Doris Schaeffer

The normalization of AIDS in Western European countries

The occurrence of AIDS led in every Western European country to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained above all by the fact that not only was a health catastrophe feared but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise, signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. Four phases are distinguished between in this process, given nationally different patterns of development: Approx. 1981-1985: emergence of exceptionalism. The reasons underlying exceptionalism are investigated. Approx. 1986-1991: consolidation and performance of exceptionalism. The investigation centers on the exceptionalist policy model. Approx. 1991-1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The forms and perspectives of the changes made in the management of HIV and AIDS are elucidated using examples from the fields of health care, primary prevention and drug policies. AIDS health-policy innovations, their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with AIDS for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which AIDS exceptionalism has been institutionalized and the distance of these innovations from medical, therapeutic events.

Chronic Illness Self-Management While Living Alone in Later Life: A Systematic Integrative Review

Older people living alone (OPLA) are considered vulnerable because of fewer resources, such as social support. As self-management becomes increasingly important in chronic care, evidence is needed on how to better support OPLA. This review synthesizes the evidence from 32 publications on the challenges as well as strategies of OPLA in managing chronic conditions. On the basis of a systematic database search and review process, being independent and being at home were identified as crucial when living alone in later life; both involve decision making and the adjustment of routines to manage everyday life and chronic conditions. These findings show that OPLA are vulnerable because of difficult living situations, limited resources, or a lack of support, and they actively manage their conditions using various strategies to remain independent, but these may cause fragile arrangements that can jeopardize independence. Awareness of these strategies is a starting point to develop interventions for self-management support in chronic illness.

Möglichkeiten der Gesundheitsförderung in der Langzeitversorgung

ZusammenfassungBasierend auf empirischen Befunden werden im vorliegenden Beitrag konzeptionelle Überlegungen zur Prävention und Gesundheitsförderung in der Langzeitversorgung angestellt. Der Bereich der Langzeitversorgung hat in der Präventionsdiskussion bislang nur einen eher marginalen Stellenwert. Zunächst erfolgt eine kurze Situationsanalyse der Langzeitversorgung in Deutschland mit dem Ziel, nach den dort bestehenden Problemen, aber auch den präventiven und gesundheitsförderlichen Potenzialen zu fragen und Ansatzpunkte für entsprechende Interventionen zu identifizieren. Dabei wird zu sehen sein, dass in der Langzeitversorgung großer Problemdruck herrscht und sowohl auf der Ebene der Mitarbeiter- als auch der Nutzergesundheit zahlreiche Interventionserfordernisse gegeben sind. Die anschließenden Überlegungen konzentrieren sich auf die meist hochbetagten Nutzer und zielen darauf, einen ersten konzeptionellen Rahmen für eine nutzerorientierte Prävention und Gesundheitsförderung in der pflegerischen Langzeitversorgung zu entwerfen.AbstractUsing empirical evidence, this paper provides conceptual approaches to prevention and health promotion in long-term care – an area that has gained only limited attention in German discussions on prevention. First, a short analysis of long-term care in Germany is provided; existing problems but also resources with regard to prevention and health promotion in order to identify starting points for the development of interventions are presented. The existing pressure and problem accumulation in long-term care that calls for action on maintaining and promoting the health of long-term care professionals as well as long-term care users are illustrated. Considerations on programs for health promotion in long-term care focus on the users, in particular the oldest old, of long-term care. Finally, considerations on a conceptual framework for a user-oriented approach to prevention and health promotion in long-term care is presented.Using empirical evidence, this paper provides conceptual approaches to prevention and health promotion in long-term care - an area that has gained only limited attention in German discussions on prevention. First, a short analysis of long-term care in Germany is provided; existing problems but also resources with regard to prevention and health promotion in order to identify starting points for the development of interventions are presented. The existing pressure and problem accumulation in long-term care that calls for action on maintaining and promoting the health of long-term care professionals as well as long-term care users are illustrated. Considerations on programs for health promotion in long-term care focus on the users, in particular the oldest old, of long-term care. Finally, considerations on a conceptual framework for a user-oriented approach to prevention and health promotion in long-term care is presented.

Dying in Germany - consequences of societal changes for palliative care and the health care system

The changes in the way people die and the new challenges in dealing with dying and death have not been realized to their full extent or discussed in respect to their implications and consequences for end-of-life care in Germany. The purpose of this problem analysis paper is to provide an overview of the most important societal changes and to address the consequences for end-of-life care in the German Health Care System from a public health nursing point of view. It will be demonstrated that an exclusive focus on fostering the development of palliative care as a form of specialized health care and thereby allowing only a few people access to qualified care at the end of life is not a sufficient approach. It will be rather necessary to make broad changes in all areas of health care in order to achieve a level of end-of-life care that is of high quality and appropriate to match people’s needs. The most important challenges to be managed in the German health care system will be presented and discussed.

