C. Heintze - Academia.edu (original) (raw)
Papers by C. Heintze
Medizinische Klinik - Intensivmedizin und Notfallmedizin
Prävention und Gesundheitsförderung
Zusammenfassung Hintergrund Aufgrund der Zunahme von Adipositas in Deutschland werden präventive... more Zusammenfassung Hintergrund Aufgrund der Zunahme von Adipositas in Deutschland werden präventive Ansätze bei der Betreuung übergewichtiger Patienten für Hausärzte immer wichtiger. In dieser Untersuchung wurden Ursachenzuschreibungen zu Übergewicht analysiert, die Betroffene gegenüber Hausärzten thematisierten. Methode Zwölf Hausärzte nahmen ihre Arzt-Patienten-Gespräche von 52 übergewichtigen Patienten [Body-Mass-Index (BMI)≥25 kg/m2] auf, bei denen eine Gesundheitsuntersuchung realisiert wurde. Nach Transkription der Tonaufnahmen wurden die Gespräche mittels der
ZFA - Zeitschrift für Allgemeinmedizin
Das Gesundheitswesen
Zusammenfassung Zielsetzung Ältere Menschen mit depressiven Erkrankungen nehmen seltener Psychoth... more Zusammenfassung Zielsetzung Ältere Menschen mit depressiven Erkrankungen nehmen seltener Psychotherapie in Anspruch als jüngere Menschen. HausärztInnen sind für die Vermittlung in psychotherapeutische Behandlung insbesondere für ältere Menschen von großer Bedeutung. Dieser Beitrag präsentiert Ergebnisse zur hausärztlichen Sicht auf die Hindernisse und Voraussetzungen für eine Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie. Methodik Hausärztliche LehrärztInnen wurden mit einem Fragebogen zur Versorgung älterer Menschen (60+) mit depressiven Erkrankungen befragt. In 2 offenen Fragen wurde die Sicht auf Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in psychotherapeutische Behandlung erfragt. Ergebnisse Die meisten Aussagen betreffen Hindernisse, die auf PatientInnen-Seite wahrgenommen werden, gefolgt von Barrieren, die auf Seiten des Versorgungssystems gesehen werden. Vor allem hinderliche Einstellungen und Emotionen, a...
Journal of Affective Disorders
Das Gesundheitswesen, 2016
Zusammenfassung Ziel der Studie: Nach dem fünften Sozialgesetzbuch §20 Abs. 1 können die Gesetzli... more Zusammenfassung Ziel der Studie: Nach dem fünften Sozialgesetzbuch §20 Abs. 1 können die Gesetzlichen Krankenversicherungen (GKV) Kosten für primärpräventive Programme im Bereich Bewegung, Ernährung, Stressmanagement und Suchtmittelkonsum bis zu 80% rückerstatten. Inwieweit Allgemeinärzte in ihrer Praxis auf solche Angebote verweisen oder selbst im Primärpräventionsbereich Programme nach §20 oder als individuelle Gesundheitsleistungen (IGeL) anbieten, ist unbekannt. Ziel der hier dargestellten Befragung war es, zu erfassen, an welche Anbieter sie für Primärpräventionsangebote verweisen und inwieweit sie dabei berücksichtigen, ob diese erstattungsfähig sind. Zusätzlich wurde untersucht, inwieweit Allgemeinärzte/innen individuelle Gesundheitsleistungen (IGeL) in diesen Bereichen anbieten. Methodik: Zwischen November 2010 und Februar 2011 erhielten alle Allgemeinärzte mit Praxissitz in Berlin (n=1 168) einen Fragebogen, der erfasste ob und auf welche Präventionsprogramme sie ihre Patie...
Medical science monitor : international medical journal of experimental and clinical research, 2010
To examine health- related locus of control, self- efficacy and attribution tendencies in obese p... more To examine health- related locus of control, self- efficacy and attribution tendencies in obese patients and to discuss their impact on primary care consultations. 123 patients, showing a BMI >25 kg/m(2) and following a health Check up, rated questionnaires regarding health-related locus of control, self-efficacy and attribution tendencies concerning obesity. Physical health parameters like BMI, level of cholesterol, blood pressure and existing cardiovascular co morbidities were assessed by GPs. Statistical analysis were conducted using SPSSv16.0. Patients scored comparable to a norm- population on self- efficacy and the three dimensions of health related locus of control. Physical health parameters did not explain variance. Patients named mainly behavioral causes for their overweight; those with a BMI >30 kg/m(2) tend to attribute their bodyweight to genetically origins. In order to conduct individual tailored consultancies it is necessary to explore the individual beliefs an...
