[Primary and secondary data on dementia care as an example of regional health planning]. / Planung einer kleinräumigen Versorgung unter Nutzung von Primär- und Sekundärdaten am Beispiel von Demenzerkrankten.

BACKGROUND: Health service planning that takes into account as far as possible the regional needs and regional discrepancies is a controversial health issue in Germany. OBJECTIVES: In a pilot scheme, we tested a planning process for regional healthcare services, based on the example of dementia care. The aim of this article is to present the strengths and limitations of this planning process. MATERIALS AND METHODS: We developed an indicator set for dementia care based on routine regional data obtained from two German statutory health insurance companies. Additionally, primary data based on a questionnaire sent to all GPs in the area were evaluated. These data were expanded through the addition of official socio-demographic population data. Procedures and evaluation strategies, discussion of the results and the derivation of planning measures followed, in close agreement with a group of local experts. RESULTS: Few epidemiological data on regional variations in health care planning are publicly available. Secondary data from statutory health insurance companies can be assessed to support the estimation of regional health care needs, but interpretation is difficult. The use of surveys to collect primary data, and the assessment of results by the local health board may facilitate interpretation and may contribute towards more valid statements regarding regional health planning. CONCLUSIONS: Despite the limited availability of data and the considerable efforts involved in data analysis, the project demonstrates how needs-based health service planning can be carried out in a small region, taking into account the increasing demands of the local health care providers and the special local features.

Exploring the enactment effect from an information processing view: what can we learn from serial position analyses?

The focus of the present article was to analyze processes that determine the enactment and age effect in a multi-trial free recall paradigm by looking at the serial position effects. In an experimental study (see Schatz et al 2010), the performance-enhancing effect of enactive encoding and repeated learning was tested with older and younger participants. As expected, there was a steady improvement of memory performance as a function of repeated learning regardless of age. In addition, enactive encoding led to a better memory performance than verbal encoding in both age groups. Furthermore, younger adults outperformed the elderly regardless of type of encoding. Analyses in the present article show that encoding by enacting seems to profit especially from remembering the last items of a presented list. Regarding age differences, younger outperformed older participants in nearly all item positions. The performance enhancement after task repetition is due to a higher amount of recalled items in the middle positions in a subject performed task (SPT) and a verbal task (VT) as well as the last positions of a learned list in VT.

Is there a memory profit after repeated learning of subject-performed actions? Comparing direct and long-term memory performance level as a function of age.

The present two studies investigated the possibility for improvement and maintenance of episodic memory in young and older adults. In a first study, the performance-enhancing effect of two separate as well as combined learning devices, enactive encoding and repeated learning, was tested. With a time lag of one week, four different series of 30 action phrases were encoded either verbally or by enacting them symbolically. Memory was assessed in four immediate free recall tests. In a second study, the maintenance of the memory profit was tested in an unexpected fifth session half a year later. As expected, there was a steady improvement of memory performance as a function of repeated learning in study one. This holds true regardless of age. In addition, enactive encoding led to a better memory performance than verbal encoding in both age groups. Moreover, younger adults outperformed the elderly regardless of type of encoding. The combination of the two learning devices was not efficient enough to eliminate aging effects in episodic memory. However, memory flexibility is demonstrated also in the elderly. In the long-term follow-up, maintenance of learning and memory could be found in all participant groups.

Does action make you faster? A retrieval-based approach to investigating the origins of the enactment effect.

The enactment effect, the stable finding that memory for action phrases is enhanced in a subject-performed compared to a verbal task (SPT; VT), has repeatedly been demonstrated. The question remains whether the enactment effect has to do with specific characteristics of the SPT-retrieval process. Experiment 1 tested younger and older adults in a within-subjects design with two direct free recall tests. Thorough analyses of the recall process showed that the benefit from self-performing the items becomes apparent early into the retrieval phase for both age groups. Experiment 2 tested the same age groups with a retention phase of 30 minutes. The same general results pattern emerged. The acceleration of the recall process in SPTs is indicative of a heightened accessibility of the actively encoded material, making it less susceptible to forgetting. This property of SPTs must be taken into account when trying to determine the origins of the enactment effect.