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B P Robra

Publications and source records attributed to B P Robra.

At least 37 records · Page 2Linked to original sources
PubMed1997

Quantitative estimates of the impact of sensitivity and specificity in mammographic screening in Germany.

STUDY OBJECTIVE: To estimate quantitatively the impact of the quality of mammographic screening (in terms of sensitivity and specificity) on the effects and costs of nationwide breast cancer screening. DESIGN: Three plausible "quality" scenarios for a biennial breast cancer screening programme for women aged 50-69 in Germany were analysed in terms of costs and effects using the Microsimulation Screening Analysis model on breast cancer screening and the natural history of breast cancer. Firstly, sensitivity and specificity in the expected situation (or "baseline" scenario) were estimated from a model based analysis of empirical data from 35,000 screening examinations in two German pilot projects. In the second "high quality" scenario, these properties were based on the more favourable diagnostic results from breast cancer screening projects and the nationwide programme in The Netherlands. Thirdly, a worst case, "low quality" hypothetical scenario with a 25% lower sensitivity than that experienced in The Netherlands was analysed. SETTING: The epidemiological and social situation in Germany in relation to mass screening for breast cancer. RESULTS: In the "baseline" scenario, an 11% reduction in breast cancer mortality was expected in the total German female population, ie 2100 breast cancer deaths would be prevented per year. It was estimated that the "high quality" scenario, based on Dutch experience, would lead to the prevention of an additional 200 deaths per year and would also cut the number of false positive biopsy results by half. The cost per life year gained varied from Deutsche mark (DM) 15,000 on the "high quality" scenario to DM 21,000 in the "low quality" setting. CONCLUSIONS: Up to 20% of the total costs of a screening programme can be spent on quality improvement in order to achieve a substantially higher reduction in mortality and reduce undesirable side effects while retaining the same cost effectiveness ratio as that estimated from the German data.

Adult↗
PubMed1997

[Evaluation of Federal Health Insurance process data as instrument for structural and quality analysis of inpatient care].

Statistically based quality assurance, despite its advantages also has a few marked disadvantages. In particular, it is not proven that it promotes measures of internal quality assurance. Instead, processing data of the statutory health insurance bodies are shown as flexible and easily available data covering a defined population and region. Hence, these processing data may be the starting point for internal quality management in hospitals. As examples, from an analysis of hospitalised cases some questions were derived concerning the structure and quality of hospital care. These questions should be answered by common efforts of hospitals, health insurance bodies, and public institutions. This may guarantee good and efficient inpatient care.

Adult↗
PubMed1997

[Prerequisites to successful conversion to the Swiss model managed care-gatekeeper systems in Germany].

In Switzerland different gatekeeper-systems to improve the capacity and economic efficiency were successfully tried and tested. The systems show clear advantages of the gatekeeper-system concerning the costs and quality of health care over the customary Swiss health insurances. The German as well as the Swiss health care system are facing similar problems. The introduction of the Swiss gatekeeper-system in Germany would offer a promising opportunity to achieve economic efficiency and quality in German Statutory Health Insurance. Thus, greater flexibility is imperative in the subjects of legal conditions, especially the contract, incentive and information systems.

Cost-Benefit Analysis↗
PubMed1996

Possible environmental, occupational, and other etiologic factors for Parkinson's disease: a case-control study in Germany.

In a case-control study, we investigated the possible etiologic relevance to Parkinson's disease (PD) of rural factors such as farming activity, pesticide exposures, well-water drinking, and animal contacts; toxicologic exposures such as wood preservatives, heavy metals, and solvents; general anesthesia; head trauma; and differences in the intrauterine environment. We recruited 380 patients in nine German clinics, 379 neighborhood control subjects, and 376 regional control subjects in the largest case-control study investigating such factors and collected data in structured personal interviews using conditional logistic regression to control for educational status and cigarette smoking. The latter was strongly inversely associated with PD. There were significantly elevated odds ratios (OR) for pesticide use, in particular, for organochlorines and alkylated phosphates, but no association was present between PD and other rural factors. A significantly elevated OR was present for exposure to wood preservatives. Subjective assessment by the probands indicated that exposure to some heavy metals, solvents, exhaust fumes, and carbon monoxide was significantly more frequent among patients than control subjects, but this was not confirmed by a parallel assessment of job histories according to a job exposure matrix. Patients had undergone general anesthesia and suffered severe head trauma more often than control subjects, but a dose-response gradient was not present. Patients reported a significantly larger number of amalgam-filled teeth before their illness than control subjects. The frequency of premature births and birth order did not differ between patients and control subjects. Patients reported significantly more relatives affected with PD than control subjects. These results support a role for environmental and genetic factors in the etiology of PD.

