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Biomedical subjects

B P Robra

Publications and source records attributed to B P Robra.

At least 19 recordsLinked to original sources
PubMed2002

[The "Adjusted Annual Index" (aJaX): A proposal for the use of the IMPP results in the evaluation of teaching at German medical faculties].

BACKGROUND AND OBJECTIVE: Teaching evaluations should create an incentive to improve academic teaching quality. Teaching also gains importance in the performance-oriented allocation of resources. The results of the country wide written examinations conducted by the Federal Institute for Medical and Pharmaceutical Examination Questions (IMPP) are obvious indicators for purposes of comparative evaluation. However, a comparison of medical faculties is confounded by heterogeneous proportions of students in the so called "reference group" This group includes students who attend their examinations within the regular duration of study; these candidates achieve significantly better results than other students. This contribution describes a comparative educational achievement index (aJaX) adjusting for the varying proportions of students in the reference group. MATERIAL AND METHODS: The IMPP publishes the results of the examinations, disaggregated according to faculties, type of examination, examination subjects, examination semester and membership in the reference group. Aggregation of the semi-annual data to annual data leads to equal treatment of faculties with different admittance regulations. The proportion of students in the reference group is taken into account by calculating an adjusted annual index (aJaX) which compares the observed result of the respective medical faculty with the result one would expect if the average (federal) outcome would apply to a faculty with an equal proportion of students in the reference group (i. e. indirect standardisation). RESULTS: The success rates of the faculties, as defined by the adjusted annual index aJaX, lie with a few exceptions in the interval between 0.95 and 1.05 during the years 1994 to 2000. The results of the second year examinations demonstrate the largest variance. Over time strong deviations rarely occur. These stable results are not observed with the frequently used reference-autumn-index (ReX), which only takes into consideration the results of the reference groups in the autumn examinations. Temporal trends therefore become more clearly visible in the aJaX. The faculties of the new federal states show a clear upward trend in the analysed period. CONCLUSIONS: The results of the medical faculties in the uniform examinations can be compared using an adjusted annual index aJaX. Advantages of the aJaX lie in its stability and neutrality, which are obtained by the annual aggregation of data and the reference group adjustment. The low degree of scatter emphasises a high standardisation in academic medical teaching. However, the aJaX measures only one output of teaching. For the assessment of teaching efficiency in the sense of an input/output relation, inputs must also be taken into account, such as the final school grades of the entering and transferring students.

Education, Medical↗
PubMed2002

[Subjective need for help and objectified geriatric assess. Comparison of the Halberstädter Gerontologic Study and the Augsburger Senior Study].

The Halberstadt Geriatric Study and the Augsburg Senior Citizens Study contain common elements of geriatric assessment (self-assessment of functional dependence, objective evaluation of the functional status). In our cross-sectional investigation, the objective was to examine associations between functional dependence and functional tests and to investigate whether association patterns differed between the surveyed groups. The prospective Halberstadt study began in the German Democratic Republic in 1983 within the framework of a vocational examination before employees entered retirement. In 1995 the study was reactivated; 367 survivors answered a postal questionnaire of which 167 persons took part in a test battery including performance and psychometric tests. The 214 Augsburg test persons had already taken part in the MONICA survey (monitoring of trends and determinants of cardiovascular disease). In 1997 they were assessed in a follow-up study, the aim being to determine the functional status of an elderly cohort through interviews and functional tests. In both studies functional dependence was defined by the (I)ADL concept [(instrumental) activities of daily living]. The participants' functional status was determined with the help of performance tests such as foot tapping and cognitive tests such as the Mini-Mental State Examination. Additionally, medical diagnoses and the use of medical facilities were investigated. The presence of functional dependence was consistently and predominantly significantly associated with the functional status assessed by performance tests. These results were largely confirmed by a logistic regression model. Our results show that even in populations with a different socialization, performance tests are stable indicators of functional dependence and should therefore be incorporated in geriatric assessment programs. The introduction of a standardized assessment program with subsequent intervention measures could lead to a delay of functional dependence and need of care and reduce costs in the health care system.

Activities of Daily Living↗
PubMed2002

[Preparing for the G-DRG system: portfolio analysis of the hospitals in Saxony-Anhalt, Germany].

