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Background
As individuals with thalidomide embryopathy now reaching their 60's they undergo long-term sequelae of their prenatal damage and experience a wide range of secondary health problems, in particular chronic musculoskeletal pain, movement restrictions, and mental disorders. These health problems are having a negative impact on their life circumstances and their health-related quality of life (HRQOL).
Objective
The aim of this study was to determine the HRQOL in individuals with thalidomide embryopathy in comparison to individuals of the age-adjusted general population in Germany with and without chronic disease conditions (primary outcome). And, further explore the influence of impairment patterns, pain stage, and mental disorders on physical and mental dimensions of HRQOL (secondary outcome).
Methods
A cross-sectional survey of 202 individuals with thalidomide embryopathy from North Rhine-Westphalia/Germany was conducted, which gathered information about physical examinations including a standardized determination of the pain stage, a structured psychological interview, and the HRQOL. The final dataset was 186 cases for primary outcome.
Results
Individuals with thalidomide embryopathy (50.6 years, 55.9% females) show a significantly reduced physical HRQOL comparison to the age-adjusted German population with chronic diseases (physical component score; pcs: 33.4 vs. 45.3, p < .001). In addition, male individuals with thalidomide embryopathy show a significantly reduced mental HRQOL to their male counterparts in this comparison (mental component score; mcs: 45.0 vs. 50.0, p = .005). The subgroup analyses show that individuals with thalidomide embryopathy with quadruple impairment have a significantly lower physical HRQOL than those with hearing loss (pcs: 25.0 vs. 38.5; ci's not overlapping). Second, individuals with thalidomide embryopathy with severe compared to mild stages of pain have significantly poorer levels of physical and mental HRQOL (pcs: 25.8 vs. 37.7, ci not overlapping; mcs: 40.4 vs. 51.8, ci's not overlapping). And, individuals with thalidomide embryopathy without a mental disorder show a high mental HRQOL (mcs: 53.2), while in comparison to the total sample those with somatoform and personality disorders have a significantly reduced physical HRQOL (pcs: 27.5 and 24.8; both ci's not overlapping), and those with depressive disorders have a significant reduced mental HRQOL (mcs: 38.0 vs. 45.8, ci's not overlapping).
Conclusions
A longitudinal decreasing HRQOL in individuals with thalidomide embryopathy is known, as well as high prevalence of mental disorders and chronic pain syndromes. This study shows a strong association between these two influencing factors and a poor HRQOL.
Ziel der Studie
Ziel der Studie war es, Häufigkeit, Lokalisation, Intensität, Qualität und Chronifizierungsgrad von Schmerzen bei Menschen mit vorgeburtlichen Conterganschädigungen (Thalidomid-Embryopathie) darzustellen sowie die Zusammenhänge mit biopsychosozialen Faktoren näher zu untersuchen.
Methodik
Erstmalig wurde eine Gruppe von 202 contergangeschädigten Menschen aus Nordrhein-Westfalen sowohl physisch auf das Muster der Ursprungsschädigung, als auch psychisch mittels eines strukturierten diagnostischen Interviews (SKID I & SKID II) untersucht. Diese Untersuchungsdaten wurden mit einem standardisierten Schmerzinterview (MPSS) sowie Fragebogenangaben zu weiteren schmerzbezogenen (SF-36, PainDetect) und soziodemografischen Variablen zusammengeführt und analysiert. Für die Analyse wurden letztlich 167 vollständige Datensätze berücksichtigt.
Ergebnisse
Die Schmerprävalenz betrug 94,0%. Die Mehrzahl (107 TN, 54,0%) wies im MPSS bereits fortgeschrittene Chronifizierungsgrade auf: 63 TN mit Stadium II (37,7%) bzw. 44 TN mit Stadium III (26,3%). Bei 74 Studienteilnehmern (44,3%) lag im PainDetect eine mögliche oder wahrscheinliche neuropathische Schmerzkomponente vor. Signifikante Zusammenhänge mit Schmerzchronifizierung zeigten sich bei Schmerzlokalisation im Hüftbereich (p<0,001) sowie bei dem Vorliegen von psychischen Störungen (p=0,001), insbesondere majoren Depressionen (p<0,001), somatoformen und substanzbezogenen Störungen (je p=0,001). Soziale Variablen erwiesen sich hierbei ebenso als nicht-signifikant (p=0,094 für Alleinleben, p=0,122 für Erwerbslosigkeit, p=0,167 für Nichtakademiker), wie die Versorgungssituation (p=0,191 für Pflegebedürftigkeit) und das zugrundeliegende organische Schädigungsmuster (p=0,229 für Hörschädigungen, p=0,764 für Dysmelien).
