[Associations between socioeconomic status and self-rated health in northeast German rural communities in 1973, 1994, and 2004/2008]. / Zusammenhänge zwischen dem sozioökonomischen Status und dem selbstberichteten Gesundheitszustand der Bevölkerung in nordostdeutschen Landgemeinden 1973, 1994 und 2004/2008.

This paper reports on selected results from the study "Health and Lifestyle in Rural Northeast Germany". A special characteristic of this study is the regional focus on peripheral rural communities and the trend study design. It was analyzed whether, and to what extent, associations exist between socioeconomic status and self-rated health in this regional context and over time. Thus, regression analyses were conducted using equivalent income, level of school education, and age as independent variables and self-rated health as the dependent variable. Analyses are based on paper-pencil surveys of the adult residents of 14 rural communities chosen at random in northeast Germany, performed in 1973, 1994, and 2004-2008. In all survey waves, a lower level of school education was associated with poor self-rated health. By contrast, associations between income and health were less consistent and constant over time. The associations between income and health are discussed as being specific to East Germany and as a consequence of social transformation in the context of reunification.

[Health and life satisfaction in north-east German rural communities in 1973, 1994 and 2004/08]. / Gesundheit und Lebenszufriedenheit in nordostdeutschen Landgemeinden 1973, 1994 und 2004/08.

The development of the perceived state of health, the lifetime prevalence of chronic heart disease, hypertension and diabetes mellitus, and the life satisfaction of residents in rural communities in north-eastern Germany were analysed over the years 1973, 1994 and 2004/08 with reference to age and sex, and evaluated in comparison with nationally representative data. The analyses are based on data of surveys of the adult residential population of 14 rural communities in north-eastern Germany carried out in 1973 (N=3,603), 1994 (N=2,155) and 2004/08 (N=1,246). While there was an increase over time in the proportion of the population who assessed their health status as very good or good, the prevalence of hypertension and diabetes mellitus also rose successively. Life satisfaction was lower in 2004/08 than in 1994 in terms of almost all factors. A comparison with the results of nationally representative surveys shows that the illness burden of the population in the region we investigated was higher than average, while the perceived health status was considerably below average, as was the satisfaction with the work situation and the financial situation in particular. The development of health and illness parameters in accordance with the general trend is assessed as an expression of the modernisation of the working and living conditions in the region over this period, whereas the observed differences in levels are interpreted as a consequence of the rural nature of the region and peripherisation.

[Everyday life and solidarity in north-east German rural communities - first qualitative results of the Rural Health Study]. / Alltägliche Lebensführung und Solidarität in nordostdeutschen Landgemeinden - Erste qualitative Ergebnisse der Landgesundheitsstudie.

There have been increasing discussions in the health sciences in recent years about socio-spatial influences on health activities. The starting point has been the growing territorial inequality in spatial development resources, which has an effect on the participatory chances of people in structurally weak regions. The concept of "peripherisation" is used to describe this change. Empirical investigations of socio-spatial resources at the local level are rare, because the theoretical preconditions have not been elaborated sufficiently for the theoretical modelling to be recognised for hypothesis-based empirical investigations. At the centre of this theorisation are analyses of the "social capital" of every-day actions. As part of the Rural Health Study 2008 at the University of Applied Science Neubrandenburg (involving a longitudinal analysis with quantitative surveys in 14 rural communities in north-eastern Germany 1973, 1994, 2008), a qualitative approach was also adopted with case and community studies. The first results are compared with the state of the literature. Case studies are presented showing strategies for adaptation and improvement of the individual's situation, and also the daily solidarity of people in villages. Development potentials are outlined.

[Results of a survey of insurance customers participating in a DMP for diabetes mellitus type 2 of BARMER Health Insurance, Neubrandenburg]. / Ergebnisse einer Versichertenbefragung zur Versorgung im DMP für Diabetes mellitus Typ 2 bei der BARMER Neubrandenburg.