Versorgungsforschung in Deutschland Fragestellungen und Förderbedarf

Absicht des Beitrags ist, einen speziellen Bereich der Public Health Forschung eingehender zu beleuchten und die Notwendigkeit und den gesellschaftlichen Bedarf an Versorgungsforschung herauszuarbeiten. Ausgehend von einer definitorischen Klärung des Gegenstands und der Aufgaben von Health Services Research — zu deutsch: Versorgungsforschung — wird zunächst die internationale Entwicklung skizziert und der in Deutschland trotz zahlreicher Anstrengungen in den vergangenen Jahren nach wie vor existente Nachholbedarf auf diesem Gebiet aufgezeigt. Exemplarisch an einigen wichtigen ausgewählten gesundheitspolitischen und -wissen-schaftlichen Problemstellungen — Zielorientierung im Gesundheitswesen, Evidenzbasierung, Versorgungsprozessgestaltung, Qualitätsentwicklung und Patientenori-entierung-werden dann die sich auf inhaltlicher Ebene stellenden Herausforderungen im Bereich der bundesdeutschen Versorgungsforschung aufgezeigt.AbstractThe paper focuses on health services research as a special part of public health. The authors try to contextualize the mission of health services research to reconstruct its recent development and to specify different subject matters of urgent importance to the ongoing health care reform in Germany: goal-orientation, evidence-based practice, evaluation and quality development, patient-orientation and self-help.

The Health of Women and Girls Determines the Health and Well-Being of Our Modern World: A White Paper From the International Council on Women's Health Issues

The International Council on Womens Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of womens health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girls health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

Pflegestützpunkte – Impuls zur Weiterentwicklung der Pflege

ZusammenfassungIm Pflege- Weiterentwicklungsgesetz ist die Einrichtung von Pflegestützpunkten geplant. In dem nachfolgenden Beitrag werden die damit verbundenen Chancen thesenartig diskutiert und erste konzeptionelle Überlegungen angestellt.AbstractThe recent reform act on long-term care insurance includes plans for the establishment of Community Care Access Centers. This paper addresses chances and challenges of these centers and proposes some important steps for program development.The recent reform act on long-term care insurance includes plans for the establishment of Community Care Access Centers. This paper addresses chances and challenges of these centers and proposes some important steps for program development.

Selbstmanagementförderung bei chronischer Krankheit: Geschichte, Konzept und Herausforderungen

Das Thema Selbstmanagement bei chronischer Krankheit wird international seit langerem diskutiert und vermehrt auch im deutschsprachigen Raum erortert. Auch die Entwicklung von Programmen zur Selbstmanagementforderung ist in den letzten Jahren vorangeschritten. Zugleich hat Selbstmanagement im Zuge dessen mehr und mehr den Charakter eines Sammelbegriffs erhalten. Ziel des Beitrags ist es daher, zur Begriffsklarung beizutragen, konzeptionelle Aspekte zu diskutieren, die Aufgaben von Selbstmanagementforderung darzustellen und abschliesend den bestehenden Diskussionsbedarf zu erortern. Dabei wird der Schwerpunkt auf die Bedeutung von Selbstmanagementforderung fur die Bewaltigung chronischer Krankheit gelegt – einem der wichtigsten Anwendungsfelder des Konzepts.

Health Literacy in the German Population: Results of a Representative Survey

BACKGROUND Persons with low health literacy have difficulty dealing with the health care system and understanding health-related information. Studies from multiple countries have shown that low health literacy negatively affects health, health-related and illness-related behavior, and the utilization of health care resources. The data available till now on health literacy in Germany have been sparse. The goal of this study is to acquire representative data on the health literacy of the German population. METHODS In a cross-sectional study, we collected data from a representative group of 2000 persons over age 15 in Germany by means of computer-assisted personal interviews (CAPI) that were based on the long version of the questionnaire used in the European Health Literacy Survey (HLS-EU-Q47). Sociodemographic data were also collected. RESULTS The respondents were a representative sample of the German population. 54.3% of them were found to have limited health literacy. Multiple logistic regression revealed associations of limited health literacy with advanced age (odds ratio [OR] 1.83, 95% confidence interval [CI] [1.36; 2.48]), an immigrant background (OR 1.87 [1.27; 2.75]), low self-assessed social status (OR 5.25 [3.57; 7.72]), and low functional literacy (OR 1.94 [1.49; 2.52]). CONCLUSION The low health literacy of many Germans can impair communication between doctors and patients and exacerbate existing problems in health policy. In the future, greater effort will have to be made to foster health literacy, make health-related information for patients easier to understand, and intensify research in the field of health literacy.

Nationales Gesundheitsziel „Gesund älter werden“

ZusammenfassungWelche Ziele sind in der Versorgung älterer Menschen anzustreben? Welche Maßnahmen sind notwendig, um vor dem Hintergrund zukünftiger Herausforderungen eine gute Versorgung älterer Menschen sicherzustellen? Der Kooperationsverbund gesundheitsziele.de hat sich im Rahmen des neuen nationalen Gesundheitsziels „Gesund älter werden“ mit diesen Fragen beschäftigt. Es werden konkrete Ziele und Empfehlungen von Maßnahmen zur Umsetzung anhand der Versorgungsbereiche „Ambulante und stationäre Versorgung“, „Pflegerische Versorgung“ und „Rehabilitation im Alter“ vorgestellt. gesundheitsziele.de will eine gemeinsame Zielorientierung unterstützen und auf Grundlage von Selbstverpflichtungen der Akteure konkrete Maßnahmen zur Zielerreichung in der gesundheitlichen Versorgung älterer Menschen anstoßen.AbstractWhat kind of health targets should be pursued concerning the health care of elderly people? What kind of activities should be implemented to ensure good health care with regard to future challenges? The Association for the Continuous Development of the National Health Target Process, health-targets.de, deals with these issues under the new national health target “Healthy Ageing”. We develop concrete objectives and proposals for practical implementation in the areas of “outpatient and inpatient care”, “nursing” and “rehabilitation in old age”. health-targets.de supports a common health target process and initiates interventions in the field of health care for elderly people.