[Paediatric Rehabilitation by the German Pension Insurance - Status Quo and Future Developments]. / Kinder- und Jugendlichen-Rehabilitation ­ Stand und Perspektiven aus Sicht der Deutschen Rentenversicherung.

In Germany inpatient rehabilitation plays a major role for the treatment of children and adolescents with chronic health conditions. The German Pension Insurance carries out the rehabilitation of children and adolescents with high commitment. Paediatric rehabilitation enables children to go to kindergarten and school without interruption and participate in later professional life. The article specifies the basics of paediatric rehabilitation, describes the disease structure, defines the therapeutic care and explicates survey results.

[Rehabilitation goals in discharge reports and in patient questionnaires--on the example of endometriosis patients]. / Rehabilitationsziele in ärztlichen Entlassungsberichten und in Patientenfragebogen--am Beispiel von Endometriose-Patientinnen.

BACKGROUND: [corrected] The goal orientation of rehabilitation has increasingly found its way in research and practice. Though, shortcomings were ascertained for the implementation into the clinical routine furthermore. An empirical analysis of goal setting in clinical practice should complement the available evidence. METHODS: The study is based on a cross-sectional survey of all endometriosis patients, who had been treated at a rehabilitation center in 2008 or 2009. Data stemmed from the uniform medical rehabilitation discharge reports, and a patient questionnaire, which was sent to the registered women by the clinic routinely before the beginning of the rehabilitation. Data about rehabilita­tion goals were available as free text information for both the discharge reports as well as the pa­tient questionnaires. A category system oriented at the ICF system (International Classification of Functioning, Disability and Health), was developed to structure the goals. RESULTS: 293 patients had provided information concerning their rehabilitation goals, while 69 patients didn't reply to the question of their rehabilitation goals. The latter were excluded to the analysis. In the discharge reports, altogether, more goals were documented than in the patient questionnaires (5.98 compared to 4.97 goals per patient). In 35% of the numbers of rehabilitation goals clear congruence was found between the data in the discharge reports and the patient questionnaires. CONCLUSION: The results support the assump­tion that the included patients had difficulties in goal-setting. In addition it is obvious that the goals in the discharge reports had little relation to the goals framed by the patients, in language and content. A goal-setting process less oriented towards the medical and clinical needs but more towards the patients needs and expectation would be desirable particularly with regard to a more intensive patient orientation. The implementation of a prepared list of possible rehabilitation goals could serve for the shared goal-setting process in the context of anamnesis.

Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences.

STUDY QUESTION: What is the length of the diagnostic delay for endometriosis in Austria and Germany, and what are the reasons for the delay? SUMMARY ANSWER: The diagnostic delay for endometriosis in Austria and Germany is surprisingly long, due to both medical and psychosocial reasons. WHAT IS KNOWN ALREADY: Diagnostic delay of endometriosis is a problematic phenomenon which has been evaluated in several European countries and in the USA, but has not been reported for Germany and Austria. STUDY DESIGN, SIZE, DURATION: A cross-sectional, questionnaire-based multicentre study was conducted in tertiary referral centers in Austria and Germany. From September 2010 to February 2012, 171 patients with histologically confirmed endometriosis were included. PARTICIPANTS, SETTING, METHODS: Patients with a previous history of surgically proven endometriosis, internal diseases such as rheumatic disorders, pain symptoms of other origin, gynecological malignancy or post-menopausal status were excluded from the analysis. Patients with histologically confirmed endometriosis completed a questionnaire about their psychosocial and clinical characteristics and experiences. Of 173 patients, two did not provide informed consent and were excluded from the study. MAIN RESULTS AND THE ROLE OF CHANCE: The median interval from the first onset of symptoms to diagnosis was 10.4 (SD: 7.9) years, and 74% of patients received at least one false diagnosis. Factors such as misdiagnosis, mothers considering menstruation as a negative event and normalization of dysmenorrhea by patients significantly prolonged the diagnostic delay. No association was found between either superficial and deep infiltrating endometriosis or oral contraceptive use and the prolongation of diagnosis. LIMITATIONS AND REASONS FOR CAUTION: There was a possible selection bias due to inclusion of surgically treated patients only. WIDER IMPLICATIONS OF THE FINDINGS: Several factors causing prolongation of diagnosis of endometriosis have been reported to date. The principal factors observed in the present study are false diagnosis and normalization of symptoms. Teaching programs for doctors and public awareness campaigns might reduce diagnostic delay in Central Europe. STUDY FUNDING/COMPETING INTEREST(S): No competing interests exist.

