RESUMEN
The German health system is under pressure due to increasing costs of healthcare provision and rising demand for health services. With the new coalition government, Germany has increased efforts to build a modern, innovative infrastructure for prevention and high-quality health services. The coalition agreement has a strong climate, innovation, and sustainability focus, reflecting at the same time the ambition of the new government to implement a preventive, inter-connected, and modern healthcare system in Germany. However, the agreement lacks detailed information on the achievement of the plans, especially concerning the question of how those measures should be funded in light of increasing expenditures for healthcare. Thus, the objectives of this study are to interpret the new government's plans and answer the question of how Germany in the new legislative period can ensure and fund population-based prevention programmes, health-promoting measures and innovative solutions despite the rising healthcare costs. By analysing the relevant content of the coalition agreement and drawing on an expert workshop, this paper suggests the establishment of a prevention fund and flexible remuneration model for digitalised and innovative forms of care in the new legislative period. Our findings may help identify feasible approaches to sustainable financing of health promotion, prevention and innovation in the German healthcare system.
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Atención a la Salud , Promoción de la Salud , Humanos , Alemania , Costos de la Atención en Salud , Gobierno , Financiación GubernamentalRESUMEN
Occupational safety and health promotion in the context of nurse staffing: A scoping review Abstract. Background: Increasing workload has led to a rise in mental and physical burden among nurses. In order to prevent this, it should be investigated, whether and to what extent aspects of occupational safety and health promotion can be integrated into nurse-staffing ratios. Aims: The objective of this scoping review was to identify ways and approaches of including occupational safety and health promotion into existing nurse-staffing ratios. Methods: A scoping review was conducted. The literature search took place in relevant professional databases. Articles in English and German language published between January 2015 and April 2020 with a focus on (care) organisations, staffing, occupational safety and/or health promotion, and person-related services were included. Results: Fifteen articles met the inclusion criteria. Three main topics were identified: staffing methods, leadership and control, and work organisation and design. No evidence was found regarding the inclusion of occupational health and safety and health promotion in staffing procedures. However, there is a demand for consideration of aspects "beyond numbers". Conclusions: In the further development of staffing-ratios, factors should be included that go beyond quantifiable measures and, by doing so, also address occupational safety and health promotion.
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Salud Laboral , Promoción de la Salud , Humanos , Liderazgo , Recursos Humanos , Carga de TrabajoRESUMEN
In order to strengthen health promotion spreading knowledge is as essential as tackling typical problems of its implementation. Both aspects can be adressed by using game-based learning approaches. To this end, we specifically developed a discussion game divided into four phases of play. Our aim is to (1) spread facts, (2) raise awareness of the topic and (3) promote well-informed political opinion-forming at individual as well as group levels. Experience shows that these objectives can be achieved with this game. The game as a whole or parts of it can easily be integrated into university teaching in different ways. In addition, there is major potential for using the game in lifelong learning settings and health promotion projects. In the next step the game will be adapted to enable its implementation in the workplace as a special setting for health promotion.
