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PubMed1994

[Problems of radiotherapy in Germany after the recent events in Hamburg].

BACKGROUND: During the 3rd Symposium on "Experimental Radiotherapy and Clinical Radiobiology" (Hamburg, March 1994) the consequences of the recent events in the Department of Radiotherapy of the University-Hospital in Hamburg for daily radiotherapy practice in Germany were discussed. The following topics were covered: information of the patient, choice of therapy, development of new treatment modalities, ethics committee, follow-up and role of radiobiology. DISCUSSION AND RESULTS: Information of the patient: Due to the insecure juridical situation in Germany there is a tendency to inform patients excessively, which is rather confusing for them. Adequate information of patients is a difficult task for physicians considering their daily workload. Choice of therapy: Unfortunately in Germany radiotherapists are often not initially involved in planning of the overall treatment strategy for individual cancer patients. The recent events in Hamburg led to a decreased referral of cancer patients for radiotherapy. This might even hold for tumor entities where radiotherapy is an essential part of therapy. Another problem is that dose might be reduced inadequately. This would reduce complications but also significantly increase local failure. Development of new treatment modalities: There are no special juridical problems with the conduction of clinical studies for optimization of radiation treatments. Ethics committee: Ethics committees are not only meant to safeguard patients but also protect physicians and institutions from the consequences of questionable research. FOLLOW-UP: Only radio-oncologists are adequately trained for follow-up after radiation treatment. Nevertheless, because of administrative, financial, legal and political problems many patients in Germany are not regularly seen by the radiation oncologist after end of radiation treatment. Always when new treatment strategies are established, careful follow-up is of special concern. Role of radiobiology: The main obligation of clinical radiobiology is to introduce radiobiological knowledge into clinical practice. This may be best promoted by a period of radiobiological research during residency. However, close collaboration between radiotherapists and radiobiologists is only possible at very few centres in Germany, because the institutes of radiobiology are dismantled systemically.

Aftercare↗
PubMed1997

Changes in drug prescribing under the Public Health Reform Law--a survey of general practitioners' attitudes in East and West Germany.

The aim of the study was to examine general practitioners' attitudes towards drug prescribing in times of economic pressure, and to determine the relevance of different factors for changed prescribing behavior. A random sample of general practitioners in Eastern Germany and in Western Germany was surveyed, after the Public Health Reform Law, a budgetary initiative to reduce prescribing costs in Germany, had come into effect. Multiple logistic regression was performed to analyze the association between self-reported prescribing behavior and covariates (such as sex and age, level of certification, doctors' prescribing costs, criteria of prescribing, sources of drug information). Response rates had been 53.4% (n = 550) in Eastern Germany and 56.8% (n = 579) in Western Germany respectively. About two thirds of the doctors (East: 60.4%, West: 73%) believed that they had changed their prescribing behavior under the new law. They used generic drugs more often (East: 29.5%, West: 52.3%) and often used more generic drugs (East: 29.5%, West: 52.3%) and were less liberal in meeting patients' wishes (61.0% and 72.8%, respectively). Doctors whose total prescribing costs were above the average of their colleagues, more frequently reported change in prescribing behavior in response to the new law (OR: 3.11, 95% CI: 1.63, 5.91 for Eastern doctors and OR: 5.90, 95% CI: 2.49, 13.98 for Western doctors). This was also true for doctors who considered the price of a drug to be a very important criterion for drug selection (OR: 4.34, 95% CI: 2.69, 7.01 and OR: 3.23, 95% CI: 1.9, 5.49, respectively). "Price-oriented" and "cost-concerned" doctors were also more likely to handle patient prescription wishes less liberal and to prescribe generic rather than original brand name drugs more often. We conclude that budgetary initiatives, such as the German Public Health Reform Law, seem to influence general practitioners towards a more economic prescribing behavior. Doctors concerned about their prescribing costs or about drug costs may be more responsive to such administrative regulations.

Adult↗
PubMed1998

[Out-patient hospice services--their importance for palliative care in Germany].

