S. Bisson

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction.

ObjectiveAngiotensin-converting enzyme inhibitors are an effective therapy for all stages of heart failure due to reduced systolic left ventricular function. Because sufficient data on intravenous angiotensin-converting enzyme inhibitors following coronary artery bypass surgery complicated by postoperative left ventricular dysfunction are unavailable, the efficacy and safety of intravenously administered enalaprilat were evaluated. DesignA placebo-controlled, randomized, double-blind protocol. SettingPostoperative intensive care unit at the German Heart Institute Berlin. PatientsForty patients with a left ventricular ejection fraction <35% following coronary artery bypass surgery on the second postoperative day or after weaning from intra-aortic balloon counterpulsation. InterventionsA loading dose of enalaprilat 0.625 mg infused over 1 hr was followed by 5 mg/24 hrs administered continuously for up to 72 hrs. Measurements and Main ResultsSystemic and pulmonary hemodynamic variables, blood gases, hormonal variables, renal function, and electrolytes were measured before and repeatedly during therapy. Acute effects were as follows: At 1 hr, enalaprilat increased the cardiac index (p < .001), stroke volume index (p < .001), and right ventricular stroke work index (p < .03) compared with placebo, whereas mean arterial pressure (p < .008) and both systemic (p < .001) and pulmonary (p < .02) vascular resistance decreased. Continuous effects were as follows: Over 72 hrs, enalaprilat decreased diastolic pulmonary artery pressure (p < .019), pulmonary artery occlusion pressure (p < .02), and central venous pressure (p < .02). The cardiac and stroke volume indexes were consistently higher in the enalaprilat group, whereas systemic and pulmonary vascular resistances were lower. The arterial blood-pressure lowering effect was blunted and heart rate remained unchanged. Mixed venous oxygenation (p < .02) was higher and arterial oxygenation was not modified. Finally, enalaprilat increased creatinine clearance (p < .002) and decreased creatinine (p < .02) and urea (p < .03). ConclusionsIntravenous enalaprilat safely and effectively improves cardiac and renal function following coronary artery bypass surgery complicated by postoperative left ventricular dysfunction.

Krankheitslast und Gesundheit im Alter

ZusammenfassungIn der zweiten Lebenshälfte nehmen die körperlichen und psychosozialen Beeinträchtigungen besonders durch chronische Erkrankungen und Multimorbidität erheblich zu. Auch wenn sich in den vergangenen Jahrzehnten die Gesundheit der Älteren deutlich verbessert hat, bestehen weiterhin große und häufig unterschätzte präventive Potenziale. Der Beitrag gibt auf der Basis von Surveys, Daten der Kassenärztlichen Vereinigung und Krankenkassendaten einen Überblick über die Krankheitslast, die Gesundheit und das Gesundheitsverhalten der Älteren in Deutschland. Ziel ist es, präventionsrelevante Bereiche sowie Ansätze zur Prävention aufzuzeigen. Erforderlich sind Strategien, die neben der körperlichen auch die psychische und soziale Dimension des Alterns berücksichtigen. Noch hemmen vielfach system-, betroffenen- und professionenbezogene Faktoren ihre Realisierung. Als primäre professionelle Ansprechpartner für die Zielgruppe spielen Ärzte und Pflegekräfte eine besonders wichtige Rolle. Allerdings sind Prävention und Gesundheitsförderung im Alter gesamtgesellschaftliche Aufgaben, die die adäquate Einbeziehung weiterer Berufsgruppen sowie eine deutliche Weichenstellung in der Politik erfordern.AbstractDue to chronic illness and multimorbidity, the physical and psychosocial impairments increase significantly in the second half of life. Even though the health condition of the elderly has improved in recent years, the potential for prevention in older people is still undervalued. On the basis of surveys, data from the Association of CHI Physicians and health insurance data, this article provides a review of health and health behaviour of the elderly in Germany. It aims to point out areas of particular relevance for prevention and preventive approaches. Strategies that consider mental and social aspects of aging beside the physical ones are necessary. Systematic, personal and professional factors still inhibit the realisation of these strategies. In this context, doctors and nurses are particularly important as primary professional contact persons for the target group. However, prevention and health promotion in that age group are social tasks, which need the appropriate involvement of further professionals and an explicit political agenda setting.

Morbidity and health in old age. A challenge for prevention and health care

ZusammenfassungIn der zweiten Lebenshälfte nehmen die körperlichen und psychosozialen Beeinträchtigungen besonders durch chronische Erkrankungen und Multimorbidität erheblich zu. Auch wenn sich in den vergangenen Jahrzehnten die Gesundheit der Älteren deutlich verbessert hat, bestehen weiterhin große und häufig unterschätzte präventive Potenziale. Der Beitrag gibt auf der Basis von Surveys, Daten der Kassenärztlichen Vereinigung und Krankenkassendaten einen Überblick über die Krankheitslast, die Gesundheit und das Gesundheitsverhalten der Älteren in Deutschland. Ziel ist es, präventionsrelevante Bereiche sowie Ansätze zur Prävention aufzuzeigen. Erforderlich sind Strategien, die neben der körperlichen auch die psychische und soziale Dimension des Alterns berücksichtigen. Noch hemmen vielfach system-, betroffenen- und professionenbezogene Faktoren ihre Realisierung. Als primäre professionelle Ansprechpartner für die Zielgruppe spielen Ärzte und Pflegekräfte eine besonders wichtige Rolle. Allerdings sind Prävention und Gesundheitsförderung im Alter gesamtgesellschaftliche Aufgaben, die die adäquate Einbeziehung weiterer Berufsgruppen sowie eine deutliche Weichenstellung in der Politik erfordern.AbstractDue to chronic illness and multimorbidity, the physical and psychosocial impairments increase significantly in the second half of life. Even though the health condition of the elderly has improved in recent years, the potential for prevention in older people is still undervalued. On the basis of surveys, data from the Association of CHI Physicians and health insurance data, this article provides a review of health and health behaviour of the elderly in Germany. It aims to point out areas of particular relevance for prevention and preventive approaches. Strategies that consider mental and social aspects of aging beside the physical ones are necessary. Systematic, personal and professional factors still inhibit the realisation of these strategies. In this context, doctors and nurses are particularly important as primary professional contact persons for the target group. However, prevention and health promotion in that age group are social tasks, which need the appropriate involvement of further professionals and an explicit political agenda setting.

Problems and challenges for palliative care: What are the views of different stakeholders on the meso and macro level of the health system?

OBJECTIVES To study the views of a wide range of representatives from organizations and institutions at the meso and macro level of the health system regarding palliative care in Germany. METHODS 442 organizations and institutions were included (e.g. medical associations, political boards, health insurances). Using a standardized questionnaire, the main topics included the most recent health care reform, quality in palliative care and living will. RESULTS The response rate was 67%. Most of the respondents (69.9%) rated the recently introduced specialist outpatient palliative care positively. The majority of the interviewees agreed that the effectiveness (74.2%) and efficiency (56.4%) of palliative care services need to be further evaluated. Two-thirds believed that political regulations of living wills could help minimize uncertainties concerning end-of-life decisions; palliative care specialists were less likely to be of that opinion compared to the other groups. CONCLUSIONS The recent political measures go into the right direction in order to further improve health care of severely ill and dying people in Germany. However, the effects on the health care system and on the routine delivery of care are uncertain. It is important to further develop palliative care on a broad societal, political and scientific base.

Rahmenbedingungen für die palliative Versorgung in Deutschland und Entwicklung von Public-Health-Zielen

ZusammenfassungEine angemessene, an den Bedürfnissen der Betroffenen orientierte gesundheitliche Versorgung unheilbar kranker Menschen am Lebensende ist eine elementare, aber deutlich vernachlässigte Aufgabe im deutschen Gesundheitswesen. Für die Public-Health-Forschung liegen wichtige Handlungsfelder darin, die gesellschaftlichen Anforderungen sowie die Möglichkeiten und Voraussetzungen des Gesundheitssystems für die palliative Versorgung zu analysieren und Ansätze für eine Weiterentwicklung zu geben. Deshalb werden im Rahmen einer von der Deutschen Forschungsgemeinschaft geförderten Studie erstmals (1) die Sichtweisen unterschiedlicher Akteure auf der Meso- und Makroebene des Gesundheitssystems zum Themengebiet exploriert und (2) auf dieser Basis Public-Health-Ziele für die Palliativversorgung in Deutschland entwickelt. Dieser Beitrag präsentiert Hintergrund und Design der Studie sowie das methodische Vorgehen.AbstractTo provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.To provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.

Gesundheits- und Präventionsverhalten von Personen mit und ohne Migrationshintergrund

Based on a sample of the Hannover registration office this project analyses the health and prevention behaviour of Russian- and Turkish-language migrants compared to natives. The project analysis revealed considerable differences, particularly concerning addiction behaviour and physical activities.

Rahmenbedingungen für die palliative Versorgung in Deutschland und Entwicklung von Public-Health-Zielen@@@Framework of palliative care in Germany and development of public health targets. Study design and methods: Studiendesign und Methodik

ZusammenfassungEine angemessene, an den Bedürfnissen der Betroffenen orientierte gesundheitliche Versorgung unheilbar kranker Menschen am Lebensende ist eine elementare, aber deutlich vernachlässigte Aufgabe im deutschen Gesundheitswesen. Für die Public-Health-Forschung liegen wichtige Handlungsfelder darin, die gesellschaftlichen Anforderungen sowie die Möglichkeiten und Voraussetzungen des Gesundheitssystems für die palliative Versorgung zu analysieren und Ansätze für eine Weiterentwicklung zu geben. Deshalb werden im Rahmen einer von der Deutschen Forschungsgemeinschaft geförderten Studie erstmals (1) die Sichtweisen unterschiedlicher Akteure auf der Meso- und Makroebene des Gesundheitssystems zum Themengebiet exploriert und (2) auf dieser Basis Public-Health-Ziele für die Palliativversorgung in Deutschland entwickelt. Dieser Beitrag präsentiert Hintergrund und Design der Studie sowie das methodische Vorgehen.AbstractTo provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.To provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.

Framework of palliative care in Germany and development of public health targets. Study design and methods

ZusammenfassungEine angemessene, an den Bedürfnissen der Betroffenen orientierte gesundheitliche Versorgung unheilbar kranker Menschen am Lebensende ist eine elementare, aber deutlich vernachlässigte Aufgabe im deutschen Gesundheitswesen. Für die Public-Health-Forschung liegen wichtige Handlungsfelder darin, die gesellschaftlichen Anforderungen sowie die Möglichkeiten und Voraussetzungen des Gesundheitssystems für die palliative Versorgung zu analysieren und Ansätze für eine Weiterentwicklung zu geben. Deshalb werden im Rahmen einer von der Deutschen Forschungsgemeinschaft geförderten Studie erstmals (1) die Sichtweisen unterschiedlicher Akteure auf der Meso- und Makroebene des Gesundheitssystems zum Themengebiet exploriert und (2) auf dieser Basis Public-Health-Ziele für die Palliativversorgung in Deutschland entwickelt. Dieser Beitrag präsentiert Hintergrund und Design der Studie sowie das methodische Vorgehen.AbstractTo provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.To provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.