German Health Research Articles

Einschätzung der Sturzgefährdung gebrechlicher, noch selbstständig lebender, älterer Menschen

Mobility is one of the most important factors for well-being and autonomy in old age. Impairments in mobility, falls and fear of falling are, therefore, of prognostic value. Falls generally result from an interaction of multiple risk factors. However, older people are often not aware of the risks of falling. They neither recognize risk factors nor report these factors to their physicians. The aim of this study was to develop and to test a self-reported multidimensional screening instrument to evaluate risk factors of falling in community-dwelling older people. Therefore, we identified multiple risk factors of falls based on a systematic literature review and then developed a new questionnaire - the Senior Citizen Risk of Falling Check. Risk factors, i.e. cognitive disorders, that are closely associated with the demand of nursing care were not covered in this relatively healthy target group. We pretested this instrument and adapted it before its use in a pilot test in residents of a sheltered housing complex in Hamburg. A group of 117 residents (average age 82.9 years, range 68.2-98.2 years, 83.8% women), all without care needs (assessed by the German health and care insurance system) returned the Senior Citizen Risk of Falling Check. Within 2 weeks all 117 participants were interviewed by telephone to analyze the test-retest reliability of the instrument (Cohen's kappa). We administered 13 questions on visual and hearing deficits, neurological impairment, depressive mood, medication use, muscle weakness, gait and balance deficits, nutrition, and history of falls. On average, 6 risk factors were reported (range 0-12). Reductions in gait speed (64.1%) was most frequently mentioned. Of the participants, 30.8% fell at least once during the last year and 22.2% of these falls resulted in injuries (fractures, hematomas, laceration, pain). Cohen's kappa was good (2/13 questions) to excellent (10/13 questions) with one exception (balance question kappa=0.20). The study results confirm good test-retest reliability of the fall risk screening Senior Citizen Risk of Falling Check. At the moment we are working on the validation of this questionnaire to provide it to senior citizens throughout Hamburg in cooperation with the City of Hamburg.

Fresh Air for Breathing - Equipment for Air Supply on Earth-Moving Machinery During Rehabilitation Work on Contaminated Sites

This paper describes how, during rehabilitation work carried out on contaminated sites hazardous substances or harmful micro-organisms are emitted from the polluted base surface, masonry or groundwater. This frequently leads to fumes developing in the operator�s cabs of the earth-moving machinery, causing a corresponding health hazard for the driver. In order to minimize this risk, earth-moving machinery and vehicles used on polluted sites must be equipped with �equipment for air supply.� The equipment for supplying fresh air for breathing is basically comprised of a specially sealed operator�s cab (for maintaining slight gauge pressure in the cab), an air supply unit that uses a filter system (activated carbon filter and/or particle filter) or compressed air system. Requirements put on the design, arrangements for the operation of such equipment (e.g. air volume/h, gauge pressure and monitoring measurements, where to place the equipment on the earth-moving machinery etc.) are, in Europe, at present only to be found in German health and safety regulations. There are, however, plans take up such requirements in an annex to the European Standard EN 474-1 �Earth-moving machinery � General safety requirements.� This paper presents the basic requirements put on the different types of equipment for air supply on earth-moving machinery and vehicles.

