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Biomedical subjects

N Schmacke

Publications and source records attributed to N Schmacke.

15 recordsLinked to original sources
PubMed2002

[Migration and health: is segregation inevitable?].

In the immigrant-absorbing countries migrants are regularly confronted with manifold forms of segregation and exclusion. This is also true of the health care system, thus impeding it in its humanitarian goals. One must try to understand why there should be a traditional tendency to encourage segregation. Among the reasons are explicit rejection of migration as such, poor understanding of other peoples, fear of infectious diseases and rising health care costs. In addition a misunderstanding of the integration process plays an important role. What is necessary is, firstly, a realistic view of the world-wide process of migration which inevitably affects the rich industrial nations and, secondly, respect for ethnic identity instead of an out-dated concept of assimilation.

Acculturation↗
PubMed2001

[Reimbursement and importance of hyperbaric oxygenation for diabetic foot ulcers in German publically funded ambulatory health care].

The Standing Committee of Statutory Health Insurance Physicians and Sickness Funds is the legal body that makes decisions on reimbursement for health care services in the German ambulatory health care sector. In 1994, the Committee declined the reimbursement of hyperbaric oxygen therapy (HBO). In 1999, a new deliberation of the efficacy, appropriateness and cost-effectiveness of HBO was initiated as the proponents of this technology claimed that the efficacy of HBO had since been proven in clinical trials. The deliberation was announced and published in the journal of the German Medical Association (Deutsches Arzteblatt) and the federal register (Bundesanzeiger). All institutions, groups, and interested individuals were given the opportunity to provide a written statement. The statements and, in particular, the scientific literature cited in those statements, were critically appraised by the Committee. In addition, the Committee conducted a thorough review of the literature, guidelines and status of the therapy in other health care systems. More than 40 potential indications for the use of HBO were reviewed by the committee. One indication was for diabetic foot ulcers. Most clinical trials related to this field represented only retrospective case series, which, in view of the established therapies, cannot be used as a sound basis for the acceptance of HBO as a new technology for the therapy of diabetic foot ulcers. Some studies were planned as randomized controlled trials but had serious methodological flaws in conduct and analysis. The main problems were the low numbers of patients included and serious inbalances of important and well known prognostic factors between the treatment groups. Systematic reviews that were published in the international literature after the decision of the Committee drew similar conclusions in view of the methodological flaws in the clinical trial data. In summary, the Committee decided once again to decline coverage of HBO in German ambulatory health care.

Ambulatory Care Facilities↗
PubMed1998

[Social inequalities and health: the role played by local health departments in Germany].

Social inequality in health is one of the most challenging of problems for all Public Health services. Health reports and the development of guidelines in this area are very demanding tasks. Based on the latest academic research on tackling inequalities in health, the article shows how two German cities, Potsdam and Hamburg, started to place inequality in children's health on the public agenda. With reference to research and public health policy in the Netherlands, the authors propose that the German local health departments develop similar methods of intervention in cooperation with all relevant partners in the health and social services.

Community Health Services↗
PubMed1997

Overdramatization of the burdens on health and social services: a continuing debate in the history of German medicine.

Departing from the latest academic research into Nazi medicine in Germany, the author looks at theoretical and ideological concepts in German history that left their mark on the formation of race hygiene. He argues that the overdramatization of the economic burden caused by the special requirements of the chronically ill and handicapped runs through all epochs of modern medical history and that this culturally pessimistic way of looking at a serious social problem in Germany reveals a frightening tradition which reached its cruelest climax in the so-called T4 operation of the Nazis. The author makes a plea for this dark chapter of German medical history to be carefully analyzed and for the results of this research to be used in the current discussion on the further development of the health system, particularly in regard to patients who require special care.

Advisory Committees↗
PubMed1995

[Complete nutrition and social assistance].

Additional supplementary benefits for nutrition are provided by social legislation; they are based on recommendations which have to be reconsidered in general as regards contents and quantities. The practice of assessment by Public Health Offices has no standardized regulations. Surveys have indicated that the recommendations are based on low-price calculations. The fundamental basis of supplementary benefits cannot guarantee healthy nutrition and therefore ignores the aim of prevention which had originally been included in social legislation.

Cost-Benefit Analysis↗
PubMed1993

[Prevention of sexually transmitted diseases or control of prostitutes and patients with venereal diseases? An exemplary, epicritical study in Bremen].

Data derived from laboratory and activity statistics of the Venereal Disease" department of the Public Health Office in Bremen were analysed between 1961 and 1991. The traditional concept to fight venereal diseases" aimed at controlling persons "at risk" for syphilis, gonorrhoea, chancroid or lymphogranuloma. This "high-risk" approach of STD prevention stressed the compulsory, at least twice monthly screening of female prostitutes and neglected other population groups like clients of prostitutes and young people, who might have an elevated risk in acquiring STD. The spread of STD like chlamydia, HPV, herpes and even HIV in considerable parts of the general population underlines the need for developing a more effective STD prevention, based on scientific diagnosis and treatment. Intervention programmes in STD control must be performed in full partnership with the targeted population; this can require great effort and time. But STD control certainly cannot be achieved under the threat of punishment or proscription.

Adolescent↗
PubMed1992

[Expert assessment for long-term care--starting point for comprehensive help in medical and social rehabilitation].

Based on the various definitions of people in need of constant care the authors describe the needs and chances of professional assessment in the process of financing care at home and in nursing homes. They stress the often neglected point of rehabilitation and plead for participation of social workers and nurses in the assessment process. The precarious situation for many relatives of people in need of care is pointed out. The authors come to the conclusion that public health offices in Germany should--as an important task in the future--concentrate more intensively on the actual problems of people in need of care and participate in local strategies to improve their living conditions.

Comprehensive Health Care↗
PubMed1991

[Establishment of environmental medicine ambulatory/counseling facilities in public health offices--a promising concept?].

The establishment of medical environmental centres at public health offices is hardly questioned any longer even though it means a crucial shift regarding the points of emphasis in human ecology in general as well as the extension of the fields of activity in public health services. It is doubtful whether the individual-orientated approach of environmental medicine can meet the complexity of medical problems due to environmental factors or which rating preventive medicine can have in this context. Environmental medicine could well not only overtax the personnel resources of public health offices, as previous experience shows, but also change the fields of activity of public health services qualitatively. At present the lack of knowledge and experience in environmental medicine enables only research-orientated institutions to perform appropriate work in this field.

Environmental Health↗
PubMed1980

Psychiatry and the origins of Nazism.

This paper examines the social environment in which the psychiatric profession evolved in Germany in the period between the bourgeois revolution and the onset of Nazism, and delineates the stages of psychiatric theory which paved the way for the murderous alliance between the profession and the fascist state. To bolster its professional status, psychiatry pretended to adopt the methods of the physical sciences. This led to an exclusive concern with genetically determined etiological factors and a rejection of the potential for therapy. Psychiatric theory thus became an instrument used to legitimate the authoritarian state's drive to isolate those who treatened to disrupt society or were economically unproductive. This development ultimately strengthened the racial hygiene ideology of the Third Reich and facilitated the extermination of 100,000 mental patients.

Attitude of Health Personnel↗