Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment.

BACKGROUND: Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS: A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS: Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION: Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION: Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Assessment of excess medical costs for persons with type 2 diabetes according to age groups: an analysis of German health insurance claims data.

AIM: This cross-sectional study used a large nationwide claims data set to assess the excess medical costs of people with type 2 diabetes according to age group in 2015. METHODS: Data from 291 709 people with diabetes and 291 709 age- and sex-matched controls were analysed. Total costs (expressed as 2015 euros) of outpatient and inpatient services, medication, rehabilitation, and the provision of aids and appliances were examined. Overall and age-stratified excess costs of people with diabetes were estimated using gamma regression with a log-link. RESULTS: Overall, the estimated total direct costs of a person with type 2 diabetes are approximately double those of a person without diabetes: €4727 vs. €2196, respectively. Absolute excess costs were approximately the same in all age groups (around €2500), however, relative excess costs of persons with diabetes were much higher in younger (~ 334% for < 50 years) than in older age groups (~ 156% for ≥ 80 years). Regional costs, both absolute and excess, partly differed from the national level. CONCLUSIONS: This study complements and updates previous studies on the excess medical costs of people with diabetes in Germany. The results indicate the importance of preventing the development of type 2 diabetes, especially in younger age groups. Longitudinal and regional studies examining changes in prevalence and the development of excess costs in groups with different types of diabetes, and according to age, would be of interest to validate our findings and better understand the avoidable burden of having diabetes.

Medication costs by glucose tolerance stage in younger and older women and men: results from the population-based KORA survey in Germany.

To estimate medication costs in individuals with diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal blood glucose values in a population-based sample by age and sex.Using the KORA F4 follow-up survey, conducted in 2006-2008 (n=2611, age 40-82 years), we identified individuals' glucose tolerance status by means of an oral glucose tolerance test. We assessed all medications taken regularly, calculated age-sex specific medication costs and estimated cost ratios for total, total without antihyperglycemic drugs, and cardiovascular medication, using multiple 2-part regression models.Compared to individuals with normal glucose values, costs were increased in known diabetes, undetected diabetes and impaired glucose regulation, which was more pronounced in participants aged 40-59 years than in those aged 60-82 years (cost ratios for all medications: 40-59 years: 2.85; 95%-confidence interval: 1.78-4.54, 2.00; 1.22-3.29 and 1.53; 1.12-2.09; 60-82 years: 2.04; 1.71-2.43, 1.17; 0.90-1.51 and 1.09; 0.94-1.28). Compared to individuals with diagnosed diabetes, costs were significantly lower among individuals with impaired glucose regulation across all age and sex strata, also when antihyperglycemic medication was excluded (40-59 years: 0.60; 0.36-0.98, 60-82 years: 0.74; 0.60-0.90; men: 0.72; 0.56-0.93; women: 0.72; 0.54-0.96).We could quantify age- and sex-specific medication costs and cost ratios in individuals with diagnosed diabetes, undetected diabetes and impaired glucose regulation compared to those with normal glucose values, using data of a population-based sample, with oral glucose tolerance test-based identification of diabetes states. These results may help to validly estimate cost-effectiveness of screening and early treatment or prevention of diabetes.

The influence of silicone oil used in ophthalmology on the proton therapy of uveal melanomas.

In ocular proton therapy the important parameters range and modulation of the proton field are calculated by a simple geometric ray tracking. Due to the assumed homogeneous eye tissue, the relative-to-water proton stopping power is nearly constant within the radiation field. In cases when silicone oil tamponades are used, this will no longer hold. CT-data which are necessary to estimate the path length of protons within the oil show bigger attenuation of x-rays then in eye tissue. The use of a CT-calibration curve to deduce the relative-to-water electron density for proton stopping power calculation would be misleading giving a value of 1.05 and thus a higher proton stopping power. In reality the relative-to-water electron density is smaller, namely 0.95, leading to a proton range prolonged by about 11% of the path length within the silicone oil, if the demand for the range adjustment would not be recognized (missing information from ophthalmologists or no CT data). This finding is congruent in analytical and Monte Carlo calculations as well as in experimental investigations, being presented here. The misleading result of the CT calibration curve is explained and therapeutic consequences are demonstrated. Multiple Coulomb scattering in silicone oil does not affect the size of the planed irradiation field.

[Improvements in type 2 diabetes care? Pooled analysis of survey data in southern Germany (KORA) from 1999-2008]. / Verbesserungen in der Versorgung von Patienten mit Typ-2-Diabetes? Gepoolte Analyse dreier bevölkerungsbasierter Studien (KORA) in der Region Augsburg zwischen 1999 und 2008.