Hospice services can be divided into three groups. Few institutions deliver the full scope of palliative home care, most of the others can provide considerably less. The third group of services are those that do not support patients but aim to establish a home care service or a hospice. In February, 1997 396 home care services were working in Germany. 48 of these services provided palliative home care, 69 services were hospice initiatives. The scope of services rendered is very broad and reaches from psychosocial support to complex medical tasks. In the last year, 13,700 patients have been supported at home by hospice services in Germany. Palliative care services usually have professional staff, but they would not be able to work without honorary help. Beside of support for patients and relatives tasks of the home care service are the coordination and exchange between in-patient units, general physicians and social care ward. By cooperation with all institutions for out-patient and home care as well as with general physicians, they contribute to avoid in-patient treatment for their patients. Another important function is to spread the hospice idea and work as multipliers for knowledges and attitudes in palliative care. The number of home care services available in Germany is not sufficient. Only 48 institutions can be ranked as palliative care services. The distribution of the hospice services in Germany is very irregular, and providers of home care services are even more scarce in the eastern part of Germany.

Germany↗
PubMed1998

Isonymy and isolation by distance in Germany.

The isonymy structure of Germany was studied using the surname distributions of 5,150,310 private telephone users selected from 39,000,000 users registered in a 1996 commercial CD-ROM, which contains all telephone users in the country. The users were distributed in 106 towns selected on a geographic basis. Germany was subdivided into 50 adjacent rectangles, each 115 x 80 km, and at least the largest town in the rectangle was selected for study; the private telephone users in that district were downloaded from the CD-ROM and included in the analysis. The shortest distance between nearest neighbor towns was 10.7 km (Travemunde and Lübeck), and the largest distance was 69.8 km (Meppen and Osnabruck). The number of different surnames found in the whole analysis was 462,526. Lasker's distance, the negative value of the logarithm of isonymy between localities, was found to be linearly and significantly correlated with geographic distance (r = 0.51 +/- 0.010). A dendrogram was built with the matrix of isonymy distances, using UPGMA. This method separates the German towns into two main clusters, one in the southern half of the country and the other in the northern half. Within each cluster small subclusters with specific geographic distributions could be delimited. The two main clusters correspond fairly well to the north-south division of German sublanguages (Nieder- and Mitteldeutsch in the north vs. Frankisch-Alemannisch in the south). The other clusters are related to minor sublanguages. Comparisons with the results of a previous analysis of Switzerland's structure are given. From the present analysis isolation by distance emerges clearly, although it is less strong than in Switzerland and indicates that Germany has a fairly homogeneous isonymy structure. The random component of inbreeding estimated from isonymy indicates that eastern Germany is on average more inbred than western Germany.

CD-ROM↗
PubMedDate not supplied

Social gradient of CVD risk in Germany before/after unification.

A social gradient of cardiovascular risk has been found in several European countries, including the former East and West Germany. Have any changes have occurred in Germany, particularly in the east, since the wall came down? We analyzed the results of three compatible, population-based, interview-and-examination health surveys that were performed in both parts of Germany between 1984 and 1992. Total years of education was the social indicator. Systolic/diastolic blood pressure, body mass index, prevalence of hypertension, obesity, and cigarette smoking showed a social gradient in favor of higher social class groups; the social gradient for total cholesterol and hyper-cholesterolemia in men was less clear. Despite a much higher risk-factor profile in the east, neither a difference between the social gradients of the former East and West Germany nor a clear trend after the wall came down were found. In both areas, the social gradient clearly increased only for women smokers. Overall, we found very little evidence to support the idea that the ferocity of socioeconomic changes in the east had already led to a higher gradient of cardiovascular risk in 1991/1992 relative to that in the western part of the German population.

Adult↗
PubMed1996

Respiratory hypersensitivity and environmental factors: East and West Germany.

We assessed the prevalence of asthma and allergic disorders in 9-11 year old children in Leipzig and Halle in East Germany, and Munich, West Germany. Both East German cities were heavily polluted due to private coal burning and industrial emissions, whereas Munich has moderate industry but heavy car traffic. All fourth grade pupils in Munich (n = 7445) were compared with those in Leipzig, 1990 (n = 1429) and Leipzig and Halle, 1991 (n = 3105). The prevalence of hay fever and skin test reactivity to common aeroallergens was considerably higher in West Germany as compared to East Germany. Furthermore, the prevalence of asthma was also higher in the West German study area. However, when atopy was taken into account, there was no longer a significant difference in the prevalence of asthma between the two parts of the country.

