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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 70 (1999), S. 817-822 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Versorgungskosten ; Gemeindepsychiatrische Versorgung ; Schizophrenie ; Kosten-Effektivitäts-Analyse ; Key words Costs of care ; Community based mental health care ; Schizophrenia ; Cost-effectiveness-study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Empirical data on costs of care for chronically mentally ill patients in Germany are rare. There is a lack of cross-sectional studies as well as of any analysis of the long-term course of mental health care costs. This study combines data from two cost-studies on patients with schizophrenia, conducted in the same catchment area at an interval of 15 years, to draw conclusions about the long-term course of these costs. The direct costs of comprehensive community based mental health care had increased by 77.0% during 15 years, while the costs of a permanents stay in a long-term ward of a psychiatric hospital had increased by 78.5% in the same period. This increase was 27 and 28.5 per cent higher than the general rise in cost of living in Germany during the interval between the two studies. This higher-than-average increase in mental health care costs was accompanied by a much higher cost-effectiveness. Thus, this rise of costs must be seen as a consequence of the great deficits and the resulting basic improvement of care for chronically mentally ill patients in Germany, which was demanded by an expert-commission of the government in the mid-seventies.
    Notes: Zusammenfassung Empirische Studien über die Kosten der psychiatrischen Versorgung chronisch psychisch Kranker in Deutschland sind immer noch selten. Es fehlt nicht nur an Querschnittsuntersuchungen, sondern noch gravierender an Analysen über den Langzeitverlauf der psychiatrischen Versorgungskosten. Die vorliegende Studie stellt Daten aus zwei Kostenuntersuchungen, die im gleichen Versorgungsgebiet im Abstand von 15 Jahren an Patienten mit Schizophrenie durchgeführt wurden, gegenüber und zieht Schlußfolgerungen über den Langzeitverlauf der Versorgungskosten von Patienten mit Schizophrenie. Die empirisch ermittelten gemeindepsychiatrischen Versorgungskosten sind im 15-Jahreszeitraum um 77,0%, die der Dauerunterbringung im psychiatrischen Krankenhaus um 78,5% der Ausgangswerte gestiegen. Der Anstieg liegt damit um 27 bzw. 28,5 Prozentpunkte über der allgemeinen Preissteigerungsrate. Dem überproportionalen Anstieg der psychiatrischen Versorgungskosten steht eine parallel dazu erheblich gestiegene Versorgungseffektivität gegenüber. Dieser Anstieg muß zusätzlich auf dem Hintergrund der großen Qualitätsdefizite und des daraus resultierenden Nachholbedarfs der psychiatrischen Versorgung seit der Psychiatrie-Enquête gesehen werden.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 67 (1996), S. 757-764 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Medizinstudenten ; Bevölkerungsmeinungen ; Weiterbildung ; Meinungsführer ; Key words Medical students ; Public attitudes ; Professional education ; Opinion leaders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Numerous studies conducted during the past decades indicate that the public's attitude toward the mentally ill is strongly prejudiced. Since the attitude of the general public also has an effect on community-based psychiatric care, we must ask how public opinion might be influenced. One possible approach could be through so-called key community leaders – those who are highly respected in society because of their competence in a particular area. Doctors belong to this group of people. For this reason we questioned medical students, as future key community leaders, with respect to their attitudes toward the mentally ill within the framework of their first contact with psychiatric patients during their studies. In order to make a direct comparison possible, we interviewed a sample of the Mannheim population who live in a part of the city where a variety of complementary facilities have been set up. The comparison shows that medical students do not have a more positive attitude toward the mentally ill; in fact, in certain areas they have an even more negative attitude toward the mentally ill than the general population has. We were not able to establish what effect teaching has with respect to changing attitudes.
