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Dissertations / Theses on the topic 'Grundversorgung'

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Published: 4 June 2021
Last updated: 16 February 2022

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1

Eifert, Martin. "Grundversorgung mit Telekommunikationsleistungen im Gewährleistungsstaat /." Baden-Baden [u.a.] : Nomos-Verl.-Ges, 1998. http://www.gbv.de/dms/spk/sbb/recht/toc/251590720.pdf.

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2

Ringwald, Roman. "Daseinsvorsorge als Rechtsbegriff Forsthoff, Grundgesetz und Grundversorgung." Frankfurt, M. Berlin Bern Bruxelles New York, NY Oxford Wien Lang, 2007. http://d-nb.info/986248002/04.

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3

Mertens, Ralph. "Abrechnungsverhalten von Leistungen zur psychosomatischen Grundversorgung bei niedergelassenen Ärzten." [S.l.] : [s.n.], 2005. http://deposit.ddb.de/cgi-bin/dokserv?idn=975912917.

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4

Mertens, Ralph Eugen. "Abrechnungsverhalten von Leistungen zur psychosomatischen Grundversorgung bei niedergelassenen Ärzten." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2005. http://dx.doi.org/10.18452/15280.

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Datensätze der von Berliner Ärzten abgerechneten psychosomatischen und psychiatrischen Leistungen des Einheitlichen Bewertungmaßstabs (EBM) in den Jahren 1995-1997 werden im zeitlichen Verlauf untersucht und mit Veränderungen der Leistungsdefinition verglichen. Die Abrechnungsdaten werden nach Fachrichtung, Geschlecht und Stadtteil des abrechnenden Arztes gruppiert und mit Daten zur Qualifikation des Arztes - aus einem von Berliner Ärzten beantworteten Kurzfragebogen zur psychosomatischen Grundversorgung (PSGV) - korreliert. Hypothesen zu strukturellen Unterschieden beim Abrechnungsverhalten innerhalb der Ärzteschaft werden formuliert. Weiterhin wird untersucht, wie das Abrechnungsverhalten von Ärzten durch Änderungen in der Gebührenordnung beeinflußt wird. Zuletzt wird nach Kriterien gesucht, die den Bedarf an PSGV quantifizieren. Die in der Arbeit postulierten Hypothesen lassen sich wie folgt beantworten: (H 1.a.): Das Geschlecht des Arztes spielt für die Abrechnungshäufigkeit psychosomatischer Leistungsziffern keine Rolle. (H 1.b.): Ärzte im Westteil Berlins rechnen häufiger Leistungen der PSGV ab als ihre Ostberliner Kollegen. (H 1.c.): Gesprächstherapien werden von Ärzten mit hoher Balintgruppenerfahrung häufiger durchgeführt. (H 2.a.): Die therapeutische Leistungsziffer 851 wird trotz besserer Bewertung ab dem Jahr 1996 nicht häufiger abgerechnet. (H2.b.): Die Budgetierung einer Leistung verringert deren Abrechnungshäufigkeit. (H3.a.): Ärzte rechnen seltener Leistungen der PSGV ab als sie es aufgrund der geschätzten Häufigkeit psychosomatischer Erkrankungen am eigenen Patientenklientel könnten. Zufällig findet sich in der Datenanalyse ein statistischer Fehler. Die bereitgestellten Leistungsstatistiken der KV-Berlin stellen in Bezug auf den Mittelwert keine korrekten Abrechnungsgegebenheiten dar. Die asymmetrische Verteilung der Abrechnungsdaten läßt sich durch Angabe des Median und eines Perzentilenbereiches besser beschreiben als der derzeitig ausgewiesene arrhythmetische Mittelwert. Die Leistungsmengenausweitungen nach Einführungen des EBM ab dem Jahr 1996 können auch durch diesen Umstand mitverursacht worden sein. Bei der Literaturbetrachtung fällt auf, dass die Morbidität psychischer und psychosomatischer Erkrankungen zunimmt und diese einen hohen volkswirtschaftlichen Schaden in Hinblick auf Krankheitszeiten und Medikamentenkosten verursachen. Qualitätsverbessernde Maßnahmen in der PSGV können effektiv Krankheitskosten reduzieren.
Data sets about psychosomatic and psychiatric services from “Einheitlichen Bewertungmaßstabs” (EBM), which were deducted from Berliner physicians during the years 1995 -1997 will be researched in a time dependent process and will be compared to the change of definition of achievement. The billing data will be grouped according to the field, gender and district of the accounting physician, and will be correlated with data which comes from a short questionnaire, answered by Berlin physicians, about the psychosomatic primary health care, for the qualification of the physician. Hypotheses of structural distinctions from the account behaviour, within the Medical profession, will be formulated. Furthermore, it will be examined, how the account behaviour of the physicians will be affected by change in the tariff. Lastly, we will be searching for criteria, which will quantify the demand of psychosomatic primary health care. The postulated hypotheses in this work can be answered as follows: (H 1.a.): The gender of the physician is irrelevant to the settlement frequency of the psychosomatic output figures. (H 1.b.): Physicians in West Berlin account for services from psychosomatic primary health care more often then there colleagues in East Berlin. (H 1.c.): Physicians with high Balint group experience administer more client-centered therapies. (H 2.a.): Despite the better valuation starting from the year 1996, the therapeutic output figure 851 does not become more frequently accounted for. (H 2.b.): The budgeting of an achievement reduces their account frequency. (H 3.a.): Physicians account more rarely for services of psychosomatic primary health care as they could do it due to the estimated frequency psychosomatic diseases of there own patient clientele. A statistic error is coincidental in the data analysis. The provided statistical activities of the KV-Berlin don’t represent correct account conditions in reference to the median. The asymmetrical distribution of the billing data can be better described by the indication of the median and a percentile range, than by the current stated arrhythmetic median. The expansions of achievement quantities after changing of the EBM, starting from the year 1996, could be, among other things, caused by this circumstance. During the examination of the literature, it becomes noticeable, that the morbidity of psychological and psychosomatic diseases increases, and these cause high economical damage in terms of illness times and medication cost. Quality-improving measures in the psychosomatic primary health care can effectively reduce disease costs.
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5