Der Urologe. Ausg. A, 2009
The objective of this study was to evaluate whether rebiopsy of the prostate leads to a significa... more The objective of this study was to evaluate whether rebiopsy of the prostate leads to a significant increase in the detection rate of prostate cancer compared with performing a single biopsy. Data from 406 patients were evaluated retrospectively. The patients had undergone ultrasound-guided transrectal biopsy of the prostate between January 2004 and August 2005. Besides demographic data, the patient information was reviewed with regard to the number of biopsy samples taken per patient, histological results, and the occurrence of complications during or after the examination. If prostate cancer was detected, data acquisition included the number of positive biopsy samples taken per examination as well as the subsequent therapy and the TNM classification of the tumor. After a follow-up time between 24 and 42 months, all patients with a histologically negative first biopsy were reevaluated regarding rebiopsy. We evaluated the follow-up time (in months) and the histological results. If p...
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2009
ABSTRACT Background The number of overweight patients in Germany has been continuously increasing... more ABSTRACT Background The number of overweight patients in Germany has been continuously increasing during the past years. The so-called “check-up 35” consultation presents primary care providers with an opportunity for preventive counselling talks with the respective individuals. In this qualitative study we analysed family physician encounters. We were particularly interested in the way in which the subject matter was addressed and the risk counselling performed by the physicians when confronted with overweight patients. Methods Twelve physicians audio-taped their final check-up dialogue with 52 overweight or obese patients (BMI⩾25 kg/m2). The interviews were transcribed, and a content analysis was conducted using the established method developed by Mayring. Results Physicians used direct or more often indirect strategies to address overweight in counselling talks that were most often initiated by their patients. They largely addressed this topic while communicating laboratory results. Some obese patients did not receive any advice on health risks. In the encounters analysed the physicians did not employ standardized risk counselling tools. Conclusions The reasons for addressing overweight indirectly and the lack of standardized risk counselling with obese patients are carefully discussed.
Medizinische Klinik, 2006
Consultations due to most different bowel diseases and abdominal symptoms are common in primary c... more Consultations due to most different bowel diseases and abdominal symptoms are common in primary care. However, little is known about the concrete situation in the general practitioner's office so far. In this study, practitioners involved in the actual treatment of patients with bowel diseases document their medical strategies by the use of an internet-based data entry system. Hence, with the support of an internet-based data collection tool, health care research has started to break new ground. Following the programming of a digital data collection system and the installation of a nationwide research network of general practitioners interested in this matter, participating physicians communicated anonymised data on medical care of patients with various abdominal problems and intestinal/bowel diseases to the principal study investigators for 12 months, thereby using a computer-based data entry system (via internet). Within the 12 months of observation, 94 general practitioners documented 1,584 patient contacts by using the new data collection system. Accordingly, the most frequent reasons for consultation were abdominal pain (39%) and a change in stool habits (28%), each over a period of > 21 days. Women reported abdominal pain more often than men. Furthermore, the willingness to cooperate with specialists (hospitalization, referrals) was high among participating physicians, in reference to abdominal problems, thereby not demonstrating gender specificity. In the majority of cases, computer-assisted data entry took place outside regular consultation hours, and physicians frequently documented more than one patient within one session. High numbers of hospitalizations and specialist referrals, as shown in this study, points toward a high intensity of medical attendance necessary for patients with unspecific symptoms of the bowel or related abdominal problems. Computer-assisted data entry systems, however, represent a challenging yet still realizable way of data collection. This procedure should be brought forward for future projects in health care research.
