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PubMed2002

[Dementia, trauma and transcultural nursing--the complex need for nursing care in Jewish geriatric nursing in Germany].

Complex nursing requirements are typical for the care of the Jewish elderly in Germany. As an example, the old age home care-center of the Jewish community in Frankfurt am Main, Germany, is need to show typical needs and care-profiles. Survivors of the holocaust who have survived persecution either in Europe or emigration are living in the center. A few years ago, elderly people who immigrated from the former Soviet Union and arrived in Germany only at age, began living in the center. Because the inhabitants of the center come from 18 different countries, the structure of the residents is multiethnic and therefore more atypical for Germany. The daycare for people suffering from dementia is offered in two languages, which is also a new experience for Germany. The multiethnical and plurilingual orientation of the care center convinced the German Ministry of Health to promote new care-concepts as a model, which are based on these mentioned structures. The author also presents some ideas in order to experience the feeling of being a foreigner, which can be need as a basis for the development of an institutional culture.

Aged↗
PubMed2004

A comparative study of psychopathology in Greek adolescents in Germany and in Greece in 1980 and 1998--18 years apart.

OBJECTIVE: In the 1980s, we assessed Greek adolescents living in Germany and Greek adolescents living in Greece. Data from this earlier study supported the hypothesis of selective migration with higher psychopathology self-rating scores in Greek adolescents in Greece as compared to Greek adolescents in Germany. The current study uses the same design and instruments so that the comparison of the mental health of populations in the same areas, almost two decades apart, becomes possible. METHODS: In 1980, a total of 2631 Greek adolescents were assessed in Munich, Germany or Veria, Greece. In 1998, 2920 Greek adolescents were assessed in Munich, Germany and Veria, Greece. The General Health Questionnaire (GHQ-28) was used to assess mental health status at both times. RESULTS: 1) GHQ-28 scores showed a significant increase from 1980 to 1998 in both locations. 2) While in 1980, Greeks in Veria, Greece had higher psychopathology scores than Greek adolescents in Munich, Germany, this (with the exception of depression) was no longer true for 1998. 3) At both times and both locations adolescent girls scored higher in the GHQ-28 than adolescent boys. CONCLUSIONS: While the 1980 data supported the selective migration hypothesis, this was no longer true for the 1998 data. The increase in psychopathology in both locations is alarming and deserves further exploration.

Adolescent↗
PubMed2007

Mental health care in Germany: current state and trends.

Germany turned towards community-based mental health care in the mid seventies, during a general climate of social and political reform. The continuing deinstitutionalisation process and the implementation of community mental health services was considerably affected by the reunification of East and West Germany in 1990, which required dramatic changes in the structure and quality of the mental health care system of the former German Democratic Republic (GDR). Overall, German mental health care is organised as a subsidiary system, where planning and regulating mental health care is the responsibility of the 16 federal states. So German mental health care provision is spread among many sectors and characterised by considerable regional differences. A key characteristic is the particularly wide gap between inpatient and outpatient services, which are funded separately and staffed by different teams. In 2003 the total number of psychiatric beds was a mere two thirds of the overall bed capacity in 1991, the first year as a re-unified Germany, when psychiatric beds in East and West Germany totalled 80,275. From 1970 onwards the number of psychiatric beds was cut by roughly half. So the momentum of the reform has been strong enough to assimilate the completely different mental health care system of the former German Democratic Republic and, in the course of a decade, to re-structure mental health services for an additional 17-18 million new inhabitants. In an ongoing struggle to adapt to changing administrative set-ups, legal frameworks, and financial constraints, psychiatry in Germany in currently facing specific problems and is seriously challenged to defend to considerable achievements of the past. A major obstacle to achieving this aim lies in the fragmented system of mental health care provision and mental health care funding.

Germany↗
PubMed2002

Will the 7-valent pneumococcal vaccine have a similar impact on all invasive pneumococcal infections in children in Germany as in the Kaiser Permanente Trial?