Zagrosek, Stefan. "Der Grundversorgungsauftrag der öffentlich-rechtlichen Rundfunkanstalten in Deutschland und in der Schweiz Ein zeitgemässes System? /." St. Gallen, 2004. http://www.biblio.unisg.ch/org/biblio/edoc.nsf/wwwDisplayIdentifier/00637298001/$FILE/00637298001.pdf.

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6

Mundt, Rebekka Sophia [Verfasser]. "Erwartungen multimorbider PatientInnen an die hausärztliche Grundversorgung / Rebekka Sophia Mundt." Hamburg : Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky, 2020. http://d-nb.info/1226289053/34.

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7

Vollmeier, Ines. "Grundversorgung im konvergierenden Mediensektor : die Sicherstellung der Teilhabe aller an der Informationsgesellschaft /." Münster, Westf : LIT, 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=012827084&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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8

Klein, Ralf. "Dezentrale Grundversorgung im ländlichen Raum : Interaktionsmodelle zur Abschätzung von Nachfragepotentialen im Einzelhandel /." Osnabrück : Selbstverl. des Fachgebietes Osnabrück im Fachbereich Kultur- und Geowiss. der Univ. Osnabrück, 1992. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=004916708&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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9

Dehne, Thomas. "Service public in Randregionen - Zwischen Angebot und Nutzung." St. Gallen, 2005. http://www.biblio.unisg.ch/org/biblio/edoc.nsf/wwwDisplayIdentifier/02600245001/$FILE/02600245001.pdf.

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10

Weber, Karsten. "Das Recht auf Informationszugang : Begründungsmuster der politischen Philosophie für informationelle Grundversorgung und Eingriffsfreiheit /." Berlin : Frank & Timme, 2005. http://www.gbv.de/dms/spk/sbb/recht/toc/480333831.pdf.

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11

Schlumpf, Oliver. "Soll die Swisscom privatisiert werden? Eine allokationstheoretische Analyse /." St. Gallen, 2007. http://www.biblio.unisg.ch/org/biblio/edoc.nsf/wwwDisplayIdentifier/02606150002/$FILE/02606150002.pdf.

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12

Glaesmer, Heide. "Die gesundheitsökonomische Bedeutung ärztlicher Qualitätszirkel eine Analyse von Abrechnungsdaten niedergelassener Ärzte eines Qualitätssicherungsprojektes zur psychosomatischen Grundversorgung." Saarbrücken VDM Verlag Dr. Müller, 2004. http://d-nb.info/98516235X/04.

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13

Erkens, Andre. "Der öffentlich-rechtliche Rundfunk und exklusive Sportberichterstattung : geben ist öffentlich-rechtlicher denn nehmen - darf und/oder muss der öffentlich-rechtliche Rundfunk exklusive Sportberichterstattung anbieten? /." Hamburg : Kovač, 2009. http://d-nb.info/997222077/04.

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14

Kondic, Nicole. "Zeitschriften in der Max-Planck-Gesellschaft E-only als tragbares Bezugsmodell im Rahmen der neuen Grundversorgung untersucht am Beispiel der Max-Planck-Institute Stuttgart /." [S.l. : s.n.], 2004. http://www.bsz-bw.de/cgi-bin/xvms.cgi?SWB11675741.

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15

Warman, Dennis-N. [Verfasser]. "Energie als Menschenrecht : Ein Recht auf Zugang zur Grundversorgung mit Energie als Menschenrecht nach dem Internationalen Pakt über wirtschaftliche, soziale und kulturelle Rechte / Dennis-N. Warman." Frankfurt a.M. : Peter Lang GmbH, Internationaler Verlag der Wissenschaften, 2017. http://d-nb.info/1127485008/34.

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16

Andresen, Ole Marquard. "Die Pflichten der EU-Mitgliedstaaten zum Abbau versorgungspolitisch motivierter Marktinterventionen : ein Beitrag zum nationalen und gemeinschaftsrechtlichen Liberalisierungsdruck und zu seiner Durchsetzung im Bereich der existenziellen Grundversorgung /." Berlin : Duncker & Humblot, 2005. http://swbplus.bsz-bw.de/bsz115320377vlg.htm.

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17

Barkow, Katrin, Wolfgang Maier, T. Bedirhan Üstün, Michael Gänsicke, Hans-Ulrich Wittchen, and Reinhard Heun. "Risk factors for new depressive episodes in primary health care." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-103618.