Science Is A Matter of Cumulative Learning: Authors' Reply to the Commentary

F OR three reasons, we would like to thank Zarit, Stephens, Townsend, Greene, and Femia (2003) for opening the discussion about the effectiveness of day care for caregivers in their response to our article ‘‘Evaluation of Geriatric Day Care Units: Effects on Patients and Caregivers’’ (Zank & Schacke, 2002). First, we discussed our results cautiously and did not conclude that day care is ineffective for caregivers. Yet, we do agree that there is a possibility of political misuse of our data. We certainly did not intend to support political decisions against day care. Second, the commentary gives us a chance to report our complex multimethodological approach and results that were beyond the scope of the original article (Zank & Schacke, 2002). Third, some of the issues raised could be due to differences between the American and the German health and care systems, which will be described later. When we started our study in 1994, we were very much aware of the risk that standardized measures might not grasp certain effects that day care might have on caregivers. We, therefore, applied a multimethod approach. First, we chose the most prominent standardized measures at that time, namely, the Burden Interview (BI) and the Memory and Behavior Checklist (Zarit & Zarit, 1983/1990), and the Family-Caregiving Conflict and Job-Caregiving Conflict scales (Pearlin, Mullan, Semple, & Skaff, 1990). These quantitative data failed to show positive effects of day care on caregivers. We will give detailed reasons for our choice of instruments later (see Criterion 4). Second, to examine the caregiver’s stress, we developed a semistructured qualitative interview based on stress theory. This interview took approximately an additional 1–1.5 hr to administer. We conducted these qualitative interviews twice with caregivers of dementia patients only (N 1⁄4 37, T1, and, after 9 months, T2 1⁄4 74 interviews). As the first step, we analyzed these qualitative interviews by using content-analytical techniques (Mayring, 1988). Then, to allow further statistical analyses, we developed response scales to measure the intensity of caregiving stress. Results from the analyses of variances of these data show that day care significantly reduced conflict between caregiving and job requirements, caregiving and family needs, and recreational constrictions. Initial results from these qualitative data were published in German (Schacke, 2001; 2002, Zank & Schacke, 2001, Zank, 2000), and an English article has been submitted (Schacke & Zank, 2002). These results convinced us that day care is effective, not only for patients but also for caregivers; nevertheless, we have to accept that the results based on the standardized measures did not reflect this conclusion. Zarit and colleagues (2003) suspected several methodological flaws in our quantitative data that could explain our results. In the following, we will explain why we think that these methodologicial flaws did not exist. Finally, we will explain our interpretation of the results and consequences we drew.

Restructuring Care for the Elderly in Germany

Health insurance typically falls short of meeting the needs of frail elderly and other disabled persons. In 1995, Germany began implementing new provisions in its national health insurance law to provide for long-term care assistance. Payments are available for family caregivers, community-based services and nursing homes and institutions for the disabled This article is based on interviews carried out in the autumn of 1996 with German citizens and health care, insurance company and government officials. The insurance program has created: (1) affordable access to long-term care services for frail and disabled persons; (2) a restructuring toward community-based care; (3) the emergence of hundreds of new agencies; (4) new issues concerning the quality of care by families and by home care agencies; and (5) a recognition that eligibility criteria and benefits are overly narrow for certain types of disabilities.

Helicobacter pylori infection among offspring of patients with stomach cancer

Background & Aims: A positive family history is associated with an increased risk of stomach cancer. We compared the prevalence of Helicobacter pylori infection, a known risk factor for stomach cancer, between subjects with and without parental history of stomach cancer to evaluate a potential role of H. pylori infection in familial aggregation of stomach cancer. Methods: A total of 1351 men and women aged 30-74 years who participated in the German Health and Nutrition Survey conducted in the western part of Germany in 1987-1988 were included in the study. Detailed information on sociodemographic factors, nutritional factors, and parental history of cancer was obtained by standardized interviews. Serum samples were analyzed for immunoglobulin G antibodies against H. pylori by enzyme-linked immunosorbent assay. Results: The prevalence of H. pylori infection was much higher (69%) among subjects with a parental history of stomach cancer than among other subjects (44%). This association persisted after control for potential confounders by multiple logistic regression (adjusted odds ratio, 2.7;95% confidence interval, 1.3-5.9), and was particularly strong among subjects below age 55 (adjusted odds ratio, 5.1;95% confidence interval, 1.6-16.1). Conclusions: These results suggest that familial aggregation of stomach cancer may be explained at least partly by familial clustering of H. pylori infection. GASTROENTEROLOGY 2000;118:31-35