UNLABELLED: A 7-valent pneumococcal conjugate (7-vPc) vaccine was shown to be highly effective in California preventing 89.1% of all invasive pneumococcal infections (IPI) regardless of serotype. There is concern whether a similar effectiveness will be attained in Germany where 52% of all IPI in children <16 years were caused by the serotypes in the vaccine. The study was based on prospective, active surveillance of IPI in German children aged <16 years during 1997 to 2000. Coverage by the 7-vPc vaccine (with and without 6A) in unvaccinated children in the Kaiser Permanente Trial (KPT) was compared to the coverage in German children in the same age period as in the KPT. The proportion of potentially preventable cases was estimated both for unvaccinated children in the KPT and for Germany by multiplication of the coverage rates with the vaccine efficacy estimate from the KPT (intention to treat analysis). Successful serotyping could be attained for 38.3% of the 1,743 German IPI cases. In the age period from 7 to 43 months concerned in the KPT, the proportion of cases with serotypes covered by the 7-vPc vaccine (+6A) was 91% (95% CI 80%-97%) in the unvaccinated children in the KPT compared to 76% (95% CI 71%-80%) in Germany. The respective estimates for the number of potentially preventable IPI cases were 85% (95% CI 75%-91%) in the KPT compared to 71% (95% CI 67%-75%) in Germany. CONCLUSION: Age specific serotype coverage rates have to be considered for extrapolation of the Kaiser Permanente Trial to the German situation. Although 14% lower than in the Kaiser Permanente Trial, 71% of potentially preventable cases of invasive pneumococcal infection still predict an excellent effectiveness for the 7-valent pneumococcal conjugate vaccine in Germany.

Adolescent↗
PubMed2006

Comparison of attitudes towards breakfast by Turkish fourth graders living in Turkey and Germany.

The purpose of this article is to identify and compare Turkish fourth graders attitudes towards breakfast living in Turkey and Germany. A sample group of 882 Turkish students enrolled in fourth grade in Hamburg (Germany, N=422) and Konya (Turkey, N=460) were surveyed. Independent t-tests, chi(2) test and Pearson product-moment correlations were used. More students living in Turkey had breakfast and had enough time before going to school (P<0.01). Students living in Turkey reported that eating breakfast affected them positively (P<0.01). Students living in Germany reported that eating breakfast made them feel tired (P<0.01). The consumption of breakfast cereal (P<0.05) and fruit juice (P<0.01) that had not been consumed widely in Turkey increased in Germany. Students who eat breakfast also eat lunch (r=0.296 and -0.236, P<0.01, students living in Turkey and Turkish students living in Germany, respectively). Nutrition education programs in primary schools may change Student's attitudes about breakfast and offering a breakfast programme in schools may greatly improve breakfast consumption rates.

Child↗
PubMed2004

A comparison of pressure ulcer prevalence: concerted data collection in the Netherlands and Germany.

OBJECTIVES: Because of a lack of epidemiological data of pressure ulcer (PU) among care dependent patients yearly prevalence measurements are held in the Netherlands and in Germany with identical methods. A comparison shows remarkable differences in the PU prevalence so that further analysis is needed to enlighten the reasons. DESIGN: With a standardized questionnaire all patients were examined by trained nurses of the participating facilities. SETTING: In-patients in 42 Dutch and 10 German acute care Hospitals. PARTICIPANTS: All patients who handed in their informed consent were included. In the Netherlands n = 8734, and in Germany n = 2832. MAIN OUTCOME MEASURES: For calculating the PU prevalence the sample was divided inpatients at risk and not at risk for PU in accordance to the Bradenscale. Comparisons between the Netherlands and Germany refer to population details, quota of patients at risk for PU and PU prevalence. Finally the impact of eight controlled variables on the PU occurrence was calculated in a logistic regression. RESULTS: Both samples showed the same sex distribution, the same mean age and the same distribution among the medical specialties. The share of patients at risk for PU is higher in the Netherlands (55%) than in Germany (38%). The frequency of PU is higher in the Dutch population (22%) than in the German one (12%). Regarding only the risk-patients the differences reduce. The prevalence in the Netherlands was 33%, in Germany it was 28%. The highest impact on PU occurrence had the age and the length of stay in hospital. The Country ranges on third position. CONCLUSIONS: The Dutch sample had a higher share of risk-patients and a higher PU frequency. A standardization appropriate to a risk assessment reduce the differences. For enlightening the remaining differences further research is needed.

Aged↗
PubMed1988

Species identification and serotyping (capsular antigen) of Pasteurella strains from sheep flocks in south Germany and in Syria.