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Background. Studies that examined community samples have reported several risk factors for the development of depressive episodes. The few studies that have been performed on primary care samples were mostly cross-sectional. Most samples had originated from highly developed industrial countries. This is the first study that prospectively investigates the risk factors of depressive episodes in an international primary care sample. Methods. A stratified primary care sample of initially non-depressed subjects (N = 2445) from 15 centres from all over the world was examined for the presence or absence of a depressive episode (ICD-10) at the 12 month follow-up assessment. The initial measures addressed sociodemographic variables, psychological/psychiatric problems and social disability. Logistic regression analysis was carried out to determine their relationship with the development of new depressive episodes. Results. At the 12-month follow-up, 4·4% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that the recognition by the general practitioner as a psychiatric case, repeated suicidal thoughts, previous depressive episodes, the number of chronic organic diseases, poor general health, and a full or subthreshold ICD-10 disorder were related to the development of new depressive episodes. Conclusions. Psychological/psychiatric problems were found to play the most important role in the prediction of depressive episodes while sociodemographic variables were of lower importance. Differences compared with other studies might be due to our prospective design and possibly also to our culturally different sample. Applied stratification procedures, which resulted in a sample at high risk of developing depression, might be a limitation of our study.
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18

Friedrich, Nele, Harald Jörn Schneider, Marcus Dörr, Matthias Nauck, Henry Völzke, Jens Klotsche, Caroline Sievers, et al. "All-cause mortality and serum insulin-like growth factor I in primary care patients." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-112820.

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Objective: Previous population-based studies provided conflicting results regarding the association of total serum insulin-like growth factor I (IGF-I) and mortality. The aim of the present study was to assess the relation of IGF-I levels with all-cause mortality in a prospective study. Design: DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a large, multistage, and nationally representative study of primary care patients in Germany. The study population included 2463 men and 3603 women. Death rates were recorded by the respective primary care physician. Serum total IGF-I levels were determined by chemiluminescence immunoassays and categorized into three groups (low, moderate, and high) according to the sex- and age-specific 10th and 90th percentiles. Results: Adjusted analyses revealed that men with low [hazard ratio (HR) 1.70 (95% confidence interval [CI] 1.05–2.73), p=0.03] and high [HR 1.76 (95% CI 1.09–2.85), p=0.02] IGF-I levels had higher risk of all-cause mortality compared to men with moderate IGF-I levels. The specificity of low IGF-I and high IGF-I levels increased with lower and higher cut-offs, respectively. No such association became apparent in women. Conclusions: The present study revealed a U-shaped relation between IGF-I and all-cause mortality in male primary care patients.
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19

Roetzer, Steffen. "Qualitätsmanagement im deutschen Krankenhaus : Wege zur Implementierung nach dem Qualitätsmodell der European Foundation for Quality Management (EFQM) unter den besonderen Bedingungen kleinerer Krankenhäuser der Grundversorgung am Beispiel des Operationsbereiches /." [S.l. : s.n.], 2000. http://www.bsz-bw.de/cgi-bin/xvms.cgi?SWB8991485.

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20

Andresen, Ole Marquard [Verfasser]. "Die Pflichten der EU-Mitgliedstaaten zum Abbau versorgungspolitisch motivierter Marktinterventionen. : Ein Beitrag zum nationalen und gemeinschaftsrechtlichen Liberalisierungsdruck und zu seiner Durchsetzung im Bereich der existenziellen Grundversorgung. / Ole Marquard Andresen." Berlin : Duncker & Humblot, 2011. http://d-nb.info/1238344771/34.

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21

Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche, and Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106354.

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Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany. Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications. Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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22

Bramlage, Peter, David Pittrow, Hendrik Lehnert, Michael Höfler, Wilhelm Kirch, Eberhard Ritz, and Hans-Ulrich Wittchen. "Frequency of albuminuria in primary care: a cross-sectional study." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106780.

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Background: We aimed to assess the point prevalence of microalbuminuria (MAU) in a sample of unselected consecutive primary-care attendees, with particular focus on patients with diabetes mellitus (with and without additional concomitant diseases) and those with hypertension. Design: Cross-sectional observational study in a nationwide representative sample of 1912 primary-care practices and a patient population consisting of 39 125 primary-care attendees. Diagnoses for diabetes, hypertension and co-morbidities were provided by the treating physician and complemented by blood pressure (BP) measurements and selected lab tests. Screening for microalbuminuria (>20 and <200 μg/ml) was done with a spot urine dipstick test. Results: The clinical diagnosis of nephropathy was assigned to 7.6% of patients. The point prevalence of MAU was 19.0% in the total sample; the proportion was 33.6% in diabetics whereas the diagnosis was assigned to only 7.1% in the total sample. Amongst diabetic patients with MAU, 92.6% had BP above the target value of < 130/80 mmHg. Frequency rates rose with increasing BP (e.g. 20.6% in diabetic patients with BP< 120/70 mmHg, and 36.3% in diabetic patients with BP > 140/90 mmHg). Of note, patients with MAU had a higher burden of co-morbidity compared to those without MAU. Conclusions: We found a high prevalence of MAU in primary care, particularly in diabetic patients. The frequency of MAU was closely related to the BP level and the degree of co-morbidity. The present study underlines the magnitude of the problem of MAU in primary care, and should serve as a starting point to initiate measures to address this important public health issue.
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23

Barkow, Katrin, Wolfgang Maier, T. Bedirhan Üstün, Michael Gänsicke, Hans-Ulrich Wittchen, and Reinhard Heun. "Risk factors for new depressive episodes in primary health care: an international prospective 12-month follow-up study." Cambridge University Press, 2002. https://tud.qucosa.de/id/qucosa%3A26456.