[General conditions concerning the implementation of an outpatient education programme--characteristics and distinctions from an inpatient training programme]. / Rahmenbedingungen für die Umsetzung eines ambulanten Schulungsprogramms--Besonderheiten und Abgrenzung zu einer stationären Schulung.

INTRODUCTION: The aim of the EVA study was to develop an outpatient education programme for women with endometriosis with a view to permanent transfer into routine care. Implementation of the programme generated several problems and obstacles that are not, or not to this extent, present in the inpatient setting of a rehabilitation clinic. METHODS: The patient education programme was developed in line with an existing inpatient programme, taking into account the criteria for evaluating such training programmes. Several adjustments to process, structure and content level had to be made to achieve the conditions of the outpatient setting. RESULTS: Since May 2008, 17 training courses took place in various outpatient and acute inpatient settings, and a total of 156 women with diagnosed endometriosis participated. The problems and obstacles that emerged affected similarly the process, structure and content of the training programme. DISCUSSION: On the structural level, especially problems with availability of rooms, technical equipment and trainers occurred, leading to significant time pressures. The main problem on the procedural level was the recruitment of participants, since--in contrast to the inpatient setting and to disease management programmes--no assignment by physicians or insurers takes place. Furthermore, gainful activity of the participants and the resulting shift of the training beyond the usual working and opening hours are important barriers for implementation. The unavailability of trainers in these settings requires creative solutions. Regarding the contents of the training it has to be taken into consideration that--unlike the inpatient setting--no aftercare intervention and no individual psychological consultation are possible. The training programme has to be designed in such a way that all problems that have occurred could be dealt with appropriately. CONCLUSION: In summary, the permanent implementation of an outpatient training programme is possible but is more time-consuming than inpatient trainings due to unfavourable conditions concerning recruitment, organization and procedure. It seems that "soft" factors such as motivation, integration into the clinic concept, well-defined acceptance of responsibility and experience in dealing with the disease and with patient groups are the critical success factors. Until now cost carriage by the health insurance funds has not been realized--except for disease management programmes; so there is still a need for action here.

[Comparison of the legal basis for health prevention and promotion in the school laws of the federal states in Germany]. / Vergleich der Schulgesetze der Länder der Bundesrepublik Deutschland im Hinblick auf die Verankerung von Prävention und Gesundheitsförderung im Gesetzestext.

BACKGROUND: Health prevention and promotion in schools are key public health tasks in most countries. This study focuses on the importance given to prevention and promotion of health in law texts through comparatively analysing school laws for the sixteen federal states in Germany. MATERIAL AND METHODS: The basis for the analysis are the sixteen federal school laws in Germany. A conceptual framework to analyse the law texts has been developed grouped according to the following categories: aims of literacy and education; development of organization; individual and social health; and security and accident prevention. Examples for second level categories include nutrition, motility, alcohol, violence, and road-traffic accident prevention. Based on a point-system of valuation, a ranking for the federal states was derived in terms of an assessment of the importance of health prevention and promotion in federal states' school laws. RESULTS: Berlin, Brandenburg and Mecklenburg-Vorpommern -- three "new" states (i. e. formerly East-German) are leading the ranking. Bavaria and Baden-Württemberg, two states that had been ruled by conservative governments for a long time, had special difficulties to take over new values in their legislation and occupied rank 14 in our ranking. The last place was taken by a state under social-democratic rule -- Nordrhein-Westfalen. However, this law dated from 1952 and a new law has just been passed in August 2005. CONCLUSION AND DISCUSSION: The comparison of the school laws of the federal states in Germany demonstrates that there has been a substantial amount of change in recent years. In some school laws, the impulses of the Ottawa Charta regarding health prevention can be clearly recognised. In others prevention and promotion of health are only subordinated subjects. As in many other areas of social importance, reorientation is taking place. In particular, federal states who have placed little emphasis on school health will have to renew their corresponding legislation.