To evaluate the quality of diabetes care, processes and outcomes of health care for type 2 diabetes were compared across three population-based surveys in Germany with cross-sectional and longitudinal perspectives. The surveys were conducted in the Augsburg region, southern Germany, in 1999-2001, 2003-2005, and 2006-2008 and included physical examinations, an interview, self-administered diabetes questionnaires, and laboratory tests. Quality indicators derived from guidelines for type 2 diabetes managed care programs in Germany served as the evaluation framework. Multiple regression models were used for analysis, adjusting for age, sex, education, diabetes duration, and cardiovascular comorbidity. Results show that medical examinations of eyes (61-71%) and feet (38-55%) and the use of antihypertensives, antiplatelet drugs, and lipid-lowering medications were reported more frequently over time. There was no increase in patient self-care behaviors or diabetes education. Blood pressure and cholesterol outcome targets were achieved more frequently over time. In conclusion, medical care and drug therapy of type 2 diabetes have improved; however clinical practice has failed to intensify patient participation and health behavior.

Nurse practitioners in developing countries: some ethical considerations.

One of the principles of health care ethics is the principle of justice. An important expression of justice is equity. The provision of basic primary health care services to all people is the key to eliminating the gross inequities in health status existing in many countries. For many years nurses in developing countries have 'led the way' in bringing these essential services to poor rural communities, including the diagnosis and treatment of illnesses, and the prescribing and dispensing of medications. Nurses are the most appropriate health workers for this role, but most have not been prepared adequately for it. This is unsafe for patients and puts nurses at legal risk. Justice requires that patients should obtain access to safe health care and that nurses should receive appropriate education. Nurse practitioner programmes are being established to prepare nurses for this advanced practice role, but here again ethical considerations apply. Justice will be served only if nurse practitioner programmes are accessible to the nurses who are most likely to work in medically underserved communities where the need is greatest.

Ethical considerations in rural health nursing.

Nurses are the health workers most frequently found providing primary health care services in rural communities throughout the world. In these settings, often with limited resources and far from professional support systems, nurses may encounter ethical dilemmas quite different from those experienced by their colleagues in urban hospital settings. Consider the following example from a remote island community. A young nurse with two years experience in an urban hospital is posted to a remote village. In this country there are very few doctors, so nurses diagnose and treat common health problems. On this day a traditional political leader, a middle-age man, is brought to the small clinic by his adult son to be treated for his cough. Other patients are waiting to be seen, but the son makes it clear that he expects his father to be cared for immediately. The nurse doesn't think it is right to give preferential treatment, but the other patients back away and she defers to the son's demands. The nurse examines the man and concludes that he has a common viral infection requiring only symptomatic treatment. When she tries explaining this to the patient, he becomes annoyed and insists that what he needs is a penicillin injection. That's how the last nurse working in this clinic had treated him when he was sick and he had recovered within days. Finally, the young nurse overwhelmed by his age and status and under pressure from his family gives the injection. Shortly afterwards the patient collapses in shock and very nearly dies. The family blamed the nurse, and the community council demanded that she be removed. The case was eventually investigated by the authorities, and the nurse was formally reprimanded for giving the patient an unnecessary injection which caused him harm. Rural nurses-indeed all rural health workers-need support in order to maintain ethical standards in practice. The purpose of this paper is to examine four potential sources of such support: nursing education programs; the Ministries of Health; the law; and the professional nursing organization.

Ethics of nursing and midwifery: responding to change.

Nurses and midwives are taking an increasing interest in ethical matters in their professions. Although the conditions in which they work vary immensely and are undergoing rapid change, it is possible to detect certain basic notions of patient care which transcend cultural, socioeconomic and technological differences.

Speech-language habilitation of hearing-impaired children: basis for assessment and training.

Spoken language assessment and training for profoundly deaf children should be based on normal developmental sequences. However, existing models of normal speech/language development have not been able to account for shifts from one developmental level to another. The implications of more recent theories of the development of expressive communication are reviewed. The concept of levels of spoken language development is reevaluated in terms of these theories. It is proposed that the developmental landmarks that initiate each level are a product of changes with growth in underlying subsystems. Some of these changes are specific to motor subsystems, but in addition, the interaction of motor, cognitive, linguistic, and social domains is stressed. The implications of these findings for development of assessment procedures and speech/language training programs is summarized.

Assessment of value of glycosylated albumin and protein in detection of gestational diabetes.

There is a recognized need for the early detection of gestational diabetes, and a single blood test, if reliable, would be advantageous. Because serum albumin and total protein are glycosylated and have short life spans, we investigated the usefulness of glycosylated albumin and glycosylated protein in the detection of gestational diabetes. We studied five groups, each with 20 subjects: nonpregnant and pregnant controls, nonpregnant and pregnant insulin-dependent diabetic (IDDM) patients, and gestational diabetic patients. All patients with no history of diabetes had an oral glucose tolerance test to define their carbohydrate status. Our results showed that percent glycosylated albumin and percent glycosylated protein were significantly elevated in both groups of IDDM patients compared with the other groups. However, gestational diabetic patients had glycosylated albumin and glycosylated protein values similar to those of both control groups. Both glycosylated albumin and glycosylated protein correlated well with HbA1c determinations. Thus, glycosylated albumin and glycosylated protein may be a good index of glycemic control, but they are of little value in the diagnosis of gestational diabetes because of a lack of sensitivity: 8 and 3% for glycosylated albumin and glycosylated protein, respectively.