of restrictive smoking policies at the worksite appears to be a reasonable measure of nonsmoker protection, even before definitive evaluation of the impact on smoking behavior of active smokers. Such implementation should take place without discrimination of smokers in the context of comprehensive worksite prevention programs and should be accompanied by thorough scientific evaluation.

Humans↗
PubMed1992

Smoking prohibition in the workplace and smoking cessation in the Federal Republic of Germany.

BACKGROUND: The relationship between prohibition of smoking at the workplace and smoking cessation was assessed in a national sample survey conducted in the Federal Republic of Germany in 1987. METHODS: Four hundred thirty-nine men and women ages 21 to 65, who were actively engaged in the workforce for at least 20 hr per week and were either current or former smokers, were included in the study. RESULTS: Quit ratios were substantially higher among women who worked at worksites designated as smokefree compared with women who were allowed to smoke at their workplace. Among men, there were only minor differences between both types of worksites. After simultaneously controlling for age, marital status, and level of education by multiple logistic regression, the odds ratio of being a current smoker (vs former smoker) was 0.80 (95% confidence interval, 0.44-1.45) for men and 0.22 (95% confidence interval, 0.09-0.50) for women working at places where smoking was prohibited (compared with men and women who were allowed to smoke at the workplace). CONCLUSION: These results suggest that prohibition of smoking at the workplace may help a substantial proportion of smokers, particularly female smokers, to quit. Prohibition of smoking at the workplace might therefore be a particularly cost-effective public health measure.

Adult↗
PubMed1992

Social inequities in cardiovascular disease risk factors in East and West Germany.

Social class related differences in prevalence of cardiovascular disease risk factors in Germany were investigated with special emphasis on comparisons between East and West Germany and on time trends. Databases for West Germany are the first and second National Health Survey (survey 1: N = 4794, survey 2: N = 5315), carried out in the framework of the German Cardiovascular Prevention Study, and for East Germany the first GDR-MONICA project (N = 6125). Different social class indices were applied to evaluate social inequities for hypertension, hypercholesterolemia, cigarette smoking, obesity and predicted cardiovascular disease mortality. As a main result, it was found that very similar patterns in the relation between social class characteristics and cardiovascular disease risk factor prevalence occurred for both parts of Germany. Social class gradients were strongest for obesity and weakest for hypercholesterolemia. Analysis of time trends for the period from 1984 to 1988 (for West Germany only) revealed an increase in social inequalities for hypertension in males and cigarette smoking in females. These findings point to the need to focus more on social disadvantaged segments in the population when community based health promotion and disease prevention programs are brought into action.

Adult↗
PubMed1991

[Education level and participation in early cancer diagnostic studies in the Federal Republic of Germany].

In Germany only a few persons take part in cancer screening programs. In order to raise participation rates one needs to ask which subgroups of the population these efforts should focus on. Studies from other countries unanimously show that participation rates decrease with decreasing education and income. Based on this results it was hypothesized that in Germany participation rates also decrease with decreasing education. In a secondary analysis of data from a population survey conducted in Germany in 1987, the hypothesis could be supported only for employed women, whereas for men a non-significant and for not employed women a significant, association was found in the opposite direction.

Adult↗
PubMed1991

The role of socioeconomic factors in the survival of patients with colorectal cancer in Saarland/Germany.

The role of socioeconomic factors in the survival of patients with colorectal cancer was assessed using data from the cancer registry of Saarland/Germany, and census information. Among 2627 patients with colorectal cancer diagnosed from 1974 to 1983, patients from communities in the lowest of three categories defined by socioeconomic factors showed significantly lower survival rates than patients from other communities. After adjustment for potential biological and other sociogeographic risk factors in multivariate analyses, relative hazard of death associated with low socioeconomic status (SES) compared with high SES was estimated to be 1.22 (95% CI: 1.01-1.47) for colon cancer and 1.32 (95% CI: 1.09-1.60) for rectum cancer. The results are in agreement with earlier studies from North America, Hawaii and Sweden and indicate that an attempt to improve health care services and acceptance and possibly other relevant general living conditions in socioeconomically less privileged communities may be a rewarding approach towards increasing survival of patients with colorectal cancer.

Aged↗
PubMed1990

Worksite smoking cessation programs: need in West Germany and recommendations for evaluation.

In distinction from the USA, worksite smoking cessation programs are not yet implemented and their importance is not yet discussed in West Germany. Data from a national survey show that a majority of employees in West Germany are regular or occasional smokers and that about 50% of them are not strongly opposed to joining a smoking cessation program. A review of worksite smoking cessation or reduction programs in the USA reveals necessary characteristics of the implementation and evaluation of such programs in West Germany.

Germany, West↗