135 Pasteurella strains were cultivated from nasal swabs of sheep as well as pneumonic lungs of dead and slaughtered sheep. The specimen originated from 41 flocks in South Germany and from 15 flocks and 60 slaughter sheep in Syria (Hama region). Serovariety A2 prevailed amongst P. haemolytica strains (6) isolated in South Germany (53 strains) and in Syria (41 strains). In addition 10 further serovarieties were identified in South Germany (next frequent were A8, A1 and A6) and 7 in Syria. Untypable strains appeared to be more frequent in Syria. Other Pasteurellae (17) represented 1/4 of isolates in Syria and 1/3 of isolates in South Germany. Species identification resulted in P. multocida ssp. multocida (25), P. multocida ssp. septica (4 strains, Syria only), P. canis (3 strains, South Germany only) and Pasteurella-like strains (9 strains). Twelve P. multocida ssp. multocida strains carried capsular antigen D and 7 capsular antigen A. In most cases where multiple samples were examined from one flock, strains with different capsular antigens and/or belonging to different Pasteurella species were isolated (max. 8).

Animals↗
PubMed2000

Research on ageing in Germany.

The present review on ageing research in Germany is biased towards experimental biogerontology, because this is the field which will define the future of ageing research as a whole. In absolute numbers of publications between 1995 and 1999, Germany is comparable to other large European countries. However, Germany ranks definitively last among 10 major developed countries if the numbers of scientific papers per year are seen in relation to the economic capability. This is true for the whole of biomedical research, but it is even more exaggerated for ageing research. There are potent groups in German ageing research capable of producing a good fraction of high-impact papers, however. There are many more researchers in areas highly relevant to gerontology which recently became attracted by gerontological problems. However, the importance of modern biogerontology has not made clear to decision-makers in Germany, so that structural and financial limitations will probably prevent any significant rise in the near future, which would be necessary to keep Germany along with other developed countries.

Aged↗
PubMed2001

Pertussis in Germany: regional differences in management and vaccination status of hospitalized cases.

The incidence of pertussis requiring hospitalization in children younger than 16 years was estimated by the use of an active surveillance-system. Of special interest were differences between West and East Germany following different vaccination strategies before reunification. In 1997 and 1998, 754 pertussis cases required a total of 11,151 hospital inpatient days. The incidence of hospitalized pertussis was 2.68/100,000 person years and this was significantly higher in East than in West Germany. In East Germany an unusually high percentage of hospitalized cases was found in children aged 6-15 years (45% versus 13% in West Germany). The difference between the regions may be due either to a different perception of the disease or to an increased immunity induced by prior disease or vaccination. In East Germany, pertussis was rare until reunification but it has increased significantly since then. Older children may thus represent a population at risk of pertussis having not had previous exposure to pertussis antigens.

Adolescent↗
PubMed2003

The emigration of Germany's Jewish dermatologists in the period of National Socialism.

In the context of our investigation, we found information on 432 (76%) of the 569 Jewish dermatologists in Germany. There is evidence that 57 (10%) of the Jewish dermatologists were murdered in concentration camps, 61 (10.7%) died a natural death, 13 (2%) committed suicide, and 25 (4%) survived the Third Reich in Germany. After 1933, 276 (49%) Jewish dermatologists were able to leave Germany; the United States of America was the main destination and 107 (or 41%) emigrated there. A total of 34 (13%) Jewish dermatologists emigrated from Germany to Palestine and 16 to Latin America. Regarding emigration to other European countries, 20 of the Jewish dermatologists from Germany went to Great Britain (including Walter Freudenthal, 1893-1952, and Ernst Sklarz, 1894-1975), and 24 emigrated to other European countries, such as France (Rudolf Mayer, 1895-1962), Sweden (Carl Lennhoff, 1883-1963), and the Netherlands (Otto Schlein, 1895-1944).

Dermatology↗
PubMed1998

Oral contraceptives and venous thromboembolic disease: the findings from database studies in the United Kingdom and Germany.