Schlussfolgerungen
Contergangeschädigte Menschen leiden häufig unter einer eigenständigen Schmerzkrankheit, die als thalidomid-induzierte Folgeschädigung verstanden werden kann . Es besteht ein starker Zusammenhang zwischen fortgeschrittener Schmerzchronifizierung und dem Vorhandensein von psychischen Störungen, welcher in der einer spezialisierten und individualisierten multimodalen Schmerzbehandlung besondere Berücksichtigung finden sollte.
Stability, performance and innovation orientation of a higher education funding model in Kazakhstan
(2021)
This article is situated in a growing body of literature, focusing on higher education reforms in countries which emerged, or re-emerged, 25 years ago as the Soviet Union dissolved. With the focus specifically on Kazakhstan, this paper examines how the leadership of universities in this country views a higher education funding model– the state grants. The paper applies the lenses of stability, performance and innovation orientation to the examination of the state grants-based higher education funding model in Kazakhstan. This paper finds that despite recognition of the limitations of the existing funding model, there is limited interest to push for changes. This can be explained by the complex higher education policy environment which is also discussed in this paper.
Hintergrund
Seit Jahren ist eine hohe Aktivität zum Zusammenschluss zu Netzwerken in der Betrieblichen Gesundheitsförderung (BGF) zu verzeichnen. Bislang gibt es nur wenige Evaluationen zu diesen Netzwerkbildungen. Ziel dieser Studie ist die Evaluation von Netzwerken in der BGF am Beispiel des regionalen Netzwerkes „Gesunde Betriebe Kinzigtal“. Das Netzwerk unterstützt Betriebe im Kinzigtal bei der Implementierung und Umsetzung von BGF.
Methode
Mittels einer Online-Befragung bewerteten die zuständigen Mitarbeitenden der beteiligten Unternehmen das Netzwerk und die Maßnahmen zur BGF. Schwerpunkte bilden die Konstrukte Zufriedenheit und Nutzen sowie die Wahrnehmung von Netzwerken in der BGF.
Ergebnis
Von den 21 am Netzwerk beteiligten Unternehmen, nahmen 13 an der Studie teil, dies entspricht einer Rücklaufquote von 62%. Die Analyse ergab eine positive Bewertung der Netzwerkarbeit. Die Unternehmen sind mit dem Netzwerk „Gesunde Betriebe Kinzigtal“ sowie den Maßnahmen zur BGF zufrieden und ziehen einen Nutzen hieraus. Weiterhin nehmen die Unternehmen das Netzwerk als hilfreich wahr und können von der Teilnahme profitieren.
Schlussfolgerung
Netzwerke stellen eine Unterstützung bei der Einführung und dauerhaften Umsetzung von BGF dar.
In diesem Beitrag wird die Rolle der in § 4 Abs. 1 KKG genannten Berufsgeheimnisträger*innen (z. B. Psychotherapeut*innen) bei Verdacht auf Kindeswohlgefährdung beleuchtet und ein mögliches fachliches Vorgehen zur Einschätzung und Abwendung einer Kindeswohlgefährdung beschrieben. Schwerpunkte bilden dabei datenschutzrechtliche Aspekte und die Frage der Gewichtung von Hinweisen auf eine Kindeswohlgefährdung
Footpad dermatitis (FPD) is an indicator of animal welfare in turkeys, giving evidence of the animals' physical integrity and providing information on husbandry management. Automated systems for assessing FPD at slaughter can present a useful tool for objective data collection. However, using automated systems requires that they reliably assess the incidence. In this study, the feet of turkeys were scored for FPD by both an automated camera system and a human observer, using a five-scale score. The observer reliability between both was calculated (Krippendorff's alpha). The results were not acceptable, with an agreement coefficient of 0.44 in the initial situation. Therefore, pictures of 3,000 feet scored by the automated system were evaluated systematically to detect deficiencies. The reference area (metatarsal footpad) was not detected correctly in 55.0% of the feet, and false detections of the alteration on the footpad (FPD) were found in 32.9% of the feet. In 41.3% of the feet, the foot was not presented straight to the camera. According to these results, the algorithm of the automated system was modified, aiming to improve color detection and the distinction of the metatarsal footpad from the background. Pictures of the feet, now scored by the modified algorithm, were evaluated again. Observer reliability could be improved (Krippendorff's alpha = 0.61). However, detection of the metatarsal footpad (50.9% incorrect detections) and alterations (27.0% incorrect detections) remained a problem. We found that the performance of the camera system was affected by the angle at which the foot was presented to the camera (skew/straight; p &lt; 0.05). Furthermore, the laterality of the foot (left/right) was found to have a significant effect (p &lt; 0.001). We propose that the latter depends on the slaughter process. This study also highlights a high variability in observer reliability of human observers. Depending on the respective target parameter, the reliability coefficient (Krippendorff's alpha) ranged from 0.21 to 0.82. This stresses the importance of finding an objective alternative. Therefore, it was concluded that the automated detection system could be appropriate to reliably assess FPD at the slaughterhouse. However, there is still room to improve the existing method, especially when using FPD as a welfare indicator.