The healthcare system in Germany is characterised by fragmentation and a lack of communication between the various sectors of care. Since the late 1990s, intensive efforts have been made to enhance integration. Disease Management Programs (DMPs) represent an attempt to improve the care for the chronically ill which is known to be deficient, in particular for diabetics. As quality assurance studies do not yet provide a comprehensive picture and, in the absence of convincing evaluations, surveys of health insurance customers are particularly interesting and can provide information about preferences, motivation and evaluation of the participants in the DMPs. Thus, one year into a program started in July 2004, a representative survey was carried out of participants in the DMP for diabetics (customers of BARMER Health Insurance, Neubrandenburg). (Random sample net=124). The participants were generally age 61 years or older (77.4%), and two-thirds of them had suffered from diabetes or received treatment for more than 5 years. During the program, the proportion consulting a diabetes specialist had doubled to 31%. The assessment of the quality of care had improved markedly; 19% of the participants reported an improvement in their health status. The main reasons given for participating in the program were an anticipated improvement in the quality of care and an activation of the patient's role. Analyses indicate that those who reported the most benefit from the program are the core group of the elderly chronically ill. But as this group was particularly well informed about their own disease, attention should always be paid to the possibility of social selection processes in such health programs. In future, quality assurance studies should be carried out in order to validate surveys addressing participants in DMPs and, conversely, surveys of DMP participants should be conducted to validate quality assurance findings.

[Risk factors of premature birth and their significance for prevention and health promotion--an analysis based on the BabyCare Program]. / Risikofaktoren der Frühgeburt und ihre Bedeutung für Prävention und Gesundheitsförderung--Eine Analyse auf der Grundlage des BabyCare-Programms.

In this report: Preterm birth will be characterized as a so far widely neglected public health problem in Germany. Actual evidence with respect to epidemiological and intervention knowledge will be summarized. Objectives, methods and routines of the BabyCare program will be presented. Associations between main risk factors and preterm birth will be calculated. Considerable deficiencies in nutritional habits and in micro nutritional intake will be summarized. And conclusions will be derived for future additional focussed actions in the prevention of preterm birth and other important complications in pregnancy within the program and for additional interventions in health policy which are imperative. It will be shown that the rate of preterm birth can be reduced and there is a high probability for further reduction by additional and targeted interventions in smoking, stress and especially nutrition.

[Health- and care reporting in Germany. State and perspectives]. / Gesundheits- und Pflegeberichterstattung in Deutschland. Zu Stand und Perspektiven.

The first Health Report for Germany gives a good opportunity to look for further perspectives of the development of health and care reporting. This article refers briefly to concept, historical development, the report itself and critical analyses of contents, political function and organisational structures of health reporting in Germany. These have a similar importance for care monitoring. The article proposes a stronger participation of care reporting in health reporting not only in Germany and a stronger differentiation between nursing research and care reporting.

[Physician practice patterns and attitudes to euthanasia in Germany. A representative survey of physicians]. / Arztliche Handlungsmuster und Einstellungen zur Sterbehilfe in Deutschland. Eine Repräsentativbefragung unter Arzten.

Growing life expectancy and increasing pharmaceutical and technical methods in medicine are leading to more and more discussions among the general population and among physicians as to whether methods to shorten the sufferings of mortally ill persons should be legalised further. In Australia 60% of physicians wish to be able to perform active euthanasia if this would be legal. In the Netherlands physicians do not commit an offence if they perform euthanasia on the basis of ethically consented rules. In the FRG the National Board of Physicians (Bundesärztekammer) still rejects any liberalisation concerning active euthanasia. However, little is known of the attitudes and behaviour of physicians concerning the questions of active and passive euthanasia. Sponsored by Gruner and Jahr publishers for a magazine "Stern" publication we conducted a representative study among physicians working in hospitals and their colleagues in free practices concerning this topic. Beginning with qualitative interviews with 50 physicians we tested the questionnaire developed and looked for the data production method best fitting for this difficult matter resulting in telephone interviews or a self-administered questionnaire. In the main study a representative sample of n = 282 physicians in free practices and n = 191 physicians in hospitals were interviewed. The response rates were 94% and 51% respectively. Analysis of non-responses did not indicate any bias. Half of the physicians think that a broader discussion on euthanasia is necessary, 34% disagree and 17% consider even a discussion already dangerous. 6% of the physicians in hospitals and 11% in free practices have already experienced methods of active euthanasia. Half of the physicians have seen patients who strongly wished euthanasia, a situation which happens once in every two years. The majority of physicians feel a deep understanding but only a minority of 4% comply with the wish. The vast majority of physicians advocate indirect euthanasia. However, they experience difficulties in defining the difference between active and passive euthanasia in a concrete situation. Summing up, our data indicate that a broader and open discussion on euthanasia seems necessary even if this discussion in Germany will be even more difficult than in other countries due to our recent past. The discussion will be reopened by a proposal on guidelines concerning euthanasia launched by the German National Board of Physician

[Development of a model for explaining health inequality]. / Entwicklung eines Modells zur Erklärung gesundheitlicher Ungleichheit.

