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R H Dinkel

Publications and source records attributed to R H Dinkel.

At least 19 recordsLinked to original sources
PubMed1997

[Long-term changes in availability of domestic nursing care based on family structure changes--a model calculation].

A central hypothesis in German family sociology is the observation of a disruption of family structures. If this disintegration prevails up to highest ages it must, among others, lead to an increasing inability to perform nursing care within families. The most important person in case of a need for nursing care is the spouse. The main topic of this paper is to determine whether demographic and familiar developments in Germany will increase or decrease the share of men and women at higher ages with a living spouse within the next decades. In spite of a slowly increasing share of the never-married and the divorced, on the average elderly men and women will be married to a greater and widowed to a much lesser proportion within the next decade. The Dutch LIPRO-model is used to calculate the exact numerical developments. The surprising result is primarily due to the fact that the actual high shares of the widowed are a consequence of distortions caused by the two World Wars. During the next few decades, these unusual developments will disappear even among the most elderly.

Aged↗
PubMed1997

[Future population growth in the Augsburg area--model calculations using the DEPOP model].

Regional population forecasts are on average even more uncertain than nationwide projections, due to the greater importance of migration and the unstable smaller absolute numbers. Other than national projections, local or regional calculations do normally have an explicit goal. In this paper, a projection of the population and age structure in the region of Augsburg is used to demonstrate some specific aspects of local population projections used for public health purposes. If institutions of childhood ages are to be projected the results are primarily determined by the assumptions on migration. If questions of old age are to be answered, the main factor of influence is the development in mortality. Depending on the specific alm of a local population projection, the principal insecurity about the future should be integrated by calculating confidence bands for those demographic parameters, that are most important for the specific question.

Adolescent↗
PubMed1997

[Regional differences of results of disability assessment for domestic health care needs in 1995 and possible explanations].

In 1995 a statutory nursing care insurance was set up in Germany. The MDK (Medical Service of Health Care Insurance Institutions) has been asked to evaluate the eligibility of the individual patients. Within a few months after this body began its work, strong regional differences in incidence became visible. A survey of 1995 MDK records from Bavarian counties was selected to determine whether and how sociodemographic or socioeconomic variables may explain these differences. An age incidence rate of nursing care, standardised according to age and sex, was correlated with a variety of explanatory factors. Only two variables in the multiple regression model were statistically significant: the refusal rate by local MDK officials and the regional supply of outpatient care facilities. Further work is needed to improve the process of evaluation and to minimise unexplained regional differences.

Aged↗
PubMed1996

[Development of dementia to the year 2050. Model calculations for Germany with special reference to future mortality progress].

On the basis of existing age structures of the demented, a demographic-epidemiological model (DEPOP) is used to project the number of demented to the year 2050 in Germany. In particular a future progress in survivorship of the oldest is assumed in the simulation run in continuation of the already visible path of demographic aging. Taking future mortality reductions into calculation the total number of the demented population will increase at least threefold. Together with the stagnation or decline of the total population, this signifies a considerable increase in the relative importance dementia results.

Aged↗
PubMed1994

[Mortality in relation to type of insurance--an empirical study with representative German data 1974 to 1990].

In Germany different forms of insurance funds (private funds, social security for blue collar or for white collar workers, firm-specific funds) secure against sickness risks. Actual governmental policy is to increase the competition between funds by introducing the possibility to switch from one to the other. In order to compensate for the differences in risk of health status between individual members a compensation payment planned according to age and sex of the members. In 1974 a representative sample of the adult West German population has been asked about its sickness fund membership (among other questions). A new epidemiological concept, the demographic variant of the relative survival method, is used here to determine whether mortality in the 16 years after 1974 differed between the sickness fund members. Even after exact demographic control members of private sickness funds survived considerably better than members of other insurance funds. The highest mortality was found for members of the social security of blue collar workers (AOK). These results show that apart from the pure demographic factors other important health related differences exist between members of different sickness funds.

Aged↗
PubMed1994

[Suicide mortality by age groups in both parts of Germany].

In the past a long-term comparison of suicides between the two German states has been prevented by the lack of published data on suicide mortality in the former GDR. These data are available now, showing a surprising similarity in the developments. The level of suicide mortality has been higher in the GDR from the beginning, but both countries experienced very similar reductions in the absolute und relative importance of suicide for overall mortality since the mid 1970's. A cohort analysis of suicide mortality is able to contribute to the explanation of the gap in suicide mortality between East and West Germany. The excess suicide mortality in East Germany is the result of a cohort effect and heavily concentrates on male and female birth cohorts from 1925 to 1945. For these cohorts the excess mortality due to suicide explains up to 25 percent of the total excess mortality compared with the same West German birth cohorts.

Adolescent↗
PubMed1994

A survey of nosocomial infections and their influence on hospital mortality rates.

