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PubMed1996

[Postoperative wound infections in surgery--prevalence in Germany (Nosocomial Infections in Germany--Assessment and Prevention Study)].

Part of the NIDEP study was to determine the prevalence of surgical site infections in the surgical departments of 72 representatively selected hospitals. Four physicians, trained and validated in detecting nosocomial infections, carried out the surveillance, based on the CDC criteria for nosocomial infections. The prevalence of surgical site infections was 1.34% for all surgical patients (n = 5377) and 2.13% for all operated patients (n = 3383). Lower rates were found in patients with a low ASA score, clean wounds, and an average duration of the operation. Most surgical site infections were noted after amputations (7.2%), operations on colon or rectum (4.1%), and appendectomies (3.8%).

Cross Infection↗
PubMed2005

[Quality of health care in Germany. A six-country comparison].

Sicker adults in Germany suffer many of the same issues and concerns as do sicker adults in Australia, Canada, New Zealand, the United Kingdom, and the USA. However, quality of care in sicker adults in Germany stands out from the other countries in a few key areas: 1. DISSATISFACTION WITH THE HEALTH CARE SYSTEM: Almost one in three sicker adults in Germany feels that their health care system should be completely rebuilt. This is comparable to the USA and Australia and higher than in New Zealand, Canada, and the UK. 2. STRENGTHS AND WEAKNESSES IN COORDINATION OF CARE: On the plus side, Germany is doing better than most countries to insure that needed information is available at the time of a patient''s scheduled appointment. Also, sicker adults in Germany are more likely than in other countries to have a long-term relationship with their primary care physician and receive less often conflicting informations. However, Germany stands out in the proportion of sicker adults who feel that their doctors have ordered a medical test that they thought was unnecessary because it had already been done. 3. COMPARATIVELY EASY ACCESS TO OUTPATIENT, SPECIALTY AND EMERGENCY CARE: Though substantial minorities of sicker adults in Germany struggle with access to care as compared to other countries, they find it easier to get after hours care and have the shortest waits to see a doctor, to see a specialist, to have nonemergency surgery, and to be seen in the emergency room. Along with the USA, German respondents are most satisfied with the amount of choice they have in a surgeon 4. COMMUNICATION ABOUT RISKS DURING HOSPITALIZATIONS: Hospitalized sicker adults in Germany are more likely than those in other countries to have the risks of their treatment explained to some extent prior to the procedure. However, German patients are less likely to have the risks of their treatment fully explained than those in other countries. German patients who were given new medications were more likely than patients in other countries to report that they did not have a clear understanding of the purpose of these medications. Further, German patients are more likely than those in other countries to report that their regular doctor rarely or never explains the possible side effects of their medications. 5. FAILURES IN HOSPITAL DISCHARGE PLANNING: Overall, hospitalized sicker adults in Germany face more failures in discharge management than in other countries. Of particular note is that Germany is less likely than all other countries to ensure that hospitalized patients have appointments for follow-up care upon discharge from hospital. 6. HOSPITAL-BASED INFECTIONS ARE RARE.: Hospitalized patients in Germany are less likely than in other surveyed countries to report that they developed an infection while in the hospital. 7. LAB NOTIFICATION DELAYS ARE INFREQUENT: Sicker adults in Germany are less likely than in other surveyed countries to report that they have experienced delays in being notified about abnormal lab test results. 8. GERMAN DOCTORS ARE LESS LIKELY TO INFORM PATIENTS ABOUT AN ERROR: When German patients experience medical and medication errors, they are less likely than are patients in other countries to be told by a doctor or other health care professional that an error had been made. 9. BETTER QUALITY OF CARE IN CHRONICALLY ILL PATIENTS: Generally , Germany is doing a better job than other countries at providing patients with chronic conditions some basic standards of preventive care. These patients are more likely to have a nurse in their doctor's office who is regularly involved in the management of their care. Patients from the old Bundeslaender seem to receive a better quality of diabetes care compared to those from the new Bundeslaender. 10. HAVING PRIVATE INSURANCE IS ASSOCIATED WITH INCREASED USE OF HEALTH CARE: German respondents who have private health insurance are more likely to see a specialist, to be hospitalized, and to have nonemergency surgery than those without private insurance. They are also more likely than those without such supplemental insurance to report that doctors ordered an unnecessarily duplicative test. Wait times are shorter for those with private insurance, both to see a specialist and for nonemergency surgery. There is no difference in the overall quality of care for chronic diseases between patients having private or statutory insurance. 11. GERMAN FEMALE RESPONDENTS REPORT MORE COMMUNICATION AND COORDINATION FAILURES THAN DO MALES: German female patients are more likely than males to report failures by their doctors to communicate with them about treatment choices, the specific goals and treatment, symptoms to watch for and when to seek further care, and possible medication side effects. Women are also more likely to report coordination problems in unnecessarily duplicative tests or information not being available at the time of their appointment. Females are less likely than males to rate their overall care as excellent or very good.

Adolescent↗
PubMed2003

Social representations of major depression in West and East Germany--do differences still persist 11 years after reunification?

BACKGROUND: In a population survey that was carried out in 1990, differences between the former Federal Republic of Germany and the German Democratic Republic were observed with regard to the social representation of depression. Back then, we predicted that in a few years these differences would have reduced. To test this hypothesis, a second survey was conducted in 2001. METHOD: In 1990, a representative survey was carried out in both parts of Germany. A total of 3,098 personal, fully structured interviews were completed, 2,118 in West Germany and 980 in East Germany. The survey was repeated in 2001 using the same measures. This time, 5,025 interviews were conducted, 4,005 in West Germany and 1,020 in East Germany. RESULTS: While in 1990 there had been numerous differences between the two parts of Germany with regard to the social representation of depression, in 2001 most of these differences had disappeared. Lay concepts of depression held by interviewees from East Germany have assimilated to those held by interviewees from West Germany. In both parts of Germany, a marked change in favor of biological conceptualizations of depression was observable, with heredity and brain disease more frequently being seen as a cause in 2001. CONCLUSION: The hypothesis that the differences between lay concepts of depression that were prevalent in West and East Germany in 1990 would have reduced by 2001 was supported by our results. Our study shows that cultural processes, such as the process of acculturation that took place in Germany between 1990 and 2001, have an effect on the social representation of mental disorders.