Urologe A, 2009
Zusammenfassung Ziel Ziel der vorliegenden Arbeit war zu evaluieren, ob die Durchführung einer R... more Zusammenfassung Ziel Ziel der vorliegenden Arbeit war zu evaluieren, ob die Durchführung einer Rebiopsie bei Verdacht auf ein Prostatakarzinom (PCA) zu einer signifikant gesteigerten Inzidenz an PCA im Vergleich zur einmalig durchgeführten Stanzbiopsie führt. Patienten und Methoden Es wurden retrospektiv 406 Patienten erfasst, bei denen zwischen Januar 2004 und August 2005 eine ultraschallgestützte transrektale Multibiopsie der Prostata durchgeführt worden war. Neben der Erfassung
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007
ABSTRACT Owing to increased epidemic activity and difficulties in controlling the insect vector, ... more ABSTRACT Owing to increased epidemic activity and difficulties in controlling the insect vector, dengue has become a major public health problem in many parts of the tropics. The objective of this review is to analyse evidence regarding the achievements of community-based dengue control programmes. Medline, EMBASE, WHOLIS and the Cochrane Database of Systematic Reviews were searched (all to March 2005) to identify potentially relevant articles using keywords such as 'Aedes', 'dengue', 'breeding habits', 'housing' and 'community intervention'. According to the evaluation criteria recommended by the Cochrane Effective Practice and Organisation of Care Review Group, only studies that met the inclusion criteria of randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after trials (CBA) or interrupted time series (ITS) were included. Eleven of 1091 studies met the inclusion criteria. Of these, two were RCTs, six were CBAs and three were ITS. The selected studies varied widely with respect to target groups, intervention procedures and outcome measurements. Six studies combined community participation programmes with dengue control tools. Methodological weaknesses were found in all studies: only two papers reported confidence intervals (95% CI); five studies reported P-values; two studies recognised the importance of water container productivity as a measure for vector density; in no study was cluster randomisation attempted; and in no study were costs and sustainability assessed. Evidence that community-based dengue control programmes alone and in combination with other control activities can enhance the effectiveness of dengue control programmes is weak.
Patient Education and Counseling, 2012
The aim of this study was to assess general practitioners&#39... more The aim of this study was to assess general practitioners' (GP) readiness to involve obese patients in therapy decision making and to determine whether they integrate motivational interviewing techniques. Fifty-eight preventive Check-up 35 encounters with overweight and obese patients in primary care were audio recorded in 12 GP practices. The use of motivational interviewing techniques was rated with the Behavior Change Counseling Index (BECCI). The involvement in medical decisions was rated with the Observing Patient Involvement Scale (OPTION). OPTION and BECCI scores were low (means=0.71 and 1.65), indicating minimal implementation of shared decision making and motivational interviewing in preventive encounters with these patients. GPs used more motivational interviewing for patients with a BMI>30 kg/m(2) than for those with a BMI<30 kg/m(2). Female GPs had significantly higher shared decision making scores, indicating that they prefer to involve patients in medical decisions. GPs differed significantly in their use of both approaches. Shared decision making and motivational interviewing, though known to be successful strategies in lifestyle counseling, are rarely used during obesity encounters in our sample of German GPs. GPs should be sensitized and trained in the application of these methods.
International Journal for Quality in Health Care, 2010
Objective. The increasing prevalence of obesity requires particularly primary care providers to t... more Objective. The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI 30 kg/m 2 would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI , 30 kg/m 2. Design. Cross sectional comparison of audiotaped encounters of patients with a BMI 30 kg/m 2 and those with a BMI , 30 kg/m 2. Setting. Twelve GP surgeries in Berlin, Germany. Participants. Fifty patients who agreed to have preventive checkup encounters audiotaped. Main Outcome Measures. Based on the Roter Interaction Analysis System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. Results. An increased BMI was found to be a predictor for the length of encounters (P ¼ 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P. 0.05). Conclusions. Our results indicate that GPs rarely use the checkup program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.
Das Gesundheitswesen, 2012
Improving individual health behaviour is a promising approach especially in cardiovascular preven... more Improving individual health behaviour is a promising approach especially in cardiovascular prevention. In general practice, preventive advice-giving is hitherto put into practice insufficiently. The study explores which role general practitioners are willing and able to play in behaviour-oriented prevention. 50% of general practitioners in Brandenburg (n=748) were randomly selected for the study. A standardised questionnaire was mailed to them in which their attitudes towards preventive advice-giving were measured using Likert scaling. Participation was anonymous. 37% of the physicians answered the questionnaire. Almost all of them see it as their responsibility to inform patients about possible reduction of lifestyle-dependent health risks and to motivate them accordingly. Self-assessment concerning advisory skills is predominantly positive (best for physical activity, worst for smoking cessation and sexual risk behaviour advice). Time resources for behaviour-oriented prevention are sparse. For this reason, the delegation of many advisory tasks to physician assistants is regarded positively. Most physicians see themselves as willing and able to perform behaviour-oriented prevention. Nevertheless, realising this task seems to be difficult, e. g., concerning the frame conditions of general practice. The role of general practitioners in prevention and health promotion should be defined more accurately.
