[Networking, Coordination and Responsibilities based on Health Regionsplus: New Health Political Approaches and Developments in Bavaria]. / Vernetzung, Koordination und Verantwortung durch Gesundheitsregionenplus: Neue gesundheitspolitische Ansätze und Entwicklungen in Bayern.

For many health and health-care problems in the population, there is a need for professional management and coordination instruments as well as a competent local network. The new "Health Regionsplus" in Bavaria offer such a structure. This new concept is presented in the following article. The "Health Regionsplus" aim to improve the population's health, the health-related quality of life, equity in health, as well as to further develop the local health care. The Bavarian State Ministry of Health and Care will support up to 24 regions with a funding of up to 50 000 Euro yearly per "Health Regionplus" until the end of 2019. The structure of "Health Regionsplus" implies the establishment of a coordinating agency that works as a "motor", a health forum on the strategic level and relevant working groups. "Health Regionsplus" involve all relevant stakeholders of the regional health system and are chaired by the district administrator or mayor. They work primarily in the fields of health care and prevention/health promotion but can also pursue other region-specific fields. The Bavarian Health and Food Safety Authority supports and evaluates the "Health Regionsplus". There is also a coordinating office which organises the exchange of information and experience among the "Health Regionsplus". Although such a comprehensive regional approach does not change the statutory decision-making structures and responsibilities it does offer the communities an instrument to involve local needs in their decision-making processes.

[Cooperation in Public Health: Formative Evaluation of the Model Project "Regional Health Conferences" in Bavaria]. / Kooperation im Gesundheitswesen: Formative Evaluation des Modellprojekts Regionale Gesundheitskonferenzen in Bayern.

Aim of the study: Health conferences offer opportunities for better cooperation and coordination in local health management. The aim of the explorative evaluation study was to assess structures, processes and results of "Regional Health Conferences (RGK)" in 3 model regions, to inform about potential for development and to test their transferability to other regions. Method: After the model project had been up and running for 18 months (08/2013 to 12/2014), a survey of 80 participants of the RGK in 3 regions was conducted, based on a semi-standardized questionnaire. The response rate was 90%. The results were complemented by document analysis and an additional survey of the managers of the RGK. Results: The 3 RGK were established with their agencies and 13 working groups on health care. Almost all participants felt that the number of members was appropriate and that the main stakeholders were represented. According to a large part of the respondents, the majority actively took part in the RGK and usually everyone had the equal opportunity to propose a topic. Although almost half of the respondents reported conflicts, the atmosphere was constructive for 3-quarters of them. Nearly all the interviewees confirmed the importance of a chairman and a manager of the agency, as well as the positive influence of the moderator. Almost everyone agreed that RGK are suited to improve health care and cooperation. From the participants' point of view, the main problems were identified; 94% of the respondents agreed that the previous work could be regarded as successful and 91% were satisfied or rather satisfied with the processes of the RGK. The level of satisfaction was similar among the three model regions, but it varied among the member groups; 98% of the interviewees would also take part in the future. Conclusion: According to this survey, RGK are an appropriate platform for coordination, exchange und cooperation of stakeholders and a good instrument for cooperation. In Bavaria, the approach will be further improved as well as extended to other regions based on a new concept called "Health Regionsplus".

[Evidence-based health services research--a short review and implications]. / Versorgungsforschung--evidenzbasiert Ein Kurzüberblick und Implikationen.

BACKGROUND: Health services research aims to generate knowledge about care processes of people with illnesses who access health-care services. In addition, the consequences of those processes in the care routine concerning the involved persons and the health system are analyzed. CONCEPT OF THE THEORETICAL WORK: In the first part of the manuscript, an overview concerning the current definitions and subsumptions of the concept of health services research is given. The second part of the manuscript focuses on demonstrating how evidence-based health services research can be used to enable optimization of the care system. The concept is called the "circle of care optimization". In the first step the current care situation concerning its deficits and their reasons is analyzed. In the second step a relevant care goal is defined. In the third step an improvement of an existing care process is developed to achieve the defined care goal. In the fourth step, a comparative empirical study with a high-quality study design is carried out, to assess whether the improved care process is superior to the current care as usual. A health economic evaluation will be performed if applicable. If the results show no or only small advantages, the "circle" starts again with step 3. However, if the results show a significant effect in favour of the new care process and are relevant for the delivery of care and efficient in the context of health economics, a fifth step will be performed which involves developing and testing strategies for implementation. Where relevant, the consequences of implementation are investigated in a sixth step. A "best-practice" practical example is demonstrated to illustrate the "circle of care optimization". CONCLUSIONS: conclusions are derived by illustrating future challenges for health services research.