Determination of sample size (the number of replications) is a key step in the design of an observational study or randomized experiment. Statistical procedures for this purpose are readily available. Their treatment in textbooks is often somewhat marginal, however, and frequently the focus is on just one particular method of inference (significance test, confidence interval). Here, we provide a unified review of approaches and explain their close interrelationships, emphasizing that all approaches rely on the standard error of the quantity of interest, most often a pairwise difference of two means. The focus is on methods that are easy to compute, even without a computer. Our main recommendation based on standard errors is summarized as what we call the 1-2-3 rule for a difference of two treatment means.
Background
As healthcare and especially health technology evolve rapidly, new challenges require healthcare professionals to take on new roles. Consequently, the demand for health informatics competencies is increasing, and achieving these competencies using frameworks, such as Technology Informatics Guiding Reform (TIGER), is crucial for future healthcare.
Aim
The study examines essential health informatics and educational competencies and health informatics challenges based on TIGER Core Competency Areas. Rather than examine each country independently, the focus is on uncovering commonalities and shared experiences across diverse contexts.
Methods
Six focus group interviews were conducted with twenty-one respondents from three different countries (Germany (n = 7), Portugal (n = 6), and Finland (n = 8)). These interviews took place online in respondents’ native languages. All interviews were transcribed and then summarized by each country. Braun and Clarke’s thematic analysis framework was applied, which included familiarization with the data, generating initial subcategories, identifying, and refining themes, and conducting a final analysis to uncover patterns within the data.
Results
Agreed upon by all three countries, competencies in project management, communication, application in direct patient care, digital literacy, ethics in health IT, education, and information and knowledge management were identified as challenges in healthcare. Competencies such as communication, information and communication technology, project management, and education were identified as crucial for inclusion in educational programs, emphasizing their critical role in healthcare education.
Conclusions
Despite working with digital tools daily, there is an urgent need to include health informatics competencies in the education of healthcare professionals. Competencies related to application in direct patient care, IT-background knowledge, IT-supported and IT-related management are critical in educational and professional settings are seen as challenging but critical in healthcare.
Introduction
Despite the improvements made in recent decades, the OECD regards hospital-acquired pressure injuries (HAPI) as high priority areas for actions to ensure patient safety. This study was aimed at investigating the degree of utilization of two types of electronic patient record systems for wound care on lowering HAPI rates. Furthermore, the effect of user satisfaction with the systems and perceived alignment with clinical processes should be studied.
Material and methods
A regression analysis of post-stratified data from German hospitals obtained from the Hospital Quality Reports (observed/expected HAPI ratio) and the IT Report Healthcare was performed. The sample comprised 319 hospitals reporting on digital wound record systems and 199 hospitals on digital nursing record systems for system utilization and the subset of hospitals using a digital system for user satisfaction and process alignment.
Results
The study revealed a significant effect of hospital ownership for both types of systems and a significant interaction of ownership and system utilization for digital wound record systems: Only the for-profit hospitals benefited from a higher degree of system utilization with a lower HAPI ratio. In contrast, non-profit hospitals yielded a reversed pattern, with increasing HAPI rates matching an increased system utilization. User satisfaction (significant) and the perceived alignment of the clinical process (trend) of the digital nursing record system were related with lower HAPI ratios.
Discussion
These findings point to a differential effect of system utilization on HAPI ratios depending on hospital ownership, and they demonstrate that those users who are satisfied with the system can act as catalysts for better care. The explained variance was small but comparable to other studies. Furthermore, it shows that explaining quality care is a complex undertaking. Sheer utilization has no effect while a differential perspective on the facilitators and barriers might help to explain the patient outcomes.
Background: As healthcare depends on health information technology, there is a growing need for Health Informatics competencies in daily practice. This review aimed to explore how the teaching of education in HI has been arranged. 28 publications, published in English between 2016 and 2020 and obtained from selected bibliographic databases, were reviewed. The data was analyzed using deductive content analysis with the following pre-formulated topics: target audience, course content and learning arrangements. The results highlight three key competencies: documentation and communication, management, and understanding of health information technology. It underlines a blended teaching method to improve the competencies of healthcare professionals, graduates, undergraduates, and suggests adding active interactions, multi-professional interactions, and hands-on skills. This study highlights the importance of adapting to changes in healthcare, improving HI competencies in healthcare, and fostering positive digital experiences. It underlined the need for practical training, in theory and hands-on sessions, including key competencies in documentation and communication, management and health information systems.