Das Gesundheitswesen, 2011
Das Gesundheitswesen, 2009
... K. Schlöpker 1 , M. Herrmann 2 , C. Großer-Kaya 2 , B.-P. Robra 4 , B. Dippelhofer-Stiem 3 , ... more ... K. Schlöpker 1 , M. Herrmann 2 , C. Großer-Kaya 2 , B.-P. Robra 4 , B. Dippelhofer-Stiem 3 , F. Schütze 3 ... Aufenthaltsstatus in Deutschland weist Ähnlichkeiten zu einer sozialräumlichen Verteilung dokumentierter Festnahmen illegaler Tatverdächtiger auf, die von Cyrus in einem ...
Das Gesundheitswesen, 2012
Family Practice, 2012
Background. Many countries with shortages in health personnel are introducing task shifting in pr... more Background. Many countries with shortages in health personnel are introducing task shifting in primary health care. GPs' attitudes and practices strongly affect task shifting and the expansion of the roles of physician assistants (PAs). Objective. To assess, in a German state with shortages of health personnel, the overall willingness of GPs to delegate home visit tasks to PAs and to elicit their perceptions of barriers to and benefits of such delegation and the current practice of informal delegation. Methods. Postal self-administered anonymous survey of all practicing GPs in the rural state of Mecklenburg-Vorpommern. Main outcomes were GPs' willingness to delegate in home visit tasks to a properly trained PA, perceived barriers to and benefits of home visit delegation and current practice of informal delegation. Using multinomial logistic regression, associations were identified among outcome variables, and characteristics of the GPs and of their practices. Results. Response rate was 47%. Responders (500) were comparable to all GPs in the state (1096); 48% of practitioners are willing to delegate home visits tasks to PAs. The main barrier to delegation was the related costs of PAs' training (34%), and the main benefit that it 'saves the GP's time' (67%). The 46% of practitioners who are informally delegating home visit tasks were significantly more likely be younger [odds ratio (OR) and 95% confidence interval (CI)] [OR = 0.96 (0.93-0.99)] and female [OR = 1.70 (1.12-2.58)]. Conclusion. The increasing proportion of women in family medicine might favor task shifting in General Practice.
Medizinische Klinik - Intensivmedizin und Notfallmedizin
Prävention und Gesundheitsförderung
Zusammenfassung Hintergrund Aufgrund der Zunahme von Adipositas in Deutschland werden präventive... more Zusammenfassung Hintergrund Aufgrund der Zunahme von Adipositas in Deutschland werden präventive Ansätze bei der Betreuung übergewichtiger Patienten für Hausärzte immer wichtiger. In dieser Untersuchung wurden Ursachenzuschreibungen zu Übergewicht analysiert, die Betroffene gegenüber Hausärzten thematisierten. Methode Zwölf Hausärzte nahmen ihre Arzt-Patienten-Gespräche von 52 übergewichtigen Patienten [Body-Mass-Index (BMI)≥25 kg/m2] auf, bei denen eine Gesundheitsuntersuchung realisiert wurde. Nach Transkription der Tonaufnahmen wurden die Gespräche mittels der
ZFA - Zeitschrift für Allgemeinmedizin
Das Gesundheitswesen
Zusammenfassung Zielsetzung Ältere Menschen mit depressiven Erkrankungen nehmen seltener Psychoth... more Zusammenfassung Zielsetzung Ältere Menschen mit depressiven Erkrankungen nehmen seltener Psychotherapie in Anspruch als jüngere Menschen. HausärztInnen sind für die Vermittlung in psychotherapeutische Behandlung insbesondere für ältere Menschen von großer Bedeutung. Dieser Beitrag präsentiert Ergebnisse zur hausärztlichen Sicht auf die Hindernisse und Voraussetzungen für eine Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie. Methodik Hausärztliche LehrärztInnen wurden mit einem Fragebogen zur Versorgung älterer Menschen (60+) mit depressiven Erkrankungen befragt. In 2 offenen Fragen wurde die Sicht auf Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in psychotherapeutische Behandlung erfragt. Ergebnisse Die meisten Aussagen betreffen Hindernisse, die auf PatientInnen-Seite wahrgenommen werden, gefolgt von Barrieren, die auf Seiten des Versorgungssystems gesehen werden. Vor allem hinderliche Einstellungen und Emotionen, a...
