[Mental disorders of working age : Evaluation of the administrative incidence and prevalence as well as regional differences in Lower Saxony on the basis of secondary data from a statutory health insurance provider]. / Psychische Störungen im Erwerbsalter : Ermittlung der administrativen Inzidenz und Prävalenz sowie regionaler Unterschiede in Niedersachsen anhand von Sekundärdaten einer gesetzlichen Krankenkasse.

BACKGROUND: Mental disorder is the subject of ever-increasing attention in the field of public health. However, the actual number of such cases is difficult to determine owing to the lack of comprehensive longitudinal studies. OBJECTIVES: The administrative incidence and prevalence of mental disorders were estimated on the basis of data from 2010 to 2013 provided by the health insurance company AOK, Lower Saxony, and were assessed according to age and gender. Additionally, possible correlations between local conditions and the occurrence of diagnosed mental disorders were examined for both urban and rural districts. MATERIALS AND METHODS: Analyses were conducted using the secondary datasets of 1.5 million persons born between 1940 and 1994 who had been continuously insured throughout the period specified. Only documented diagnoses from outpatient care were taken into account. RESULTS: One third of the insured persons showed at least one documented diagnosis of a mental disorder within a 12-month period. In approximately 11 out of 100 cases, there was a newly documented diagnosis in 2012. With the exception of cases relating to psychotropic substance use, women were significantly more frequently affected than men. Age-specific differences were also determined. At a regional level, in relation to administrative prevalence, mental disorders showed positive correlations in the density of doctors and psychotherapists. Moreover, regions with a high rate of unemployment generally show a higher prevalence of mental disorders. CONCLUSION: Despite certain limitations, the use of administrative incidence and prevalence data is a viable approach to assessing gender- and age-specific, and regional differences. Our regional analyses suggest a correlation between the local job situation and the level of regional administrative prevalence.

Drug supply for children with psoriasis in Germany.

BACKGROUND: In Germany there is a lack of robust nationwide data on psoriasis therapy in children. PATIENTS AND METHODS: Secondary data from the statutory health insurance Gmnder Ersatzkasse (GEK) of the year 2009 were analyzed. Continuously insured children with psoriasis vulgaris were identified by ICD-10 codes (L 40. X). Their treatment was determined on the basis of prescriptions according to ATC code. RESULTS: 1,313 of 293,181 children and adolescents had psoriasis (0.45%). Of these, n = 651 (49.6%) received at least one medication during the observation period. Topical and systemic corticosteroids were most frequently prescribed (70.8% and 4.0% respectively). The relative frequency of prescription of systemic corticosteroids was higher in children treated by pediatricians and family physicians (by a factor of 3 and 5, respectively) than in those treated by dermatologists. Vitamin D analogs were the second most frequently prescribed drugs, used far more often by dermatologists (14.7%) than by general practitioners (1.7%) and pediatricians (0.9%). CONCLUSIONS: Drug supply for children with psoriasis in Germany appears to be inadequate. The consensus guidelines are not sufficiently considered and the use of systemic corticosteroids is still too high, even after adjustment for steroid-dependent indications. The data underline the necessity of guideline-oriented therapy and implementation of current therapeutic evidence in juvenile psoriasis.

"Gender-specific drug prescription in Germany" results from prescriptions analyses.

There are still considerable differences in the medication supply for men and women. While the prescription volumes for both men and women have, for some time, been similar or have even risen for the men, there are still characteristic differences between the sexes when it comes to the prescription of certain indication groups. Women are still prescribed clearly more drugs in the field of psychotropic medication, especially antidepressants, hypnotic drugs, and tranquilisers. As the American Beers criteria for quite some time now and, more recently, the German PRISCUS list have shown, the effects of such drugs are potentially dangerous, particularly for older women. The known adverse effects are, apart from dependence problems, restricted cognitive capacities, insecure or instable walking, and badly healing wounds from falling accidents that are followed by patient's nursing care dependency. In secondary prophylaxis after acute myocardial infarction, the characteristic prescription features of the various medicinal products that are used for both men and women (such as platelet aggregation inhibitors, beta-receptor blockers, ACE-inhibitors, statins) have become similar; women's still higher mortality risk appears to go back to the fact that too much time is spent before proper hospital treatment commences. In general, more attention should be paid to the right medication, the right length of treatment, and the right dosage of the medication prescribed to women; the evidence concerning women's supply of medicinal products should also be improved.

The impact of the Women's Health Initiative Randomized Controlled Trial 2002 on perceived risk communication and use of postmenopausal hormone therapy in Germany.

OBJECTIVE: The purpose of this representative, nationwide telephone survey was to collect information about postmenopausal hormone therapy (HT) use in relation to women's knowledge about the Women's Health Initiative Randomized Controlled Trial 2002 (WHI-RCT) in Germany. DESIGN: During July 2003, telephone interviews were conducted with randomly selected women aged 45 to 60 years (N = 10,030; response 59.9%; completed interviews n = 6,007). They were asked about information sources regarding the WHI-RCT, and use of HT in conjunction with it. RESULTS: Most women stated that they knew about the WHI-RCT (88.6%), and those with high educational status appeared to have more information than those with middle or low educational status. Among informed women (uninformed excluded), 46.6% continued, 25.7% stopped, and 14.2% ceased use of HT before the WHI-RCT. The prevalence of lifetime use of HT was higher in West Germany (37.4%) than in East Germany (29.2%), the highest prevalence of use was in the group aged 55 to 59 years. The most common reason to continue HT was the benefit risk assessment by physicians (58%); the most common reason to stop HT were women's perceptions that the risks of HT exceeded the benefits (56%). If information was solely given by physicians, women were more likely to continue HT (60.4%), compared with mass media (46.1%), as a source of information. CONCLUSIONS: The survey demonstrates the impact of the WHI-RCT in Germany, and shows that both the media and advice given by physicians were important. Women who continued to use HT did so largely because of their physician's advice. Women who discontinued were mainly those who had a negative subjective perception about risk of HT.