Diagnosis-Related Groups are scheduled for step-by-step introduction into the German hospital system. Initially DRG base rates will be specific to each hospital (i. e. in keeping with the present budget), but eventually (by 2007) a common base rate will be reached in each federal state. This development may have grave financial consequences for some hospitals where initial base rates are above average and hence likely to be reduced. Therefore, we grouped the remunerations paid by the AOK Saxony-Anhalt (i. e. the largest statutory health insurance company in this federal state) for a total of 308,495 hospital cases in fiscal year 2000 according to hospital and diagnoses, expressed them as a percentage difference from the average remuneration, and analysed them jointly with the average length of stay (LOS). We found considerable differences between hospitals in terms of the payments per case and the LOS, independent of the stratification of the cases. For example, Magdeburg University Clinical Centre registered hospitalisations that were short (below average) but expensive (well above average), hence there is less scope for further rationalization of the LOS in this hospital compared to others. Considerable adjustments will become necessary in due course when switching over from hospital-specific base rates to a common regional base rate.

Budgets↗
PubMed2001

Workplace conditions predict the risk of premature death and functional dependence after retirement--results of a gerontological follow-up study in Germany.

Between 1983 and 1985, 595 employees who were entering retirement in East Germany were given a medical examination and asked to assess their workplace conditions. Ten years later, we examined whether occupational predictors were associated with death and functional dependence among the study participants and assessed how the surviving pensioners coped with activities and instrumental activities of daily living. We assigned the occupational factors reported between 1983 and 1985 to two scales: demands and resources. Multiple logistic regression analyses were carried out to examine the association of occupational and medical predictors with the outcome variables death and functional dependence. Workplace resources but not demands were significantly associated with a reduced chance of death in women, independent of medical diagnoses. For men neither of these associations were verified. Concerning functional dependence individual items such as 'control over work content' (for both sexes) significantly reduced the risk of developing ADL-dependence. The associations remained stable after medical diagnoses were additionally taken into consideration. The results of our study highlight the influence of occupational factors beyond working life and support the importance of starting geriatric health promotion before retirement age.

Activities of Daily Living↗
PubMed2001

[Necessary and desirable future emphasis in social medicine from the theoretical viewpoint].

Social medicine, like medicine as a whole, is based on biomedical science and has responsibilities in clinical care, at the same time linking the health system, an important element in the welfare state, to society. Social medicine investigates and expands the scientific basis for securing and promoting health by way of social action, sharing common roots with public health. In the biomedical sphere, emphasis is on improving our understanding of the biological foundations of social behaviour; scanning and assessing the ethical, legal, economical and social implications of scientific progress; influencing the social and economic effects of demographic developments, and improving the scientific basis of preventive, styles of living and interventions. In the clinical sphere, the main objectives are to expand such areas as clinical epidemiology and clinical health economics, to assert patients' rights and to promote population-related medicine in the training of doctors. As far as the health care system is concerned, emphasis is on restoring the solidarity concept between the healthy and the sick as the principle of statutory health insurance, and on securing transparency of performance, quality, and cost. A further objective is to encourage more creative management by the health insurance funds by granting freedom of contract. Open public discussion about the rationale of an ethical health care system is required, discussion in which independent experts trained in population-related medicine must play an active part.

Forecasting↗
PubMed2001

[Evaluation of the public health service law of the Saxony-Anhalt region--community affairs, transfer of power and loss of control].

AIM: In the state of Saxony-Anhalt, a new Public Health Service law came into force in 1998. Our study investigated whether this new legislation has led to an extension of duties performed by regional health departments and to a subsequent increase in expenditure. METHODS: Guided interviews at all administrative levels of the public health system were conducted. The catalogue of duties was systematized and a questionnaire was developed and distributed to all regional health departments (response rate: 17 out of 24). Data concerning revenues and expenditures of the regional health departments were analysed on the basis of the administrative districts' budget data. RESULTS: Regional health departments stated that there had been practically no change in their activities over the last few years. When questioned about the coverage of 58 specific duties, a considerable disparity was evident between departments. A core group of "classical" duties comprising environmental health and hygiene, child health protection, individual health appraisal, and public health supervision are carried out on an established basis. Some duties were handled by external institutions, others, mostly community health duties, were not performed on an extensive scale. When asked about the desired model for their health department, most departments preferred the model of being an executor of sovereign duties, however a corporate model was deemed to be almost as acceptable. The following fields will gain increasing significance in the future: environmental medicine, health reporting, preventive medicine, co-ordination of regional health care, and health promotion. Since 1995, staff has been reduced in all regional health departments (-10.4%; 1999: 2.92 employees per 10,000 inhabitants). In 1999, expenditures amounted to an average of 24.64 German Marks per capita (range 14.20-44.58 DM). The number of inhabitants and the revenue of the regional districts were determinants of their health budgets. CONCLUSION: Our results showed that no uncompensated additional expenditure by regional authorities resulted from this law. So far, most districts have not perceived regional health as a community affair offering possible competitive advantages. The federal state lost considerable influence at the regional level. Recommended are regional health priorities, conjoint staff development, and state guidance by a head agency providing leadership and support, while leaving responsibility with the districts.

