["Just its Meaning is Hard to Understand Because of the Words" --A Qualitative Study on the Suitability of Health-Related Information for Socially Disadvantaged People]. / "Bloß diesen Sinn kann man nicht so gut verstehen wegen den Wörtern"--Qualitative Studie zur Bedarfsgerechtigkeit von Gesundheitsinformationen für sozial Benachteiligte.

Due to a higher prevalence estimates of risk factors, it is assumed that socially disadvantaged persons have a considerable need for health-related information and prevention. Yet this target group is hardly ever reached. There is a need to examine whether available health-related information is appropriate for the needs of socially disadvantaged people. On behalf of the Institute for Quality and Efficiency in Health Care (IQWiG) a qualitative study was conducted to evaluate published health-related information by socially disadvantaged people. Semi-structured interviews were carried out with 28 persons with low income, low occupational status and a very low education level. 7 different types of health information (4 texts and 1 film, quiz and flyer each) were evaluated regarding their suitability. The interviews were audio-taped, transcribed according to protocol, and qualitatively analysed in view of the central questions. Respondents evaluate the film format most positively, because of the vividness of the contents. In text-based information, a clear structure of the text and the use of case examples are particularly advantageous. All respondents accept the credibility of the given information. Problems occur regarding the comprehensibility and sentence structures with complex information. Numerous technical terms and foreign words remain misunderstood, even though explanations are given in the text. Compact contents and the description of several alternative therapy options are experienced as overstraining. Furthermore, the recognition of hazard potentials is hindered by misinterpretation of percentages or negated descriptions of frequencies. Some respondents doubt that they would read text-based health information voluntarily in their everyday life, especially when texts are lengthy. The respondents wish clear guidance, which relieves them of an active informed decision-making. They prefer advice they can apply in their everyday life and to recognise their personal affliction in the information. It becomes apparent that the health-related information published by the IQWiG only partly meets the needs of socially disadvantaged people. But a mere simplification of the content seems insufficient. Instead a more detailed consideration of the personal circumstances of the target group and a better communication of practical information are needed.

Modified percutaneous endoscopic gastrostomy (PEG) with gastropexy--early experience with a new introducer technique.

OBJECTIVE: The Cliny PEG 13 has been available since 1999 for clinical use in the modified introducer technique in combination with endoscopically controlled gastropexy. Data on indication, insertion technique and safety have not yet been reported in the literature. METHODS: During the time period from January 1999 to June 2000, from a total of 457 patients receiving a PEG 27 (5.9%) subjects, in whom the insertion of a PEG by means of pull-through technique was impossible or only in combination with an intervention e.g. bougienage were included in this prospective study. Each patient received a Cliny PEG 13 by means of introducer technique with endoscopically controlled double gastropexy. Tumor patients with severe stenosis made up more than 90% of the cases. The insertion and 30 day follow-up were performed using a standardized protocol. Method-related and unrelated complications were recorded. RESULTS: PEG insertion was successful in all patients without additional intervention. We did not see any method-related complications. The peri-interventional local infection rate was 3.7%. One patient died during the 30-day follow-up period as a result of progression of the underlying disease. No further complications occurred in long term follow-up. CONCLUSIONS: Our results show that the Cliny PEG 13 is a safe technique and an alternative to other methods and surgical procedures in patients in whom a PEG was not applicable by means of the pull-through technique. Larger case numbers and the use in other patient collectives will have to prove these initial results.