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Background. Studies that examined community samples have reported several risk factors for the development of depressive episodes. The few studies that have been performed on primary care samples were mostly cross-sectional. Most samples had originated from highly developed industrial countries. This is the first study that prospectively investigates the risk factors of depressive episodes in an international primary care sample. Methods. A stratified primary care sample of initially non-depressed subjects (N = 2445) from 15 centres from all over the world was examined for the presence or absence of a depressive episode (ICD-10) at the 12 month follow-up assessment. The initial measures addressed sociodemographic variables, psychological/psychiatric problems and social disability. Logistic regression analysis was carried out to determine their relationship with the development of new depressive episodes. Results. At the 12-month follow-up, 4·4% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that the recognition by the general practitioner as a psychiatric case, repeated suicidal thoughts, previous depressive episodes, the number of chronic organic diseases, poor general health, and a full or subthreshold ICD-10 disorder were related to the development of new depressive episodes. Conclusions. Psychological/psychiatric problems were found to play the most important role in the prediction of depressive episodes while sociodemographic variables were of lower importance. Differences compared with other studies might be due to our prospective design and possibly also to our culturally different sample. Applied stratification procedures, which resulted in a sample at high risk of developing depression, might be a limitation of our study.
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24

Friedrich, Nele, Harald Jörn Schneider, Marcus Dörr, Matthias Nauck, Henry Völzke, Jens Klotsche, Caroline Sievers, et al. "All-cause mortality and serum insulin-like growth factor I in primary care patients." Technische Universität Dresden, 2011. https://tud.qucosa.de/id/qucosa%3A26868.

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Objective: Previous population-based studies provided conflicting results regarding the association of total serum insulin-like growth factor I (IGF-I) and mortality. The aim of the present study was to assess the relation of IGF-I levels with all-cause mortality in a prospective study. Design: DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a large, multistage, and nationally representative study of primary care patients in Germany. The study population included 2463 men and 3603 women. Death rates were recorded by the respective primary care physician. Serum total IGF-I levels were determined by chemiluminescence immunoassays and categorized into three groups (low, moderate, and high) according to the sex- and age-specific 10th and 90th percentiles. Results: Adjusted analyses revealed that men with low [hazard ratio (HR) 1.70 (95% confidence interval [CI] 1.05–2.73), p=0.03] and high [HR 1.76 (95% CI 1.09–2.85), p=0.02] IGF-I levels had higher risk of all-cause mortality compared to men with moderate IGF-I levels. The specificity of low IGF-I and high IGF-I levels increased with lower and higher cut-offs, respectively. No such association became apparent in women. Conclusions: The present study revealed a U-shaped relation between IGF-I and all-cause mortality in male primary care patients.
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25

Bischoff, Bernhard, Sigmund Silber, Barbara M. Richartz, Lars Pieper, Jens Klotsche, and Hans-Ulrich Wittchen. "Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany." Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26666.

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Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany. Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications. Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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26

Deutsch, Tobias, Stefan Lippmann, Maximilian Heitzer, Thomas Frese, and Hagen Sandholzer. "Choosing to become a general practitioner – What attracts and what deters?" Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-206209.

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Background: To be able to counter the increasing shortage of general practitioners (GPs) in many countries, it is crucial to remain up‑to‑date with the decisive reasons why young physicians choose or reject a career in this field. Materials and Methods: Qualitative content analysis was performed using data from a cross‑sectional survey among German medical graduates (n = 659, response rate = 64.2%). Subsequently, descriptive statistics was calculated. Results: The most frequent motives to have opted for a GP career were (n = 74/81): Desire for variety and change (62.2%), interest in a long‑term bio‑psycho‑social treatment of patients (52.7%), desire for independence and self‑determination (44.6%), positively perceived work‑life balance (27.0%), interest in contents of the field (12.2%), and reluctance to work in a hospital (12.2%). The most frequent motives to have dismissed the seriously considered idea of becoming a GP were (n = 207/578): Reluctance to establish a practice or perceived associated risks and impairments (33.8%), stronger preference for another field (19.3%), perception of workload being too heavy or an unfavorable work‑life balance (15.0%), perception of too low or inadequate earning opportunities (14.0%), perception of the GP as a \"distributor station\" with limited diagnostic and therapeutic facilities (11.6%), perception of too limited specialization or limited options for further sub‑specialization (10.6%), rejection of (psycho‑) social aspects and demands in general practice (9.7%), and perceived monotony (9.7%). Conclusion: While some motives appear to be hard to influence, others reveal starting points to counter the GP shortage, in particular, with regard to working conditions, the further academic establishment, and the external presentation of the specialty.
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27

Bramlage, Peter, David Pittrow, Hendrik Lehnert, Michael Höfler, Wilhelm Kirch, Eberhard Ritz, and Hans-Ulrich Wittchen. "Frequency of albuminuria in primary care: a cross-sectional study." Technische Universität Dresden, 2007. https://tud.qucosa.de/id/qucosa%3A26698.

