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Background: We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements.
Methods: 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis.
Results: Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements.
Conclusion: The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.
"The limits of my language are the limits of my mind. All I know is what I have words for" (Wittgenstein). When learning something completely new, we connect the unknown term to an already existing part of our knowledge. We can only build new ideas and insights upon an existing conceptual foundation. In the field of statistics, we educators frequently find ourselves met with great confusion when teaching novices. These students, entirely unfamiliar with even basic statistics, must connect the introduced statistical terms within their personal existing networks of largely non-statistical knowledge. Lecturers, on the other hand, who are well versed in statistics, have deeply internalized the content to be taught and its relevant context. The juxtaposition of the two roles may produce amusement in a lecturer upon gaining insight into the word associations made by the statistical novices. For example, a ‘logistic regression’ does not involve the ‘shipping of goods in economically difficult times,’ though this might seem entirely reasonable and intuitive to the statistics learner. Other times, these different perspectives can lead to headaches and frustration for both learners and their lecturers. In this article, we illustrate how simple statistical terms are initially connected to a student’s pre-exiting knowledge and how these associations change after completing an introductory course in applied statistics. Furthermore, we emphasize the important difference between “term”, “approach”, and “context”. Understanding this fundamental distinction may help improve the communication between the lecturer and the learner. We offer a collection of practical tools for instructors to help promote students’ conceptual understanding in a supportive, mutually-beneficial learning environment.
Reduzierung im Außer-Haus-Verzehr zu erleichtern, analysiert unsere Studie die Auswirkungen von zwei gängigen Interventionsstrategien zur Reduzierung von Speiseresten in einem ganzheitlichen Verhaltensmodell. Auf der Grundlage eines quasi-experimentellen Baseline-Interventions-Designs haben wir in einem Strukturgleichungsmodell untersucht, wie sich das Aushängen von Informationspostern und die Reduzierung von Portionsgrößen auf persönliche, soziale und umweltbezogene Faktoren auswirken. Anhand von Daten aus Online-Befragungen und Beobachtungen von 880 Gästen (503 Baseline, 377 Intervention) während zwei Wochen in einer Universitätsmensa erlaubt das vorgeschlagene Modell, die Effekte der beiden Interventionen auf die Tellerreste spezifischen Veränderungen von Verhaltensdeterminanten zuzuordnen. Es hat sich gezeigt, dass die Verringerung der Portionsgröße bei den Zielgerichten mit einer geringeren Menge an Tellerabfällen zusammenhängt, die auf bewusster Wahrnehmung, die sich in einer geringeren Bewertung der Portionsgröße ausdrückt. Die Auswirkungen des Sehens von Informationsplakaten auf veränderten persönlichen Einstellungen, subjektiven Normen und wahrgenommener Verhaltenskontrolle beruhen. Je nachdem, wie eine Person auf die Information reagiert (indem sie sich nur bemüht, alle Speisen aufzuessen, oder indem sie sich bemüht und zusätzlich ein anderes Gericht in der Kantine wählt), ergeben sich jedoch entgegengesetzte Auswirkungen auf diese Determinanten und folglich auch auf die Tellerreste. Insgesamt sprechen die differenzierten Ergebnisse zu den Interventionseffekten dafür, dass ganzheitlichere und tiefer gehende Analysen von Interventionen zur Reduktion von Essensresten und damit zu einem nachhaltigeren Lebensmittelkonsum in der Außer-Haus-Verpflegung beitragen können.
What determines ingredient awareness of consumers? : A study on ten functional food ingredients
(2014)
Given the importance of consumer awareness of functional food ingredients for healthy food choices, the aim of this study is to explore consumers’ ingredient awareness and the determinants which influence the awareness about functional food ingredients.
A sample of 200 German consumers was interviewed via CATI (computer aided telephone interview) during September 2011. The participants have been asked about their specific awareness regarding to ten functional food ingredients. Likewise, determinants like health status and health motivation have been assessed and their influence on the construct “consumers’ ingredient awareness” has been tested by employing structural equation modeling.
The study shows that consumers’ ingredient awareness varies throughout the sample. Overall it can be stated, that 19% of consumer awareness about functional food ingredients is explained through the described model based on the following predictors: age, educational level, health status, health motivation and information strategies. Among these factors, consumers’ health motivation seems to have the highest relevance to explain consumer awareness. But also the determinants information strategies as well as the education show a significant influence on consumers’ ingredient awareness. As health motivation shows the highest impact on consumers’ ingredient awareness this study underlines the importance of prevention propensity for healthy food choices.
Objectives: eHealth and innovation are often regarded as synonyms - not least because eHealth technologies and applications are new to their users. This position paper challenges this view and aims at exploring the nature of eHealth innovation against the background of common definitions of innovation and facts from the biomedical and health informatics literature. A good understanding of what constitutes innovative eHealth developments allows the degree of innovation to be measured and interpreted.
Methods: To this end, relevant biomedical and health informatics literature was searched mainly in Medline and ACM digital library. This paper presents seven facts about implementing and applying new eHealth developments hereby drawing on the experience published in the literature.
Results: The facts are: 1. eHealth innovation is relative. 2. Advanced clinical practice is the yardstick. 3. Only used and usable eHealth technology can give birth to eHealth innovatio. 4. One new single eHealth function does not make a complex eHealth innovation. 5. eHealth innovation is more evolution than revolution. 6. eHealth innovation is often triggered behind the scenes; and 7. There is no eHealth innovation without sociocultural change.
Conclusions: The main conclusion of the seven facts is that eHealth innovations have many ingredients: newness, availability, advanced clinical practice with proven outcomes, use and usability, the supporting environment, other context factors and the stakeholder perspectives. Measuring eHealth innovation is thus a complex matter. To this end we propose the development of a composite score that expresses comprehensively the nature of eHealth innovation and that breaks down its complexity into the three dimensions: i) eHealth adoption, ii) partnership with advanced clinical practice, and iii) use and usability of eHealth. In order to better understand the momentum and mechanisms behind eHealth innovation the fourth dimension, iv) eHealth supporting services and means, needs to be studied. Conceptualising appropriate measurement instruments also requires eHealth innovation to be distinguished from eHealth sophistication, performance and quality, although innovation is intertwined with these concepts. The demanding effort for defining eHealth innovation and measuring it properly seem worthwhile and promise advances in creating better systems. This paper thus intends to stimulate the necessary discussion.
Climate change is expected to exacerbate the current threats to freshwater ecosystems, yet multifaceted studies on the
potential impacts of climate change on freshwater biodiversity at scales that inform management planning are lacking. The aim of this study was to fill this void through the development of a novel framework for assessing climate
change vulnerability tailored to freshwater ecosystems. The three dimensions of climate change vulnerability are as
follows: (i) exposure to climate change, (ii) sensitivity to altered environmental conditions and (iii) resilience potential.
Our vulnerability framework includes 1685 freshwater species of plants, fishes, molluscs, odonates, amphibians, crayfish and turtles alongside key features within and between catchments, such as topography and connectivity. Several
methodologies were used to combine these dimensions across a variety of future climate change models and scenarios. The resulting indices were overlaid to assess the vulnerability of European freshwater ecosystems at the catchment scale (18 783 catchments). The Balkan Lakes Ohrid and Prespa and Mediterranean islands emerge as most
vulnerable to climate change. For the 2030s, we showed a consensus among the applied methods whereby up to 573
lake and river catchments are highly vulnerable to climate change. The anthropogenic disruption of hydrological
habitat connectivity by dams is the major factor reducing climate change resilience. A gap analysis demonstrated that
the current European protected area network covers <25% of the most vulnerable catchments. Practical steps need to
be taken to ensure the persistence of freshwater biodiversity under climate change. Priority should be placed on
enhancing stakeholder cooperation at the major basin scale towards preventing further degradation of freshwater
ecosystems and maintaining connectivity among catchments. The catchments identified as most vulnerable to climate
change provide preliminary targets for development of climate change conservation management and mitigation
strategies.