[Health services research for the public health service (PHS) and the public health system]. / Versorgungsforschung für den Öffentlichen Gesundheitsdienst (ÖGD) und das öffentliche Gesundheitswesen.

INTRODUCTION: There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. RESULTS: The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. DISCUSSION: Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich".

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. / Memorandum "Weiterentwicklung der Gesundheitsversorgungsforschung in Bayern aus Sicht der Landesarbeitsgemeinschaft Gesundheitsversorgungsforschung: Status quo - Entwicklungspotenziale - Strategien".

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

[Health conferences in Germany: an overview]. / Gesundheitskonferenzen in Deutschland: ein Überblick.

Health conferences are a special management instrument of health policy. Less is known about the distribution. There is a lack of systematic evaluation methods.This overview is based on comprehensive literature, data base and internet searches about health conferences in Germany.The establishment of structured conferences is derived from funding projects of the federal states or local initiatives which began in different phases and with various emphases. The strategies varied from individual actions to an implementation in the whole state. Currently there are altogether 130 health conferences in Germany for approximately one third of the county and city districts in 13 federal states. The federal states assist health conferences by providing financial support, health policy, support by health authorities and regulations in the law. In the majority of the cases the office is located within the public health service. There is a great diversity in the composition of the stakeholders and in the contents. A systematic monitoring and outcome evaluation was conducted only in a few cases. Those studies predominantly report positive results but also promoting and inhibiting factors. They referred to restrictions.Health conferences are broadly disseminated, especially in west Germany. They offer opportunities for a community health management. There is a need for more intensive exchange and evaluation to improve their development.

[Status quo and potential of health services research: the perspective of Bavarian actors]. / Stand und Potenziale der Versorgungsforschung: Die Perspektive der Akteure in Bayern.

In 2011, the Bavarian Parliament decided to advance health services research (HSR) in Bavaria by bundling scientific competencies in a State Working Group and integrating other actors in it. The establishment of such a State Working Group "Health Services Research" -(LAGeV) together with members from science, health care and politics followed in 2012. The objective of this study is to identify the status quo of HSR in Bavaria including its determinants and potential for development based on the actors' perspective.After the inaugural meeting a semi-structured questionnaire was sent to all 36 members from 28 organisations. Items comprise information on the respondent's background as well as status quo, future topics and potential for development of HSR in Bavaria.27 members took part in the survey, resulting in a response rate of 75.0%. Satisfaction of actors with the status quo of HSR is rather low, especially regarding the effectiveness of policy advice. Researchers and health care providers are also not much satisfied with the HSR environment. For the future of HSR, respondents prioritise the topics interface and networking research, followed by innovative care concepts, care for patients with multiple or chronic conditions as well as evaluation of innovations, processes and technologies. Potential for development and thus improvement of care is primarily seen in the abolishment of existing constraints by an overall HSR concept (including selective research promotion), networking and cooperation, research funding as well as improving the interface between politics and science. Respondents assess the benefit of an increased networking within the LAGeV as high.Status quo of HSR in Bavaria is not very satisfactory. The survey reveals important constraints as well as promoting factors based on the viewpoints of different groups of actors. It also prioritises future HSR topics and identifies potential for development, which are important for the LAGeV. The findings can be used for advancing HSR in Bavaria and beyond.

[Obesity in the population of North Rhine-Westphalia and its communities in the 2009 German Microcensus: prevalence, illness and prevention potential]. / Adipositas in Nordrhein-Westfalen und dessen Kommunen im Mikrozensus 2009: Prävalenz, Krankenstand und Präventionspotenziale.

