scholarly journals The Effect of Heat and Cold Waves on the Mortality of Persons with Dementia in Germany

2020 ◽  
Vol 12 (9) ◽  
pp. 3664 ◽  
Author(s):  
Thomas Fritze
Keyword(s):  
Heat Effect ◽  
Health Claims ◽  
Heat Index ◽  
P Value ◽  
Term Care ◽  
Winter Climate ◽  
Cox Models ◽  
Cold Waves ◽  
Heat Effects ◽  
Health Claims Data

We investigated whether persons with dementia (PwD) are at particular risk of mortality when exposed to extreme temperatures and whether the temperature effect depends on long-term care (LTC) need and residency. German health claims data provide information on inpatient and outpatient sectors. Data from the German Meteorological Service were merged, and measures of immediate and delayed heat, cold, and normal temperature (Heat Index, Wind Chill Temperature Index) were calculated. Cox models were applied to explore the interaction of temperature, dementia, and LTC, as well as residency. Immediate and delayed effects of heat and cold were tested as compared to normal temperatures. Models were adjusted for age, sex, comorbidities, urban/rural living, and summer/winter climate zones. The 182,384 persons aged ≥65 contributed 1,084,111 person-years and 49,040 deaths between 2004 and 2010. At normal temperatures, PwD had a 37% (p-value < 0.001) increased mortality risk compared to persons without dementia (PwoD). Immediate heat effects further increased this effect by 11% (p = 0.031); no immediate heat effect existed for PwoD. The immediate heat effect was even greater for PwD suffering from severe or extreme physical impairment and for those living in private households and nursing homes. Immediate and delayed cold effects increased mortality independent of dementia. Care level and type of residency did not modify this effect among PwD. PwD revealed an increased vulnerability to immediate heat effects. Cold waves were risk factors for both groups. LTC need appeared to be an important intervening factor.

scholarly journals The Impact of Dementia and Extremity Injuries on the Plasticity of Long-term Care Demand: An Analysis of Counterfactual Projection Scenarios Based on German Health Insurance Routine Data

2019 ◽  
Vol 44 ◽  
Author(s):  
Alexander Barth
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Claims Data ◽  
Health Claims ◽  
Term Care ◽  
Home Based ◽  
Health Claims Data ◽  
The Impact ◽  
At Home

Although demand for long-term care (LTC) in Germany is expected to increase over the coming decades, the LTC sector will struggle to provide sufficient capacity. Evaluating the impact of different risk factors on future LTC demand is necessary in order to make informed policy decisions. With regard to LTC need, dementia and lower extremity injuries (LEI) are common risk factors. Both are used to demonstrate their maximum attainable efficacy in mitigating the future increase in overall LTC need, both at home and in nursing homes.We use a multi-state projection model for which the estimation of the underlying transition and mortality rates is based on longitudinal health claims data from AOK, Germany’s largest public health insurance provider, between 2004 and 2010. We project six different scenarios of LTC for ages 75+ in Germany for the period from 2014 to 2044, including counterfactual scenarios that remove the effects of LEI, dementia, or both. Our multi-state projections distinguish between home-based and institutional LTC.Removing the effect of LTC risk factors mitigates the increase in total LTC demand and postpones demand until a later age. Removing dementia markedly shifts future care demand from institutional LTC to LTC at home and even increases demand for LTC at home at older ages beyond the baseline projection due to the dual function of dementia as a risk factor for both LTC demand and mortality. Removing LEI has less of an effect on overall and sectoral LTC demand. Removing both risk factors at the same time results in the greatest impact, which is even more marked than that of both individual scenarios combined, thus indicating a synergistic relationship between dementia and LEI on LTC risk.The type of LTC demand (home-based or institutional) shows considerable plasticity when specific risk factors are removed. We demonstrate the degree to which LTC demand can be affected in favour of LTC at home, using dementia and LEI as examples of potentially modifiable risk factors, and thus show how the efficacy of potential intervention targets for policy-makers can be assessed.This study provides evidence on the degree of plasticity of future long-term care demand at home and in institutions that would hypothetically be attainable when completely removing specific cognitive or physical risk factors of care need (dementia or lower EI). It is based on large-scale health claims data, which contain longitudinal individual level data on morbidity and long-term care status. A close link exists between the cognitive risk factor of dementia and the type of LTC, as its absence shifts care demand to home-based care at older ages. The study also demonstrates the usefulness of counterfactual projections based on health claims data in assessing the hypothetical maximum efficacy of different intervention strategies.

Prevalence and Mortality of Venous Leg Diseases of the Deep Veins: An Observational Cohort Study Based on German Health Claims Data

Angiology ◽  
2020 ◽  
Vol 71 (5) ◽  
pp. 452-464 ◽  
Author(s):  
Daniel Kreft ◽  
Jonas Keiler ◽  
Eberhard Grambow ◽  
Sabine Kischkel ◽  
Andreas Wree ◽  
...  
Keyword(s):  
Claims Data ◽  
Health Claims ◽  
Postthrombotic Syndrome ◽  
Cox Models ◽  
Vein Thrombosis ◽  
Venous Ulcers ◽  
Venous Diseases ◽  
Health Claims Data ◽  
Observational Cohort ◽  
Deep Vein