Nosocomial infections play an important role in contributing to hospital mortality. In order to obtain a large sample a survey was conducted between 1978 and 1989 of more than 66,000 patients in German acute care hospitals. The data were used to assess the influence of nosocomial infections on mortality rates. Hospital infections were more frequent in female patients, but mortality with or without nosocomial infection was higher in male patients. Nosocomial infections increased hospital mortality threefold when raw numbers were used. Controlling for age and sex, the existence of at least one nosocomial infection (diagnosed at the second or a later day of hospital stay) increased hospital mortality by a factor of two. The influence of nosocomial infections was shown to be small for some diseases, such as malignancy, but was greater for others such as metabolic and immunological diseases or trauma. In the case of trauma, nosocomial infections increased hospital mortality rates by a factor of three even after controlling for age.

Adolescent↗
PubMed1994

[Hospital infections and their consequences in patients of advanced age].

On the basis of a representative survey of more than 66,000 patients in German acute hospitals from 1978 to 1989 the incidence and consequences of nosocomial infections on length of hospital stay and mortality for patients above age 60 are discussed. Infection rates are higher for female patients and increase with age for both sexes. Surprisingly the length of stay differences due to nosocomial infections are smaller in absolute and relative terms for older patients. The consequences on mortality, however, strongly concentrate on older patients. Using realistic assumptions on incidence and mortality and on possible degrees of infection the number of "preventable deaths" due to nosocomial infections are calculated. For 1990 the results sum up to more than 6000 deaths at ages above 60 alone for the Federal Republic of Germany within its former borders.

Adolescent↗
PubMed1993

[The long-term development of labor force potential using alternative assumptions of (net) migration to Germany].

"Using model calculations to the year 2050, this paper shows the decisive role that assumptions on future (net) migration to Germany will play in the long-term development of the labor force potential. The particular focus of this paper is to point out the importance of (net) migration not only in terms of absolute figures, but more importantly in terms of the age and gender structure. The annual net migration of 500,000 or 250,000 persons leads, depending on the assumption of its age structure, to extreme differences in the long-term development of the labor force potential." (SUMMARY IN ENG AND FRE AND RUS)

Age Factors↗
PubMed1992

[Cohort fertility of men and women in the Federal Republic of Germany. A measurement with data from empirical social research].

The availability of mates and the consequences for cohort fertility by sex in Germany is analyzed using pooled data from various fertility surveys conducted since 1900. "All German male cohorts born before 1930 have a greater number of children than their female counterparts. German men up to cohorts around 1930 experienced favourable conditions of the marriage market due to the consequences of the two World Wars.... The general decline of births beginning around 1970 will, however, turn around this relative position. Leaving the preferred age-difference between spouses unchanged smaller female cohorts will now be able to select partners from greater (and older) cohorts of potential male partners. These changing relative positions are already visible in the differences between male and female cohort fertility." (SUMMARY IN ENG)

Cohort Studies↗
PubMed1991

[Length of stay, diagnostic classification, treatment outcome and discharge status of patients living alone or not of German federal hospitals].

To assume that the length of stay in hospital depends on whether a patient lives alone or not belongs to conventional wisdom in social epidemiology. In the DTI (diagnosis- and therapy) index of Infratest Health Research a randomly selected number of patients of German acute hospitals was asked whether they were living alone or not. Measuring the average length of stay in hospital and the average success of treatment with these data, only a marginal effect of the variable "social situation" remains after correcting for age. The social situation is a very influential variable, however, when considering where patients are released to. A much greater margin of male and female geriatric patients of acute hospitals leave the hospital to go into institutions of long term care and into other hospitals. The social situation proves to be less important within the acute hospital, but to have a severe influence in the process of leaving it.

Adult↗
PubMed1991

[Reduction in length of stay in Federal German acute hospitals between 1980 and 1989 in connection with hospital size].

This investigation was conducted on the basis of data collected by the German opinion poll company Infratest (whose health research division created a DTI = diagnosis and therapy index) to find out whether the reduced length of stay of patients in Federal german hospitals for acute disease that took place during the past decade, showed any kind of distribution pattern in respect of hospital size. First of all, the average age distribution and diagnostic patterns of the patients in the individual size ranges of the hospitals for acute diseases were determined. Secondly, the investigation aimed at determining how the development of multimorbidity was distributed among the individual size ranges of hospitals. The reduced length of hospital stay between 1980 and 1989 took an almost uniform course in all hospital size groups. The largest hospitals (over 1,000 beds) have the lowest average duration of stay over the investigated period, whereas the small hospitals with 100-200 beds have the highest. The only mavericks were the smallest hospitals with less than 100 patients, where the length of stay had been highest in 1980, the reduction being subsequently the strongest despite the fact that the patient structure had become less favourable. Thus, the very smallest hospitals had overall a less-than-average length of stay in 1989.

Adolescent↗
PubMed1985

Cost-benefit analysis: a helpful tool for decision makers?

Cost-benefit analyses (CBA) claim to be an important basis for decision makers who are interested in a cost-effective approach to health care. But despite an increasing frequency in the number of CBA there is growing concern about their usefulness as a decision-making tool. Predominantly methodological controversies spread confusion and block their user-oriented development. The present article identifies and discusses necessary amendments of CBA from a practical point of view to narrow the existing gap between claim and actual efficiency: consideration of differing interests of differing parties in the health care sector, inclusion of qualitative aspects of medical events and a change in the temporal orientation towards prospective studies.

Cost-Benefit Analysis↗