BACKGROUND AND OBJECTIVE: There are only few data about regional and social disparities in obesity, the related diseases, and related morbidity in Germany. METHODS: The 2009 Microcensus regional file North Rhine-Westphalia was used for this analysis. The Microcensus represents a decentralised household survey. The selection rate of the random sample survey was 1 % of the population. RESULTS can be extrapolated at state and community levels in North Rhine-Westphalia. The body weight and the height were reported by 72 % of the interviewees above 18 years in the voluntary health supplementary programme (N = 10 705 000). RESULTS: About 11 % of the adults above 18 years in North Rhine-Westphalia are obese class I, further 3 % of the adults are obese class II and 1 % are obese class III according to Body-Mass-Index classification. After adjustment for age, male and female adults with obesity have a highly significantly elevated odds ratio of 1.4 and 1.7 for illness or accident injury at the survey date. Obesity prevalence is associated with officially confirmed disability.There is a social gradient in the prevalence of obesity in the population of employable age (18-64 years). The probability of obesity decreases with the rise of the level of education. Male and female blue-collar workers and female jobseekers were more often obese. The Microcensus shows distinct disparities in obesity prevalence between the communities in the population of employable age. CONCLUSION: The Microcensus may have potential for a harmonized monitoring concerning obesity. But there is a need for further research in regard to the methods. The regional and social disparities in obesity prevalence reveal needs for interventions to combat obesity.

[Regional and social disparities in tobacco use in the 2009 Microcensus: results in the population of North Rhine-Westphalia and its communities]. / Regionale und soziale Unterschiede im Tabakkonsumverhalten im Mikrozensus 2009: Ergebnisse für das Land Nordrhein-Westfalen und dessen Kreise.

INTRODUCTION: Tobacco smoking is the single greatest cause of avoidable morbidity and mortality. The official Microcensus is one of the most important sources of systematic reporting about smoking in Germany. METHODS: The selection rate of the random sample survey was 1% of the population in the 2009 Microcensus in North Rhine-Westphalia. Most of the information was given under statutory obligations. Providing health information in the health supplementary programme was optional with response of about four-fifths of the interviewees. RESULTS: According to the 2009 Microcensus regional file, 37% of the men and 28% of the women of employable age (15-64 years) are smokers in North Rhine-Westphalia (N=9 219 thousand). Tobacco smoking prevalence is associated with influencing social factors. The probability of current smoking rises with the decrease of the socioeconomic status and the level of education. Job-seekers have a significantly elevated odds ratio for smoking, the chance of quitting smoking is minimised. The analyses show that the percentages of smokers and ex-smokers varied widely between the communities in North Rhine-Westphalia. The prevalence of current tobacco smoking increases highly in the communities with rates of inhabitants who receive government financial aid or unemployment benefits to secure their basic livelihood. CONCLUSION: The Microcensus reveals distinct disparities in adult smoking prevalence between the regions and additionally strong social disparities in adult smoking prevalence. The nicotine addiction accelerates health inequalities. The Microcensus may have potential for monitoring tobacco use in Germany and in the regions and communities and for evaluating the effectiveness of tobacco control programmes over time. The Microcensus analyses can be used for the development of primary and secondary tobacco prevention strategies.

[Health and illness in the country, state NRW, and its communities. Results from the 2009 German Microcensus]. / Gesundheit und Krankheit in Bund, Land NRW und dessen Kommunen. Ergebnisse des Mikrozensus 2009.

The health-for-all policy framework needs data for action. Results from the German Microcensus can be extrapolated to the population at the country, state ("Bundesländer"), and community levels. Most of the information in the 2009 Microcensus was given under the statutory obligation; providing health information in the supplementary program was optional. The selection rate was 1% of the population. The Microcensus' continuous sampling method during the year, thus, determines illness rates as an average for the year. There are distinct health disparities between not only the states but also between communities in North Rhine-Westphalia. Annual average illness rates for 2009 are associated in NRW with influencing social factors, e.g., education. Illness rates rise with decreasing net income for the past month. Blue-collar workers suffered more often from illness or accident injuries at the time. The levels of illness in the overall employable population increase in the communities of NRW with the proportion of inhabitants who receive governmental financial aid or unemployment benefits to secure their basic livelihood. The Microcensus has the potential to be a source for systematic and harmonized monitoring concerning health in the country, states, and communities of Germany.

[Work-site health promotion in Germany. Results of the IAB--establishment panel 2002 and 2004]. / Betriebliche Gesundheitsförderung in Deutschland--Ergebnisse des IAB-Betriebspanels 2002 und 2004.

According to the answers of employers to the representative IAB establishment panel 2004, one-fifth of the companies in Germany voluntarily carried out or financially supported measures for the protection or promotion of the health and well-being of their work force. The proportion of health-promoting companies was above average in all East German federal states as well as in Bavaria, in Saarland and in Lower Saxony. North Rhine-Westphalia was precisely average. In East Germany, almost one-fourth and in West Germany just under one-fifth of all companies surveyed carry out health-promoting measures.Work-site health promotion varies considerably depending on the corresponding federal states, industrial branches and company sizes. Work-site health promotion has ,up to now, been concentrated in big companies and groups. An under-representation of work-site health promotion is observed above all in small and very small companies and particularly in the catering trade. Work-site health promotion was principally determined by analyses of sickness leaves and surveys on health protection in the work place which were mentioned in about 9% and 8% of the companies interviewed. 6% of the companies provided courses on health-relevant ways of behaviour. About 4% of the companies maintain health circles and 5% realised other health promoting measures. Further correlation analyses reveal that in companies with a workers council/staff council, work-site health promotion was significantly much more common. This correlation is especially strong in small and medium-size companies. The longitudinal analysis of the IAB establishment panel 2002 and 2004 reveals much dynamism in work-site health promotion. On the one hand, half of the companies involved in work-site health promotion in 2002 had stopped their commitment to work-site health promotion by 2004. Sustainability remains one of the biggest challenges in work-site health promotion. On the other hand, a bit more than one tenth of the repeatedly interviewed companies started health-promoting activities in 2004. According to the longitudinal data set, altogether 29% of the companies were reached by work-site health promotion measures (for the years 2002 and 2004).

[Cross-border cooperation in Europe: what are Euregios?]. / Grenzübergreifende Zusammenarbeit in Europa: Was sind Euregios?

In cross-border cooperation, much importance has been attributed to the so-called "Euregios", synonymously also called "Euroregions". These are cross-border structures in which, above all, local and regional authorities have joined together across one or several national borders. As early as 1958, the first Euregio was established along the German-Dutch border. Meanwhile many other Euregios have been set up. Euregios provide the testing ground for pilot projects to examine practical solutions of cooperation. Euregios are therefore also called "laboratories of Europe" or "testing laboratories of European integration". Also in the health sector, several cross-border projects are being and have already been carried out. According to what has been found out so far, above all Euregios with long years of experience in cross-border cooperation seem to commit themselves to the health issue. A huge number of the projects is co-financed by the European Union. Compared to other thematic areas, in some border regions the health issue has, on the whole been, underrepresented in cross-border cooperation. In this respect, there is potential for development. Information on existing projects as well as their experiences can facilitate the successful implementation of health-relevant cross-border projects also in those regions which have up to now not carried out any or only a few projects of this kind. The EU-funded Euregio project, carried out by lögd NRW, is the first project in which a systematic inventory analysis of cross-border health care projects will be drawn up.

[Care and preventive experts lecture in the elementary school programme "Klasse2000" - co-operative teaching]. / Einsatz von Präventionsfachleuten im Grundschulprogramm Klasse2000 - Kooperativer Unterricht im Programm Klasse2000 -

In the context of the health promotion programme 'Klasse2000', 483 health experts gave specific lessons to pupils from the first to the fourth grade of the elementary school. Following the classes a survey was conducted as to the valuation of the programme, its translation into practice and co-operation between class teachers and health experts. Those questioned considered the programme as really applicable and were absolutely content with the organisation. They regarded direct working with pupils as fairly positive. Co-operation with class teachers was seen as ambivalent. The findings of this survey trigger further optimisation of the programme, especially to enlarge the time spent on efforts by the health experts and to intensify parent co-operation.