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Background: We aimed to assess the point prevalence of microalbuminuria (MAU) in a sample of unselected consecutive primary-care attendees, with particular focus on patients with diabetes mellitus (with and without additional concomitant diseases) and those with hypertension. Design: Cross-sectional observational study in a nationwide representative sample of 1912 primary-care practices and a patient population consisting of 39 125 primary-care attendees. Diagnoses for diabetes, hypertension and co-morbidities were provided by the treating physician and complemented by blood pressure (BP) measurements and selected lab tests. Screening for microalbuminuria (>20 and <200 μg/ml) was done with a spot urine dipstick test. Results: The clinical diagnosis of nephropathy was assigned to 7.6% of patients. The point prevalence of MAU was 19.0% in the total sample; the proportion was 33.6% in diabetics whereas the diagnosis was assigned to only 7.1% in the total sample. Amongst diabetic patients with MAU, 92.6% had BP above the target value of < 130/80 mmHg. Frequency rates rose with increasing BP (e.g. 20.6% in diabetic patients with BP< 120/70 mmHg, and 36.3% in diabetic patients with BP > 140/90 mmHg). Of note, patients with MAU had a higher burden of co-morbidity compared to those without MAU. Conclusions: We found a high prevalence of MAU in primary care, particularly in diabetic patients. The frequency of MAU was closely related to the BP level and the degree of co-morbidity. The present study underlines the magnitude of the problem of MAU in primary care, and should serve as a starting point to initiate measures to address this important public health issue.
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28

Leistner, David M., Jens Klotsche, Sylvia Palm, Lars Pieper, Günter K. Stalla, Hendrik Lehnert, Sigmund Silber, Winfried März, Hans-Ulrich Wittchen, and Andreas M. Zeiher. "Resting heart rate as a tool for risk stratification in primary care: does it provide incremental prognostic information?" Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120152.

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Background: Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention. Design: Prospective, population-based cohort study. Methods: We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008. Results: During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979). Conclusion: The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.
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29

Deutsch, Tobias, Stefan Lippmann, Thomas Frese, and Hagen Sandholzer. "Who wants to become a general practitioner?" Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-162522.

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Objective: Because of the increasing shortage of general practitioners (GPs) in many countries, this study aimed to explore factors related to GP career choice in recent medical graduates. Particular focus was placed on the impact of specific practice-orientated GP courses at different stages of the medical undergraduate curriculum. Design: Observational study. Multivariable binary logistic regression was used to reveal independent associations with career choice. Setting: Leipzig Medical School, Germany. Subjects: 659 graduates (response rate = 64.2%). Main outcome measure: Choice of general practice as a career. Results: Six student-associated variables were found to be independently related to choice of general practice as a career: age, having family or friends in general practice, consideration of a GP career at matriculation, preference for subsequent work in a rural or small-town area, valuing the ability to see a broad spectrum of patients, and valuing long-term doctor – patient relationships. Regarding the curriculum, after adjustment independent associations were found with a specifi c pre-clinical GP elective (OR = 2.6, 95% CI 1.3 – 5.3), a four-week GP clerkship during the clinical study section (OR = 2.6, 95% CI 1.3 – 5.0), and a four-month GP clinical rotation during the final year (OR = 10.7, 95% CI 4.3 – 26.7). It was also found that the work-related values of the female participants were more compatible with those of physicians who opt for a GP career than was the case for their male colleagues. Conclusion: These results support the suggestion that a practice-orientated GP curriculum in both the earlier and later stages of undergraduate medical education raises medical schools’ output of future GPs. The findings are of interest for medical schools (curriculum design, admission criteria), policy-makers, and GPs involved in undergraduate medical education. More research is needed on the effectiveness of specific educational interventions in promoting interest in general practice as a career.
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30

Wittchen, Hans-Ulrich, Beverley Balkau, Christine Massien, Alain Richard, Steven Haffner, and Jean-Pierre Després. "International Day for the Evaluation of Abdominal obesity: rationale and design of a primary care study on the prevalence of abdominal obesity and associated factors in 63 countries." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106708.

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Sedentary lifestyles and energy-rich diets are driving an increasing prevalence of abdominal obesity, which is associated with cardiovascular risk. Reliable estimates of the worldwide prevalence of abdominal obesity are needed to quantify the associated health risk. The International Day for the Evaluation of Abdominal obesity (IDEA) study is a large, international epidemiological cross-sectional study designed to provide reliable data on the distribution of waist circumference according to region, gender, age, and socio-economic level in 177 345 primary care patients from 63 countries across five continents. Any non-pregnant patient aged 18–80 consulting one of the randomly selected primary care physicians on two pre-defined half days was eligible to participate in the study. The primary objective was to estimate the prevalence of abdominal obesity in primary care, in each participating country. Secondary objectives were to estimate the prevalence of hypertension, type 2 diabetes, dyslipidaemia, and smoking, and to evaluate their associations with abdominal obesity, according to age, gender, and socio-economic level and region. The IDEA study will provide the first global map of the prevalence of abdominal obesity and associated comorbidities in primary care practice.
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31

Leistner, David M., Jens Klotsche, Sylvia Palm, Lars Pieper, Günter K. Stalla, Hendrik Lehnert, Sigmund Silber, Winfried März, Hans-Ulrich Wittchen, and Andreas M. Zeiher. "Resting heart rate as a tool for risk stratification in primary care: does it provide incremental prognostic information?" Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A26063.

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Background: Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention. Design: Prospective, population-based cohort study. Methods: We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008. Results: During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979). Conclusion: The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.
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32

Meves, Saskia H., Curt Diehm, Klaus Berger, David Pittrow, Hans-Joachim Trampisch, Ina Burghaus, Gerhart Tepohl, et al. "Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-135267.

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Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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33

Wittchen, Hans-Ulrich, Beverley Balkau, Christine Massien, Alain Richard, Steven Haffner, and Jean-Pierre Després. "International Day for the Evaluation of Abdominal obesity: rationale and design of a primary care study on the prevalence of abdominal obesity and associated factors in 63 countries." Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26694.