Age of Onset↗
PubMed1996

Diet and Parkinson's disease. I: A possible role for the past intake of specific foods and food groups. Results from a self-administered food-frequency questionnaire in a case-control study.

In a case-control study, we compared the past dietary habits of 342 Parkinson's disease (PD) patients recruited from nine German clinics with those of 342 controls from the same neighborhood or region. Data were gathered with a structured interview and a self-administered food-frequency questionnaire, and analyzed using multivariate conditional logistic regression to control for educational status and cigarette smoking. There was no significant difference between cases and controls in the consumption of fruits and vegetables, although there was a negative trend for the consumption of raw vegetables. Controls reported a higher potato consumption than patients (OR = 0.43, 95% confidence interval [CI]: 0.24-0.74, highest versus lowest quartile). Patients reported eating significantly larger quantities of sweet foods as well as having more snacks than controls. This may, however, be the result of an illness-related change in dietary habits leading to a selective recall effect, since sweet foods may enhance the transport of L-dopa across the blood-brain barrier. We also found that patients consumed less beer (OR = 0.26, 95% CI: 0.14-0.49) and spirits (OR = 0.56, 95% CI: 0.36-0.86), but not wine, and they consumed less coffee (OR = 0.27, 95% CI: 0.14-0.52, highest versus lowest quartile), but not tea, than controls. This may relate to a possible interaction between dopaminergic activity and the intake of ethanol or caffeine. Significantly more patients than controls reported ever consuming raw meat (OR = 1.78, 95% CI: 1.21-2.63). These results suggest that the intake of certain foods may be associated with the development of PD.

Case-Control Studies↗
PubMed1996

Diet and Parkinson's disease. II: A possible role for the past intake of specific nutrients. Results from a self-administered food-frequency questionnaire in a case-control study.

In a case-control study, we compared the past dietary habits of 342 Parkinson's disease (PD) patients recruited from nine German clinics with those of 342 controls from the same neighborhood or region. Data were gathered with a structured interview and a self-administered food-frequency questionnaire. Nutrient intakes were calculated from the reported food intakes through linkage with the German Federal Food Code and analyzed using multivariate conditional logistic regression to control for total energy intake, educational status, and cigarette smoking. At the macronutrient level, patients reported higher carbohydrate intake than controls after adjustment for total energy intake, smoking, and educational status (OR = 2.74, 95% confidence interval [CI]: 1.30-6.07, for the highest versus lowest quartile, p trend = 0.02). This was reflected in higher monosaccharide and disaccharide intakes at the nutrient level. There was no difference between patients and controls in protein and fat intake after adjustment for energy intake. We found an inverse association between the intakes of beta-carotene (OR = 0.67, 95% CI: 0.37-1.19, p trend = 0.06) and ascorbic acid (OR = 0.60, 95% CI: 0.33-1.09, p trend = 0.04) by patients, although only the trend for ascorbic acid intake reached statistical significance. There was no difference between groups for alpha-tocopherol intake after adjustment for energy intake. We also found that patients reported a significantly lower intake of niacin than controls (OR = 0.15, 95% CI: 0.07-0.33, p trend < 0.00005). Our results suggest that if antioxidants play a protective role in this disease, the amounts provided by diet alone are insufficient. Although the interpretation of the inverse association between niacin intake and PD is complicated by the high niacin content in coffee and alcoholic beverages, which were also inversely associated with PD in this study, the strength of this association and its biologic plausibility warrant further investigation.

