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Biomedical subjects

H Piechowiak

Publications and source records attributed to H Piechowiak.

At least 19 recordsLinked to original sources
PubMed1992

[Assessment of risk factors and their modification in rehabilitation applicants].

Compared with the general population male workers applying for medical rehabilitation show a higher risk-load, especially regarding smoking and alcohol consumption. However, at present it can't be decided, if the risk-load within this group of applicants is even higher than among the non-applying workmen. Such a selection would be intended. Overweight is the main risk-factor among applicants for medical rehabilitation. It is present far more often than generally within the general population and even within the working class. Male workers with repeated courses of medical rehabilitation exhibit a significant lower risk-load than applicants for a first rehabilitative procedure. A causal relation might be suggested, but at present other explanations regarding the observed relationship have to be considered. A long-term Follow-up study is necessary.

Adult↗
PubMed1992

[Need for intensive disability care. Part 3: Classification of nursing care stages--relation to time requirements].

The proviso "a requirement for constant intensive care" in almost all "care-requirement situations" is an extremely strict criterion. It may even exclude some people with an extremely urgent need of care--for example if some of these situations completely fail to apply. In practice, a less strict criterion needs to be applied if the intended sociopolitical aims are to be achieved. On the basis of our experience of the actual situation presenting, orientation to the time-requirement for the services needed in the individual case is recommended as the basis for an assessment of Schwerpflegebedürftigkeit. A minimum requirement of a daily "bodily" care need of about two hours would appear to be necessary. However, an analysis of time requirement must be supplemented by an evaluation of the overall situation.

Activities of Daily Living↗
PubMed1992

[Severe disability. Part 2: The difficult comparison with same age probands].

With their texts on Schwerpflegebedürftigkeit, the legislators have set the interpreters of legal texts a difficult task. In practice, attempts by the "users" of such texts to find solutions inexorably lead to aporias. Responsible for decision-taking is the health insurance carrier, with the physician exclusively acting as a counsellor on the medical aspects. The advised comparisons with persons of identical age with the intention of establishing Schwerpflegebedürftigkeit is not required by the legislator, and it is not easy to see what sense it is supposed to make. The corresponding guidelines drawn up by the leading associations are not unequivocal and are therefore open to misunderstanding.

Disability Evaluation↗
PubMed1992

[Eligibility for intensive nursing care. Part 1: Guidelines and current experience].

Against the background of the planned statutory Pflegeversicherung (insurance for nursing care) in Germany, a report is presented on experience gained to date with the new Leistungsbestand "Schwerpflegebedürftigkeit" (situation requiring social benefit "urgent need of nursing care") (Para. 53 ff. SGB V). The experience gained so far is of particular interest since, for the first time on a large scale, monetäre Erstattungsleistung (the provision of a monetary entitlement) replaces the Sachleistungsprinzip (benefit in the form of services) that is otherwise applied in the area of health insurance. It is intended that this form of entitlement will form the core of the planned nursing care insurance scheme.

Persons with Disabilities↗
PubMed1992

[Duration of work incapacity before and after inpatient therapeutic procedures].

An analysis has been made of days off work prior to and following a course of treatment in clinics for rehabilitation. A comparison of pre-treatment and after-treatment three-year periods revealed a small decrease of 8 days (9.2%). The youngest age group had the most time off work and--measured in terms of days off work--also the greatest response to treatment. Also after post-hospital rehabilitative treatment clear, though not statistically significant, reductions in the number of days off work were observed. The most striking changes were seen when (only) total number of working days lost prior to the course of treatment was recorded: in the case of high pre-treatment figures for working days lost, a considerable decrease was subsequently observed, while in the case of low working days lost figures, a marked increase in days off occurred. With respect to some of the groups participating, the methodological approach we employed did not make it appear probable that (measured in terms of total working days lost) these groups were "more pathological". It must be pointed out that these results were obtained in relatively small groups; it was not possible to extend the investigation.

Absenteeism↗
PubMed1990

[Health resorts--dissatisfaction with health resorts].

An efficient medical rehabilitation is an important part of a modern health care system. There should be no doubts about its necessity. The medical rehabilitative system in Germany however, as it is organized by the sick-insurances and the annuity-insurances, does not fulfil all the claims urgently required. Much criticism seems really correct: the missing scientific basis of rehabilitation, the poor flexibility around the administrative procedures of application and performance, which is inadequate to medical needs, the nearly total absence of any negative selective criteria on the one hand and the huge problems in finding out those persons badly needing rehabilitative measures on the other, and last not least the uncertainty regarding the real economic benefits of the total enterprise of rehabilitation as it is actually practised.

Cost Control↗
PubMed1990

[Analysis of social medicine--quality of information and decisions in 360 expert assessments of work incapacity].

Before the medical expertise the patients are asked by the health insurance body to collect medical information from their family physician. Analysis of the information actually supplied showed that the quality of the information could be rated "good" in 45% of the cases only. In 38% it was mediocre to poor and in 17% there was no information at all. When the patients to be expertised were called for interview for the first time, "good" information was available in only 38.9%. The percentage of expertises written on the basis of "good" information increased very slowly from the first to the sixth interview (usually after one year), when it reached a maximum of 66.7%. In more than 75% of the cases the question of further inability to work that had been addressed to the family physician remained unanswered. Likewise, no reply was forthcoming in more than 60% of the cases in respect of the need for rehabilitation. In 25.5% the expertising physician arrived at the verdict of ability to work within one week, and in another 17.8% within two weeks. The highest percentage of "ability decisions" (64.3%) was arrived at among insurees who were 18 to 30 years of age and who had lost their job a short while ago. The lowest rate of "ability decisions" (8%) was seen among persons of 50 to 60 years of age who had not been discharged.

Disability Evaluation↗
PubMed1989

[Evaluation of social medicine expert assessment].

There are only few scientific publications in literature on medical expertising in social medicine. Although this deficit may be explained by several facts, it cannot be justified. Evaluation is a systematic set of data collection and analysis activities undertaken to place social practice on a more rational basis, i.e. greater efficiency and justice. These aims also hold good for social medicine. Evaluation, however, is only the first step within a broader research programme for quality control and quality improvement efforts, which can be successfully performed only in cooperation with the social insurance institutions. Within their medical services these institutions should provide the organisational prerequisites to enable qualified scientific research in practical social medicine.

Disability Evaluation↗
PubMed1989

[Social medicine analysis: forensic responsibility in primary care: patients, characteristics of the consultation and referring physicians].

The study presents data from 360 consecutive medical expertises performed on 268 patients. The characteristics of the insurees are described and quantified, the duration between the beginning of the incapability to work and the medical examination is analysed, and some data of the physicians, whose patients had been invited, are shown. About two-thirds of all patients were men. More than one-third of all insurees invited for the first time were singles. 13% of the patients were foreigners. Compared with their percentage within the insurees of the local statutory health insurance bureau, foreigners were invited to the medical expertise about four times more often than German insurees. 35.8% of the examined patients were out of work, and this group was also invited about four times as often as would be calculated from the percentage of persons out of work recorded by the local health insurance bureau (9.7%) on is Jan. 1987. Foreigners and recently dismissed persons had also been invited to the examination considerably earlier (2 1/2 resp. 3 weeks) than other insurees. Most patients had been treated by general practitioners (70%), the others were treated by specialists. About 28.9% (15% of all general practitioners of the region) of the practising GP's were 'responsible' for 60.6%, whereas 11% of the expertises were necessary because 3.6% of the doctors (3 practising physicians) had failed to submit sufficiently detailed data.

Adolescent↗