[Loneliness in Bavaria before and during the COVID-19 pandemic]. / Einsamkeit in Bayern vor und während der COVID-19-Pandemie.

BACKGROUND: Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes. METHODS: Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources. RESULTS: According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups. DISCUSSION AND CONCLUSIONS: During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted.

[Avoidable mortality-a new indicator version for prevention reporting]. / Vermeidbare Sterblichkeit ­ Neufassung eines Indikators für die Präventionsberichterstattung.

BACKGROUND: "Avoidable mortality" is used as an indicator in health reporting. The indicator aggregates selected causes of death. In Germany two versions exist, both of which are no longer up to date. A new version is proposed. METHODS: The new version is based on preparatory work on the European level. The feasibility and plausibility of a common OECD Eurostat list are examined using official statistics data from Bavaria from 2016 to 2018. The analysis includes an examination of the variability over time and within the Bavarian administrative districts, as well as possible systematic errors through regional differences in coding behaviour or changes over time. RESULTS: The OECD Eurostat list can be implemented at the regional level with only minor modifications. The age-standardized avoidable mortality in Bavaria in 2018 is almost 23 deaths per 10,000 inhabitants, with preventable deaths by far outweighing treatable deaths. For men, the death rate due to avoidable causes is 30 per 10,000 male inhabitants, which is almost twice as high as that for women (16 per 10,000 female inhabitants). The regional findings on avoidable mortality are consistent with findings on regional health from other studies. DISCUSSION AND CONCLUSION: The results do not indicate a threat to reliability due to random fluctuation or systematic methodological errors. The new version is recommended for application in health reporting.

[Prevention reporting-a new impetus for health reporting?] / Präventionsberichterstattung ­ neue Impulse für die Gesundheitsberichterstattung?

In 2015 the "Act to Strengthen Health Promotion and Prevention" (German Prevention Act) was passed. This act stipulates reporting on its implementation and impact by means of a regular prevention report by the National Prevention Conference. It also furthers prevention reporting at the regional level in the federal states. There are varying approaches and concepts of prevention reporting.The first prevention report by the National Prevention Conference was published in 2019. In the federal states, prevention reporting develops in different ways and at different rates, mirroring the heterogeneous conditions and concepts at the local level. This includes a varied interpretation of the relation of health reporting to prevention reporting: some see prevention reporting as part of health reporting, others tend not to and focus on aspects like the reporting of prevention structures and interventions.Challenges for the future of prevention reporting include the development of indicators and identification of data sources, particularly regarding resources for health, structural aspects, and living conditions. Further tasks are the development of feasible approaches to survey and report prevention interventions as well as the attempt to report outcomes and effects within causal models instead of merely reporting inputs and outputs.In conclusion, the dynamic induced by the German Prevention Act serves as a stimulus to health reporting-with a view to its contents, methods and policy relevance. Research to accompany and support the development of prevention reporting would be highly desirable.

[Establishing Prevention Reporting in Bavaria - Concept, Implementation and First Results]. / Aufbau einer Präventionsberichterstattung in Bayern ­ Konzept und erste Umsetzungsschritte.

BACKGROUND: Bavaria is currently embarking on the endeavour of building up systematic prevention reporting. Prevention reporting is meant to support the implementation of the Bavarian Prevention Plan and the German Prevention Law and to further the ongoing development in the field of health promotion and health-related prevention in Bavaria. GOALS: Prevention reporting in Bavaria aims to draw on general health reporting and complement it with specific prevention-related data taking into special consideration the Bavarian Prevention Plan. Particularly, data on prevention-amenable health determinants, prevention interventions, prevention spending and on indicators related to the targets of the Bavarian Prevention Plan are meant to be included. Periodic reporting will allow ongoing monitoring and the observation of trends. The reporting system will encompass shorter publications for the general public as well as more extensive reports for an expert audience. Where possible, data will be reported not only Bavaria wide but also on a smaller regional level to support local action. IMPLEMENTATION AND FIRST RESULTS: An extensive stocktaking of prevention and health promotion activities in Bavaria in 2014/2015 as well as a survey of the partner organisations in the Bavarian Prevention Alliance in 2016 presented an overview of the prevention scene in Bavaria. A core indicator set to support the implementation of the Bavarian Prevention Plan was developed in 2016 and a first short data brochure for the public was published. A comprehensive compilation of prevention-related data and a Bavarian prevention report are planned for 2017 and 2018. CONCLUSIONS: Like health reporting, prevention reporting, as conceptualised in Bavaria, presents overview data and thus allows a monitoring of prevention. For specific planning or evaluation purposes, it needs to be supplemented by more in-depth analyses. Current challenges include the development of valid, prevention-specific indicators, the generation of an empiric database and the attempt of a coordinated approach amongst the federal states within Germany.

Prevention survey in Bavaria - an approach to prevention reporting at the federal state level?

The Preventive Health Care Act stipulates the production of a national prevention report with the option of contributions by the federal states. Bavaria is currently establishing a system of prevention reporting. This effort aims to provide information on health related aspects relevant to prevention and health promotion and, through intervention reporting, deliver also a picture of current prevention measures. An online survey took stock of the measures of primary prevention and health promotion. This provided an overview of the Bavarian prevention landscape with respect to activities as well as aspects related to the structure and quality and allowed to derive recommendations for further development. Moreover, this article highlights the limitations of such a survey.

[Evidence and evaluation in health promotion and prevention: the example of the health promotion initiative "healthy living in Bavaria"]. / Evidenzbasierung und Evaluation in der Gesundheitsförderung und Prävention am Beispiel, Gesund. Leben. Bayern."

BACKGROUND: The use of evidence and evaluation is rapidly gaining importance in the field of health promotion and prevention. The evidence base, evaluation methods as well as the capacity and required competencies among practitioners are still being developed. AIMS: Beyond its specific health-related targets, the health promotion initiative "Healthy Living in Bavaria" aims to integrate the use of evidence and evaluation as key components into project funding as part of a total quality management concept. Another objective is the creation of new evidence for the field of health promotion and prevention. APPROACH: A core element of the quality management concept is the initiative's multistage evidence and evaluation model which embraces the initiative as a whole as well as the individual projects. The model is operationalized through a set of matching instruments for application, reporting, evaluation, and appraisal. CONCLUSION: Nationally as well as internationally, evidence and evaluation stand out as central aspects of quality improvement instruments in health promotion and prevention. Characteristic of Bavaria's quality improvement approach is the seamless process from the application to the evaluation under consideration of scientific as well as pragmatic aspects.

Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey.

OBJECTIVES: To assess the association of socioeconomic position with health (care) outcomes in type 2 diabetes with a particular focus on glycaemic control. METHODS: A cross-sectional survey in the region of Augsburg (Germany) on 373 men and women with type 2 diabetes, drawn from representative MONICA surveys and the myocardial infarct register. Analysis of association of socioeconomic position with HbAlc levels, cardiovascular risk factors and long-term macro- and microvascular diabetes complications using logistic regression models. RESULTS: Glycaemic control, measured by HbAlc levels, is strongly associated with indicators of socioeconomic position favouring the better off. Comparison of the lowest with the highest socioeconomic group showed an odds ratio of 2.49 (95% CI: 1.22-5.07) for the MI register subgroup and 1.80 (95% CI: 0.80-4.06) for the survey subgroup for failure to achieve the recommended HbAlc target. This association could not be accounted for by differences across social groups in age, sex, diabetes duration, obesity, or physical activity. CONCLUSIONS: Social inequalities in glycaemic control do exist. This finding may indicate a level of diabetes care that is inappropriate to the need of socially disadvantaged groups.

Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease.

BACKGROUND: (Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances. OBJECTIVE: To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates. METHODS: Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses. RESULTS: In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates. CONCLUSION: The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors.