Gesundheitswesen
· 2026 Jun · PMID 40738126
·
Publisher ↗
BACKGROUND: Lung cancer (ICD-10-GM C34) is one of the most common cancer diseases and cause of cancer death worldwide. Costs of lung cancer treatment has increased over the past years. OBJECTIVE: This study aimed to iden...BACKGROUND: Lung cancer (ICD-10-GM C34) is one of the most common cancer diseases and cause of cancer death worldwide. Costs of lung cancer treatment has increased over the past years. OBJECTIVE: This study aimed to identify therapeutic procedures causing increased expenses. METHODS: Based on the database of the Cancer Registry of Rhineland-Palatinate in the Institute for Digital Health Data, lung cancer patients diagnosed with either non-small cell lung cancer (NSCLC; n=16,114) or small cell lung cancer (SCLC; n=3,323) in the years 2016-2022 were included. Distribution of tumor stages and number of administered therapies were investigated. RESULTS: For NSCLC and SCLC, therapies administered showed marginal changes in the observed time span with one exception: the number of patients treated with targeted and antibody therapies showed an increase. Whereas about 3% of patients with NSCLC were given these therapies in the years 2016 and 2017, this number increased to over 5% from 2019 on. For SCLC, these therapies were reported for less than 1% of patients in the years 2016-2018; this number increased to over 4% in the years 2021 and 2022. CONCLUSION: Therapeutic treatment of lung cancer seems to remain stable over the past years. Only targeted and antibody therapies increased during the period 2016 to 2022. The increasing number of these therapies could explain the higher costs of cancer treatment.
Schreiber J, Strauß C, Weidlich A
… +2 more, Thober S, Schröder-Bäck P
Gesundheitswesen
· 2025 Dec · PMID 40690951
·
Publisher ↗
Between March 16th and December 31st 2022, compulsory vaccination against COVID-19 in medical and care facilities was legislated through § 20a of the Infection Protection Act. Until March 15th 2022, employees in medical...Between March 16th and December 31st 2022, compulsory vaccination against COVID-19 in medical and care facilities was legislated through § 20a of the Infection Protection Act. Until March 15th 2022, employees in medical and care facilities had to provide proof of completed vaccination against COVID-19, proof of recovery, or a medical certificate indicating that vaccination was not feasible. In case the deadline was not met, the facility management was obliged to report immediately to the local health authority, who proceeded with a discretionary decision. There was controversy about the law among politicians, health care workers, employees in public administration as well as in the media landscape and civil society. Federal states and local authorities implemented the law to varying degrees. This study describes the implementation of compulsory vaccination in medical and care facilities in detail for the district Hamburg Eimsbüttel and presents administrative, medical and ethical challenges of the law in its implementation.
Epple K, Schmidt K, Löffler C
… +2 more, Feldmeier G, Dierich A
Gesundheitswesen
· 2026 Jun · PMID 40690950
·
Publisher ↗
BACKGROUND: Long-term illnesses have far-reaching consequences for the patients themselves, as well as for society as a whole. The aim of this study was to analyze risk factors for long-term illnesses among soldiers of t...BACKGROUND: Long-term illnesses have far-reaching consequences for the patients themselves, as well as for society as a whole. The aim of this study was to analyze risk factors for long-term illnesses among soldiers of the German armed forces in order to derive target group-specific and risk-adapted prevention measures. METHOD: The sick leaves of all soldiers of the German armed forces in the period 2008-2018 were analyzed descriptively and risk factors were determined using two-dimensional contingency tables for the attributes gender, military career group, age group and main diagnosis in relation to sick leave (>42 and>84 days), whereby a statistically significant odds ratio (OR)>1.00 (McNemar test, p<0.05) had to be present. Risk constellations were identified by linking risk factors with the three most common underlying ICD-10 diagnoses. RESULTS: The age groups 30-39 years (OR 1.13; 95% confidence interval [1.10; 1.16]), 40-49 years (OR 1.50 [1.45; 1.54]), 50-59 years (OR 1.81 [1.74; 1.88]), the military career group of non-commissioned officers (OR 1.35 [1.32; 1.37]) and officers (OR 1 .26 [1.23; 1.30]), as well as female gender (OR 1.23 [1.19; 1.26]) were identified as risk factors. Main diagnoses from the ICD-10 chapters "mental and behavioral disorders (F-codes)" (OR 6.50 [6.35; 6.65]), "diseases of the musculoskeletal system (M-codes)" (OR 2.54 [2.48; 2.60]) and "injuries, poisoning and certain other consequences of external causes (S-T-codes)" (OR 3.37 [3.30; 3.45]) were also risk factors. The ICD-10 diagnoses "reactions to severe stress and adjustment disorders (F43)" and "depressive episode (F32)" were among the three most frequent diagnoses for all analyzed attributes. Non-commissioned officers with "knee injuries (S83)", officers with "intervertebral disc disorders (M51)" and women with "pregnancy complaints (O26)" were risk constellations. CONCLUSION: In addition to the comprehensive relevance of diagnoses of "mental and behavioral disorders", the study identified further risk factors and risk constellations for long-term illnesses. Based on this results target group-specific and risk-adapted prevention measures can be developed, e. g. as part of company health management. Concepts for "women's health" should also be implemented in the future. The effects of target group-specific and risk-adapted prevention measures need to be analyzed in follow-up studies.