Journal of Affective Disorders
Das Gesundheitswesen, 2016
Zusammenfassung Ziel der Studie: Nach dem fünften Sozialgesetzbuch §20 Abs. 1 können die Gesetzli... more Zusammenfassung Ziel der Studie: Nach dem fünften Sozialgesetzbuch §20 Abs. 1 können die Gesetzlichen Krankenversicherungen (GKV) Kosten für primärpräventive Programme im Bereich Bewegung, Ernährung, Stressmanagement und Suchtmittelkonsum bis zu 80% rückerstatten. Inwieweit Allgemeinärzte in ihrer Praxis auf solche Angebote verweisen oder selbst im Primärpräventionsbereich Programme nach §20 oder als individuelle Gesundheitsleistungen (IGeL) anbieten, ist unbekannt. Ziel der hier dargestellten Befragung war es, zu erfassen, an welche Anbieter sie für Primärpräventionsangebote verweisen und inwieweit sie dabei berücksichtigen, ob diese erstattungsfähig sind. Zusätzlich wurde untersucht, inwieweit Allgemeinärzte/innen individuelle Gesundheitsleistungen (IGeL) in diesen Bereichen anbieten. Methodik: Zwischen November 2010 und Februar 2011 erhielten alle Allgemeinärzte mit Praxissitz in Berlin (n=1 168) einen Fragebogen, der erfasste ob und auf welche Präventionsprogramme sie ihre Patie...
Medical science monitor : international medical journal of experimental and clinical research, 2010
To examine health- related locus of control, self- efficacy and attribution tendencies in obese p... more To examine health- related locus of control, self- efficacy and attribution tendencies in obese patients and to discuss their impact on primary care consultations. 123 patients, showing a BMI >25 kg/m(2) and following a health Check up, rated questionnaires regarding health-related locus of control, self-efficacy and attribution tendencies concerning obesity. Physical health parameters like BMI, level of cholesterol, blood pressure and existing cardiovascular co morbidities were assessed by GPs. Statistical analysis were conducted using SPSSv16.0. Patients scored comparable to a norm- population on self- efficacy and the three dimensions of health related locus of control. Physical health parameters did not explain variance. Patients named mainly behavioral causes for their overweight; those with a BMI >30 kg/m(2) tend to attribute their bodyweight to genetically origins. In order to conduct individual tailored consultancies it is necessary to explore the individual beliefs an...
Der Urologe. Ausg. A, 2009
The objective of this study was to evaluate whether rebiopsy of the prostate leads to a significa... more The objective of this study was to evaluate whether rebiopsy of the prostate leads to a significant increase in the detection rate of prostate cancer compared with performing a single biopsy. Data from 406 patients were evaluated retrospectively. The patients had undergone ultrasound-guided transrectal biopsy of the prostate between January 2004 and August 2005. Besides demographic data, the patient information was reviewed with regard to the number of biopsy samples taken per patient, histological results, and the occurrence of complications during or after the examination. If prostate cancer was detected, data acquisition included the number of positive biopsy samples taken per examination as well as the subsequent therapy and the TNM classification of the tumor. After a follow-up time between 24 and 42 months, all patients with a histologically negative first biopsy were reevaluated regarding rebiopsy. We evaluated the follow-up time (in months) and the histological results. If p...
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2009
ABSTRACT Background The number of overweight patients in Germany has been continuously increasing... more ABSTRACT Background The number of overweight patients in Germany has been continuously increasing during the past years. The so-called “check-up 35” consultation presents primary care providers with an opportunity for preventive counselling talks with the respective individuals. In this qualitative study we analysed family physician encounters. We were particularly interested in the way in which the subject matter was addressed and the risk counselling performed by the physicians when confronted with overweight patients. Methods Twelve physicians audio-taped their final check-up dialogue with 52 overweight or obese patients (BMI⩾25 kg/m2). The interviews were transcribed, and a content analysis was conducted using the established method developed by Mayring. Results Physicians used direct or more often indirect strategies to address overweight in counselling talks that were most often initiated by their patients. They largely addressed this topic while communicating laboratory results. Some obese patients did not receive any advice on health risks. In the encounters analysed the physicians did not employ standardized risk counselling tools. Conclusions The reasons for addressing overweight indirectly and the lack of standardized risk counselling with obese patients are carefully discussed.