OBJECTIVE: Three research articles published in late 1995 and early 1996 suggested that oral contraceptives containing either of the newer progestogens (gestodene or desogestrel) could be associated with an increased risk of venous thromboembolism. During the months after the initial publications, the results have been scrutinized with great care and further studies have been published. The findings of 2 recent database studies, 1 in the United Kingdom and 1 in Germany, are presented in this article. PATTERNS OF USE: The average age of users of combined oral contraceptives in Germany was 27 years, compared with 26 years in the United Kingdom. In Germany the use of gestodene-based products was lower than that in the United Kingdom. In the United Kingdom the users of desogestrel with 20 microg ethinyl estradiol (Mercilon) were older than the users of desogestrel with 30 microg ethinyl estradiol (Marvelon). CRUDE INCIDENCE: The crude incidence of venous thromboembolism in the UK study was 4.1 cases/10,000 woman-y exposure to combined oral contraceptives. In Germany it was 4.2 cases/10,000 woman-y. In Germany the rates among users of second-generation combined oral contraceptives were higher than those among users of third-generation products. The reverse was the case in the United Kingdom. In the United Kingdom the crude incidence rates were higher for the 20 microg estrogen desogestrel product than for the 30 microg product. CASE-CONTROL ANALYSIS: The adjusted odds ratios in the UK study did not show significant increases for desogestrel or gestodene compared with levonorgestrel products. There were inconsistencies in the results among centers in the 2 international studies (the World Health Organization and Transnational studies). In both there was a consistent inverse dose-response relationship with estrogen in all centers. CONCLUSION: The limitations of the observational studies are such that the hypothesis that the newer progestogens are more likely to cause venous thromboembolism cannot be proved.

Adult↗
PubMed1997

The status of iodine nutrition in newborn infants, schoolchildren, adolescents and adults in former East Germany.

In the former East Germany (GDR) like in the former West Germany (FRG) iodine deficiency and endemic goiter have been described since more than 2 decades. After a program of salt iodization which was started in East Germany in 1985 the urinary iodine excretion of the population increased significantly. The thyroid gland of the newborn is much more sensible to changes of the iodine supply than the thyroid of older children. A total of 1732 subjects was enrolled in the study. After the implementation of the mandatory salt iodization the goiter prevalence in newborns decreased markedly to less than 1%. After the reunification of Germany in 1990 the mandatory prophylaxis was stopped and the urinary iodine excretion in newborns, school-children, adolescents and adults diminished markedly. So in newborns the renal iodine excretion decreased to 2.82 micrograms I/dl in 1992. Since 1994 a reasonable improvement of the iodine supply is observed in the region of Leipzig. In school-children, adolescents and adults the mean value of the urinary iodine excretion is now above 10.0 micrograms I/dl. This value may be considered as an indicator for a normal iodine supply. In a small cohort (n = 28) of newborns infants we found a renal iodine excretion of 18.74 micrograms/dl in 1997. That value also means a significant increase since 1992 and a normal iodine supply in the fetal period. The present results from the region of Leipzig/Saxonia are not representative for the whole of East Germany. To provide an optimal iodine nutrition the use of iodized salt for food manufacturing must be significantly increased.

Adolescent↗
PubMed2001

[The status of vaccine preventable diseases in Germany].

The European members of the World Health Assembly (WHO) adopted the goal of eliminating poliomyelitis by the year 2000 (certification 2003), tetanus of the newborn by 2005 and measles by 2007 (certification 2010). Regarding the reduction by 2010 diphtheria, hepatitis B, pertussis and rubella syndrome are in the foreground of discussions. As WHO-member Germany looks after these aims with growing acceptance, too. The current situation of the specific target illnesses is differentiated in the eastern and western part of Germany. While the final stage of certification for a polio-free region in the whole of Germany has been reached and there have only been single illnesses of diphtheria and tetanus for years, there are reported more than 5,000 illnesses of hepatitis B every year with an estimated number of unknown cases of at least 15,000 clinically manifested illnesses and a high age specific incidence rate for people who are 20-40 years old. The incidence rate in the eastern federal states is lower than in the western federal states owing to a smaller portion of endangered risk groups in the population. The trend on the whole is declining. Useful epidemiological data of measles and pertussis are currently only available in the eastern federal states of reunited Germany. To control measles a national intervention programme "measles, mumps, rubella" was started. The aim of this programme is to reduce the illnesses of measles in Germany from currently 50 to at first 5 illnesses per 100,000 inhabitants. In the eastern German federal states the situation is still better than in the western federal states. However, a permanent lower incidence rate of less than 1/100,000 inhabitants has not been reached after 1990. Pertussis is an example for the consequences of different vaccination strategies in East and West. The estimated illness rates in the western federal states are at 80-100/100,000 inhabitants. In the eastern federal states a continuous increase of incidence rates of more than 5 per 100,000 inhabitants has been noticed since 1991. For a permanent reduction of incidence rates of infectious diseases which are preventable by vaccination, provable high vaccination coverage and an effective epidemiological control are necessary.