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Promoción de la Salud , Aprendizaje , Alemania , HumanosRESUMEN
Einleitung: Ziel dieser systematischen Übersicht war die Bewertung der verfügbaren Evidenz zur Wirkung der Kneipp-Therapie. Methoden: MEDLINE, Embase, Web of Science, Cochrane-Library und CAMbase wurden nach relevanten Artikeln, veröffentlicht zwischen 2000 und 2019, durchsucht. Graue Literatur wurde über Google Scholar und andere Tools bezogen. Studien mit jeglicher Art von Studiendesign, die die Effekte der Kneipp-Therapie untersuchten, wurden eingeschlossen. Die Qualitätsbewertung erfolgte mittels EPHPP-QAT. Ergebnisse: 25 Quellen, darunter 14 kontrol-lierte Studien, wurden eingeschlossen. Gemäß EPHPP-QAT wurden 3 Studien "stark", 13 "moderat" und 9 "schwach" bewertet. Neun (64%) der kontrollierten Studien berichteten signifikante Verbesserungen nach Kneipp-Therapie im Gruppenvergleich bei chronisch-venöser Insuffizienz, Hypertonie, leichter Herzinsuffizienz, menopausalen Be-schwerden und Schlafstörungen in verschiedenen Patientenkollektiven sowie verbesserte Immunparameter bei gesunden Probanden. Im Hinblick auf Depression und Angst bei Mammakarzinom-Patientinnen mit klimakterischen Beschwerden, Lebensqualität bei Post-Polio-Syndrom, krankheitsbedingten polyneuropathischen Beschwerden und Inzidenz von Erkältungsepisoden bei Kindern konnten keine signifikanten Gruppenunterschiede festgestellt werden. Elf unkontrollierte Studien berichteten Verbesse-rungen bei allergischen Symptomen, Dyspepsie, Lebens-qualität, Herzratenvariabilität, Infekten, Hypertonie, Wohlbefinden, Schmerz und polyneuropathischen Beschwerden. Diskussion/Schlussfolgerung: Die Kneipp-Therapie scheint bei zahlreichen Beschwerdebildern in verschiedenen Patientenkollektiven positive Effekte zu bewirken. Zukünftige Studien sollten noch stärker auf eine methodisch sorgfältige Studienplanung achten (Kontrollgruppen, Randomisierung, adäquate Fallzahlen, Verblindung), um Verzerrungen entgegenzuwirken. INTRODUCTION: The aim of this systematic review was to evaluate the available evidence on the effect of Kneipp therapy. METHODS: MEDLINE, Embase, Web of Science, Cochrane Library and CAMbase were searched for relevant articles published between 2000 and 2019. Grey literature was obtained through Google Scholar and other tools. Studies with any kind of study design that examined the effects of Kneipp therapy were included. The quality assessment was carried out using EPHPP-QAT. RESULTS: 25 sources, including 14 controlled studies, were included. According to EPHPP-QAT, 3 studies were rated as "strong," 13 as "moderate" and 9 as "weak." Nine (64%) of the controlled studies reported significant improvements after Kneipp therapy in a between-group comparison in chronic venous insufficiency, hypertension, mild heart failure, menopausal complaints, and sleep disorders in different patient collectives as well as improved immune parameters in healthy subjects. Regarding depression and anxiety in breast cancer patients with climacteric complaints, quality of life in post-polio syndrome, disease-related polyneuropathic complaints and incidence of cold episodes in children, no significant group differences were found. Eleven uncontrolled studies reported improvements in allergic symptoms, dyspepsia, quality of life, heart rate variability, infections, hypertension, well-being, pain and polyneuropathic complaints. DISCUSSION/CONCLUSION: Kneipp therapy seems to be beneficial for numerous symptoms in different patient groups. Future studies should pay even more attention to methodologically careful study planning (control groups, randomisation, adequate case numbers, blinding) to counteract bias.
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Hidroterapia , Fitoterapia , Calidad de Vida , HumanosRESUMEN
Research in the field of health promotion generates evidence-based knowledge and has the potential to increase the acceptance, impact and long-term effectiveness of interventions. Typically, a distinction is made between qualitative and quantitative approaches. Yet, with complex and multidimensional re-search questions in the field of health promotion a combination of the two approaches has proven useful. Using mixed-methods designs promises, among other things, to compensate for weaknesses of the individual methods, to improve the scope of the results, and to provide a comprehensive insight into the topic. In this systematic review of two German journals we examine the role of the mixed-methods approach in the field of health promotion and how it can be translated into specific research projects. The review's results show that mixed-methods designs are implemented in various contexts. In most studies, the quantitative research strand plays the central role. The use of the mixed-methods designs in health promotion can be further discussed, especially taking into account technical innovations in the field of data collection or with regard to the interpretative potential of qualitative research. The presentation of the review is based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) by the Equator Network.
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Promoción de la Salud , Proyectos de Investigación , Alemania , Investigación CualitativaRESUMEN
BACKGROUND: The proportion of adults suffering from hypertension worldwide was estimated at 31.1 % in 2010. The aim of this study was to evaluate the effects of lifestyle changes in patients with arterial hypertension (AH) in primary care. MATERIAL AND METHODS: Systematic literature search in the online databases PubMed, Embase, Cochrane and Opengrey. Only randomized controlled trials of the years 2005 to 2017 in German or English were considered. RESULTS: 11 studies out of 458 identified references were evaluated. The patient groups investigated were very heterogeneous and underwent different types of intervention. Educating patients about the clinical picture, regular self-measurements of blood pressure, or patient memories of maintaining a healthy lifestyle have been used most frequently. CONCLUSION: There is a need for further studies focusing on primary care. However, many lifestyle interventions seem to show very good effects in patients with pre-existing AH (secondary prophylaxis), so these measures should form the basis of antihypertensive therapy in all patients with AH. In addition, it is important to maintain advice on a healthy lifestyle during drug therapy.