Medizinische Klinik, 2006
Consultations due to most different bowel diseases and abdominal symptoms are common in primary c... more Consultations due to most different bowel diseases and abdominal symptoms are common in primary care. However, little is known about the concrete situation in the general practitioner's office so far. In this study, practitioners involved in the actual treatment of patients with bowel diseases document their medical strategies by the use of an internet-based data entry system. Hence, with the support of an internet-based data collection tool, health care research has started to break new ground. Following the programming of a digital data collection system and the installation of a nationwide research network of general practitioners interested in this matter, participating physicians communicated anonymised data on medical care of patients with various abdominal problems and intestinal/bowel diseases to the principal study investigators for 12 months, thereby using a computer-based data entry system (via internet). Within the 12 months of observation, 94 general practitioners documented 1,584 patient contacts by using the new data collection system. Accordingly, the most frequent reasons for consultation were abdominal pain (39%) and a change in stool habits (28%), each over a period of > 21 days. Women reported abdominal pain more often than men. Furthermore, the willingness to cooperate with specialists (hospitalization, referrals) was high among participating physicians, in reference to abdominal problems, thereby not demonstrating gender specificity. In the majority of cases, computer-assisted data entry took place outside regular consultation hours, and physicians frequently documented more than one patient within one session. High numbers of hospitalizations and specialist referrals, as shown in this study, points toward a high intensity of medical attendance necessary for patients with unspecific symptoms of the bowel or related abdominal problems. Computer-assisted data entry systems, however, represent a challenging yet still realizable way of data collection. This procedure should be brought forward for future projects in health care research.
Urologe A, 2009
Zusammenfassung Ziel Ziel der vorliegenden Arbeit war zu evaluieren, ob die Durchführung einer R... more Zusammenfassung Ziel Ziel der vorliegenden Arbeit war zu evaluieren, ob die Durchführung einer Rebiopsie bei Verdacht auf ein Prostatakarzinom (PCA) zu einer signifikant gesteigerten Inzidenz an PCA im Vergleich zur einmalig durchgeführten Stanzbiopsie führt. Patienten und Methoden Es wurden retrospektiv 406 Patienten erfasst, bei denen zwischen Januar 2004 und August 2005 eine ultraschallgestützte transrektale Multibiopsie der Prostata durchgeführt worden war. Neben der Erfassung
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007
ABSTRACT Owing to increased epidemic activity and difficulties in controlling the insect vector, ... more ABSTRACT Owing to increased epidemic activity and difficulties in controlling the insect vector, dengue has become a major public health problem in many parts of the tropics. The objective of this review is to analyse evidence regarding the achievements of community-based dengue control programmes. Medline, EMBASE, WHOLIS and the Cochrane Database of Systematic Reviews were searched (all to March 2005) to identify potentially relevant articles using keywords such as 'Aedes', 'dengue', 'breeding habits', 'housing' and 'community intervention'. According to the evaluation criteria recommended by the Cochrane Effective Practice and Organisation of Care Review Group, only studies that met the inclusion criteria of randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after trials (CBA) or interrupted time series (ITS) were included. Eleven of 1091 studies met the inclusion criteria. Of these, two were RCTs, six were CBAs and three were ITS. The selected studies varied widely with respect to target groups, intervention procedures and outcome measurements. Six studies combined community participation programmes with dengue control tools. Methodological weaknesses were found in all studies: only two papers reported confidence intervals (95% CI); five studies reported P-values; two studies recognised the importance of water container productivity as a measure for vector density; in no study was cluster randomisation attempted; and in no study were costs and sustainability assessed. Evidence that community-based dengue control programmes alone and in combination with other control activities can enhance the effectiveness of dengue control programmes is weak.
Patient Education and Counseling, 2012
The aim of this study was to assess general practitioners&#39... more The aim of this study was to assess general practitioners' (GP) readiness to involve obese patients in therapy decision making and to determine whether they integrate motivational interviewing techniques. Fifty-eight preventive Check-up 35 encounters with overweight and obese patients in primary care were audio recorded in 12 GP practices. The use of motivational interviewing techniques was rated with the Behavior Change Counseling Index (BECCI). The involvement in medical decisions was rated with the Observing Patient Involvement Scale (OPTION). OPTION and BECCI scores were low (means=0.71 and 1.65), indicating minimal implementation of shared decision making and motivational interviewing in preventive encounters with these patients. GPs used more motivational interviewing for patients with a BMI>30 kg/m(2) than for those with a BMI<30 kg/m(2). Female GPs had significantly higher shared decision making scores, indicating that they prefer to involve patients in medical decisions. GPs differed significantly in their use of both approaches. Shared decision making and motivational interviewing, though known to be successful strategies in lifestyle counseling, are rarely used during obesity encounters in our sample of German GPs. GPs should be sensitized and trained in the application of these methods.
