Kinder- und Jugendmediziner spielen aufgrund ihrer Verordnungshäufigkeit eine wichtige Rolle bei Antibiotikaverordnungen im ambulanten Bereich in Deutschland. Trotz des Rückgangs in den letzten Jahren werden Antibiotika häufig nicht leitliniengerecht verordnet. Ziel der Studie war es, die Kenntnisse von niedergelassenen Kinder- und Jugendmedizinern über die Therapie häufiger Infektionskrankheiten zu untersuchen. Außerdem sollten Einflussfaktoren auf das Verordnungsverhalten und ein orientierender Überblick über den Bedarf an Fortbildungen zum rationalen Umgang mit Antibiotika in der Praxis ermittelt werden. Hierfür wurde ein Fragebogen entwickelt und an alle niedergelassenen Kinder- und Jugendmediziner in Bayern und Baden-Württemberg per Post versendet. Von 1661 kontaktierten Kinder- und Jugendmedizinern nahmen 681 (41%) an der Studie teil. Im Schnitt wurden 17.0 (SD=1.8) von 20 Fragen zu klinischen Fällen richtig beantwortet. Die selbst eingeschätzte Sicherheit im Umgang mit Antibiotika war hoch. Bei Entscheidungen zur Therapie mit Antibiotika wurde der größte Einfluss den Empfehlungen der Leitlinien und der geringste Einfluss Wünschen von Patienten bzw. deren Eltern zugeschrieben. Obwohl 85% der Teilnehmer in den letzten drei Jahren eine Fortbildung zum Thema Antibiotikatherapie besucht hatte, würden sich zwei Drittel ein größeres Angebot wünschen. Die Studie zeigte umfassende Kenntnisse niedergelassener Kinder- und Jugendmediziner zur Therapie häufiger Infektionskrankheiten. In weiteren Studien sollten die Ergebnisse mit objektiven Verordnungsdaten von Antibiotika verglichen und der Bedarf an weiteren Fortbildungsangeboten zu dem Thema genauer erforscht werden. / Pediatricians play an important role in prescribing antibiotics in the outpatient sector in Germany due to their prescription frequency. Although there has been a decline in recent years, antibiotics are still often not prescribed according to guidelines. The aim of this study was to investigate the knowledge of outpatient pediatricians regarding the treatment of common infectious diseases. Additionally, the study sought to identify factors influencing prescribing behavior and assess the need for further training on the rational use of antibiotics. To achieve this, a questionnaire was developed and sent by post to all outpatient pediatricians in Bavaria and Baden-Württemberg. Of the 1661 pediatricians contacted, 681 (41%) took part in the study. On average, 17 out of 20 questions on clinical cases were answered correctly. Self-assessed confidence in antibiotic use was high. The recommendations of clinical guidelines were reported as having the greatest influence on decisions regarding antibiotic treatment, while the wishes of patients or their parents had the least influence. Despite 85% of participants having attended further training on antibiotic therapy in the last three years, two-thirds expressed a desire for more training opportunities. The study revealed that outpatient pediatricians have extensive knowledge about the treatment of common infectious diseases. Future studies should compare these findings with objective antibiotic prescription data and further investigate the need for additional training courses on this topic.

Die vorliegende Studie untersucht den Einsatz von Kurz-Screening-Instrumenten (bestehend aus dem PHQ-4, mit seinen beiden Untereinheiten dem GAD-2 und dem PHQ-2) hinsichtlich der Tauglichkeit für einen Routineeinsatz in Hausarztpraxen. Gescreent wurde auf das mögliche Vorliegen einer Angst- und/oder depressive Störungen mit anschließender Validitätsprüfung einer kleineren Stichprobe. Hinsichtlich der Validitätsprüfung konnte zwischen den CIDI- und den Screening-Ergebnissen eine gute Übereinstimmung ermittelt werden (prozentuale Über-einstimmung von 80,8% bei einem Cohen-Kappa von 0,62). Insgesamt betrachtet lässt sich mit einem vertretbaren Mehrbedarf an Zeit für nicht-ärztliche Mitarbeiter ein PHQ-4-Screening in einer Hausarztpraxis durchführen. Durch diese Maßnahme können - bei gleichzeitiger Entlastung des Arztes - wichtige Informationen für eine Krankheitserkennung und für eine ggf. notwendige Therapie gewonnen werden. Über einen Routineeinsatz von Kurz-Screenern in der primär-ärztlichen Versorgung sollte nachgedacht werden. / The present study investigates the use of short screening instruments (consisting of the PHQ-4, with its two subunits the GAD-2 and PHQ-2), regarding the suitability for routine use in primary care practices. It was screened for the possible presence of anxiety and / or depressive symptoms with a following validity check on a smaller unit. The accordance between CIDI and the screening-results could be rated as good (accordance percentage of 80.8% with a Cohens kappa of 0.62). The PHQ-4 leads to a need of more non-medical employees(more time needed), but overall is the PHQ-4 a pracitable instrument in the primary care. Through a routine use of short-Screenern in the primary health care should be considered.

Objective: To examine health services use on the basis of alcohol consumption. Material and Methods: A cross-sectional study was carried out on patients visiting the Primary Health Care (PHC) settings in Catalonia during 2011 and 2012; these patients had a history of alcohol consumption. Information about outpatient visits in the PHC setting, hospitalizations, specialists’ visits and emergency room visits for the year 2013 was obtained from 2 databases (the Information System for the Development of Research in PHC and the Catalan Health Surveillance System). Risky drinkers were defined as those who consumed more than 280 g per week for men or more than 170 g per week for women, or any amount of alcohol while being involved in a high risk work activity, or taking medication that significantly interferes with alcohol or when being pregnant. Binge drinkers (>60 g in men or >50 g in women in a short amount of time more than once a month) were also considered risky drinkers. Results: A total of 606,948 patients reported consuming alcohol (of which 10.5% were risky drinkers). Risky drinkers were more likely to be admitted to hospitals or emergency departments (range of ORs 1.08–1.18) compared to light drinkers. Male risky drinkers used fewer PHC services than male light drinkers (OR 0.89, 95% CI 0.87–0.92). In general, risky alcohol users used services more and had longer hospital stays. When stratifying by socioeconomic level of the residential area, we found that risky drinking failed significance, while current or past cigarette smoking was associated with higher healthcare use. Conclusions: Risky drinkers use more expensive services, such as hospitals and emergency rooms, but not PHC services, which may suggest that prevention strategies and alcohol interventions should also be implemented in those settings.

Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment.