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In einer konsumorientierten Kultur ein Leben der Suffizienz zu führen, ist vielleicht eines der ehrgeizigsten Experimente, die ein Mensch unternehmen kann. Um diese Herausforderung zu untersuchen, haben wir einen sozial-praktischen Ansatz gewählt. Dieser Artikel basiert auf 42 qualitativen Interviews, in denen die Befragten gefragt wurden, warum und wie sie sich in einer westlichen Infrastruktur und Kultur suffizient verhalten. Die Ergebnisse deuten darauf hin, dass Suffizienz-orientierte Menschen bei ihren ressourcenintensiven Handlungen auf bestimmte Bedeutungen in der Alltagspraxis zurückgreifen. Diese Bedeutungen umfassen eine Mischung aus umweltfreundlichen Einstellungen, positiven sozialen Absichten und/oder persönlichen Verpflichtungen zur Sparsamkeit. Darüber hinaus haben wir eine Reihe spezifischer Praktiken identifiziert, darunter Teilen, Recycling und Wiederverwendung, die für einen ressourcenschonenden Lebensstil nützlich sind. Für unsere Befragten sind viele dieser Suffizienz-Praktiken regelmäßig im täglichen Leben anzutreffen und wurden nur selten hinterfragt. Anhand einer zusätzlichen Umfrage zeigen wir, dass diese Routinen zu einem weniger ressourcenintensiven Lebensstil führen und wie es einer kleinen Gruppe von Menschen gelungen ist, sich Suffizienzpraktiken anzugewöhnen. Die Mehrheit sieht jedoch keine Notwendigkeit für eine häufigere Umsetzung solcher Routinen, da die täglichen Entscheidungsprozesse weitgehend auf den Konsum von Produkten ausgerichtet sind.
Soil versus foliar iodine fertilization as a biofortification strategy for field-grown vegetables
(2015)
Iodine (I) biofortification of vegetables by means of soil and foliar applications was investigated in field experiments on a sandy loam soil. Supply of iodine to the soil in trial plots fertilized with potassium iodide (KI) and potassium iodate directly before planting (0, 1.0, 2.5, 7.5, and 15 kg I ha-1) increased the iodine concentration in the edible plant parts. The highest iodine accumulation levels were observed in the first growing season: In butterhead lettuce and kohlrabi the desired iodine content [50–100 μg I (100 g FM)-1] was obtained or exceeded at a fertilizer rate of 7.5 kg IO3--I ha-1 without a significant yield reduction or impairment of the marketable quality. In contrast, supplying KI at the same rate resulted in a much lower iodine enrichment and clearly visible growth impairment. Soil applied iodine was phytoavailable only for a short period of time as indicated by a rapid decline of CaCl2-extractable iodine in the top soil. Consequently, long-term effects of a one-time iodine soil fertilization could not be observed. A comparison between the soil and the foliar fertilization revealed a better performance of iodine applied aerially to butterhead lettuce, which reached the desired iodine accumulation in edible plant parts at a fertilizer rate of 0.5 kg I--I ha-1. In contrast, the iodine content in the tuber of sprayed kohlrabi remained far below the targeted range. The results indicate that a sufficient spreading of iodine applied on the edible plant parts is crucial for the efficiency of the foliar approach and leafy vegetables are the more suitable target crops. The low iodine doses needed as well as the easy and inexpensive application may favor the implementation of foliar sprays as the preferred iodine biofortification strategy in practice.
In this paper we want to review and discuss research on the effects of occupational health management activities and services on different outcomes like employee health and well-being or absenteeism and other economic outcomes. In part I we outline goals and functions of occupational health management (OHM), then characterize typical occupational health promotion interventions and describe principles for implementing and organizing OHM. Part II focuses on different OHM activities and services such as creating healthy and safe workplace, reducing work-family conflicts, providing counselling via employee assistance programs and implementing health circles or stress management interventions. We will also discuss intervention design and sample studies as well as meta-analytic data relating to the effectiveness of these interventions. Finally, part III is about the economic impact of OHM. Findings from a management evaluation approach for OHM will be discussed. Then we will concentrate especially on data linking health promotion interventions to absenteeism and financial outcomes expressed as cost savings or cost-benefit ratios. The concluding part summarizes key findings of this paper.
The concept of "quality" is quite complex and challenging. In higher education, quality might be defined very differently by the various stakeholders: the students and graduates might see quality in terms of making sure they get well-paid jobs, the academics might define quality from the perspective of being able to enter in scientific debates, the ministries might define quality in terms of the efficient use of resources for reaching certain goals. But even when such issues of clarification of meanings are solved, what are the tools which work. And what does quality mean with respect to internationalisation? A number of papers in this book address quality management from various angles, and provide food for thought for those who seek for good answers.
This book is the third in a series, and assembles contributions from authors who participated in the International Deans Course, a programme for leaders in higher education from East and West Africa and Southeast Asia respectively.
A patient presenting with local pain and limitation of movement in the temporomandibular region following surgery of the left temporomandibular joint (TMJ) is described. Manual techniques like distraction of the TMJ combined with motor control exercises to restore TMJ function were not sufficient to relieve the patient's symptoms and her orofacial functions. However, during manual assessment and treatment of cranial nervous tissue, in this case the auriculotemporal nerve and its interface, pain was relieved and orofacial functions improved.
Aims:
To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children.
Methods:
A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the ‘gold standard’ for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods.
Results:
A total of 43 (49%) children (aged 6–18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%.
Conclusion:
The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
Clinically Significant Differences in Acute Pain Measured on Self-report Pain Scales in Children
(2015)
Objectives
The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale–Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics.
Methods
This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS−R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with “a little less” and “much less” pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic–based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain intensity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain.
Results
A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain intensity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain.
Conclusions
The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain intensity, therefore limiting their potential generalizability.
This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak.
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.
Background: Clinical handovers at changes of shifts are typical scenarios of time restricted and information intensive communication, which are highly cognitively demanding. The currently available applications supporting handovers typically present complex information in a textual checklist-like manner. This presentation style has been criticised for not meeting the specific user requirements.
Objectives: We, therefore, aimed at developing a concept for visualising the overview of a clinical case that serves as an alternative way to checklist-like presentations in clinical handovers. We also aimed at implementing this concept in a handoverEHR in order to support the pre-handover phase, the actual handover, and the post-handover phase as well as at evaluating its usability and attractiveness.
Results: We developed and implemented a concept that draws on Tolman's pioneering work on cognitive maps that we designed in accordance with Gestalt principles. These maps provide a pictorial overview of a clinical case. The application to build, manipulate, and store the cognitive maps was integrated into an openEHR based handover record that extends conventional records with handover specific information. Usability (n = 28) and attractiveness (n = 26) testing with experienced clinicians resulted in good ratings for suitability for the task as well as for attractiveness and pragmatism.
Conclusion: We propose cognitive maps to represent and visualise the clinical case in situations where there is limited time to present complex information.
The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.
Background: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.
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.
Incidence of Tube Feeding in 7174 Newly Admitted Nursing Home Residents With and Without Dementias
(2015)
Background:
Tube feeding is a common form of long-term nutritional support, especially for nursing home residents, of whom many have dementia.
Objective:
Estimating the incidence of feeding tube placement in nursing home residents with and without dementia.
Methods:
Using claims data, we studied a cohort of newly admitted nursing home residents aged 65 years and older between 2004 and 2009. Analyses were stratified by dementia. We estimated incidence rates and performed multivariate Cox regression analyses.
Results:
The study cohort included 7174 nursing home residents. Over a mean follow-up of 1.3 years, 273 people received a feeding tube. The incidence per 1000 person-years was 28.4, with higher estimates for patients with dementia. When adjusting for age, sex, and level of care as a time-dependent covariate, influence of dementia decreased to a nonsignificant hazard ratio.
Conclusion:
It seems that not dementia itself but the overall clinical condition might be a predictor of tube feeding placement.
Sustainable market economy
(2015)
Work–life balance is one of the challenges of a globalized world. The study described in this chapter aimed to identify the factors influencing the work–life balance of working mothers. Additionally, we will describe differences and similarities between the well-being and working styles of German and US-American working mothers. It is particularly difficult for mothers to be successful, because to do so, they must master the double burden of work and family. In this study, 320 working mothers were surveyed, 142 in Germany and 178 in the USA. It was found that the cultural concepts of work–life balance of these working mothers are comparable. Furthermore, differences in working styles were identified: US-Americans valued both well-being and work–life balance more strongly than Germans. In both cultures, younger mothers felt more burdened by work than older mothers. This may indicate that competences are learned with an increasing age, enabling a more successful mastery of challenges, even though an increasing age usually has a negative effect on health. The number of children, family status and education did not influence work–life balance. These findings are further discussed in this chapter.
Gender disparities in German home-care arrangements
An ageing population correlates with rising needs for
long-term care (LTC). Support programmes should con-
sider the specific needs of the various subgroups of care
dependents and family caregivers. The objective of this
study was to analyse the gender-specific disparities in
home-care arrangements in Germany, and for this pur-
pose, survey and insurance claims data were used. A sur-
vey of 2545 insured care recipients with high-level care
needs was conducted in 2012 with the Barmer GEK, a
major German statutory healthcare insurance. Insurance
claims data were provided for a follow-up, focussing on
the group aged 60 years and older. For statistical compar-
ison, chi-squared test and t-tests were used, and a p-
value < 0.05 was considered statistically significant. Most
care recipients are female, and they are on average
2 years older than males. Men receive family care mostly
from their wives, whereas widows frequently live alone
and receive care from daughters, sons, other relatives,
neighbours and friends, as well as from professional
nursing services. Furthermore, women more often antici-
pate the need for (further) professional assistance and
move in with a relative or to an assisted living facility or
a nursing home in good time. The desired rate for reloca-
tion to a nursing home was higher than the anticipated,
and during the 6-month follow-up, the actual rate of
relocations was in between both. In summary, the caring
situation of men and women is different. Care-receiving
men are most often cared for by their wives. Widowed
women need a social network and their children in order
to remain in their own home. To provide better home-
care arrangements for women in this situation, the fam-
ily and social networks need a stronger focus in politics
and research. To stabilise the home-care situation of men
with high-level care needs, their wives need more
support.