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Sedentary lifestyles and energy-rich diets are driving an increasing prevalence of abdominal obesity, which is associated with cardiovascular risk. Reliable estimates of the worldwide prevalence of abdominal obesity are needed to quantify the associated health risk. The International Day for the Evaluation of Abdominal obesity (IDEA) study is a large, international epidemiological cross-sectional study designed to provide reliable data on the distribution of waist circumference according to region, gender, age, and socio-economic level in 177 345 primary care patients from 63 countries across five continents. Any non-pregnant patient aged 18–80 consulting one of the randomly selected primary care physicians on two pre-defined half days was eligible to participate in the study. The primary objective was to estimate the prevalence of abdominal obesity in primary care, in each participating country. Secondary objectives were to estimate the prevalence of hypertension, type 2 diabetes, dyslipidaemia, and smoking, and to evaluate their associations with abdominal obesity, according to age, gender, and socio-economic level and region. The IDEA study will provide the first global map of the prevalence of abdominal obesity and associated comorbidities in primary care practice.
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34

Meves, Saskia H., Curt Diehm, Klaus Berger, David Pittrow, Hans-Joachim Trampisch, Ina Burghaus, Gerhart Tepohl, et al. "Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A26583.

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Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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35

Köhler, Mirjam, Matthias Kliegel, Birgitt Wiese, Horst Bickel, Hanna Kaduszkiewicz, Hendrik van den Bussche, Sandra Eifflaender-Gorfer, et al. "Malperformance in Verbal Fluency and Delayed Recall as Cognitive Risk Factors for Impairment in Instrumental Activities of Daily Living." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-135809.

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Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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36

Köhler, Mirjam, Matthias Kliegel, Birgitt Wiese, Horst Bickel, Hanna Kaduszkiewicz, Hendrik van den Bussche, Sandra Eifflaender-Gorfer, et al. "Malperformance in Verbal Fluency and Delayed Recall as Cognitive Risk Factors for Impairment in Instrumental Activities of Daily Living." Karger, 2011. https://tud.qucosa.de/id/qucosa%3A27678.

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Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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37

Mertens, Ralph [Verfasser]. "Abrechnungsverhalten von Leistungen zur psychosomatischen Grundversorgung bei niedergelassenen Ärzten / von Ralph Mertens." 2005. http://d-nb.info/975912917/34.

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38

Brandt, Danilo Hanitzsch Thomas. "Die Anwendung der Grundversorgung auf Onlineauftritte öffentlich-rechtlicher Fernsehsender : eine inhaltsanalytische Untersuchung /." 2007. http://www.gbv.de/dms/ilmenau/abs/524109907brand.txt.

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39

Dörr, Christa Schönermark Matthias. "Dokumentation zur psychosomatischen Grundversorgung : vergleichende Beobachtungen bei niedersächsischen Hausärzten mit und ohne psychotherapeutische Weiterbildung /." 2003. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=013034078&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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40

Bühler, Stefan. "Wettbewerb und flächendeckende Grundversorgung in der Telekommunikation : Regulatorische Probleme der Umsetzung des revidierten Fernmeldegesetzes /." 1999. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=008577815&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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41

Glaesmer, Heide [Verfasser]. "Können Qualitätszirkel Kosten dämpfen? : Auswertung von Abrechnungsdaten niedergelassener Ärzte eines Qualitätssicherungsprojektes zur psychosomatischen Grundversorgung (PSGV) / von Heide Glaesmer." 2004. http://d-nb.info/972685197/34.

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42

Franken, Ulla [Verfasser]. "Emotionale Kompetenz - eine Basis für Gesundheit und Gesundheitsförderung : ein gesundheitswissenschaftlicher Beitrag zur Grundversorgung von Menschen mit psychogenen Störungen und Erkrankungen / vorgelegt von: Ulla Franken." 2005. http://d-nb.info/98271839X/34.

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43

Unger, Tatjana [Verfasser]. "Der Einfluss von emotionalen Faktoren und psychosomatischer Grundversorgung auf die Einstellung des Blutzuckerspiegels (HbA1c) bei Patienten mit insulinpflichtigem Diabetes Typ 2 : eine multivariate Zeitreihenanalyse / vorgelegt von Tatjana Unger, geb. Wolf." 2006. http://d-nb.info/98279245X/34.

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44

Sobek, Cordula. "Evidenz-basierte Pharmakotherapie der Herzinsuffizienz an der stationär-ambulanten Schnittstelle." Doctoral thesis, 2007. http://hdl.handle.net/11858/00-1735-0000-0006-AF2E-9.

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45

Krause, Christina. "Evaluierung von Rauchentwöhnungsprogrammen in der stationären Behandlung von berufsbedingten Hauterkrankungen." Doctoral thesis, 2019. https://repositorium.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-201912052297.