Walter F, Maier K, Roos M
… +1 more, Lorenz-Dant K
Gesundheitswesen
· 2026 Feb · PMID 40680789
·
Full text
The demand for GP care is increasing while the number of GPs is decreasing. We investigated how GPs perceive bureaucracy during the process of establishing their own practice and how this perception changes with increasi...The demand for GP care is increasing while the number of GPs is decreasing. We investigated how GPs perceive bureaucracy during the process of establishing their own practice and how this perception changes with increasing establishment experience.Physicians who wished to set up a practice or who were in the process of setting up a practice and those who, up to two years and two to five years previously, had set up a GP practice were interviewed digitally following an interview guide. The recordings were transcribed verbatim and analysed using Braun & Clarkes Thematic Analysis.The 18 interviewees identified "bureaucracy" in various areas unrelated to patient care. A habituation effect occurs after the practice has been established. Resources for coping with bureaucratic challenges were mentioned.The participants define bureaucracy as any activity that is distant from the patient. Dealing with this should be made easier despite the habituation that occurs. Electronic processes and support through advice can help to overcome bureaucratic hurdles, and positive examples mentioned should be systematised. GPs view bureaucracy as a hurdle to setting up a practice, but it does not influence their decision to establish their own practice. Therefore, while still relevant, bureaucracy is found to be less important than previous research suggests.
Herrmann A, Piontkowski E, Roller G
… +13 more, Brockmann S, Nill F, Wolfers K, Minkwitz S, Hailer J, Stengele U, Schäfer P, Braun P, Oster N, Joos S, Häske D, Joggerst B, Rieger MA
Gesundheitswesen
· 2025 Oct · PMID 40680788
·
Full text
The 2018 mission statement of the ÖGD emphasises the importance of scientific research and cooperation with scientific institutions. In 2020, the Federal Ministry of Health (BMG) took up this aspect in a call for proposa...The 2018 mission statement of the ÖGD emphasises the importance of scientific research and cooperation with scientific institutions. In 2020, the Federal Ministry of Health (BMG) took up this aspect in a call for proposals to strengthen cooperation between the ÖGD and public health research. In the context of this call, the research network 'Infektionsschutz.Neu.Gestalten (I.N.Ge)' was established with four health authorities and one university (funding period: 09/2021-08/2024). The aim was to improve the evidence-based work of the ÖGD in the field of health and infection protection. Digitalisation, quality assurance, risk communication and special groups were examined using the example of infection control in the COVID-19 pandemic. A participatory, transformative approach with real-world laboratories and experiments was used. Lessons for successful cooperation between public health and university institutions were drawn from the intensive collaboration. Important were appropriate frameworks, targeted resource planning and clear role definitions. Issues were identified that could make future collaboration more effective and sustainable. The resulting recommendations for action are intended, among other things, to support the conception of joint research projects. I.N.Ge showed that improved framework conditions were necessary for increased cooperation. Funding projects should allow for flexible cooperation models that adapt to the specific resources and competencies of the partners. Forward-looking resource planning was determined to be essential - including job calculations, substitution arrangements and additional capacity for induction or methodological adaptation. Clear roles and responsibilities should be defined at the tendering stage to create transparency and optimise implementation. I.N.Ge emphasized the need to promote cooperation between the ÖGD and academic institutions in order to further develop and strengthen the public health service. I.N.Ge emphasises that cooperation between the ÖGD and academic institutions must be encouraged in order to further develop and strengthen the ÖGD.