Case-Control Studies↗
PubMed1996

[Analysis of regional differences in hospitalization rate and length of stay costs].

PROBLEM: Performance of an analysis of hospitalised cases based on processed statutory health insurance data on inpatient treatments. Object of the examination were regional differences in the frequency of hospitalisation and in the volume of payable (invoised) days and the relevant determining parameters. MATERIAL AND METHODS: The analysis is based on a total of 152,854 cases of hospitalisation recorded in 1994 by the Magdeburg Statutory Health Insurance Body. These include data (rendered anonymous) on each insured person and on the specialist branch of the referring physician, case characteristics as well as characterising features of the hospital. Additionally, 249,471 diagnosis recordings are available from the total of the recorded cases. RESULTS: There is considerable regional variation in the number of hospital care days within the area of the Magdeburg Statutory Health Insurance Body. These regional differences are noticeable both in the frequency of referrals (broken down according to the regional statutory health insurance offices) and in the average duration of stay (in the hospitals of the region). Reasons for this heterogeneity are evident from the structural conditions of medical care by the physicians under contact with the statutory health insurance body (greater frequency of referral to hospital in areas where there are fewer doctors per 10.000 inhabitants and with less voluminous practices) and from different management strategies of hospitals even if medical care services are well standardised. DISCUSSION: The results prompt more detailed analyses of inpatient care activities including structural parameters of the outpatient sector. Actually we can recognise certain limitations preventing a uniform patient care by statutory health insurance physicians and uniform inpatient care, in the sense imposed by the official policy to ensure such uniformity.

Costs and Cost Analysis↗
PubMed1996

[NO2 concentration in outdoor air and ambulatory physician consultations by children with asthma. Collaboration with the Lower Saxony and Saxony-Anhalt district health offices].

In a representative sample of 72 sentinel practices in Lower Saxony and 61 sentinel practices in Saxony-Anhalt, physicians were requested to record all consultations of asthmatic children (aged up to 8 years) over a period of 6 and 3 months, respectively. Children were classified as asymptomatic or newly symptomatic at each separate contact. Asymptomatic contacts with respiratory tract infections were excluded. From measurements of fixed air monitoring stations, the exposure to air pollutants (NO2, NO, SO2, ozone, particulates) at the place of the physician's practice (Lower Saxony) or at the child's residence (Saxony-Anhalt) was estimated, using a specific interpolation method (inverse distance weighting). Associations between exposure to particular air pollutants and the presence of asthmatic symptoms at the time of the consultation were determined using logistic regression. Temperature, month of the consultation region, day of the week, first or repeated contact in the recording period were included as covariates in the multivariate analyses to adjust for potential confounding. NO2 exposure was significantly and positively associated with the occurrence of asthmatic symptoms (p = 0.007). Exposure to other air pollutants did not significantly differ between asymptomatic and symptomatic contacts. A possible causal relationship between NO2 exposure and the occurrence of asthmatic symptoms in children suffering from asthma is in accordance with other studies. Our study adds data from routine office based outpatient care to independent evidence on the association between NO2 exposure and asthma.

Air Pollutants↗
PubMed1995

[Quality assurance by improved cooperation structures. The example of decentralized early detection mammography].

The German Mammography Study investigated into quality assurance measures for screening mammography, proceeding in a decentralised manner and focussing especially on structure, process and outcome of the study. The field phase lasted for three years, and during this period the technology of the equipment used in mammography improved, also to the indicators of process and of early outcome. The annual interval of examinations was well received. To include mammography into the German cancer screening programme is no easy matter: it requires a comprehensive cooperative quality assurance programme incorporating various institutions of medical care. Appropriate recommendations have been made to the Federal Committee of Physicians and Sickness Insurance Bodies.

Adult↗
PubMed1994

Prediction of the effects and costs of breast-cancer screening in Germany.