Air Pollutants↗
PubMed2004

Changing health inequalities in east and west Germany since unification.

The unification of Germany in 1990 brought about substantial social and economic changes in its eastern part, with new uncertainties and, despite increasing overall income, rising inequality. This paper explores the potential impact on health of these changes during the 1990s, looking specifically at income-related health inequalities in east and west Germany and its modulation by psychosocial factors. We used data from the German Socio-Economic Panel (GSOEP) for the years 1992 and 1997, including individuals aged 25+. We investigated changes in self-perceived health in the two parts of Germany and its socio-economic and psychosocial determinants. Analyses estimated odds ratios of less than good health using logistic regression. In 1992, 47% of east Germans rated their health worse than good compared with 54% in the west. By 1997, the east-west gap in self-rated health had disappeared, with the prevalence of poor health increasing to 56% in both parts. Income and education were important determinants of health in east and west, with, in the age-sex-adjusted model, those having available less than 60% of median equivalent income being at increased risk of poor health in 1992 (OR(east) 2.39, 1.45-3.94; OR(west) 2.04, 1.65-2.52). Addition of education reduced the strength of this relationship only slightly. In the west, income-related health inequalities widened between 1992 and 1997 yet the initially stronger gradient declined in the east, despite an overall increase in income inequality (OR(east) 1.63, 1.04-2.56; OR(west) 2.65, 2.19-3.21). The impact of education remained stable. Psychosocial variables were important determinants, mediating the effects of income, with leisure-cultural social involvement exerting the strongest effect in both east and west.The results show that, unlike in the west, the overall increase in income inequality in east Germany between 1992 and 1997 was not accompanied by a simultaneous increase in income-related health inequalities. This suggests that mechanisms involved in the association of socio-economic factors and health possibly behave differently in east and west.

Adult↗
PubMed1997

After unification: gender and subjective health status in East and West Germany.

Results of a random survey of 2574 adults in East and West Germany in 1992 show virtually no differences in subjective health status for the populations of East versus West Germany and only slight differences for men versus women. A closer analysis via multiple regression indicates, however, that contrary to previous results from other countries West German women have a better health status than men. Of the four gender groups analyzed separately East German men are the best off, while owing to a number of socio-economic status discrepancies, East German women report the worst health status. Surprisingly, West German men show a poorer subjective health status than East German men, although a number of factors like participation in sport, better income and younger age would predict otherwise. It is suggested that their health situation is negatively influenced not only by their work situation but also by outside private commitments not accounted for in this analysis. Also difficult to explain from the present data is the relatively good health status of East German men. Despite an insecure job and a difficult work situation they may experience unification in sociopolitical terms and their present social status as something positive. Overall, conditions in the system of West Germany show a tendency to favor women, while those in East Germany clearly favor men.

Adult↗
PubMed2000

Trends in bronchial hyperresponsiveness, respiratory symptoms and lung function among adults: West and East Germany. INGA Study Group. Indoor Factors and Genetics in Asthma.

Previous studies have shown higher prevalences of bronchial hyperresponsiveness (BHR), respiratory symptoms and atopic sensitization among adults in Western Germany than in Eastern Germany. One of the aims of the joint project INGA (INdoor Factors and Genetics in Asthma) is to assess incidence, prevalence and trends for asthma, BHR and atopic diseases over a time period of 11 years (1990-2001) in the former West (Hamburg) and East Germany (Erfurt), with special reference to indoor exposure. INGA was designed as a case-control study following a cross-sectional study performed from 1990 to 1992 within the European Community Respiratory Health Survey (ECRHS). The database consisted of 1159 subjects in Hamburg and 731 subjects in Erfurt from the ECRHS (age 20-44). In 1995-1996, 107 cases (diagnosed asthma, positive specific serum IgE, positive skin prick or PD20FEV1< or =2.0 mg methacholine at ECRHS) and 106 controls (none of the previous findings) participated in Hamburg (115 cases and 109 controls in Erfurt). The methodology was identical to the ECRHS and dose-response slopes (DRS) of the methacholine challenge were calculated as an index of responsiveness. In the control group, median values of DRS were 0.028% mg(-1) (1990-1992) and 0.044 (1995-1996) (P<0.01) in Erfurt. Corresponding values for Hamburg were 0.028 and 0.022 (NS). Corresponding values within the case groups were 0.041 and 0.049 (NS) for Erfurt, and 0.069 and 0.052 (P<0.05) for Hamburg. Thus, 4 years after the first survey, we found an increased BHR in the Erfurt control group while the bronchial responsiveness remained unchanged for the Hamburg group. These trends in BHR, which indicate the expected converging tendency between East and West Germany, have to be confirmed within the next INGA-survey in 2000-2001.

Adult↗
PubMedDate not supplied

[PCB exposure of children in East and West Germany].

In order to assess the exposure to polychlorinated biphenyls (PCB) in children from East- and West-Germany 276 fat tissue samples were analysed. Total PCB concentrations were calculated by means of six PCB congeners: No. 28, 52, 101, 138, 153 and 180. In children from East-Germany the mean total PCB levels amounted to 0.899 mg/kg (median 0.674) and were significantly higher than in children from West-Germany (0.766/0.555 mg/kg; p less than 0.05). Regional differences were only seen within East-Germany. In fat tissue of children with high intake of breast milk (lactation period greater than 12 weeks) PCB levels were significantly elevated compared to those with low intake of mother's milk (lactation period less than 12 weeks). A further reduction of PCB in our environment is necessary so that breast milk can be recommended for sucklings without any restrictions.

Adipose Tissue↗
PubMed2003

Sex ratios in the two Germanies: a test of the economic stress hypothesis.

BACKGROUND: Literature describing temporal variation in the secondary sex ratio among humans reports an association between population stressors and declines in the odds of male birth. Explanations of this phenomenon draw on reports that stressed females spontaneously abort male more than female fetuses, and that stressed males exhibit reduced sperm motility. This work has led to the argument that population stress induced by a declining economy reduces the human sex ratio. No direct test of this hypothesis appears in the literature. Here, a test is offered based on a comparison of the sex ratio in East and West Germany for the years 1946 to 1999. The theory suggests that the East German sex ratio should be lower in 1991, when East Germany's economy collapsed, than expected from its own history and from the sex ratio in West Germany. METHODS: The hypothesis is tested using time-series modelling methods. RESULTS: The data support the hypothesis. The sex ratio in East Germany was at its lowest in 1991. CONCLUSION: This first direct test supports the hypothesis that economic decline reduces the human sex ratio.

Economics↗
PubMed2001

The impact of maternal education on intrauterine growth: a comparison of former West and East Germany.

BACKGROUND: Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems. METHODS: Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight. RESULTS: Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17-5.67) and East Germany (OR = 2.77, 95% CI : 1.54- 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87-4.72; OR (East) = 1.95, 95% CI : 1.02-3.74. CONCLUSIONS: Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.

Body Mass Index↗
PubMed1991

Reform of health care in Germany.

For the past 45 years Germany has had two health care systems: one in the former Federal Republic of Germany and one in the former German Democratic Republic. The system in the Federal Republic was undergoing some important reforms when German reunification took place in October 1990. Now the system in eastern Germany is undergoing a major transformation to bring it more into line with that in western Germany.

Cost Control↗
PubMed1981

Investigations on the changes of sex ratio in Germany from 1826 up to 1978.

The changes of the secondary sex ratio in Bremen (North Germany) from 1826 up to 1978 are compared with those of Germany in the period from 1872 to 1978. To some extent there are marked differences. The oscillation of the secondary sex ratio in Bremen is more extended in Germany. On the average in Bremen the values are lower in the 19th century than in the 20th. For Germany higher values are observed in the years between 1915 and 1959. The changes of reproductive performance, indicated by birth rate. Supposing that the primary sex ratio is dependent on the time of insemination within the intermenstruum, the same figures of monthly distribution of secondary sex ratio and birth frequency can be expected. In fact, the seasonal variations proved to be not significant and do not show the expected parallel figures.