Hauswaldt J, Groh R, Kaulke K
… +3 more, Schlegelmilch F, Zarei A, Hummers E
Gesundheitswesen
· 2025 Nov · PMID 40659057
·
Full text
A dataset can be called "anonymous" only if its content cannot be related to a person, not by any means and not even or by combination with other information. Free text entries highly impede "factual anonymization" for...A dataset can be called "anonymous" only if its content cannot be related to a person, not by any means and not even or by combination with other information. Free text entries highly impede "factual anonymization" for secondary research. Using two source datasets from GPs' electronic medical records (EMR), we aimed at de-identification in an iterative and systematic search for potentially identifying field content (PIF).EMR data of 14,285 to 100 GP patients with 40 variables (parameters, fields) in 5,918,321 resp. 363,084 data lines were analyzed at four levels: field labels, their combination, field content, dataset as a whole. Field labels were arranged into eleven semantic groups according to field type, their frequencies examined and their combination evaluated by GP experts rating the re-identification risk. Iteratively we searched for free text PIFs and masked them for the subsequent steps. The ratio of PIF data lines' number over total number yielded final probability estimators. In addition, we processed a whole dataset using ARX open source software for anonymizing sensitive personal data. Results were evaluated in a data protection impact assessment according to article 35 GDPR, with respect to the severity of privacy breach and to its estimated probability.We found a high risk of re-identification with free text entries into "history", "current diagnosis", "medication" and "findings" even after repeated algorithmic text-mining and natural language processing. Scrupulous pre-selection of variables, data parsimony, privacy by design in data processing and measures described here may reduce the risk considerably, but will not result in a "factually anonymized" research dataset.To identify and assess re-identifying field content is mandatory for privacy protection but anonymization can be reached only partly by reasonable efforts. Semantic structuring of data is pre-conditional but does not help with erroneous entries.
Gesundheitswesen
· 2025 Oct · PMID 40633820
·
Publisher ↗
Publication of the laudation and acceptance speeches on the occasion of the award of the Johann Peter Frank Medal by the Federal Association of Physicians in the Public Health Service (BVÖGD) 2025 at its National Congres...Publication of the laudation and acceptance speeches on the occasion of the award of the Johann Peter Frank Medal by the Federal Association of Physicians in the Public Health Service (BVÖGD) 2025 at its National Congress in Erlangen. This highest award of the BVÖGD is presented annually in memory of Johann Peter Frank, who is considered the founder of the German Public Health Service.
Völkel V, Gerken M, Kleihues-van Tol K
… +10 more, Schoffer O, Bierbaum V, Bobeth C, Roessler M, Blum T, Griesinger F, Günster C, Hansinger J, Schmitt J, Klinkhammer-Schalke M
Gesundheitswesen
· 2025 Dec · PMID 40628376
·
Publisher ↗
Lung cancer represents the second most frequent tumor entity worldwide with an increasing number of patients treated in specialized centers. The aim of the WiZen study was to find out whether treatment at hospitals certi...Lung cancer represents the second most frequent tumor entity worldwide with an increasing number of patients treated in specialized centers. The aim of the WiZen study was to find out whether treatment at hospitals certified by the German Cancer Society (GCS) was associated with long-term survival benefits.Data for this cohort study was derived from the largest German statutory health insurance (SHI) AOK, four regional population-based clinical cancer registries (CCR), and standardized hospital quality reports. The analyses were based on 173,999 incident lung cancer patients in the SHI dataset and 35,702 patients in the CCR dataset who received primary treatment for lung cancer (ICD-10-GM C33, C34, D38.1) between 2009 and 2017.Distributions of age, sex, comorbidities, and most tumor characteristics were similar among patients treated in certified and non-certified hospitals. The Kaplan-Meier estimator for 5-year overall survival was 28.0% for patients from certified and 16.9% from non-certified hospitals (SHI data; CCR data: 21.4% vs. 13.6%). Cox-regression adjusting for relevant confounders yielded hazard ratios of 0.97 (SHI data; 95%CI 0.94, 1.00) and 0.85 (CCR data; 95%CI 0.82, 0.88) for all-cause mortality. The adjusted hazard ratio for recurrence-free survival (CCR data, UICC stage I-III, R0 only) was 0.82 (95%CI 0.75, 0.90).The presented analyses show that treatment in certified lung cancer centers is associated with relevant survival benefits and should therefore be supported.