Report on visits in hospices located in Osnabrück/Germany and the Saint Cristopher’s Hospice in London/United
Kingdom; and present a discussion about the care mode. Methods: Experience report based on a post-doctoral research period
in Germany between November 2013 and October 2014, funded by the CAPES Foundation (Coordination for the Improvement of
Higher Education Personnel). Results: The structure, operation mode of the institutions and the main labor force were discussed,
especially the nursing staff and volunteers’ participation, the main care activities and challenges. These issues were very similar
at the hospices, highlighting the hospice responsible for spreading this moviment worldwide. Conclusion: The hospice may be
the place of death, but it provides a pleasant environment that preserves the person’s individuality and autonomy. It relies on the
participation of volunteers, dissemination of its idea and training programs, which ensure the strengthening of this movement.
International research on a construct presupposes that the same measurement instruments are implemented in different countries. Only then can the results of the studies be directly compared to one another. We report on a study in which the English-language original of the Organizational Commitment Questionnaire (OCQ) as well as a German-language version of the OCQ was adapted into four further languages (Polish, Hungarian, Spanish, Malay) and validated. The employees of an international company were surveyed in seven countries (USA, Canada, Germany, Poland, Spain, Hungary and Malaysia). For purposes of validation, the job satisfaction, the self-rated job performance and the support of the employees in implementing the company values were used. The results show that the translations proceeded successfully. In all cases, a reliable scale emerges, which correlates positively with the validity criteria.
Background
To offer vaginal birth after cesarean (VBAC) in a hospital setting is recommended in international guidelines, but offering VBAC in out‐of‐hospital settings is considered controversial. This study describes neonatal and maternal outcomes in mothers who started labor in German out‐of‐hospital settings.
Method
In a retrospective analysis of German out‐of‐hospital data from 2005 to 2011, included were 24,545 parae II with a singleton pregnancy in a cephalic presentation at term (1,927 with a prior cesarean and 22,618 with a prior vaginal birth).
Result
The overall VBAC rate was 77.8 percent. The intrapartum transfer rate to hospital was 38.3 percent (prior cesarean) versus 4.6 percent (prior vaginal) (p < 0.05), and the 10‐minute Apgar < 7 rate was 0.6 versus 0.2 percent (p < 0.05), and the nonemergency intrapartum transfer rate was 91.5 versus 85.0 percent (p < 0.05). Prolonged first stage of labor was the most common reason for intrapartum transfer in both groups. The leading reason for postpartum transfer was retained placenta.
Discussion
There was a high rate of successful VBAC in this study. The high nonemergency transfer rate for women with VBAC might mean that midwives are more cautious when attending women with a prior cesarean in out‐of‐hospital settings. Further studies are necessary to evaluate which women are suitable for VBAC in out‐of‐hospital settings.
The development of base metal electrodes that can act as active and stable oxygen generating electrodes in water electrolysis systems, especially at low pH levels, remains a challenge. The use of suspensions as electrolytes for water splitting has until recently been limited to photoelectrocatalytic approaches. A high current density (j=30 mA/cm2) for water electrolysis has been achieved at a very low oxygen evolution reaction (OER) potential (E=1.36 V vs. RHE) using a SnO2/H2SO4 suspension-based electrolyte in combination with a steel anode. More importantly, the high charge-to-oxygen conversion rate (Faraday efficiency of 88% for OER at j=10 mA/cm2 current density). Since cyclic voltammetry (CV) experiments show that oxygen evolution starts at a low, but not exceptionally low, potential, the reason for the low potential in chronoamperometry (CP) tests is an increase in the active electrode area, which has been confirmed by various experiments. For the first time, the addition of a relatively small amount of solids to a clear electrolyte has been shown to significantly reduce the overpotential of the OER in water electrolysis down to the 100 mV region, resulting in a remarkable reduction in anode wear while maintaining a high current density.
Research into positive aspects of the psyche is growing as psychologists learn more about the protective role of positive processes in the development and course of mental disorders, and about their substantial role in promoting mental health. With increasing globalization, there is strong interest in studies examining positive constructs across cultures. To obtain valid cross-cultural comparisons, measurement invariance for the scales assessing positive constructs has to be established. The current study aims to assess the cross-cultural measurement invariance of questionnaires for 6 positive constructs: Social Support (Fydrich, Sommer, Tydecks, & Brähler, 2009), Happiness (Subjective Happiness Scale; Lyubomirsky & Lepper, 1999), Life Satisfaction (Diener, Emmons, Larsen, & Griffin, 1985), Positive Mental Health Scale (Lukat, Margraf, Lutz, van der Veld, & Becker, 2016), Optimism (revised Life Orientation Test [LOT-R]; Scheier, Carver, & Bridges, 1994) and Resilience (Schumacher, Leppert, Gunzelmann, Strauss, & Brähler, 2004). Participants included German (n = 4,453), Russian (n = 3,806), and Chinese (n = 12,524) university students. Confirmatory factor analyses and measurement invariance testing demonstrated at least partial strong measurement invariance for all scales except the LOT-R and Subjective Happiness Scale. The latent mean comparisons of the constructs indicated differences between national groups. Potential methodological and cultural explanations for the intergroup differences are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
How do companies decide where to locate their manufacturing? This study uses insights from manufacturing company executives collected by means of in-depth interviews with 50 manufacturers in the United Kingdom to develop an understanding of manufacturing location decision making. The findings indicate that companies derive competitive advantage from organizing manufacturing in different ways. Retaining or reshoring manufacturing to a company’s home country can enhance new product development, control of quality, product customization, delivery performance, and cost leadership. On the other hand, companies can enhance new product development, customization, and delivery performance for new markets, if production facilities are offshored to or in proximity to these locations. In addition, some companies use a hybrid approach of offshoring the production of some components or products for cost arbitrage while retaining or reshoring other components or products for advantages from value chain integration. Based on the findings of this study, a set of key manufacturing location questions are developed that should be considered by firms pondering onshore, offshore, reshore, or hybrid manufacturing location decisions.
Background and purpose:
Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score.
Methods:
Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice.
Results:
We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were “flow of data and information”, “mobility”, “clinical decision support and patient safety”, “electronic patient record” and “integration and distribution”. The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach.
Conclusion:
Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness.
Musicians often suffer from disorders of the musculoskeletal system that are related to their instrument playing. Among the most frequent symptoms are complaints in the shoulder-neck area. Radial shock wave therapy is increasingly used in trigger point treatment, but only few high-level studies have examined of shock wave therapy used together with physical therapy in the treatment of musicians. METHODS: This randomized blinded study in musicians (n = 26) with nonspecific shoulder-neck problems was done to examine the effect of shock wave therapy in addition to current physical therapy on the symptoms and quality of life of the musicians as well as their habits of playing musical instruments (intervention group shock wave vs reference group placebo). The effects were documented by a pain VAS and other instruments. A questionnaire designed specifically for musicians (with initial and final questions) recorded intensity and manifestation of pain and handicaps in daily life, especially when practicing and playing. The Shoulder Pain and Disability Index (SPADI) and the Neck Pain Disability Index Questionnaire (NPDIQ) were also used. RESULTS: Both groups reported subjective improvement in pain, but significance was found only for the intervention group for the SPADI and NPDIQ. CONCLUSIONS: Trigger point treatment with radial shock wave used in combination with physical therapy makes the subjects feel temporarily relieved of neck and shoulder pains. The effects of radial shock wave without physical therapy will need to be examined in further studies.