Birth Rate↗
PubMed2000

The situation of preimplantation genetic diagnosis in Germany: legal and ethical problems.

Preimplantation genetic diagnosis (PGD) has not been performed in Germany. Existing German laws do not explicitly permit or prohibit PGD. German law does forbid the wasting of totipotent embryonic cells, fertilizing oocyctes without transferring them in the same cycle, and the use of micromanipulations that later may harm embryonic development. German law also limits the number of oocytes allowed to be fertilized in each in vitro fertilization (IVF) cycle to three and prohibits research on embryos. The existence of these laws may impede but not prevent the development of PGD programmes in Germany. In contrast, the liberal regulation of pregnancy termination coupled with the development of ethical guidelines specific to PGD may facilitate the introduction of PGD in Germany. Because of these contradictions, legislation is required to clarify the legal status of PGD in Germany.

Abortion, Legal↗
PubMed1994

Longitudinal statistics of mental health care in Germany.

In 1975, an expert committee was commissioned by the government to evaluate psychiatric care in the Federal Republic of Germany. The results of this study showed that Germany lacked the infrastructure to provide appropriate care for the mentally ill. Since then, measures have been taken to improve in-patient, out-patient and non-hospital care. However, in spite of these efforts, problems still exist. A closer analysis revealed that, though state mental hospitals have consolidated their position in in-patient care, there are still few psychiatric departments in general hospitals. Also, there are extreme regional differences regarding non-hospital care as seen by the varying number of long-term inpatients in each region. Out-patient care, especially for the chronically mentally ill, is also widely criticized. However, the biggest problem remains that of financing psychiatric care. Because most mentally ill persons are not properly insured and depend on social welfare, the burden falls on the government. In addition to this, efforts to modernize the antiquated mental health care system in the former East Germany are especially costly. In the future, a larger part of the available resources will go to providing community-based care in East Germany, which was nonexistent before unification.

Ambulatory Care↗
PubMed1997

Poverty and health in West Germany.

The relationship between poverty and several health-related characteristics in West Germany was investigated. Data were derived from the National and Regional Health Surveys conducted in West Germany from 1984 to 1992. 25,544 males and 25,719 females with German nationality aged 25-69 years were examined. Poverty was defined as a household income of 50% less than the mean for West Germany. Multiple logistic regression analysis was used to analyze the relationship between poverty and four health variables: individual health behavior, subjective assessment of health status, cardiovascular disease risk factors, and self-reported prevalence of lifetime chronic diseases. 10.2% of males and 12.8% of females were classified as being below the poverty line. For most but not all health parameters, less favourable results were found for the segment of the population with a household income below the poverty line. The most striking poverty-related differences were observed for lack of regular sport activities, subjective health satisfaction, obesity and myocardial infarction/stroke. Significantly lower prevalence rates for study subjects below the poverty line were observed for hypercholesterolemia in females only. Allergic disorders were the only chronic diseases reported significantly less often in males and females below the poverty line. Poverty has strong effects on individual health status and the prevalence of chronic diseases. Due to the rising unemployment rates in Germany in the last years it is very likely that the strong negative consequences of poverty for health are increasing.

Adult↗
PubMed1996

Geographic distribution and origin of CFTR mutations in Germany.

The geographic distribution and origin of CFTR mutations in Germany was evaluated in 658 three-generation families with cystic fibrosis (CF). Fifty different mutations were detected on 1305 parental CF chromosomes from 22 European countries and overseas. The major mutation. delta F508 was identified on 71.5% of all CF chromosomes, followed by R553X (1.8%), N1303K (1.3%), G542X (1.1%), G551D (0.8%) and R347P (0.8%). According to the grandparents' birthplace, 74% of CF chromosomes had their origin in Germany; the delta F508 percentage was 77%, 75%, 70% and 62% in northern, southern, western and eastern Germany, respectively. Ten or more mutant alleles in the investigated CF gene pool originated from Austria, the Czech Republic, Poland, Russia, Turkey and the Ukraine. This widespread geographic origin of CFTR mutations in today's Germany reflects the many demographic changes and migrations in Central Europe during the 20th century.

Cystic Fibrosis↗