[Can Peers Achieve Access to Socially Burdened Families? Evaluation Results of the Programme 'Community Mothers in Berlin-Kreuzberg']. / Können Peers Zugänge zu sozial belasteten Familien schaffen? Ergebnisse der Evaluation des Projekts "Stadtteilmütter in Berlin-Kreuzberg".

This study evaluated a setting-based programme whose goal was to promote the healthy upbringing of children in a disadvantaged district through the empowerment of mothers. Women from the neighbourhood were trained as community mothers (CM) to impart their knowledge in home visitations to other mothers. 67 CMs were trained. They gained access to 118 families via home visits and to 191 families in single contacts. Information and support resulted in positive changes in all families available for interviews (n=44). The families also gained access to the professional help system.

[Gesundheitsziele.de. Selection of a new health target for Germany]. / Gesundheitsziele.de. Die Auswahl eines neuen Gesundheitsziels für Deutschland.

In 2013, the forum gesundheitsziele.de selected "reduction of alcohol consumption" and "patient safety" as new health targets. Besides the two selected targets, three other topics were considered: health at work, health during pregnancy and childbirth, and health and migration. This paper describes the selection process, which followed several criteria: mortality, morbidity, prevalence, burden of disease, economic impact, potential for improvement, equity in health, empowerment of and priorities of health problems in the population. The analysis particularly focused on the assessment of the feasibility and the readiness of stakeholders to participate in the development and implementation of health targets.

[Assessing the health target "Reduce tobacco consumption"]. / Evaluation des Gesundheitsziels "Tabakkonsum reduzieren".

The consortium gesundheitsziele.de has defined health targets and actions to reduce tobacco consumption of the general population. Five primary fields of action were defined: (1) tax increase, (2) ban of advertisements, (3) protection against second-hand smoking, (SHS) (4) support of smoking cessation, and (5) actions to avoid taking up smoking. The achievements in recent years are described by means of epidemiological studies and other specific data. (1) Tax increases led to a significant rise of cigarette prices. (2) A complete ban of advertisements has not yet been achieved. The tobacco industry shifted expenditures to fields where advertising is still allowed. (3) Many actions to foster protection against SHS could be implemented. Public awareness has been raised, the acceptance of smoking bans has grown, and exposure to SHS has been reduced. (4) Demand and supply of smoking cessation interventions have been enhanced. (5) Actions to avoid taking up smoking seem to be successful as the rate of smokers among young people has decreased, the number of never-smokers has increased, and a more critical attitude of non-smokers towards smoking could be observed. It is recommended that the above actions be continued because the capabilities of the structural, mass media, and behavioral interventions have not been fully exhausted.

[gesundheitsziele.de. Results of criteria analysis to select a new health target in Germany]. / gesundheitsziele.de. Ergebnisse der Kriterienanalyse für die Auswahl eines neuen Gesundheitsziels in Deutschland.

In 2008 the forum gesundheitsziele.de selected "Healthy aging" as a new health target. Besides "Healthy aging" three other targets were considered: chronic back pain, myocardial infarction, and vaccination. This paper describes the selection process for all four health targets which followed several criteria: mortality, morbidity, prevalence, burden of disease, economic impact, potential for improvement, equity in health, empowerment of and priorities in the population. The analysis particularly focused on assessment of feasibility and readiness of stakeholders to participate in the development and implementation of the health target.

[Evaluation of Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment"]. / Evaluation des nationalen Gesundheitsziels "Depressive Erkrankungen: verhindern, früh erkennen, nachhaltig behandeln".

In 2006, Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment" was developed by an interdisciplinary group of experts. A total of six areas of activity and proposals for action with potential for improvement were defined. Subsequently, a group of experts was entrusted with designing evaluation strategies, defining indicators of progress, and examining the accessibility of data sources for evaluation. For the primary start-up activities set out in the health targets, specific progress indicators were deduced, and routine data available for evaluation were identified. As a next step, the limitations of these data sources were analyzed and necessary improvements described. Relevant indicators of progress for specific areas of activity have been described, the availability and usability of different existing data sources examined, and further supplements or additional specifications with respect to the indicators described. Due to inadequate data sources, additional systematic surveys are required to evaluate the health target and its implementation. Existing German surveys should be extended by questions concerning relevant measures and progress indicators; various progress indicators should be analyzed on a general basis.