Acculturation↗
PubMed2003

[Individual risk factors, health behaviour and mortality developments in Germany from 1984 to 1998].

The aim of the study is to investigate the contribution by the risk factors smoking, overweight, high blood pressure, physical inactivity and regular alcohol consumption to the total mortality development of the general population in Germany. Data are a mortality follow-up conducted by the Federal Institute for Population Research during 1984 - 1998 in West Germany and 1991-1998 in East Germany. 8474 persons participated at baseline in West Germany in the age group 31-69 years, and 1546 persons participated at baseline in East Germany in the age-group 40-79 years. The vital status in the year 1998 could be determined in West Germany for 86.5% and in East Germany for 97.0%. In the observation period 1986-1998 for West Germany 17.2% of the males died and 8.6% of the females. In East Germany between 1991-1998 9.6% of the males died and 6.7% of the females. The statistical analysis, based on the Cox regression showed for West Germany except for overweight in males throughout a significant contribution of the risk factor load on total mortality. The highest relative risks were found for strong smokers (males: RR = 3.47, p < 0.001, females: RR = 3.62, p < 0.001). The relative mortality risk for persons with three and more risk factors yielded in males 4.88 (p < 0.001) and in females 5.05 (p < 0.001). These findings clearly demonstrate that already a few risk markers of the individual health behaviour have a strong impact on the total mortality development in Germany. The mortality risk is about five times higher for persons with three and more risk factors. This indicates the need for preventive measures targeting high-risk population groups.

Adult↗
PubMed2000

Giant cell arteritis is more prevalent in urban than in rural populations: results of an epidemiological study of primary systemic vasculitides in Germany.

OBJECTIVE: To investigate the period prevalences of primary systemic vasculitides (PSV) in urban and rural populations in northern and southern Germany in 1994. METHODS: Questionnaires were sent to all hospital departments, all physicians, health insurance providers and pension funds, reference laboratories for autoimmune diseases, and death registries in two catchment areas in northern and southern Germany (combined population 875 983) to identify patients with PSV between 1 January and 31 December 1994. Each catchment area encompassed both an urban and a rural area. Each case was re-evaluated by the authors by applying the definitions of the 1992 Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis. RESULTS: A total of 180 PSV patients were identified. The overall prevalence of PSV was 216 cases per 1 000 000 inhabitants (95% confidence interval (CI) 173-259) in northern Germany vs 195 (95% CI 153-236) in southern Germany. The prevalence of PSV was two-fold higher in women than in men, and five-fold higher in people aged > or =50 yr than in people aged <50 yr. The most frequent type of PSV was giant cell arteritis (GCA), with 87 cases per 1 000 000 in northern and 94 in southern Germany, followed by Wegener's granulomatosis, with 58 and 42 cases respectively. In the population aged > or =50 yr the prevalence of GCA was 240 per 1 000 000 in northern and 300 in southern Germany. In both northern and southern Germany the prevalence of GCA in this older population was significantly higher in urban than in rural populations (355 per 1 000 000 vs 115 in northern Germany (P<0.01) and 395 vs 220 (P<0.05) in southern Germany). The relative risk for the older urban population having GCA was 2.25-fold higher (95% CI 1.4-3.6) than in the rural population, and for the female population it was 4.7-fold higher in the urban than in the rural areas (95% CI 2.4-9.3). CONCLUSION: In both northern and southern Germany, GCA was significantly more prevalent in urban than in rural populations, especially among people aged > or =50 yr and in women. It remains unclear whether this disparity was due to underdiagnosis of GCA in the rural regions associated with differences in the German health-care system in cities vs rural areas. Further studies must examine the role of (chronic) exposure to the environmental factors characteristic of cities.

Adolescent↗
PubMed1999

The carnage wrought by major economic change: ecological study of traffic related mortality and the reunification of Germany.

OBJECTIVE: To document the effects of sudden economic change on death rates for occupants of cars in the former German Democratic Republic (East Germany). DESIGN: Ecological time series study of East Germany in comparison with the former Federal Republic of Germany (West Germany) before and after reunification in 1990. SETTING: East and West Germany from 1985 to 1996. SUBJECTS: Populations of East and West Germany between 1985 and 1996. MAIN OUTCOME MEASURES: Death rates for occupants of cars. RESULTS: After the reunification of Germany, East Germany experienced a sudden, temporary affluence and a concomitant fourfold increase in death rates for car occupants between 1989 and 1991. Although death rates increased in all age groups, young adults (aged 18-24) were most affected. The death rate per 100 000 population for those aged 18-20 years increased 11-fold between 1989 and 1991; for those aged 21-24 years the increase was eightfold. CONCLUSION: A tragic consequence of the reunification of Germany was a dramatic increase in the death rate for car occupants. Sudden economic change and availability of cars resulted in both a rise in vehicle ownership and an increase in the number of inexperienced drivers on roads that were ill prepared for the increased traffic. The lesson learnt from Germany is that during times of economic change and modernisation, measures to prevent the predictable injury deaths that will result need to be considered.

Accidents, Traffic↗
PubMed1994

Prevalence of asthma and atopy in two areas of West and East Germany.

The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self-administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.

Asthma↗