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Hipertensión/terapia , Adulto , Presión Sanguínea , Alemania , Humanos , Estilo de Vida , Atención Primaria de SaludRESUMEN
AIM: Starting from the claim that public health interventions should aim to improve health equity, the article examines which methodological approaches of health economic evaluation exist to support the analysis of equity-related outcomes of different interventions. METHOD: Critical review of the relevant literature. RESULTS: Against the background of the normative foundations of health economic evaluation, three methodological approaches and three practical methods are presented that allow for considering health equity concerns in health economic evaluations. Implications of the different approaches and references to the German context are discussed. CONCLUSION: The use of the instruments presented offers good potential to improve transparency with respect to distributive effects of different allocation decisions. This appears to be necessary in order to meet demands for health equity improving public health interventions - especially in the context of the German Prevention Act.
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Equidad en Salud , Salud Pública , Análisis Costo-Beneficio , AlemaniaRESUMEN
Psychosocial working conditions and symptoms of burnout in somatic and psychiatric nursing Abstract. Background: While mental workload and stress among nurses are generally well-documented, differences within the nursing profession have hardly been investigated so far. Aim: This study aims to examine the differences and associations between psychosocial working conditions and symptoms of burnout of nurses working in somatic and psychiatric settings. Methods: A cross-sectional study has been conducted with employees in one somatic and one psychiatric hospital (n = 576). The Copenhagen Psychosocial Questionnaire and the Copenhagen Burnout Inventory were used to assess psychosocial workloads and burnout symptoms. The data analysis was carried out by univariate, bivariate and multivariate (regression) analyses. Results: About 50 % of respondents report at least a moderate level of symptoms of burnout with somatic nurses more frequently affected. While quantitative and physical demands are higher in somatic nursing, psychiatric nurses have a higher degree of emotional demands, socialß = 0.33) in somatic nursing and emotional demands (ß = 0.29) in psychiatric nursing serve as strongest predictors of burnout symptoms. Conclusions: Findings suggest specific profiles of psychosocial workload in somatic and psychiatric nursing as well as a high need for differentiated approaches for occupational health promotion.
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Agotamiento Profesional/psicología , Personal de Enfermería en Hospital/psicología , Enfermería Psiquiátrica , Especialidades de Enfermería , Carga de Trabajo/psicología , Estudios Transversales , Humanos , Personal de Enfermería en Hospital/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Long-term care insurance funds have been mandated by the German Prevention Act to support long-term care facilities in the implementation of health-promoting structures. One area of action is the promotion of the nursing home residents' psychosocial health. The objective of this systematic review was to describe and analyze interventions and intervention components related to the psychosocial health of nursing home residents. METHODS: First, we conducted a search for systematic reviews and meta-analyses in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo, and hand-searched additional sources. Second, references of all relevant randomized controlled trials (n=86) were extracted from the identified systematic reviews (n=27). The original articles of the included primary studies were then analyzed using criteria for the evaluation of complex interventions. The GRADE approach was used to assess the quality of the evidence. RESULTS: Seventeen interventions for promoting the psychosocial health of nursing home residents were identified. The majority of the study participants were nursing home residents with dementia. Since the underlying evidence was predominantly very low, it was not possible to draw clear conclusions concerning the efficacy of the interventions for psychosocial health outcomes. The best indications of positive effects were found for reminiscence, mealtime interventions, music therapy, and special care staff training. CONCLUSION: The diversity and heterogeneity of the interventions made both classification and consistent judgments of the quality of the evidence difficult. From the perspective of promoting the psychosocial health of nursing home residents, the identified interventions should only be considered as suggestions or proposals for prevention and health promotion measures, and future studies should evaluate their implementation.
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Promoción de la Salud , Salud Mental , Casas de Salud , Antipsicóticos/administración & dosificación , Demencia/psicología , Alemania , Personal de Salud/educación , Humanos , Agitación Psicomotora/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: The German Prevention Act mandated long-term care insurance funds to support long-term care facilities in designing health-promoting structures. One area of action is the promotion of the cognitive resources of nursing home residents. The objective of this systematic review was to describe and analyze interventions and intervention components that improve cognitive resources of nursing home residents. METHODS: First, we conducted a search for systematic reviews to identify relevant randomised controlled trials in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo; additional sources were hand-searched. Second, references of all relevant randomized controlled trials (n=43) were extracted from the identified systematic reviews (n=26). The original articles of the primary studies included were then considered and data extracted using criteria for the evaluation of complex interventions. The quality of evidence was assessed using the GRADE approach. RESULTS: Nine interventions to promote cognitive resources were identified: cognitive stimulation, cognitive training, physical training, art and music interventions, bright light, multicomponent stimulation, multisensory stimulation, care staff training and reminiscence. The quality of the underlying evidence in the inpatient long-term care setting was predominantly low, therefore, it was not always possible to draw clear conclusions regarding the efficacy of the interventions. The low quality of evidence was mainly due to the high heterogeneity as well as the low number and limited methodological quality of the primary studies. CONCLUSION: In general, a wide range of nonpharmacological interventions were reported. Due to the limited evidence, however, these may be regarded as ideas only or possible options for promoting the cognitive resources of nursing home residents.
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Cognición , Promoción de la Salud , Cuidados a Largo Plazo , Trastornos del Conocimiento/prevención & control , Alemania , Humanos , Casas de SaludRESUMEN
"For me, Pressure at School is the Most Relevant in my Life" - Empirical Based Implications for Life World Orientation in Health Promotion at School School is a key system that supports all processes of adolescent development. Next to qualification, as one part of personality development, all developmental tasks of adolescence can take place within the school environment, through close interplay. This interplay both influences, and is influenced by young people's health which is essential to promote adolescent development and foster wellbeing in everyday life for young people. On one hand, risk taking behaviour can impact health and developmental progress. On the other hand, biopsychosocial changes can emerge to challenge young people in terms of coping with life and managing the tasks of normal adolescent development. Experiencing ill health can further limit young people's access to systems and social interaction essential to promote development. In this instance, life world orientation in health promotion becomes one fundamental part of social work, especially school social work (Rademaker, 2017b). In this paper a holistic perspective on health is formulated, as an essential part of young people's daily life. The paper specifically focusses on social work's potential to empower young people to engage with their available resources to promote health related agency. A triangulated study (2013-2015) provides an empirical example. Based on a questionnaire with 500 pupils aged 15-16 years (N = 395), three health types could be identified, a healthy, an unhealthy and one in average, and prototypical cases (N = 12) were interviewed in focus group discussions. The interplay of resources and structural borders in the life world of the participants could be reconstructed to provide understanding of how health related agency emerges in the lives of young people and shape their option to health.
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Promoción de la Salud , Servicios de Salud Escolar , Instituciones Académicas , Adolescente , Desarrollo del Adolescente , Humanos , Relaciones Interpersonales , Conducta SocialRESUMEN
Health promotion and health prevention are cornerstones of public health. In Germany, a draft health prevention law was rejected in 2013, partly because it almost exclusively focused on measures at the individual level. Many health promotion and prevention measures, by contrast, (also) address the societal level and the environment, but there are few robust studies on their effectiveness, not least because of a lack of resources, the complexity of the measures, or randomisation problems. For example, regulations that protect non-smokers from smoke are subject to political processes where the majority of decision-makers would decline consent for randomisation. In a workshop at the 15(th) Annual Meeting of the German Network for Evidence-based Medicine (DNEbM) two case studies on controlled before-and-after studies (CBA) and interrupted time series (ITS) were developed by the audience as possible alternatives to randomised controlled trials for the evaluation of health promotion and health prevention programmes. The suggestions made by the audience were compared to the study designs chosen in published studies, and the strengths and weaknesses of the different study designs were discussed. The wide array of suggestions for effectiveness studies illustrated the potential of evidence-based health promotion and prevention, but also the specific challenges to be faced.