[Evaluating the health target "Increasing health competence, strengthening patient sovereignty"]. / Ansätze zur Evaluation des Gesundheitsziels "Gesundheitliche Kompetenz erhöhen, Patient(inn)en-souveränität stärken".

Establishing citizen and patient orientation is a national objective of German health policy. The cooperation network gesundheitsziele.de has defined the target area "Increasing health competence, strengthening patient sovereignty", and its Working Group 8, which bears the same name, has identified four key areas for action: increasing transparency, developing competence, strengthening patients' rights, and improving complaint management. As in the case of all the other targets defined by gesundheitsziele.de, attention is drawn to the need to evaluate the effects and success of the targets and related measures. A group of experts was given the task of developing an evaluation strategy, defining success indicators, and examining the availability of data sources for evaluation. With regard to the health target "Increasing health competence, strengthening patient sovereignty", the evaluation is focusing on what effect the corresponding targets and measures are having on users and how they are perceived (summative evaluation), i.e., primarily on measuring outcomes at the population level. An examination of available studies and surveys shows that to date little is known about the expectations and assessments of health-service users. At the same time, the analysis makes it clear that priority should be given to using continuous data in order to arrive at a continuous and systematic evaluation of the "Increasing health competence, strengthening patient sovereignty" health target and the implementation of citizen and patient orientation in healthcare in general. It would also be useful to include all hitherto underrepresented indicator questions in these surveys and to also examine the implementation of the health target among vulnerable population groups, e.g., elderly people in nursing homes.

Cardiovascular disease risk factors, CHD morbidity and mortality in the Federal Republic of Germany.

Analyses of data from the first National Health Examination Survey undertaken from 1984-1986 within the framework of the German Cardiovascular Prevention Study, show the following risk factor prevalences in 25-69 year-old men and women: overweight (BMI males: greater than 25, females greater than 24) or obese (BMI greater than 30): men 65.0%, women 57.6%; total serum cholesterol (less than 5.17 mmol/dl): men 73.7%, women 74.0%; normal blood pressure (according to JNC definitions): men 45.0%, women 59.1%; hypertension according to WHO criteria: men 26.0%, women 21.1%; controlled hypertensives (WHO criteria): men 19.9%, women 33.9%; current smoking: men 40.8%, women 26.1%. For most of the cardiovascular risk factors there is a clear negative association between prevalence and length of school education. Three myocardial infarction (MI) registries (WHO MONICA Project) are operating in the Federal Republic of Germany. Incidence and case-fatality data are within comparable ranges. Coronary heart disease (CHD) mortality has been relatively stable in both sexes from 1970 to 1986 with a minor peak in 1976 and a slight downward trend since then. A study of the reliability of coding procedures in West German state statistical offices revealed major disagreements so that trends derived from national mortality data as aggregate data of the federal states might be spurious. An ecological correlation of regional smoking prevalences (1978) and regional CHD mortality rates (1977-9) showed significant coefficients in men, but not in women.

[Life conditions and health behavior of socially disadvantaged women: implications of an action-theoretic model of social structure for health research]. / Lebenslagen und Gesundheitshandeln von sozial benachteiligten Frauen: Die Bedeutung eines handlungstheoretischen Modells der Sozialstruktur für die Gesundheitsforschung.

To operationalize social status epidemiology of social inequalities in health uses uncompounded indices, as school and job education, income and occupational status. Social epidemiology describes social inequalities from a more comprehensive perspective, including indicators of social status as well as subjective attitudes and behavior. Examples of a study on smoking in women indicate a broader framework of the relation between social indicators and healthy lifestyles. Action oriented theory of social inequalities substantiate restrictions of this epidemiological approach. Social analysis should focus on lifestyles and behavioral resources to reach overall life targets. An example of a qualitative study on health behavior in women prove the impact of this sociological theory for public health research. Health behavior of women from the lower SES is developed and improved in life history. It can be described as the capability to reach life targets regarding to health and social conditions.

[Are females healthier than males? On the health status of females in West Germany]. / Sind Frauen gesünder als Männer? Zur gesundheitlichen Lage der Frauen in der Bundersrepublik Deutschland.

Women live longer than men - are they healthier than men or do they live better than men? Morbidity data indicate that men and women differ regarding the types of illnesses they undergo. The life-expectancy for females is not the only indicator for a better or healthier life. Women feel more affected by health problems than man (indicators a.o.: complaints, handicaps to daily activities, use of medication). Objective morbidity data are insufficient but indicate significant disease occurrence in women (indicators a.o.: contacts with the physicians, self-reported history of diseases). Based on epidemiological studies the hypotheses of biological protective factors have not been proved or refuted. Women have a lower CVD-risk factor profile than men. Cluster analyses of the first Bremen health survey separated women into four groups related to health behaviour and risk status. The group with the highest risk factor prevalence had also the most social and family stress. For further research about women we have to work on epidemiological data as well as on qualitative and theoretical research on women and health.

[Socially selective degree of achievement in community-oriented intervention--analysis of participation in health actions of the German Cardiovascular Prevention Study]. / Sozial selektive Erreichungsgrade in der gemeindeorientierten Intervention--Eine Analyse der Beteiligung an Gesundheitsaktionen der Deutschen Herz-Kreislauf-Präventionsstudie (DHP).

The subject of this article is an analysis of participation in campaigns of the German Cardio-Vascular-Prevention Study (GCP). In 1988 two representative surveys were carried out in the City of Bremen. Altogether, 2360 persons were questioned. Of these, 149 stated that they had participated in campaigns of the GCP. A multivariate analysis shows that the probability of participation was highest for people with an interest in health-related issues and for members of higher social classes. The discussion of these result emphasizes some problem areas in the use of such community-based intervention concepts.

[Social inequality in myocardial infarct and stroke in West Germany]. / Soziale Ungleichheit bei Herzinfarkt und Schlaganfall in West-Deutschland.

It is examined to which extent social inequalities exist in West-Germany (old federal states) regarding myocardial infarction and stroke in the general population. Databases were the regional and national health surveys which were conducted in the framework of the German Cardiovascular Prevention Study (GCP) from 1984 to 1991. 12.445 males and 13,335 females aged 40-69 years were included in this analysis. The assessment of myocardial infarction and stroke was done by a self administered questionnaire. 648 (5.2%) males and 252 (1.9%) females reported a myocardial infarction. 209 (1.7%) males and 143 (1.1%) females reported a stroke. Social class was measured using an additive index comprising the dimensions income, occupational status and education. For both genders it was found that the prevalence of myocardial infarction and stroke increased significantly with decreasing social class. This association remained significant also under control for age and the cardiovascular disease risk factors cigarette smoking, hypertension, hypercholesterolemia and overweight. The results clearly demonstrate that in West-Germany--as was shown already for many other western industrialized nations--social factors independently from the classical risk factors have a significant effect on the incidence of myocardial infarction and stroke.

[Female life courses and health--results of a study of national survey data of 50-69-year-old women in East and West Germany]. / Weibliche Lebensverläufe und Gesundheit--Ergebnisse einer Untersuchung nationaler Surveydaten 50-69jähriger Frauen aus Ost- und Westdeutschland.

The aim of the study was to examine the impact of different forms of combining family and paid work on the health status of women. The study was a secondary analysis of cross-sectional data from the National Health Survey and included 1530 women, aged 50 to 69 years, from East and West Germany. Three groups were composed to describe different forms of family and occupation in the life course (family or occupational career, combination of family and occupation). Additionally, aspects of the social situation, resources and burdens as well as indicators of health behaviour were included in the analyses. The most remarkable result was a significantly worse state of health of employed and childless women (occupational career), aged 50 to 59 years. This finding remained after adjustment for different potential factors of influence. Considering the increasing proportion of women without children in modern societies, longitudinal analyses would be necessary to investigate the long term effect of familial and occupational factors on the health status of women.