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Die Ziele der Dissertation sind es, die Effektivität von Rauchentwöhnungsprogrammen in der stationären Behandlung von berufsbedingten Hauterkrankungen zu prüfen und den Forschungsstand zum Einfluss des Rauchens auf berufsbedingte Handekzeme zu beleuchten. In einer Längsschnittstudie wurden dazu zwei Rauchentwöhnungsprogramme in der stationären Behandlung für berufsbedingte Hauterkrankungen evaluiert. Das Rauchentwöhnungsprogramm „Rauchfrei nach Hause!?“ der IFT-Gesundheitsförderung wurde hinsichtlich der Bewertung der Teilnehmer, der Steigerung der Motivation und Zuversicht, das Rauchverhalten aufzugeben, und der Abstinenz vom Rauchen mit dem bisher durchgeführten Rauchentwöhnungsprogramm verglichen. Zudem wurde die Ausprägung des berufsbedingten Handekzems von Rauchern und Nichtrauchern während und bis zu sechs Monate nach dem stationären Aufenthalt analysiert. Die Ergebnisse bestätigen, dass sich die Implementierung des zeitlich und inhaltlich intensiveren Rauchentwöhnungsprogramms „Rauchfrei nach Hause!?“ in die stationäre Behandlung von berufsbedingten Handekzemen als effektiv erweist. Dieses Programm führt zu einer höheren Motivation und Zuversicht, das Rauchverhalten zu ändern, sowie zu einer höheren Abstinenzquote drei Wochen nach dem Aufenthalt im Vergleich zum bisherigen. Auch der negative Einfluss des Rauchens auf die Ausprägung des berufsbedingten Handekzems bestätigt sich zu bestimmten Messzeitpunkten. Mit den Ergebnissen wird die Diskussion um den schädigenden Einfluss des Rauchverhaltens auf die Ausprägung des Handekzems vorangebracht und sie regen zu weiterer Forschung auf bspw. ambulanter Behandlungsebene von berufsbedingten Hauterkrankungen an.
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46

Berger, Claudia. "Soziale Aspekte der Frühgeburtlichkeit unter besonderer Berücksichtigung von Schwangeren mit Migrationshintergrund." Doctoral thesis, 2012. https://repositorium.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-2012101610365.

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Der Anteil der Frauen mit Migrationshintergrund und eigener Migrationserfahrung, der ersten Generation, zwischen 15 und 45 Jahre, lag 2005 in Niedersachsen bei ungefähr 16 Prozent und der Anteil von Schwangeren mit einem anderen Herkunftsland als Deutschland betrug 16,8 Prozent. Diesen relevanten Anteil bezogen auf die perinatalen Ergebnisse differenziert zu betrachten war zentrales Anliegen der Studie. Insbesondere Frühgeburtlichkeit ist für die Geburtshilfe von Bedeutung, da sie trotz medizinischer Verbesserungen und umfassender Schwangerenvorsorge in Niedersachsen zwischen 2001-2008 bei durchschnittlich 8,1 Prozent lag. Die Ursachen sind multifaktoriell und beinhalten soziale und psychische Faktoren. Unter anderem stellen Spätaussiedlerinnen, durch Nichtanerkennung von Schulabschlüssen und Heiratsmigrantinnen, aufgrund des Verlustes von sozialen Netzwerken, in diesem Zusammenhang eine vulnerable Gruppe dar, weil sie häufig einen niedrigen Sozialstatus haben sowie psychisch durch Migration belastet sein können. Um Unterschiede in Bezug auf Frühgeburtlichkeit von Schwangeren aus unterschiedlichen Herkunftsregionen darzustellen und zu erklären, wurde das in den USA konstatierte "Latina Paradox" mit einbezogen. Danach haben Frauen aus lateinamerikanischen Ländern in der ersten Generation ein besseres geburtshilfliche Outcome in Bezug auf Frühgeburtlichkeit als US-Amerikanerinnen mit dem gleichen sozioökonomischen Status, obwohl sie eine geringere Schwangerenvorsorge erhielten. Fraglich war, ob sich dieses Paradox auch in Niedersachsen für Schwangere mit Migrationshintergrund nachweisen ließ. Basis für die empirische Untersuchung waren die Niedersächsischen Perinatalerhebungen der Jahre 2001-2008. Alle lebenden Einlingsgeburten mit einem Gestationsalter von < 37 + 0 SSW wurden in Bezug auf die berufliche Tätigkeit und Herkunftsregion der Mütter betrachtet. Bei den Frühgeborenen wurde zwischen Frühgeborenen, die zwischen der 32 + 0 und 36 + 6 Schwangerschaftswoche geboren wurden, sehr frühen Frühgeborenen und extrem frühen Frühgeborenen differenziert. Der Fokus lag auf Frauen aus "Osteuropa" und dem "Mittleren Osten, Nordafrika" und als Vergleichsgruppe wurden Schwangere aus Deutschland mit gleicher beruflicher Stellung herangezogen. Neben deskriptiven wurden auch multivariate Analysen durchgeführt. Bei der Analyse der N = 498.141 lebenden Einlingsgeburten zeigte sich, dass die größten Anteile eines anderen Herkunftslandes als Deutschland Frauen aus "Osteuropa" mit 5,6 Prozent und aus dem "Mittleren Osten, Nordafrika" mit 4,9 Prozent hatten. Erwartungsgemäß konnte festgestellt werden, dass Schwangere mit Migrationshintergrund aus Osteuropa und dem "Mittleren Osten, Nordafrika" im Vergleich zu deutschen Schwangeren niedrigere Bildungsabschlüsse hatten. Die Frühgeburtenrate betrug für lebende Einlingsgeburten (Herkunftsland der Mutter Deutschland) in den Jahren 2001-2008 zwischen 7,4 Prozent und 7,7 Prozent. Für Frauen aus "Osteuropa" zwischen 5,6 Prozent und 6,7 Prozent sowie für Frauen aus dem "Mittleren Osten, Nordafrika" zwischen 5,9 Prozent und 7,6 Prozent. Nach Durchführung der Logistischen Regression wurde ein signifikant geringeres Frühgeburtsrisiko für Frauen aus "Osteuropa" (AOR = 0.88; 95% CI, 0.82-0.93) (p < 0.001); und dem "Mittleren Osten, Nordafrika" (AOR = 0.93; 95% CI, 0.88-0.99) (p < 0.05) nachgewiesen. Die differenzierte Betrachtung nach beruflicher Tätigkeit der Schwangeren zeigte nach Adjustierung für Osteuropäerinnen, die als Facharbeiterin bzw. einfache Beamtin tätig waren oder ein Kleingewerbe betrieben, ein signifikant geringeres Risiko für Frühgeburtlichkeit gegenüber der Referenzgruppe (AOR = 0.757; 95% CI, 0.653 - 0.877) (p < 0.001), obwohl diese Frauen eine signifikant höhere Chance einer Schwangerschaftsvorsorge von mindestens einer Untersuchung unter dem Standard (AOR = 1.406 (95 % CI, 1.279 - 1.547) (p < 0.001) hatten. Soziale Risikofaktoren, die aus dem Eintrag im Mutterpass einbezogen wurden, hatten keinen signifikanten Einfluss auf das Frühgeburtsrisiko für Schwangere mit einem anderen Herkunftsland als Deutschland. Frauen mit Migrationshintergrund "Osteuropa" und dem "Mittleren Osten, Nordafrika" hatten im Vergleich zu Schwangeren ohne Migrationshintergrund ein geringeres Risiko einer Frühgeburt, ähnlich dem US-amerikanischen "Latina Paradox", obwohl sie häufiger eine Schwangerschaftsvorsorge unter dem Standard hatten. Insbesondere zeigte sich dieses Paradox für Schwangere aus "Osteuropa", die als Facharbeiterin, einfache Beamtin tätig waren bzw. ein Kleingewerbe betrieben. Diese Befunde unterstützen die Annahme, dass Schwangere aus bestimmten Herkunftsregionen Protektivfaktoren für Frühgeburtlichkeit besitzen und führen zu dem Schluss, dass diese Faktoren in weiteren Studien eruiert werden sollten, um protektiv auf das geburtshilfliche Outcome einwirken zu können.
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47