    Notes: Zusammenfassung Aus zahlreichen Untersuchungen der vergangenen Jahrzehnte wird erkennbar, daß die Einstellung der Bevölkerung gegenüber psychisch Kranken von großen Vorurteilen geprägt ist. Da die Einstellung der Allgemeinbevölkerung auch das gemeindenahe Konzept gemeindepsychiatrischer Versorgung beeinflußt, stellt sich die Frage, welche Möglichkeiten der Beeinflussung dieser Haltung in der Bevölkerung bestehen. Eine Zugangsmöglichkeit zur Bevölkerung besteht über sog. Vertrauens- oder Schlüsselpersonen, denen ein großes Maß an Kompetenz bei bestimmten Fragestellungen zugeordnet wird. Ärzte zählen zu diesem Personenkreis, der ein solch hohes Ansehen in der Bevölkerung genießt. Aus diesem Grund befragten wir Medizinstudenten als zukünftige Schlüsselpersonen im Rahmen ihres ersten ausbildungsbedingten Kontakes mit psychiatrischen Patienten im Hinblick auf ihre Einstellung gegenüber psychisch Kranken. Zum direkten Vergleich wurde eine Stichprobe der Mannheimer Bevölkerung befragt, die in einem Stadtteil wohnt, in dem verschiedene komplementäre Einrichtungen implementiert sind. Der Vergleich ergibt, daß Medizinstudenten keine positivere Einstellung gegenüber psychisch Kranken aufweisen und sogar in manchen Teilbereichen psychisch Kranke mehr ablehnen als die Allgemeinbevölkerung. Effekte des Unterrichts im Hinblick auf eine Einstellungsänderung konnten nicht festgestellt werden.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 245 (1995), S. 20-26 
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study presents a telephone survey of 501 randomly sampled residents of the Grand Duchy of Luxembourg older than 15 years of age. The interviewees were questioned on their attitudes and judgements towards mental health care in Luxembourg. The implementation of a community-based mental-health-services delivery system in Luxembourg is in its initial stages. Being the smallest member of the European Community Luxembourg offers the opportunity to analyze a whole catchment area in transition marked off clearly by national borders. As a general rule the people of Luxembourg are undecided when it comes to mental health care. Almost half of the sample answered “don't know” when asked about the quality of several sectors of mental health care, excluding inpatient care. The factors that had a significant influence on the attitude of the people of Luxembourg regarding mental health care were nationality, age, class and personal contact with mentally ill persons, with a tendency of worse judgements in younger age groups and in members of upper social classes. We fitted multivariate models including these variables. The results of our study point to entrenched prejudice. The findings suggest, however, that attitudes are changeable by direct or indirect contact with mentally ill persons. Possible strategies that could change public attitudes towards mental health care in a mental health care system that is in transition are discussed.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 246 (1995), S. 29-36 
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In many countries deinstitutionalization of psychiatric patients is accompanied by fragmentation of care, giving responsibility to an array of different services and providers. One of the possible side effects of this is an increased rehospitalization rate and length of stay. The need to coordinate the services involved for the benefit of individuals has led to the conceptual development of case management. However, despite an apparent belief in the effectiveness of case management, there is only limited scientific evidence to support this assumption. In the case control study presented we compared a group of 97 schizophrenic patients in the aftercare of case management services with a group of patients who received no outpatient care by case management services after discharge from hospital. Each patient in the case-managed group was exactly matched with a control patient with regard to diagnosis and known risk factors for rehospitalization. Additionally, we considered influencing factors that result from general health system conditions such as regional differences and different types of hospital care. Our analyses demonstrate that, during an observation period of 2.5 years, case management had neither a significant effect on the risk of rehospitalization nor on the length of time in hospital in the event of rehospitalization.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    New York, NY : Wiley-Blackwell
    Journal of Morphology 223 (1995), S. 109-118 
    ISSN: 0362-2525
    Keywords: Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Medicine
    Notes: Troglophilus neglectus (Gryllacridoidea, Raphidophoridae) is a nocturnal Ensifera which can be found in caves of Slovenia. The anatomy of the tibial organs in the fore-, mid-, and hindlegs, as well as the external morphology of the proximal fore-tibia and the prothoracic tracheal system, is described comparatively. In the prothorax and in the forelegs, no sound-conducting structures such as an acoustic trachea, enlarged spiracles, or tympana are developed. A group of 8-10 campaniform sensillae is located in the dorsal cuticle of the proximal tibia. In each leg, the tibial organ complex is built up by two scolopale organs, the subgenual organ and the intermediate organ; the structure and the number of scolopidia is similar in each leg. No structure resembling the crista acoustica is found. The subgenual organ contains around 30 scolopidia; the intermediate organ is subdivided into a proximal part containing 8-9 scolopidia and a distal part with 5-6 scolopidia. The two groups of scolopidia are not directly connected to the tracheal system. The tibial organs in the forelegs are insensitive to airborne sound, and they appear to be more primitive compared to those found in members of the Tettigoniidae and the Gwllidae. The results indicate that the complex tibial organs in all legs of T. neglectus are primarily vibrosensitive. © 1995 Wiley-Liss, Inc.
    Additional Material: 7 Ill.
    Type of Medium: Electronic Resource
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