Gesundheitswesen
· 2026 Mar · PMID 40628375
·
Full text
Against the background of increasing problems in the provision of medival care in rural regions, the further development of outpatient medical concepts focussing on the imperative of economic efficiency and economy is es...Against the background of increasing problems in the provision of medival care in rural regions, the further development of outpatient medical concepts focussing on the imperative of economic efficiency and economy is essential. The delegation of medical tasks to medical assistants (MFA) offers a promising approach to relieve the burden on GPs and to support the provision of sustainable care. The 'VERSORGT am ORT' (VaO) project develops this principle and aims to reduce working hours away from patients by partially shifting delegated home visits to specialised care rooms without compromising the quality of care.Parameters for evaluating the VaO concept were quality of life (LQ) and satisfaction (PZ) of patients through standardized questionnaires, time spent away from patients and distance travelled. An initial data analysis from May 2024 to May 2025 compared the standard in the form of home visits (home visit /HB scenario) with partial transfer to VaO rooms according to the VaO model (VaO scenario) using paired t-tests over two survey time points.The n=134 data sets analysed showed significant differences in favour of the VaO model in the scenario comparison. The mean differences for travel time were MW=1.89 [min], travel time MW=2.79 [min], set-up time MW=0.63 [min], total time MW=5.32 [min] and kilometres travelled MW=1.89 [km] with p-values<0.001. Overall, a 20.9% reduction in working time away from the patient from 25.32 to 20.01 min and a 7.8% reduction in kilometres travelled from 13.34 to 12.30 km were achieved. The psychological component of the patients' LQ improved significantly from MW=52.94 to MW=57.27. The physical sum scale increased slightly from MW=41.01 to MW=43.94. Satisfaction remained almost unchanged.These results indicate that the VaO system can significantly increase the efficiency of GP care in rural areas. Despite a small absolute difference in the figures, the relative comparison already shows the potential and the increased efficiency of this innovative form of care. In addition, the interim evaluation shows that the concept does not lead to negative effects on QoL and patient satisfaction. An expansion to other regions and an in-depth analysis of the outcome parameters in further studies are recommended.
In its resolution on social participation, the World Health Assembly called on member states to involve patients and the population in decision-making processes in the healthcare system. Furthermore, the resolution calls...In its resolution on social participation, the World Health Assembly called on member states to involve patients and the population in decision-making processes in the healthcare system. Furthermore, the resolution calls for the monitoring of participation processes. The survey of examples of participation in the context of health, which was carried out in 2023, comes closest to such monitoring for Austria. The article summarises lessons learned from the survey.The learning experiences are based on the analysis of process-produced data from a questionnaire survey on examples of patient and population participation in the healthcare system commissioned by the Federal Ministry of Social Affairs, Health, Care and Consumer Protection in Austria. Data included were pretest results, workshop protocols to reflect on the survey instrument and results as well as limitations in the survey report. The contents of the documents included were paraphrased and analysed thematically.The results of the questionnaire survey showed that central to the planning and implementation of a survey were (1) the objective of the survey, including clarification of the objective and the areas to be covered, (2) the target group, including clarification of the target group and requirements adapted to it, and (3) reaching the target group, including motivators, choice of words and dissemination channels. The learning experiences were summarised in ten key questions for the development of similar survey instruments.A survey of examples of participation is possible and provides an overview of which groups are involved in which areas and how. Without concrete specifications as to which groups should be involved, the survey remains exploratory and does not allow any conclusions to be drawn about representativeness. The design of the survey is also caught between breadth (short questionnaire with potentially high response rate) and depth (long questionnaire with lower response rate). The checklist presented here is intended to support similar surveys. Without an orientation framework as to where participation should take place and who acts as the contact person for these processes, such surveys remain exploratory.
Hertner L, Schödwell S, Savin M
… +2 more, Penka S, Kluge U
Gesundheitswesen
· 2025 Aug · PMID 40532894
·
Publisher ↗
Despite efforts towards intercultural opening in all health sectors, the care of people with (flight) migration histories remains inadequate. The aim of the study was to explore how healthcare professionals deal with lan...Despite efforts towards intercultural opening in all health sectors, the care of people with (flight) migration histories remains inadequate. The aim of the study was to explore how healthcare professionals deal with language barriers while treating patients in hospital and general practitioners' offices in Baden-Württemberg.Guideline-based expert interviews were conducted with six general practitioners, six physicians working in an emergency department and four representatives of migrant self-organisations and evaluated using thematic analysis. Results of a concurrently conducted structured online survey in various hospital care departments were embedded into the dominant qualitative analysis.All interviewees reported that the language barrier was the main problem in the care of people with a (refugee) migration history. Trained language mediation was rarely used. Lay interpreters, lists of staff with non-German language skills and translation apps were common compromise solutions, but they harbour various pitfalls. As a result, employees described poorer access and a lower quality of treatment for people with a (refugee) migration history. For employees themselves, this could lead to excessive demands and borderline legal situations. The respondents preferred to see low-threshold language mediation services and rely on the recruitment of foreign specialists. The online survey supported the descriptions of the expert interviews. In rural compared to urban areas, professional language mediation was more rarely implemented.The results suggest a need for clear financial and structural regulation of professional language mediation in order to ensure adequate care for population groups without sufficient knowledge of German and to relieve the burden on employees.
Dohmen S, Marx G, Küsters C
… +8 more, von Bandemer S, Zeidler C, Ständer S, Juhra C, Beckers R, Schomacher L, Suelmann C, Beckers M
Gesundheitswesen
· 2025 Aug · PMID 40494551
·
Full text
The German healthcare system is facing challenges of an aging population with an increasing number of chronically ill patients with multimorbidity. Some of these are in need of nursing care, but there is a limited supply...The German healthcare system is facing challenges of an aging population with an increasing number of chronically ill patients with multimorbidity. Some of these are in need of nursing care, but there is a limited supply of care due to continuing shortage of personnel. The project, Telemedizin@NRW, funded by the Europäischen Fonds für regionale Entwicklung (EFRE NRW), addresses these challenges and pursues a holistic concept - including a technical review - for the care of chronically ill patients with multimorbidity by focusing on cross-indication telemonitoring. Cross-indication is emphasized because diseases (multimorbidity, comorbidity) are in part mutually dependent and reinforcing. Therefore, their treatment must also be holistically "thought" of across organs and disease patterns. In the project, cases from cardiology, dermatology and pneumology were considered. Based on the available project findings, the technical feasibility of telemonitoring across indications was investigated. The telemedicine platform that was used in the project and then further developed on the basis of additional needs was able to meet the technical requirements. This development demonstrated that cross-indication telemonitoring is technically and procedurally feasible. To implement such forms of care, cross-sector structures with interoperable systems must be further developed.
This article examines the impact of the 1975 expert report on psychiatric care in Germany (Psychiatry Enquete) through the analysis of oral history interviews. From the memories of contemporary witnesses, we reconstruct...This article examines the impact of the 1975 expert report on psychiatric care in Germany (Psychiatry Enquete) through the analysis of oral history interviews. From the memories of contemporary witnesses, we reconstruct their perspectives on the reform process surrounding the Psychiatry Enquete and its effects. Our aim is to contribute to a nuanced understanding of the Enquete and its complex effects on psychiatric practice and reform dynamics.This article analyses participants' perceptions and patterns of interpretation through 28 interviews with those involved in post-war psychiatry. A secondary analysis of the interviews allows aspects of the Enquête that have not been adequately addressed to be captured and new research perspectives to be developed, taking into account ethical and data protection standards.There was a tension between the effects of the Enquete documented in the literature and the memories of the contemporary witnesses. On the one hand, the memoirs emphasised the Enquete as a significant turning point in the reform process of psychiatry, while on the other hand, in retrospect, other voices criticised shortcomings in the implementation of the Enquete and the reforms that followed. These included inadequate representation of certain stakeholder groups and a lack of historical reflection.Although the interviews do not specifically address the impact of the Enquete, they do demonstrate its lasting influence on institutional and personal developments. In retrospect, the Enquete as a central reform step in West Germany is also integrated into the professional thinking and self-image of the interviewees in the sense of a narrative of progress.
Health literacy is associated with better health behavior and increased utilization of preventive measures. However, studies indicate that a significant proportion of the German population exhibits deficits in health lit...Health literacy is associated with better health behavior and increased utilization of preventive measures. However, studies indicate that a significant proportion of the German population exhibits deficits in health literacy, particularly individuals with a low socio-economic status. Notably, the HLS-EU-Q questionnaire, a widely used instrument for measuring health literacy in this context, has not yet been evaluated for its comprehensibility within this population group, at least in German-speaking countries.This article is the first exploratory study to examine the comprehensibility of the HLS-EU-Q16 for people affected by long-term unemployment. To achieve this, the "think-aloud" method was employed, allowing participants to verbalize their understanding and thoughts while responding to selected questions from the HLS-EU-Q16. The data were analyzed using a topic-oriented content analysis. A total of 12 participants were included in this study.We observed comprehension difficulties on multiple levels, indicating that the demands of the HLS-EU-Q16 questionnaire on the level of abstraction were too high for the surveyed population. Additionally, language barriers made it difficult to interpret the answers of people with German as a second language and difficulties in understanding the differentiation of the response scale became apparent.The comprehension difficulties suggest that individuals with a low socio-economic status, such as long-term unemployed people, may benefit from health literacy assessment instruments that are less complex, use easy-to-understand language and are better tailored to the living environment and cognitive patterns of the target population.
Gesundheitswesen
· 2025 Nov · PMID 40451195
·
Publisher ↗
Diabetic kidney disease and renal replacement therapy are long-term complications of diabetes mellitus and significantly contribute to disease burden. The aim of the analysis was to develop case definitions for diabetic...Diabetic kidney disease and renal replacement therapy are long-term complications of diabetes mellitus and significantly contribute to disease burden. The aim of the analysis was to develop case definitions for diabetic kidney complications in routine data as part of the diabetes surveillance and to internally validate them.Based on an age- and sex-stratified sample of persons covered by the Barmer health insurance, individuals with documented diabetes (E10-E14) were included and differentiated by type 1 (T1D) and type 2 diabetes (T2D). Case definitions were developed for persons with diabetic nephropathy (DNP; ICD: N08.3, E1x.2), chronic kidney disease (CKD; ICD: N18) and renal replacement therapy (RRT) with long-term dialysis (EBM: 40815-40819, 40823-40828 / OPS: 8-853, 8-854, 8-855, 8-857) or kidney transplantation (OPS: 5-555; EBM: 04561, 13601; ICD Z94.0). The temporal persistence of DNP and CKD was examined by considering different observation periods, and the internal validity was assessed using additional information from the data set for DNP, CKD, and RRT.In 2018, DNP was documented in 15.4% of individuals with diabetes (T1D: 18.3%; T2D: 15.2%), and CKD in 21.8% (T1D: 14.4%, T2D: 22.2%). Considering an observation period of five years (2014-2018), the prevalence estimates increased by 22 and 23%, respectively. RRT was documented in 7.5 per 1,000 individuals with diabetes. Internal validity assessment showed that 96.6% of DNP cases, 93.5% of CKD cases, and all RRT cases met at least one validation criterion.With high internal validity, and prevalence estimate consistent across age groups, the case definition of CKD can be considered suitable for use in surveillance. However, we assume that prevalence is underestimated when considering a 1-year period. For the depiction of RRT (kidney transplantation or long-term dialysis) via routine data, documentation of services must be employed.
Gesundheitswesen
· 2025 Jun · PMID 40451194
·
Publisher ↗
The impact of COVID-19 on long-term care, and particularly on mortality, has been described early on. The aim of the present article was to estimate the number of COVID-19 deaths among care recipients while distinguishin...The impact of COVID-19 on long-term care, and particularly on mortality, has been described early on. The aim of the present article was to estimate the number of COVID-19 deaths among care recipients while distinguishing between different care situations. Additionally, the influence of protective measures and the evolution of the risk of COVID-19-related mortality among care recipients and the general population were compared. The results indicate that approximately 80% of all COVID-19 deaths in Germany occurred among care recipients, with nearly half of all deaths occurring among residents of nursing homes. The risk of COVID-19 mortality for care recipients initially decreased compared to the general population following prioritized vaccination efforts, but notably increased again in 2022.