Although breast-cancer screening programmes are now being introduced it is still debated whether this is an appropriate policy for all European countries. Taking into account empirical data from 2 regional pilot screening projects, this study has evaluated the effects and costs of a nationwide breast-cancer screening programme in Germany. Special attention was paid to the decentralized German health-care system and to the influence of attendance, interval and age group. The recent results of the analysis of the Swedish randomized screening trials were used to estimate the improvement in prognosis after early detection of breast cancer. Our analysis shows that a programme providing for the screening of women aged 50-69 at 2-year intervals might be expected to result in a decrease in mortality from breast cancer estimated at 11% for the total German population, representing 2,100 deaths from breast cancer prevented each year. The cost per life-year gained was assessed at between DM 18,800 and DM 25,300 for this scenario; 2 to 3 times less favourable than in the UK and The Netherlands. The sensitivity of mammography was estimated to be 12% lower than in The Netherlands and the attendance rate was calculated at 47% on average. A greater effort to ensure the quality of the screening programme and to improve the invitation system might finally lead to much better results. The mortality reduction might be as much as 18% if the attendance and the sensitivity of the screening could be improved to the Dutch level.

Aged↗
PubMed1993

[The prevalence of neurodermatitis among school children in the Hannover administrative district].

A special questionnaire was developed to obtain up-to-date data on the prevalence of atopic dermatitis among children. It was validated by specialist diagnosis in 320 children, providing a diagnostic sensitivity and specificity of 97%. This questionnaire was used for all school entrants in 1990 in the Hanover District. A total of 4,916 children were examined and the questionnaire satisfactorily completed by a relative or guardian (usually the mother) of 4,651. The prevalence of atopic dermatitis was 11.8%, ranging from 8.4% to 17.3% among the 20 constituent communities. The regional differences were smaller than the scatter of diagnostic classifications by the school doctors and the reports of a positive history by the parents. The results demonstrate the validity of a systematic enquiry employing relevant diagnostic and anamnestic items.

Child↗
PubMed1993

[Determinants of observer variability in early diagnostic mammography--a ROC analysis].

As part of the German mammographic study, the participating doctors were given test films of 30 histologically confirmed cases. Regarding the indications for biopsy there was good sensitivity (the median amongst 25 doctors was 0.87). Specificity (median 0.86) could be improved. Comparison of individual results with the majority showed considerable variability within the group of doctors performing mammography. ROC analysis indicated that there was considerable observer variability which was independent from the specialty or praxis characteristics of the participants. The inclusion of mammography in an early diagnostic programme requires continuing education of the participants in this technique. This should be supported by further methods of quality assurance.

Germany↗
PubMed1993

[Etiology of Parkinson disease. An epidemiologic perspective with possible implications for prevention].

This review summarizes recent epidemiological research about the etiology of idiopathic Parkinson's disease (PD). Descriptive and analytical epidemiologic studies, supported by basic neurosciences research, suggest a role for neurotoxins in the pathogenesis of PD, but also for mediating environment influences, which include occupational exposures, urban or rural living and nutritional factors. Such epidemiologic evidence can provide a basis for the potential development of preventive measures for this disease.

Aged↗
PubMed1993

[Data quality in the MORBUS Sentinel Project--expiratory wheezing in infants].

Since 1991 the MORBUS project is being conducted to establish and run a sentinel network of 100 general and paediatric practices in three regions of Germany. A number of health conditions have been and will be monitored consecutively with special emphasis on environmentally determined health problems. From March to June, 1991, 1054 contacts of 1- and 2-year-old children with expiratory wheezing were reported. Quality of these event data was assessed by means of internal completeness. Important clinical information was missing in about 10% of all cases without evidence for regional differentiations. Data quality by this criterion was better in first contact than in re-contact cases (9.7% vs 18.1% missing). Questions concerning the parents (allergies, smoking, education) were less frequently answered (up to 24% missing) than questions of obvious medical relevance to the child. Completeness of parental information varied considerably between regions. There was no association between the medical specialty of the doctors and the quality of their data. In a longitudinal view, there was a slightly positive trend over time in the proportion of clinically incomplete case reports at borderline statistical significance (p = 0.057). Apart from these minor findings then, there was an overall good consistency of completeness in the MORBUS data on expiratory wheezing. By optimizing questionnaires and data transmission, it should be possible to increase the data quality even further.

Air Pollutants↗