[Social Security Needs Social Medicine: Self-image of Physicians Practicing Social Medicine in Statutory Health Insurances and Social Security Systems]. / Soziale Sicherheit braucht Sozialmedizin Selbstverständnis von Ärztinnen und Ärzten in der sozialmedizinischen Begutachtung und Beratung.

OBJECTIVE: In January, 2014, the division "Social Medicine in Practice and Rehabilitation" of the German Society for Social Medicine and Prevention established a working group on the self-image of the physicians active in the field of social medicine (medical expertise and counseling). METHODS: The result of this work is the contribution presented here after consensus was achieved by specialists of social medicine from different fields and institutions (social security etc.) and in good cooperation with Prof. Dr. Gostomzyk and Prof. Dr. Robra. RESULTS: Based on the importance of an up to date social medicine for claimants and recipients of benefits on the one hand and the social security system on the other, and also on a description of the subjects, objectives and methods the following aspects are presented: · The perspective of social medicine. · Qualification in social medicine, concerning specialist training and continuing medical education. · The fields of duty of experts in social medicine. · The proceedings in social medicine. The working group identified challenges for the specialists in social medicine by a narrowed perception of social medicine by physicians in hospitals and practice, accompanied by an enlarged importance of expertise in social medicine, by the demand for more "patient orientation" and gain of transparency, and concerning the scientific foundation of social medicine. CONCLUSIONS: The working group postulates: · The perspective of social medicine should be spread more widely.. · Confidence in experts of social medicine and their independency should be strengthened.. · The not case-related consulting of the staff and executives should be expanded.. · Social medicine in practice needs support by politics and society, and especially by research and teaching.. · Good cooperation and transfer of experiences of the different branches of social security are essential for the impact of social medicine..

[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation]. / Bedeutung der personbezogenen Faktoren der ICF für die Nutzung in der praktischen Sozialmedizin und Rehabilitation.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

[Personal factors of the ICF]. / Personbezogene Faktoren der ICF.

PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.

[Guidance of medical experts]. / Führung ärztlicher Gutachter.

Guidance is an issue of growing importance for physicians responsible for medical experts working in public health services and on medical advisory boards. The challenge of ethics on the one hand and the constraints of economy on the other hand have considerable impact on the demands for quantity as well as quality of the expert opinions. Thus, executive staff in these organisations reflect as to whether and how they can influence performance through guidance. A short summary of the results of research on the subject of guidance - concerning the aspects (i) guidance as an interaction of people, (ii) guidance as a task in a concrete situation and (iii) guidance as a systemic process of development - shows and points out a wide range of possibilities for staff management and personnel development of medical consultants. Guidance of medical experts is possible and necessary in order to develop the professionalism of medical experts, in order to ensure quality, conformity to standards and efficiency of medical expertise, as well as for a future-oriented development of the medical advisory boards themselves.

[Personal contextual factors of the ICF draft from the Working Group "ICF" of Specialty Group II of the Geman Society for Social Medicine and Prevention]. / Personbezogene Faktoren der ICF - Entwurf der AG "ICF" des Fachbereichs II der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

Personal contextual factors play an essential part in the ICF model in relation to patient-centred care. It is generally assumed that their classification must refer to the country-specific social and cultural setting and its particular linguistic terms. Therefore personal factors are not classified as yet by the WHO for general use. In Germany in 2006 a group of experts working on the medical advisory board of statutory health insurance published a proposal for a systematic classification of relevant personal factors to describe the background of an individual's life and living. This classification was now further analysed and thoroughly revised by a more comprehensive group of German specialists working in different health care insurances and institutions, authorised by the German Society for Social Medicine and Prevention (DGSMP), supported by German-speaking Swiss ICF specialists. This classification is published as work in progress intending to broaden and prepare the process of discussion for a consensus conference to be held in Germany in 2011.

[Personal contextual factors, part I]. / Personbezogene Kontextfaktoren, Teil I.

The International Classification of Functioning, Disability and Health (ICF) does not yet classify personal contextual factors. To determine the interaction of these factors on activities and participation of a person as well as their influence on the probable outcome of interventions, they must be taken into account in individual sociomedical expertises. Therefore, a group of medical experts working for the social health insurance medical advisory boards in Germany compiled a proposal for a systematic classification of personal contextual factors into domains, categories and items with respect to the ethical guidelines of the ICF. In a second step the main issues were transferred into the preliminary draft for a short version which will be published later to give support for practical daily use in health insurance matters.

[Expert opinion on prevention and rehabilitation in the German statutory health insurance system]. / Begutachtung von Vorsorge- und Rehabilitationsleistungen in der GKV.

New Directives of the Federal Joint Committee Concerning Medical Rehabilitation Measures ("Rehabilitation Directives") came into force on 1 (st) April 2004. In this context, a survey of the expert assessment given by the Medical Service of the Statutory Health Insurance ("Medizinischer Dienst der Krankenversicherung, MDK") is provided -- as far, as medical prevention and rehabilitation are concerned.

[Application of ICIDH classification in sociomedical assessment]. / Die Anwendung der ICIDH in der sozialmedizinischen Begutachtung.

With the increase of treatable chronic diseases and of the number of elderly persons in society, rehabilitation and social services to compensate disabilities are getting increasingly important. At the same time, social security systems today are hard pressed to control health care costs and to justify their services. Against this background instruments are necessary to present e. g. rehabilitation needs in a comprehensible way. ICIDH, the International Classification of Impairments, Disabilities and Handicaps, is such an instrument. For this reason knowledge and use of this Classification are now being taught to experts of the MDK (German medical service of health insurances). The way how this is done in the MDK Berlin-Brandenburg and first results are reported.

[Effects exercised by the new federal German social legislation SGB III on assessing the incapacity to work by the medical experts of German statutory sickness insurance bodies]. / Auswirkungen des SGB III auf die Begutachtung der Arbeitsunfähigkeit durch den MDK.

The rules laid down in Volume III of German social legislation have a direct bearing on expertising on the incapacity to work. The article explains the new tolerance limits and the unrestricted validity of the relevant paragraphs of the German social laws and points out the differences in respect of other areas of social care legislation.

[Change in legal assessment of unconventional medical methods in federal health insurance--consequences for social medicine expert assessment]. / Der Wandel der Rechtsprechung zu unkonventionellen medizinischen Methoden in der GKV-Konsequenzen für die sozialmedizinische Begutachtung.

Court decisions concerning liability of the statutory health insurance to pay for alternative medicine are subject to evolution in the course of time. Judicial interpretation of the law determines the standard to be applied in future. Thus the expert assessment by the Medical advisory board of health insurance (Medizinischer Dienst der Krankenversicherung, MDK) in this context must consider the current tendency of court decisions. This survey describes the development of court criteria for claims to refund alternative medicine costs and draws some conclusions in respect of the assessment by the MDK.

[The need for special care according to the German Legislation of Intersection between Social Care Insurance and other social insurance bodies]. / Zur Begutachtung der Pflegebedürftigkeit gemäss SGB XI--Berührungspunkte der sozialen Pflegeversicherung mit anderen Sozialleistungen.

The introduction of statutory long-term care insurance into the German social security system led to connections and need of distinction between the different bodies providing benefits to severely disabled persons. In this paper, a general survey describes the different claims for these benefits based on expert assessment by the Medical Services of Statutory Health Insurance.

[Expert assessment of unconventional treatment methods within the scope of legal health insurance--problems based on current court decisions]. / Die Begutachtung unkonventioneller Heilmethoden im Rahmen der gesetzlichen Krankenversicherung--Probleme vor dem Hintergrund der derzeitigen Rechtsprechung.

Court decisions of the Federal Court for Problems of Social Welfare (Bundessozialgericht) make health insurance pay for unconventional methods under certain circumstances. Physicians of the Health Insurance Medical Service (MDK) have to examine whether these conditions are fulfilled in a special case. The specific problems they encounter there are being described in this paper. Hermeneutic differences can be noticed. To guarantee the quality of medical care, which is the duty of the statutory health insurances, seems to be difficult in the case of "unconventional" medical methods.

[Determination or expert assessment of eligibility for intensive nursing care?--Comments on a decision by the Federal Social Court (4RK 1/92, passed down 30 September 1993)]. / Feststellung oder Begutachtung der Schwerpflegebedürftigkeit?--Anmerkungen zu einem Urteil des Bundessozialgerichts (4RK 1/92, verkündet am 30.9.1993).

A decision by the Bundessozialgericht, the Supreme Social Court of Germany, determining "Schwerpflegebedürftigkeit" (permanent need of very intensive nursing care) is discussed from the viewpoint of a physician in the Medical Service of Health Insurances, in respect of the Court's definition of "Schwerpflegebedürftigkeit", which is different from the one the Health Insurances had agreed upon so far, the physician's part in finding out who is entitled to the benefits related to "Schwerpflegebedürftigkeit", the question whether and to what extent "Schwerpflegebedürftigkeit" has to be assessed by an expertise of the Medical Service of the Health Insurance, the possibly increasing importance of court decisions in the procedure of gaining benefits justified by "Schwerpflegebedürftigkeit".

[The physician as expert witness. Aspects of an ambivalent role exemplified by expert testimony for legal health insurance]. / Der Arzt als Gutachter. Aspekte einer ambivalenten Rolle am Beispiel der Begutachtung für die gesetzliche Krankenversicherung.

This article provides a broad survey of the difficulties confronting the physician in his role as a specialist in the Health Insurance Medical Service, assessing claims relating to the state medical insurance system. These problems can be divided into the three following categories. Firstly, problems on a personal level relating to the interaction of the different people involved, albeit within the given institutional framework. Secondly, problems involving matters of principle in reconciling diagnosis, the patient's subjective assessment of his condition and legal criteria. Thirdly, problems arising from the pressure created by socio-cultural developments which influence both the patient and the specialist physician in his assessment.

[The physician as expert evaluator. Aspects of an ambivalent role exemplified by the evaluation of claims in legal health insurance]. / Der Arzt als Gutachter. Aspekte einer ambivalenten Rolle am Beispiel der Begutachtung für die gesetzliche Krankenversicherung.

This article provides a broad survey of the difficulties confronting the physician in his role as a specialist in the Health Insurance Medical Service assessing claims relating to the state medical insurance system. These problems can be divided into the three following categories. Firstly, problems on a personal level relating to the interaction of the different people involved, albeit within the given institutional framework. Secondly, problems involving matters of principle in reconciling diagnosis, the patient's subjective assessment of his condition and legal criteria. Thirdly, problems arising from the pressure created by socio-cultural developments which influence both the patient and the specialist physician in his assessment.

The effect of calcitonin in vitro on tooth germs in protein-energy malnourished rats.

The effect of calcitonin on the development of incisor and molar tooth germs was studied in normal and nutritionally deprived newborn rats. Calcitonin affected the calcium uptake of nutritionally deprived molar tooth germs in the early postnatal period; this interaction was not seen in the later postnatal period, however.