The article proposes a model for systematizing the discussion about the mechanisms of production and reproduction of health inequalities. It starts from existing explanation approaches for combining social and health inequalities in West German literature, from contributions of stress and health lifestyle research and from internationally discussed approaches. The proposed model tries to integrate possibilities of explaining different existing approaches.

Immigrants and health: unemployment and health-risks of labour migrants in the Federal Republic of Germany, 1984-1992.

This article presents a longitudinal study of employment, unemployment and health of migrant workers in Germany. The analyses were conducted with longitudinal samples of the waves 1-6 (1984-1989) and the waves 6-9 (1989-1992) of the German Socio-Economic Panel (GSOEP). German and migrant workers did not respect to their health satisfaction but unemployed foreign workers were quite less satisfied with their health than unemployed Germans. This corresponded with a high percentage of foreign unemployed (30-50%) who felt chronically ill. A further examination of two (dichotomously formulated) principal investigation hypotheses could not show that the data support the explanation that the poorer health of unemployed migrants was caused by the unemployment situation. The results are interpreted in the way that the unemployed migrants' poorer health can be explained with (health) selection processes in the labour market.

[Index numbers of ambulatory care utilization. Methodical and content aspects of the value of survey data]. / Kennziffern zur ambulanten Inanspruchnahme. Methodische und inhaltliche Aspekte des Stellenwerts von Surveydaten.

Index numbers of the utilization of outpatient treatment are essential for differentiated health reporting. The established doctor fulfills nodal, coordinating and regulating functions. Therefore numbers reflecting those functions are also indicators for other types of health services. They allow conclusions about motives, preferences and attitudes of the population. Based on two representative population surveys (the Socio-economic Panel and the National Health Survey of the German Cardiovascular Prevention Study) the index numbers Quarterly-Utilization, Contact-Frequency and User-Frequency are analysed. Taking the example of age and sex differences the influence of differing research designs on the validity and possibility of interpretation of the different index numbers are discussed.

[Unemployment and your health: long-term analysis for the German Federal Republic]. / Arbeitslose und ihre Gesundheit: Langzeitanalysen für die Bundesrepublik Deutschland.

Findings from a study based on the longitudinal data of the German Socio-Economic panel (annual data, 1984-1988, N = 5516 individuals, 18-64 years) confirmed differences in health between unemployed and employed persons. The health satisfaction of unemployed persons is on a lower level as well as health impairments. This was only partially due to socio-demographic characteristics. The differences by employment status were stable in all years between 1984 and 1988. However, there were no indications for a causal influence of unemployment on health impairments. A constant health-satisfaction of persons loosing their job and of the re-employed, compared to their initial ratings, supported the selection hypotheses. This means that during the study period persons in poorer health are more likely to loose their job and persons in better health are more likely to be re-employed.

[Prematurity and prenatal care]. / Frühgeburtlichkeit und Schwangerenvorsorge.

In regard of the constant rate of low birthweight infants in Federal Republic of Germany kinds and relevance of social factors within Low Birthweight are examined. Results of a study based on all births in Berlin (West) during the years 1982-1985 (n = 72201) are presented. It shows a constant rate of low birthweight infants also in Berlin (mean: 6.3%, excluding multiple births). Several social factors (legitimacy, nationality...) with varying intensity played a major role, especially if certain risk situations were cumulating. Since Prenatal Care has particular difficulties in reaching women at higher risks early and consequently, specific approaches of intervention derived from experiences in the US are suggested.

[Vocational activity and unemployment of females and pregnancy outcome]. / Erwerbstätigkeit und Nichterwerbstätigkeit von Frauen und Schwangerschaftsergebnisse.

Epidemiologic studies relating unfavourable pregnancy outcomes of working women are reviewed. Inconsistent results are found. This is due to differing types of work and above all to the distribution of sociodemographic factors. The study presented comprising all cases of births and deaths in Berlin (West) of the years 1982-1985 (n = 72.206) showed no difference in low birth weight, but an evidently higher infant mortality for women who were not working. This is explained by sociodemographic factors. This leads to consequences for a target group and health oriented attendance for the public health services.