Wilke, Annika. "Untersuchungen zur Evaluation der Wirksamkeit präventiver Interventionen in der Berufsdermatologie." Doctoral thesis, 2014. https://repositorium.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-2014101312863.

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Aufgrund der hohen Prävalenz und Inzidenz von berufsbedingten Hauterkrankungen kommt wirksamen primär-, sekundär- und tertiärpräventiven Interventionen eine große Bedeutung zu. Die Beurteilung der Wirksamkeit ist Aufgabe der Evaluationsforschung, deren Güte sich an wissenschaftlichen, forschungsmethodischen Maßstäben und Kriterien bemisst. Das Ziel der vorliegenden Dissertation ist es, durch drei Untersuchungen dazu beizutragen, bestehende Forschungslücken im Kontext der Wirksamkeitsevaluation von Präventionsmaßnahmen in der Berufsdermatologie zu schließen. Hierfür erfolgt eine Untersuchung und Systematisierung des aktuellen Forschungsstandes anhand theoretisch abgeleiteter Kriterien. Analysiert werden das Interventionsziel, die untersuchten Outcomeparameter, das Evaluationsdesign, die Erhebungszeitpunkte sowie die Objektivität, Reliabilität, Validität und Änderungssensitivität der Erhebungsmethode. Basierend auf diesen Analysen werden Forschungslücken abgeleitet und begründet. Dies bildet den theoretischen Rahmen dieser Dissertation. Die drei durchgeführten Untersuchungen zur Evaluation der Wirksamkeit von präventiven Interventionen werden in diesen theoretischen Rahmen eingeordnet und vor dem Hintergrund der identifizierten Forschungslücken der jeweilige Beitrag zum aktuellen Stand der Forschung begründet. Alle drei Untersuchungen weisen konkrete Zielformulierungen sowie darauf abgestimmte Outcomeparameter auf, die sowohl auf der biomedizinischen als auch auf der psychischen und sozialen Ebene verortet sind. Die besondere Stärke von Untersuchung I liegt in ihrem kontrollierten Studiendesign. Aufgrund der Anzahl und Auswahl der Erhebungszeitpunkte schließen die Untersuchungen I und II Forschungslücken hinsichtlich der Untersuchung der Nachhaltigkeit und des Verlaufs des Interventionseffektes. Untersuchung III zeichnet sich durch eine objektive, reliable, valide und änderungssensitive Erhebungsmethode aus. Aus den drei Untersuchungen sowie aus der vorliegenden Dissertation in ihrer Gesamtheit leiten sich zahlreiche Ansatzpunkte für Forschungsdesiderata ab. Es lässt sich subsumieren, dass es langfristig ausgerichteter Evaluationsstudien bedarf, die eine angemessenen Zahl an Einzelerhebungen einschließen und in deren Rahmen objektive, reliable, valide und änderungssensitive Erhebungsverfahren eingesetzt werden. Ferner sollte künftig vermehrt eine Systematisierung der bislang als äußerst heterogen zu charakterisierenden Outcomeparameter erfolgen, indem die Parameter in einem theoretisch begründeten Rahmen verortet werden. Diese Optimierungen der gegenwärtigen Evaluationskultur dienen nicht nur wissenschaftlich-theoretischen Zwecken, sondern tragen langfristig zur Verbesserung der Versorgungsstrukturen mit Blick auf die Primär-, Sekundär- und Tertiärprävention berufsbedingter Hauterkrankungen bei.
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