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Background
The population-based mammography screening program (MSP) was implemented by the end of 2005 in Germany, and all women between 50 and 69 years are actively invited to a free biennial screening examination. However, despite the expected benefits, the overall participation rates range only between 50 and 55 %. There is also increasing evidence that belonging to a vulnerable population, such as ethnic minorities or low income groups, is associated with a decreased likelihood of participating in screening programs. This study aimed to analyze in more detail the intra-urban variation of MSP uptake at the neighborhood level (i.e. statistical districts) for the city of Dortmund in northwest Germany and to identify demographic and socioeconomic risk factors that contribute to non-response to screening invitations.
Methods
The numbers of participants by statistical district were aggregated over the three periods 2007/2008, 2009/2010, and 2011/2012. Participation rates were calculated as numbers of participants per female resident population averaged over each 2-year period. Bayesian hierarchical spatial models extended with a temporal and spatio-temporal interaction effect were used to analyze the participation rates applying integrated nested Laplace approximations (INLA). The model included explanatory covariates taken from the atlas of social structure of Dortmund.
Results
Generally, participation rates rose for all districts over the time periods. However, participation was persistently lowest in the inner city of Dortmund. Multivariable regression analysis showed that migrant status and long-term unemployment were associated with significant increases of non-attendance in the MSP.
Conclusion
Low income groups and immigrant populations are clustered in the inner city of Dortmund and the observed spatial pattern of persistently low participation in the city center is likely linked to the underlying socioeconomic gradient. This corresponds with the findings of the ecological regression analysis manifesting socioeconomically deprived neighborhoods as risk factors for low attendance in the MSP. Spatio-temporal surveillance of participation in cancer screening programs may be used to identify spatial inequalities in screening uptake and plan spatially focused interventions.
Management of agricultural processes is often troubled by disconnections and data transfer failures. Limited cellular network coverage may prevent information exchange between mobile process participants.
The research projects KOMOBAR and ISOCom designed, implemented und field-tested a delay tolerant platform for robust communication in rural areas and challenging environments. An adaptable combination of infrastructure-based cellular networks and infrastructure-free multihop ad hoc communication (WLAN) leads to a variety of new communication opportunities. Temporal storage and forwarding of data on mobile farm machinery as well as dynamic platform configurations during process runtime strongly enhance reliability and robustness of data transfers.
Restricted Versus Unrestricted Search Space : Experience from Mining a Large Japanese Database
(2015)
The aim of this study was to investigate whether standard Big Data mining methods lead to clinically useful results. An association analysis was performed using the apriori algorithm to discover associations among co-morbidities of diabetes patients. Selected data were further analyzed by using k-means clustering with age, long-term blood sugar and cholesterol values. The association analysis led to a multitude of trivial rules. Cluster analysis detected clusters of well and badly managed diabetes patients both belonging to different age groups. The study suggests the usage of cluster analysis on a restricted space to come to meaningful results.
BACKGROUND:
There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease.
OBJECTIVES:
To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain.METHODS: A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events.
RESULTS:
Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS.
CONCLUSIONS:
Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long-term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS.
The global climate system is currently warming due to the increase in CO2 emissions caused by humans. Technically oriented efficiency strategies are seen more frequently as solutions to reach the European Union’s maximum two degrees Celsius target. Companies play an important role in limiting climate change and must either prepare for such consequences or adopt new strategies such as the sufficiency strategy.
This article will discuss how the sufficiency strategy and the promotion of sufficient living in the context of the tourism industry can contribute to reducing CO2 emissions. Most common approaches toward sufficient living found in literature will be identified, analysed and discussed. Based on chosen keywords, the most common approaches were identified through a literature review of relevant journals from 1989 to 2014. Four main research fields that can promote sufficient living and reduce CO2 emissions were identified. Based on the prospects of the companies, it is apparent that sufficient strategies are not only able to support a market-orientated corporate management but also promote sufficient living and thus reduce CO2 emissions.
Background:
Recurrent pain is a common experience in childhood, but only few children with recurrent pain attend a physician. Previous studies yielded conflicting findings with regard to predictors of health care utilization in children with recurrent pain.
Methods:
The present study analyzes data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study comprising n = 2,149 children (3–10 years old) with recurrent pain to find robust predictors.We used multiple logistic regressions to investigate age, gender, socio-economic status(SES), migration background, pain intensity, pain frequency, pain-related disability, mental health problems, and health-related quality of life (HRQL) as predictors for visiting a doctor due to pain.
Results:
Overall, young girls with high pain-related disability, intensity, frequency, and migration background were more likely to attend a physician. Pain-related disability had the largest impact. Socioeconomic status, health-related quality of life anmental health problems were not systematically related to health care utilization. An analysis of the variability of these results indicated that several hundred participants
are needed until the results stabilize.
Conclusions:
Our findings highlight the importance of pain-related disability and frequency in assessing the severity of recurrent pain. Generic predictors and demographic variables are of lesser relevance to children with recurrent pain. On a methodological level, our results show that large-scale studies are need to reliably
identify predictors of health care utilization.
The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants’ responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals’ ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals’ criterion for giving a “painful” response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice.
Mind the gap
(2015)