Hyperhydricity (HH) is one of the most important physiological disorders that negatively affects various plant tissue culture techniques. The objective of this study was to characterize optical features to allow an automated detection of HH. For this purpose, HH was induced in two plant species, apple and Arabidopsis thaliana, and the severity was quantified based on visual scoring and determination of apoplastic liquid volume. The comparison between the HH score and the apoplastic liquid volume revealed a significant correlation, but different response dynamics. Corresponding leaf reflectance spectra were collected and different approaches of spectral analyses were evaluated for their ability to identify HH-specific wavelengths. Statistical analysis of raw spectra showed significantly lower reflection of hyperhydric leaves in the VIS, NIR and SWIR region. Application of the continuum removal hull method to raw spectra identified HH-specific absorption features over time and major absorption peaks at 980 nm, 1150 nm, 1400 nm, 1520 nm, 1780 nm and 1930 nm for the various conducted experiments. Machine learning (ML) model spot checking specified the support vector machine to be most suited for classification of hyperhydric explants, with a test accuracy of 85% outperforming traditional classification via vegetation index with 63% test accuracy and the other ML models tested. Investigations on the predictor importance revealed 1950 nm, 1445 nm in SWIR region and 415 nm in the VIS region to be most important for classification. The validity of the developed spectral classifier was tested on an available hyperspectral image acquisition in the SWIR-region.
Semi-solid metal alloys, as used in thixoforming, have a special microstructure of globular grains suspended in a liquid metal matrix. The complex rheological properties are strongly influenced by the local solid fraction, particle shape, particle size and state of agglomeration. There is a high demand for models and software tools allowing the simulation of semi-solid casting processes. The material under investigation is a tin-lead alloy (Sn-15%Pb) which exhibits a similar microstructure to aluminium alloys. The experiments were performed with a concentric cylinder rheometer of the Searle type. Initially, the liquid alloy is cooled down to the semi-solid range under constant shearing and then kept under isothermal conditions for further experimentation. Based on the experimental data, a single-phase model has been derived where the semi-solid alloy is regarded as a homogeneous material with thixotropic properties and the microstructure is characterised by a structural parameter. The model consists of two parts: the equation of state, including a finite yield stress, and a rate equation for the structural parameter. The model equations are employed in numerical software and used for the simulation of characteristic filling cases and the comparison with the conventional filling.
Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond.
In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER.
The TIGER Initiative
(2016)
Background: Lumbar discectomy is considered a safe, efficacious and cost-effective treatment for selected cases of patients with leg pain associated with the presence of a disc protrusion. But despite technically successful surgery, 30 % of patients complain of persistent pain on long-term follow up. Identification of possible predictors for a negative outcome is important, in the search for appropriate pre- and/or post-operative care and prevention of persistent disability. There is some evidence in the literature that quantitative sensory testing (QST) measures may play a role in prediction of patients’ pain persistency, however, this has never been investigated in patients undergoing lumbar discectomy.
Objective: The aim of this study is to determine the predictive value of QST parameters, in combination with previously documented predictor variables such as medical/psychological/cognitive behavioural factors, in patients with lumbar radiculopathy and/or radicular pain, for predicting patients’ clinical outcome after lumbar discectomy.
Method: Participants with radiculopathy and/or radicular pain and confirmed imaging diagnosis of nerve root compression will be recruited from the elective surgery waitlist at one hospital. All participants will undergo lumbar discectomy performed by one neurosurgeon. A standardized QST protocol comprising all of the somatosensory sub-modalities that are mediated by different primary afferents (C-, Aδ-, Aβ-) will be performed prior to surgery. QST will be conducted in the patients’ main pain area and contralateral side, in the affected dermatome and at a remote control site. The presence of other predictor variables will be captured by questionnaires. Follow-up at 3 months will include QST and measurements of pain intensity, pain descriptors, functional status, health related quality of life, return to work and health care utilisation. A further 1-year follow-up will include the same measurements except QST.
Results/Conclusions: Identification of new predictor variables may assist in the development of pre-surgical screening methods and in targeted pre- and/or post-operative patient care, with the potential to improve patients’ functional status, quality of life, work capacity whilst also reducing health care costs associated with persistent disability
Objectives
The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data; to collect data around the development of BP throughout hospital admission; and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS).
Methods
This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner).
Results
Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89; 95% confidence interval (CI) 3.0 to 11.6; p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days; CI 10.8 to 15.3) than those who did not (median 10 days; CI 8.4 to 11.6; p = 0.034).
Conclusions
Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.