Budgets↗
PubMed2001

[Prevention of congenital malformations by means of folic acid - insurmountable problems due to the German penal code and German drug legislation when preparing a preconceptional model in Saxony-Anhalt].

For the last 20 years the prophylactic effect of the vitamin folic acid against the occurrence of neural tube defects has been known but in Germany this fact has not been realized by the public. The recommendations by medical institutions fail, among other reasons, because a folic acid prescription by gynaecologists comes too late in the course of events, i.e., women go to the gynaecologist when pregnancy has already set in and it is too late for preventive measures. An effective folic acid prophylaxis must take place before the onset of pregnancy. Data from the regional surveillance of congenital anomalies of the German Federal State of Saxony-Anhalt and interviews with women in maternity, as well as gynaecologists, indicate that there is a substantial knowledge deficit concerning folic acid prophylaxis. In 1998, therefore, a working group was set up in Saxony-Anhalt. It comprises representatives from interested institutions and has the goal of rectifying the knowledge deficit of women of childbearing age by way of a broad-based campaign while making use of the results of regional congenital anomalies monitoring. A pharmaceutical company was enlisted for cost-free distribution of its folic acid product. Legal problems with the prescription drug laws, the law against unfair competitive practices, the advertising of medicaments law and the SGB V (social code) made it impossible to procure multivitamins containing folic acid free of charge for women wanting a child. A highly differentiated legislation has hitherto prevented an elementary improvement in prevention.

Drug Approval↗
PubMed2000

Diet in residents of East and West Germany in 1991-1992 as ascertained by a retrospective food frequency questionnaire.

In this study, we compared dietary habits of residents in East (N = 76) and West Germany (N = 266) using results obtained in 1992-1993 from a retrospective semi-quantitative food frequency questionnaire referring to 1991-1992. Nutrient intakes were calculated based on the German Federal Food Code. Univariate and multivariate logistic regression was used to determine whether dietary intakes varied according to residence in East and West Germany. At the food level, East German subjects reported a higher consumption of bread, spreadable fat, and sausage, whereas West German participants reported a higher intake of fruit, vegetables, and pasta and rice. At the macronutrient level, energy intake did not differ significantly between groups, nor did the percent contribution of protein, carbohydrate, fat, and alcohol to total energy intake. East German participants had a lower total water and fibre intake, the latter significant only after adjustment for confounders. At the micro-nutrient level, East German participants had a higher intake of cobalamin, retinol and retinol-equivalents (but not of beta-carotene). There were no differences in the intake of vitamins C, D, and E between groups. Less salt and more potassium, calcium, magnesium and zinc were consumed by West than by East German subjects. Overall, both groups showed disadvantageous dietary patterns. The results are discussed in the context of an overview of other dietary surveys performed in the two parts of Germany before and after reunification. In general our results are consistent with other observations showing that dietary habits in East Germany rapidly approached those in West Germany after reunification, although some residual differences seemed to persist.

Adult↗
PubMed2000

[Surgery rates and small area variations].

On the basis of the claims data of the statutory health insurance funds, surgery rates and small-area variations within the catchment area of the AOK Magdeburg were examined for the year 1997. Substantial variation can be constantly seen. The extremal quotient at the 30 most frequent ICPM groups ranged from 2 to 5. Generally, the extent of the variation was larger with elective procedures than with acute. Correlation analyses do not show clear associations with hospital bed supply and physician density in primary sectors. The extent of the small-area variation requires further research to evaluate possible determinants of surgery rates. Criteria for hospital admission and indications for surgery should be made explicit.

Data Interpretation, Statistical↗
PubMed2000

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall.

STUDY OBJECTIVE: To compare the health status and factors influencing the health of populations that had previously lived under different political systems. DESIGN: Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted. SETTING: East and West Berlin shortly after reunification 1991. PARTICIPANTS: Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%). RESULTS: Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin. CONCLUSIONS: For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.

Adolescent↗
PubMed1999

[Rationale of inpatient care--towards a new payment system].

German statutory health insurance is introducing a system of lump sum payments for hospital care in the framework of a sectorial budget. All hospital cases covered by a major regional health insurance fund (AOK Magdeburg) and completed in 1995 to 1997 (590,000 cases and 7.6 million hospital days, resp.) were analysed to find out changes in the main parameters of inpatient care. The number of hospital cases per 10,000 insured persons continues to increase even after age-adjustment. The increase was 3.1% from 1996 to 1997. Hence the objective "outpatient treatment ranks before inpatient treatment" has not been achieved. The number of hospital days per 10,000 insured patients also increased. Hence the concept of "controlled touch down" (i.e. reaching the prospectively negotiated number of hospital days exactly) has not succeeded. After taking age into account, the number of hospital days slightly and for the first time decreased in 1997 compared to 1996. The average level of hospital stay (LOS) is decreasing, but still high. The proportion of cases with hospital stays exceeding the "Length of Stay Guidelines" was more than 30% in 1997. The pattern of the three parameters (number of cases, hospital days, and LOS) indicate that hospitals manage bed occupancy rates in the first place and that the indications for inpatient treatment are getting softer. Between 1996 and 1997 there has been a 17.5% increase in the total number of cases reimbursed by lump sums. In some categories of the fee schedule the increase is considerably greater. Such changes in performance make it difficult for both contracting parties to assess the "necessary" amount of cases and procedures to be covered by lump sum payments. In a considerable proportion of cases covered by lump sum renumeration, the LOS is longer than the calculated average on which costing is based. In spite of this, however, most hospitals gain more income from lump sum payment than they would if their per diem rates were applied. The proportion of cases with the LOS exceeding the upper compensation limit is low. Between hospitals, the average LOS in the same categories of the fee schedule differs by a factor of 1.5 to 2. There is no consistent indication of adverse risk selection. If the present payment system is maintained until the end of 1999 (or even 2001 as preferred by some), German hospitals will have an opportunity to continue with their development of organisation and costing, to improve their structure of services as well as their negotiating power and- the full compensation scheme having been abandoned in favour of prospective budgets- to net rationalization profits.

Germany↗
PubMed1998

[Saxony-Anhalt/Necklenburg-Vorpommern Scientific Rehabilitation Research Groups].

Interfaces in Medical rehabilitation are the central target of the research collaboration in Sachsen-Anhalt/Mecklenburg-Vorpommern. Six scientific projects and one inter-project initiative aim at questions and problems concerning regional rehabilitation resources, the motivation of applicants and ways of access to rehabilitation, steering mechanisms in the allocation of medical rehabilitation, stages and phases in the rehabilitation system, cost-effectiveness of out-patient rehabilitation and ways and means of adaptation of medical rehabilitation to Job requirements. Research focuses on rehabilitation in persons with chronic back pain, traumatic and vascular CNS injury and coronary infarction.

Forecasting↗
PubMed1998

[Target agreements between insurance carriers and hospitals as instrument for modifying hospital length of stay].

In 1995 the statutory sickness fund (AOK) in Magdeburg arranged target agreements with 10 of 23 acute care hospitals in its district to exercise an influence on the development of the average length of hospital stay. With the aim of decreasing the length of stay as well as the administrative cost and effort, these agreements set upper limits on the average length of stay which were hospital-specific and period-specific. In return, with only a few exceptions, the AOK Magdeburg refrained from limiting the coverage of individual cases. Hospital cases discharged from 1994 and 1996 were analysed to determine whether the development of the length of stay in the ten hospitals with target agreements differed from that in the other 13 hospitals. Only some of the hospitals were successful in reaching their target agreements. The average length of stay dropped by 4.2% in the hospitals with target agreements and by 7.9% in those without target agreements. This must be considered in the context of the development of the case load and number of available hospital beds. For instance, in spite of a target agreement, one hospital showed a (compensatory) increase in the average length of stay in association with an increase in the number of authorized beds and a concurrent decrease in the number of cases. The number of days billed by AOK patients per authorized bed (as an indicator of hospital productivity) showed a more favourable development in the group of hospitals with target agreements than in the other group. This was not a controlled trial as far as the selection of the hospitals is concerned. The results suggest that there is no harm in incentives that induce hospitals to manage primarily on their own the average length of stay. The use of routine aggregate data in monitoring this development, rather than the current more expensive individual case approach, also seems reasonable. Well planned studies that further test the "tool" of target agreements can be recommended.

Cost Control↗
PubMed1998

Contamination of human breast milk with organochlorine residues: a comparison between East and West Germany through sentinel practice networks.

STUDY OBJECTIVE: The aim of the study was to assess and compare the contamination of human breast milk with organochlorine residues through two sentinel practice networks in Lower Saxony, a state of former West Germany, and Saxony-Anhalt, a state of former East Germany. DESIGN: Eligible women were enrolled in this cross sectional study by a network of 51 paediatric practices in Lower Saxony and 44 in Saxony-Anhalt when bringing their babies for a regular screening examination four to six weeks after delivery. Sociodemographic, lifestyle, and exposure factors were determined by questionnaire. Milk samples were analysed for hexachlorocyclohexane (HCH), hexachlorbenzole (HCB), DDT, dieldrin, polychlorinated biphenyls (PCB), and heptachlorepoxid (HCE); half the samples were also analysed for dioxin. Analytic statistics were computed using multiple logistic regression. SETTING: The study was conducted in Lower Saxony, Germany, from July 1992 to June 1993, and in Saxony-Anhalt, Germany, from January to June 1995. PARTICIPANTS: 156 primiparous, breast-feeding women from Lower Saxony and 113 from Saxony-Anhalt were studied, who either were born and raised in former West or East Germany, respectively. MAIN RESULT: Mean age of mothers and children differed significantly between the two study groups. In Lower Saxony all but two milk samples were well below the tolerable concentrations established by the German Research Council (Deutsche Forschungsgemeinschaft (DFG)). In Saxony-Anhalt no participant had concentrations above those recommended by the DFG. After adjustment for age of mother and child, occupational and non-occupational pesticide contact, DDT and beta-HCH concentrations were significantly lower in Lower Saxony; HCE and dieldrin concentrations were lower in Saxony-Anhalt. No differences between the two states were found for PCB, HCB, gamma-HCH, and dioxin. CONCLUSIONS: Breast milk contamination levels in former East German Saxony-Anhalt exceeded the contamination in Lower Saxony only for DDT and beta-HCH.

Adult↗
PubMed1997

[When are recommended breast biopsies carried out, and what information does the physician responsible for mammography receive? Experiences with 317 breast biopsy in a regional quality assurance project for screening mammography].

In a regional quality assurance project for screening mammography (German Mammography Study), 27,335 women were screened in 40 participating, office-based mammography units from 1990-1992. Screening led to 317 biopsies with a positive predictive value of 0.33. All biopsy documentation available to the mammography physicians was analysed with a view towards biopsy interval and completeness of information fed back to the Mx physicians. Biopsy recommendations were acted upon in 29% of cases within 2 weeks. With the exception of the dignity Mx physicians were incompletely informed about biopsy results. The surgical procedure was known in the doctors' offices in 62% of the cases. Specimen radiographies were not done regularly. A pathology report was available overall in 42 of 106 malignant cases, respectively. With the exception of the histological diagnosis itself, no variable mentioned in the reports was documented completely. Only one third of the physicians received such reports routinely. Fail-safe information are requested by Mx physicians and can help them to better target biopsy recommendations. A (regional) quality assurance center should be made responsible to analyse the flow of information in mammography screening, to fill in gaps and to speed up professional cooperation.

Biopsy↗
PubMed1997

Smoking and Parkinson's disease: a case-control study in Germany.

BACKGROUND: In a hospital based case-control study, we investigated the role of environmental factors in the aetiology of Parkinson's disease. This paper describes our results on smoking habits. METHODS: The smoking histories of 380 Parkinson's disease (PD) patients recruited from nine German clinics were compared to those of age- and sex-matched control subjects (379 neighbourhood controls and 376 controls from the same region). Detailed information on smoking behaviour was collected in structured personal interviews in order to calculate the number of pack-years smoked up to the time of diagnosis. Conditional logistic regression was used to calculate odds ratios (OR) and control for potential confounders. RESULTS: Among PD patients, 44% had ever smoked, as compared to 59% in both control groups. Among ever-smoking patients, 74% quit prior to the date of diagnosis, as compared to roughly 45% of the ever-smoking control subjects. The OR for ever having smoked was 0.5 (95% confidence interval [CI]: 0.3-0.7), P trend < 0.00005). CONCLUSIONS: The results are considered in terms of criteria for causality. Plausible explanations for the observed inverse association between smoking and PD include: 1. A genetic predisposition that increases the risk for PD (such as defective detoxification enzymes) simultaneously decreases the likelihood of smoking. 2. Inherently lower dopamine levels in predestined PD patients cause them to be less prone to addiction. 3. Smoking is neuroprotective.

Adult↗