Adolescent↗
PubMed2002

[Housing and work as criteria of the "Social Integration" of the mentally ill - development in Germany between 1900 and 2000].

AIM: This paper analyses, in what way psychiatrists considered housing and work as criteria of social integration of mentally ill people and what models of care were suggested in Germany throughout the 20th century. METHOD: Publications in 29 German professional and scientific psychiatric journals through the complete period from 1900 to 2000 and monographs were searched for papers on the above issues. RESULTS: Until the second half of the century, integrative initiatives related to housing and work generated in asylums without the aim of a full social integration of the patients. In the activistic concept of NS-psychiatry, work became an obligation for patients and a criterion for selection that decided on life and death. Not until the late 1950s, there again was an orientation towards integration in psychiatric care in both German states. Whilst already in 1963 the "Rodewisch Theses" outlined recommendations for the rehabilitation of the mentally ill already in the GDR (East Germany), a similar mark of reform ideas was published in the "enquete" in the FRG (West Germany) in 1975. In the GDR initiatives were limited to a small number of locations. In the FRG and the re-unified Germany various forms of sheltered housing and work were established - also with significant regional variation. However, a clear discussion of underlying aims and implications for the structure of mental health care was not found in the psychiatric literature. CONCLUSIONS: In the 20th century a tradition of psychiatric ideas related to housing and work did not develop in Germany. Particularly, there were only sporadic contributions from university psychiatry. Work was more frequently explicit subject of discussions than housing. Both areas were - slowly and in discontinuity - established as criteria of integration of people with mental illnesses, which was increasingly accepted as an aim of mental health care.

Deinstitutionalization↗
PubMed2003

[Assessing the impact of delivery unit size on neonatal survival: estimation of potentially avoidable deaths in Hessen, Germany, 1990-2000].

BACKGROUND AND OBJECTIVE: There are only few analyses from Germany on the impact of delivery unit size on neonatal outcome. The objective of this study was to evaluate the influence of delivery unit size on neonatal survival in Germany. PATIENTS AND METHODS: Data from the perinatal birth register for Hessen for 1990-2000 comprising 640554 births, and the Neonatal Survey for 1989-1997 in Hessen were used. Potentially avoidable deaths were assessed according to delivery unit size and birth weight category. Additionally trend analyses and an extrapolation to potentially avoidable deaths in all of Germany were performed. RESULTS: Compared to large delivery units, smaller ones showed higher risk adjusted mortality rates. Calculation of potentially avoidable deaths gave an estimate of 257 early neonatal deaths in 11 years. Although trend analyses revealed a decline of potentially avoidable deaths, an extrapolation of such deaths for all of Germany still yielded an estimate of more than 300 potentially avoidable deaths per year using data from 1997-2000 only. CONCLUSION: A valid inference as to the magnitude of the observed effect remains even in the face of a very cautious interpretation of our results. During the study period of 11 years, more than 200 neonatal deaths could be attributed to the fact that births in Hessen are dispersed among many small hospitals. If this pattern of births in small units is common throughout Germany, it suggests that several hundred neonatal deaths per year may be attributed to this risk factor when extrapolating these results nationally. Further research is necessary to describe the nation-wide magnitude of this problem and to identify the role of underlying causal risk factors more precisely. Additionally policy discussions regarding structural changes in obstetrical care should be undertaken in the meantime, aimed at reducing the observed mortality rates.

Birth Weight↗
PubMedDate not supplied

[Reproductive medicine in Germany--peculiarities and dilemmas].

BACKGROUND: Technological progress, as well as increasing success, of reproductive medicine may lower the threshold for childless couples to initiate infertility therapy. However this development may aggravate unsolved problems (e. g. multiple births) and may not increase the pregnancy rate, due to the present unsatisfactory legal situation in Germany (e. g. ban on selective blastocyst culture). METHODS: Based on a systematic review of the literature, we studied actual problems of German reproductive medicine under three public health-related topics: (1) the decline in population in Germany, (2) criteria for success in reproductive medicine and (3) new treatment options in the light of legal and ethical aspects. RESULTS: In Germany (and other industrial nations), reproductive medicine has emerged parallel to an ever-increasing rate of childlessness. Today, 2 % of all births result from treatments using the techniques of reproductive medicine. Nevertheless, the actual extent of involuntary childlessness is lower (below 8 %) than commonly suggested (between 10 and 15 %). Frequently, the success of treatment depends upon a series of treatment cycles and is, especially in Germany, accompanied by a high rate of multiple births (more than 30 %). Hence, a more adequate success rate may be the healthy, i. e., term, singleton baby. The use of selective blastocyst culture, currently not permitted in Germany, could further improve therapy or, at least, reduce patient stress and discomfort. CONCLUSION: Reproductive medicine, as seen from a public health perspective, needs to pursue patient-oriented requirements more in-depth. An open discussion of new technologies which could improve reproductive health but are at present not permitted, would be imperative.

Germany↗
PubMed2005

[Adherence to guidelines in CHF therapy in Germany].

BACKGROUND AND OBJECTIVE: The MAHLER survey examined the impact of the European guidelines for the treatment of chronic heart failure (CHF). Especially, the trial addressed the question whether adherence to treatment guidelines leads to a reduction in the rate of CHF and cardiovascular (CV) hospitalization. The present sub-study presents the Germany specific data of the MAHLER study and compares the results with the results in other European countries. PATIENTS AND METHOD: The gobal adherence index (GAI) shows the proportion of correctly prescribed heart failure medications per patient. Class adherence indicators for angiotensin-converting enzyme (AC)-inhibitors, beta-blockers, spironolactone, diuretics and cardiac glycosides and general adherence indicators (GAI3 adherence to first three classes of heart failure medications, GAI5 adherence to five classes) were constructed. In the German sub-study, 251 patient were included, who were seen by 21 cardiologists in private practice (mean age 68,6 + 10,4 years; 173 man, 78 woman; 158 NYHA II; 91 NYHA III, 2 NYHA IV). RESULTS: Mean adherence to CHF therapy guidelines was 63 % for GAI3, 62 % for GAI5. Compared to the other MAHLER-study countries, Germany was on place two and three concerning GAI3 and GAI5, respectively. Strong adherence to treatment guidelines in Germany led to a reduction of CHF and CV hospitalization rate by 40 % (p < 0.033). Thus, the German data confirm the results of the international study indicating that a good GAI3 performance is an independent predictor of time to hospitalization. Hitherto, the relative risk for hospitalization was higher for CHF patients in Germany than for patients in all other European countries. CONCLUSIONS: In Germany like in other European countries, guideline adherence for CHF therapy leads to a reduction in hospitalization rate.

Aged↗
PubMed2006

Incremental prescription and drug costs during the years preceding diabetes diagnosis in primary care practices in Germany.

INTRODUCTION: To evaluate incremental drug prescription costs before diabetes diagnosis in primary care patients in Germany. MATERIAL AND METHODS: Based on 400 primary care practices throughout Germany (Disease Analyzer, IMS Health, Frankfurt, Germany), we selected only patients receiving continuous treatment (age >or= 40 years) and ascertained drug prescriptions and costs up to 6 years before diabetes was diagnosed. For control, we selected age- and sex-matched nondiabetics (n = 6,294 pairs, age 65.5 +/- 10.5 years, 44 % male). We evaluated incremental prescriptions and costs by calculating differences and ratios between patients with and without a diabetes diagnosis. We also evaluated predictors of cost differences using multivariate regression models. The data used for the evaluation was taken from the period 1993 to 2002. RESULTS: The mean number of prescriptions in the year preceding diagnosis in men and women increased 15 % and 19 %, respectively (p < 0.001). Prescription costs were 21 % (men) and 28 % (women) higher in subjects who were destined to receive a diabetes diagnosis (269 and 264 Euros per person) compared to controls (p < 0.001). Incremental prescriptions and costs were already present six years preceding diagnosis. Cardiovascular drugs had the largest impact, accounting for about two-thirds of incremental prescriptions and costs. Women had higher numbers of prescriptions and costs, however, differences and ratios were comparable to men. Incremental costs were higher in patients with private compared to statutory health insurance, and in Western compared to Eastern Germany. DISCUSSION: Numbers of prescriptions and costs in primary care patients with future diabetes diagnosis in Germany were already increased six years before clinical detection, reflecting increased cardiovascular risk even before clinical diabetes diagnosis.

Cost of Illness↗