Introduction: In some rural, structurally weak areas in Germany, primary medical care is in peril. Fewer family practitioners have to care for a relative constant number of patients (shortage of future family physicians, demographic change). Aim of this qualitative study is to discern the concrete situation of medical care and daily practice from the perspective of the involved actors in two rural areas of Northrhine-Westfalia. Solutions for the securing of family practices which so far have not yet been discussed should be identified on the basis of sound knowledge of the local conditions.Material and Methods: Data about the situation of primary care were gathered by structured telephone interviews with the family practitioners. After that the perspective of professions involved in the health care of the population was examined by qualitative interviews. 14 interviews with 16 interviewees were conducted, including five of the seven family practitioners in the region.Results: Family practitioners in both regions see the future safeguard for family practice in peril, if there is nothing done against the actual developments in health care politics. They criticise insufficient and uncertain financing and growing bureaucratic and administrative tasks. Strongly criticised is the growing restriction of the scope in family practice, which is a form of deprofessionalisation. The interviews show a feeling of lacking acknowledgement from the health care system and society. Family medicine itself is nevertheless highly valued by the family practitioners. Especially the intensive doctor-patient-relationship in family practice in rural areas is a source for professional contentment.Conclusion: Varying context factors prove to be important for the family practice of the patients even within regionally restricted areas. We identified the professional self-conception that has to change according to new forms of cooperation as well as the necessity to develop a culture of dialog that aims for patient-centred and decentral primary care.
Summary: Global warming facilitates the importation of hitherto tropical infectious diseases also to Europe. Especially the introduction of the Asian Tiger Mosquito Aedes albopictus is an important prerequisite for the transmission of Chikungunya fever and Dengue fever. Whereas these infectious diseases are restricted to rare cases or isolated outbreaks, the West Nile fever has already arrived in several parts of Europe. Germany has been spared from these viral tropical diseases so far. However, the winter months in this country become more and more warm and humid. This may result in an increasing seasonal activity of rodent and tick populations thereby leading to significantly more infections with Hanta viruses, TBE viruses and Borrelia.
BackgroundHuman trafficking is defined as exploitation of a person by taking advantage of his or her plight. Thus, more individuals than commonly assumed are affected by human trafficking. Human trafficking includes forced prostitution, exploitative working conditions or forced criminal acts. Victims can seek out family physicians for different medical conditions.Search methodsThis text is based on the clinical article “victims of human trafficking and forced prostitution“ in Deximed (www.deximed.de), an online handbook for family physicians. For this article literature sources, identified by a selective literature research, were taken into account, including crime statistics, statements by the United Nations (UN) and the Council of Europe, reviews and other scientific publications.Main MessagesVictims of human trafficking seeking medical help cannot be easily identified at first sight. Escorts dominating and controlling the conversation with an affected person may be a hint. Scabies can be caused by a desolate housing situation or homelessness. Injuries or burns can be a signal for mistreatment. Sexual assault and forced prostitution can lead to genital infections or an unwanted pregnancy. Prevalence of mental illness, such as depression or substance abuse, is high. If human trafficking is suspected, victims can be referred to advisory centres to be found at “federal coordination council against human trafficking” or at “Fair mobility”. Here victims will get counselling and medical, therapeutic and legal help.ConclusionsFamily physicians can only identify and help victims of human trafficking if they are aware of the definition and of specific health conditions associated with human trafficking.Keywordshuman trafficking; human rights abuses, family medicine, medical care