This study estimates the prevalence and mortality of diseases of the deep veins of the legs such as deep vein thrombosis (DVT), postthrombotic syndrome (PTS), and venous leg ulceration (VLU). We used a random sample of 250 000 patients at age 50+ years of the register of the Allgemeine Ortskrankenkasse from 2004 to 2015. Selected manifestations of venous diseases assumed as risk factors for mortality were analyzed using Cox models while adjusting for various basic demographic and health characteristics. The prevalence in 2004 was 0.05% for DVT of the femoral veins, 0.50% for DVT of any deep veins, 0.86% for PTS, and 0.91% for VLU. The mortality rate in 2004 to 2015 was 20.40 deaths/100 person-years for DVT of the femoral veins, 10.69 for DVT of any deep veins, 4.34 for PTS, and 7.02 for VLU. The model revealed a 35% higher risk ( p < .001) in patients with any DVT, an 88% higher mortality ( p < .001) for femoral DVT, a 23% higher risk ( p < .001) for VLU, and no health disadvantage in persons with PTS. Our study revealed an increased mortality for patients with VLU and DVT. Even after adjustment for embolic events and infections of the venous ulcers mortality remained significantly higher.

Association between self-care and prognosis in 1123 patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Calero ◽  
E Hidalgo ◽  
R Marin ◽  
L Rosenfeld ◽  
I Fernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
Nyha Class ◽  
Self Care ◽  
P Value ◽  
Funding Source ◽  
Class Iii ◽  
Cox Models ◽  
Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

scholarly journals Predictive modeling of nontuberculous mycobacterial pulmonary disease epidemiology using German health claims data

2021 ◽  
Vol 104 ◽  
pp. 398-406
Author(s):  
Felix C. Ringshausen ◽  
Raphael Ewen ◽  
Jan Multmeier ◽  
Bondo Monga ◽  
Marko Obradovic ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Predictive Modeling ◽  
Claims Data ◽  
Health Claims ◽  
Disease Epidemiology ◽  
German Health ◽  
Health Claims Data

scholarly journals JADE: A tool for medical researchers to explore adverse drug events using health claims data

2014 ◽  
Vol 05 (03) ◽  
pp. 621-629 ◽  
Author(s):  
S.K. Sauter ◽  
C. Rinner ◽  
L.M. Neuhofer ◽  
M. Wolzt ◽  
W. Grossmann ◽  
...  
Keyword(s):  
Adverse Drug Events ◽  
Claims Data ◽  
Age Groups ◽  
Rule Learning ◽  
Health Claims ◽  
Drug Event ◽  
Study Cohort ◽  
Defined Daily Doses ◽  
Health Claims Data ◽  
Medical Researchers

SummaryObjective: The objective of our project was to create a tool for physicians to explore health claims data with regard to adverse drug reactions. The Java Adverse Drug Event (JADE) tool should enable the analysis of prescribed drugs in connection with diagnoses from hospital stays.Methods: We calculated the number of days drugs were taken by using the defined daily doses and estimated possible interactions between dispensed drugs using the Austria Codex, a database including drug-drug interactions. The JADE tool was implemented using Java, R and a PostgreSQL database.Results: Beside an overview of the study cohort which includes selection of gender and age groups, selected statistical methods like association rule learning, logistic regression model and the number needed to harm have been implemented.Conclusion: The JADE tool can support physicians during their planning of clinical trials by showing the occurrences of adverse drug events with population based information.Citation: Edlinger D, Sauter SK, Rinner C, Neuhofer LM, Wolzt M, Grossmann W, Endel G, Gall W. JADE: A tool for medical researchers to explore adverse drug events using health claims data. Appl Clin Inf 2014; 5: 621–629http://dx.doi.org/10.4338/ACI-2014-04-RA-0036

A feasibility study af a blended learning dementia care: elective course for nursing students

2020 ◽  
Vol 1 ◽  
pp. 125-131
Author(s):  
Azam David Saifullah ◽  
Sri Mulyani ◽  
Eria Riski Artanti
Keyword(s):  
Nursing Students ◽  
Blended Learning ◽  
Learning Strategy ◽  
Attitude Scale ◽  
Dementia Care ◽  
P Value ◽  
Term Care ◽  
People With Dementia ◽  
Elective Course ◽  
Care Course

As there is a limited long-term care options in Indonesia, people with dementia are cared for by their family. They often hospitalized as the condition progresses. Nurses are the profession with most contact. Therefore, preparing nursing students to care for people living with dementia is needed. Blended learning as e new learning strategy in dementia care for nursing student need to be evaluated to comprehend its feasibility in the future dementia care course.  This study aimed to evaluate the feasibility of a blended learning course for nursing students about dementia. A blended learning course was developed as a three-credits elective course that voluntarily joined by 42 fourth year nursing students. This course integrates the schedule, modules, and assignments in a learning management system called eLOK (Moodle based). One group pre-post test was conducted to evaluate this course using DKAS (Dementia Knowledge Assessment Scale) and DAS (Dementia Attitude Scale) as instruments. Google form was integrated to evaluate the course and the use of eLOK. Data were analysed using a paired t-test. 37 students (88.1%) completed the questionnaires. There is a significant improvement in knowledge towards dementia (t = 5.96, p value < .00) but not the attitude (t = 2.50, p value = .17) right after completing the course. Students also well appreciated the quizzes and project as the evaluation of learning outcomes of the course. Moreover, the audio-visual material in eLOK made them feel helpful in learning new topics and made new constructive experience of learning. In conclusion, this blended learning is feasible to be used as a learning method for delivering dementia care course.

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