Gender equality in the work of local research ethics committees in Europe: a study of practice in five countries.

BACKGROUND: Funding organisations and research ethics committees (RECs) should play a part in strengthening attention to gender equality in clinical research. In the research policy of European Union (EU), funding measures have been taken to realise this, but such measures are lacking in the EU policy regarding RECs. OBJECTIVE: To explore how RECs in Austria, Germany, Ireland, The Netherlands and Sweden deal with gender equality issues by asking two questions: (1) Do existing procedures promote representation of women and gender expertise in the committee? (2) How are sex and gender issues dealt with in protocol evaluation? METHODS: Two RECs were selected from each country. Data were obtained through interviews with key informants and content analysis of relevant documents (regulations, guidelines and review tools in use in 2003). RESULTS: All countries have rules (mostly informal) to ensure the presence of women on RECs; gender expertise is not required. Drug study protocols are carefully evaluated, sometimes on a formal basis, as regards the inclusion of women of childbearing age. The reason for excluding either one of the sexes or including specific groups of women or making a gender-specific risk-benefit analysis are investigated by some RECs. Such measures are, however, neither defined in the regulations nor integrated in review tools. CONCLUSIONS: The RECs investigated in five European member states are found to pay limited attention to gender equality in their working methods and, in particular in protocol evaluation. Policy and regulations of EU are needed to strengthen attention to gender equality in the work of RECs.

[Evaluation of the health target "tobacco control"]. / Evaluation des Gesundheitsziels "Tabakkonsum reduzieren".

UNLABELLED: "Tobacco control" is one of six health targets of the forum gesundheitsziele.de (health targets). Key stakeholders from health policy and from the health system are involved in the process of defining and deciding about health targets. The goal of gesundheitsziele.de is the improvement of the health of the population through integrated action. Goals are supplemented with recommendations for intervention measures, and indicators to mea sure whether goals had been achieved. The evaluation board of gesundheitsziele.de is committed to assess the availability and appropriateness of German data bases for the evaluation of the health target "tobacco control", and to submit a concept for the evaluation. In particular, the German health monitoring system, and the evaluation and quality assurance of the Federal Center for Health Education provide a good data base for the evaluation of the health target. Lack of data exists regarding outcome and impact evaluation of structural (policy, legal) interventions. RECOMMENDATIONS: Evaluation of health targets requires continuing conduction of representative population surveys. The evaluation of national intervention campaigns and the extension of the topic "tobacco control" within the German health report system are necessary. The collection and documentation of information about intervention measures, programs, and evaluation results is recommended. The evaluation board favors follow-up studies, and the coordination of existing data resources; the creation of new evaluation systems is not required.

[The current public health situation in Germany]. / Zur Situation von Public Health in Deutschland.

The article describes the development of health sciences/public health at German universities in the 1990s. This process had scientific objectives and kept a certain distance from the Public Health Service. The evaluation of findings made in public health locations shows that they successfully cover the relevant issues of health science. Professionalization has been achieved by the establishment of postgraduate teaching at the universities and degree courses at the "universities of applied sciences" (Fachhochschulen). Research conducted on the subsequent careers of university graduates reveals an impressive labour market demand for the qualifications that have been acquired. The theoretical and methodological professionalization of the subject in Germany was possible because the respective universities had recourse to the internationally recognized concepts of the schools of public health. The article shows that the structural establishment of public health at universities could, however, quickly be called into question if basic conditions were to change. Germany still has a long way to go before it can claim to have strong schools of public health.

[The S.I.G.N.A.L.-Intervention Project to combat violence against women]. / Das S.I.G.N.A.L.-Interventionsprogramm gegen Gewalt an Frauen.

Domestic violence has profound effects on the health of women. According to the World Health Organization, violence is a significant risk factor for morbidity and mortality in women. If violence is not taken into account as a cause of health problems, there is a high risk of inappropriate health care. More attention to the issue of domestic violence in medical history, diagnosis and therapy is the objective of the "S.I.G.N.A.L. Intervention Project to Combat Violence Against Women". The "S.I.G.N.A.L. Project" is the first intervention project against violence in a medical setting in Germany. It was started in 1999 in the emergency room of Benjamin Franklin University Hospital (Charite Campus Benjamin Franklin). The goal of the project is to initiate prevention and intervention for violence against women by providing the abused women with appropriate support and treatment. The program is based on the intervention objectives: ask about abuse, assess for danger, inform and refer victims to counselling programs and women's shelters, and document injuries and health problems for use in legal proceedings.

[Domestic violence against women and health care demands. Results of a female emergency department patient survey]. / Häusliche Gewalt gegen Frauen und Versorgungsbedarf. Ergebnisse einer Befragung von Patientinnen einer Ersten Hilfe/Rettungsstelle.

Domestic violence (DV) is a serious risk for women's health. So far, little attention has been paid to this area in research and medical care in Germany. Acknowledging this deficit, the S.I.G.N.A.L.-Intervention Project has started to develop a program to improve the medical care for victimized women. For the first time in Germany, data on the health care needs of victimized women have been collected within the S.I.G.N.A.L.-Evaluation Research Project. This article presents the results of a female patient survey (n=806) on DV conducted in the emergency department (ED) of a university hospital in Berlin. The results demonstrate that 36.6% of women reported at least one episode of DV after the age of 16. A total of 4.6% were victims of DV over the past year, and 1.5% of women came to the ED for treatment of injuries caused by violence. A total of 57% of the victims of at least one episode of DV in their lifetime after the age of 16 described a negative impact on their health. The most frequently reported sequelae were head injuries, haematomas and fractures, gastrointestinal disorders, headache/migraine and heart disease. The psychological symptoms were anxiety, depression and suicide/self-mutilation attempts. Some 52% of the victims who reported health consequences had received medical care. In case of DV occurring, 67% of all women said that they would discuss it with their physicians. Approximately 80% of all respondents favoured a routine inquiry for DV as part of the medical history protocol of the ED.

[Subjective health as predictor for mortality]. / Subjektive Gesundheit als Prädiktor für Mortalität.

In the last two decades self-rated health has received growing interest in international studies because of its consistent prediction for mortality. However, for Germany there are no studies confirming a long-term effect independent from objective health indicators in comparison of different follow-up. On the basis of the Life-Expectancy-Study (1984/86 - 1998) from the Federal Institute for Population Research it was possible to analyze the association between subjective health and mortality in relation to the length of observation. A stronger correlation between bad self-rated health and objective health status could be indicated because of a better prediction for mortality in a short-term follow-up. The evidence of a significant effect between self-rated health and mortality in the long-term follow-up not including the deaths from the short-term follow-up indicates that the mechanisms between subjective health and mortality are more complex than those between objective health status and death.

Primary prevention of coronary heart disease versus health promotion--a contradiction?

The German Cardiovascular Prevention Study is a multicentre community-based intervention study with the primary goal of reducing cardiovascular mortality by primary prevention measures. The intervention strategy comprises improving people's life styles as well as health promotion so as to modify cardiovascular risk factors (hypercholesterolemia, cigarette smoking, arterial hypertension, physical inactivity and over-weight). Design elements of the German Cardiovascular Prevention Study, now in its fifth year, were adopted from well known community intervention studies, including monitoring of mortality and morbidity, health examination surveys to assess distribution of cardiovascular risk factors, health attitudes and health behaviour in the community and use of formative and process evaluation to monitor the effects of intervention policies in the community. To identify risk factor profiles a cluster analysis was carried out from survey data. Four clusters were identified: a) people with none or few risk factors; b) those with high prevalence of smoking; c) those with high prevalence of hypercholesterolemia and hypertension; d) high risk factor exposure individuals. The clusters are different along social indicators like age, sex and social status. Process evaluation data show that special strategies like interventive blood pressure screenings reached a relatively high proportion of people from lower socioeconomic status. But they also indicate that there is a long way to go from publicity of intervention programs to lasting changes in behaviour.