International Journal for Quality in Health Care, 2010
Objective. The increasing prevalence of obesity requires particularly primary care providers to t... more Objective. The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI 30 kg/m 2 would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI , 30 kg/m 2. Design. Cross sectional comparison of audiotaped encounters of patients with a BMI 30 kg/m 2 and those with a BMI , 30 kg/m 2. Setting. Twelve GP surgeries in Berlin, Germany. Participants. Fifty patients who agreed to have preventive checkup encounters audiotaped. Main Outcome Measures. Based on the Roter Interaction Analysis System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. Results. An increased BMI was found to be a predictor for the length of encounters (P ¼ 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P. 0.05). Conclusions. Our results indicate that GPs rarely use the checkup program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.
Das Gesundheitswesen, 2012
Improving individual health behaviour is a promising approach especially in cardiovascular preven... more Improving individual health behaviour is a promising approach especially in cardiovascular prevention. In general practice, preventive advice-giving is hitherto put into practice insufficiently. The study explores which role general practitioners are willing and able to play in behaviour-oriented prevention. 50% of general practitioners in Brandenburg (n=748) were randomly selected for the study. A standardised questionnaire was mailed to them in which their attitudes towards preventive advice-giving were measured using Likert scaling. Participation was anonymous. 37% of the physicians answered the questionnaire. Almost all of them see it as their responsibility to inform patients about possible reduction of lifestyle-dependent health risks and to motivate them accordingly. Self-assessment concerning advisory skills is predominantly positive (best for physical activity, worst for smoking cessation and sexual risk behaviour advice). Time resources for behaviour-oriented prevention are sparse. For this reason, the delegation of many advisory tasks to physician assistants is regarded positively. Most physicians see themselves as willing and able to perform behaviour-oriented prevention. Nevertheless, realising this task seems to be difficult, e. g., concerning the frame conditions of general practice. The role of general practitioners in prevention and health promotion should be defined more accurately.
Das Gesundheitswesen, 2011
Das Gesundheitswesen, 2009
... K. Schlöpker 1 , M. Herrmann 2 , C. Großer-Kaya 2 , B.-P. Robra 4 , B. Dippelhofer-Stiem 3 , ... more ... K. Schlöpker 1 , M. Herrmann 2 , C. Großer-Kaya 2 , B.-P. Robra 4 , B. Dippelhofer-Stiem 3 , F. Schütze 3 ... Aufenthaltsstatus in Deutschland weist Ähnlichkeiten zu einer sozialräumlichen Verteilung dokumentierter Festnahmen illegaler Tatverdächtiger auf, die von Cyrus in einem ...
Das Gesundheitswesen, 2012
Family Practice, 2012
Background. Many countries with shortages in health personnel are introducing task shifting in pr... more Background. Many countries with shortages in health personnel are introducing task shifting in primary health care. GPs' attitudes and practices strongly affect task shifting and the expansion of the roles of physician assistants (PAs). Objective. To assess, in a German state with shortages of health personnel, the overall willingness of GPs to delegate home visit tasks to PAs and to elicit their perceptions of barriers to and benefits of such delegation and the current practice of informal delegation. Methods. Postal self-administered anonymous survey of all practicing GPs in the rural state of Mecklenburg-Vorpommern. Main outcomes were GPs' willingness to delegate in home visit tasks to a properly trained PA, perceived barriers to and benefits of home visit delegation and current practice of informal delegation. Using multinomial logistic regression, associations were identified among outcome variables, and characteristics of the GPs and of their practices. Results. Response rate was 47%. Responders (500) were comparable to all GPs in the state (1096); 48% of practitioners are willing to delegate home visits tasks to PAs. The main barrier to delegation was the related costs of PAs' training (34%), and the main benefit that it 'saves the GP's time' (67%). The 46% of practitioners who are informally delegating home visit tasks were significantly more likely be younger [odds ratio (OR) and 95% confidence interval (CI)] [OR = 0.96 (0.93-0.99)] and female [OR = 1.70 (1.12-2.58)]. Conclusion. The increasing proportion of women in family medicine might favor task shifting in General Practice.