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Hintergrund: Im Zuge der weltweiten Flüchtlingsbewegungen ist in den letzten Jahren eine hohe Anzahl an geflüchteten Personen nach Deutschland gekommen. Laut amtlicher Statistik lebten Ende 2018 ca. 1.780.000 Schutzsuchende in Deutschland (Statistisches Bundesamt 2019). Der Anteil weiblicher Schutzsuchender beträgt ca. 37,4 Prozent. Zirka 51 Prozent der geflüchteten Frauen, die in Deutschland ankommen und Asyl beantragen, befinden sich im gebärfähigen Alter zwischen 15 und 45 Jahren (Statistisches Bundesamt 2019a; _b). Darüber, wie viele schutzsuchende Frauen schwanger eingereist sind oder zum Zeitpunkt ihres Aufenthaltes in der Erstaufnahmeeinrichtung schwanger geworden sind, liegen keine Daten vor. Ebenso fehlen bisher in Deutschland repräsentative gesundheitsbezogene Daten von Schutzsuchenden (Frank, Yesil-Jürgens & Razum et al. 2017). Insbesondere zu den gesundheitlichen Problemlagen und Bedürfnissen von schutzsuchenden Frauen im Bereich Schwangerschaft, Geburt und postpartaler Phase liegen keine Erkenntnisse vor (Bozorgmehr, Mohsenpour & Saure et al. 2016; Heslehurst, Brown & Pemu et al. 2018). Internationale Studien deuten allerdings darauf hin, dass die gesundheitsbezogene Bedarfslage schutzsuchender Frauen komplex ist (Gagnon, Zimbeck & Zeitlin et al. 2009;van den Akker & van Roosmalen 2016). Die systematische Identifizierung von Versorgungsbedarfen und eine bedarfsgerechte Versorgungsplanung sind deshalb derzeit kaum möglich (Mörath 2019). Aus rechtlicher Perspektive ist diese unbefriedigende Situation ebenfalls problematisch (Klotz 2018). Die Umsetzung des völkerrechtlich bindenden internationalen Rechts auf ein für sie [Anmerk. d. V. : die Person] erreichbares Höchstmaß an körperlicher und geistiger Gesundheit (BGBI. 1976), welches von Deutschland 1976 ratifiziert wurde, sowie des UN-Übereinkommens zur Beseitigung jeder Diskriminierung der Frau von 1979 (BGBI. 1985) und der in der EU-Richtlinie 2013/33/EU in Kapitel IV aufgeführten Bestimmungen für schutzbedürftige Personen erfordert für diese spezifische Personengruppe vielfache Bemühungen. Denn die Förderung und Verbesserung der sexuellen und reproduktiven Gesundheit bzw. Rechte von schutzsuchenden Frauen kann einen Beitrag zu ihrer gesellschaftlichen Integration nach sich ziehen (Janssens, Bosmans & Temmerman 2005). Zuzüglich zur rechtlichen Situation schutzsuchender Frauen gilt das Recht ihrer Kinder auf Gesundheit. Im Artikel 24 der UN-Kinderrechtskonvention (UN, Committee on the Rights of the Child 2013) ist dieses verankert und unterstreicht u. a. für die Vor- und Nachsorge relevante Versorgungsbereiche wie z. B. prä- und postnatale Versorgung der Mütter, Aufklärung über Gesundheit und Ernährung u. w. m. (Deutsches Institut für Menschenrechte 2017).
Background
Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient’s care. Yet, to our knowledge, no study to date has examined the family caregivers’ exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient’s critical health events and relate that to the caregiver’s own psychological distress to examine associations with general health within a home-based palliative care situation in Germany.
Methods
A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data.
Results
The frequency of the caregiver’s exposure, or witness of, critical health events of the patient ranged from 95.2% “pain/discomfort” to 20.8% “family caregiver thought patient was dead”. The highest distress scores assessing fear and helpfulness were associated with “family caregiver felt patient had enough’” and “family caregiver thought patient was dead”. Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers.
Conclusions
Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver’s degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.
Background
This study describes a low-cost and time-efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST).
Method
Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non-specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated.
Results
Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind-up ratio) did not significantly correlate with QST.
Conclusion
Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low-cost screening tool in a clinical setting.
Significance
Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low-cost and time-efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.
Seit der Trennung von ihrem Freund klagt die 32-jährige Anne über morgendliche Kopfschmerzen, Parästhesien am Hinterkopf, Schwindel und verspannte Kiefermuskeln. Lange bleibt für ihren Hausarzt, die Psychologin und Physiotherapeut Professor Harry von Piekartz unklar, was die Symptome auslöst. Denn der Unruhestifter ist unsichtbar.
Ludwig ist irritiert. Auf seiner rechten Schulter hat sich eine sichtbare Beule entwickelt, die vor allem am Schreibtisch Schmerzen auslöst. Seinem Hobby, dem Kickboxen, kann er glücklicherweise noch nachgehen. Da die Beule weiter wächst und ihn seine Freundin darauf aufmerksam macht, dass er seinen Kopf schief hält, geht er zum Arzt und schließlich zu Physiotherapeut Prof. Dr. Harry von Piekartz.
Um den Anforderungen eines Erstkontaktes in der Physiotherapie gerecht zu werden, ist es unerlässlich, internistische oder viszerale Erkrankungen zu (er)kennen, die sich hinter muskuloskelettalen Symptomen verbergen können. Dr. Christoff Zalpour stellt die häufigsten Erkrankungen und ihre Symptome vor.
Sozial-emotionale Bildungsprozesse anzuleiten, ist eine zentrale frühpädagogische Aufgabe. Um deren erfolgreiche Umsetzung in Kindertageseinrichtungen besser planen zu können, wurde im Rahmen des Projektes „Integrierte und beteiligungsorientierte Planung in der Kindertagesbetreuung in Baden-Württemberg“ per Fragebogen erhoben, wie die frühpädagogische Arbeit in diesem Bildungsbereich von Fachkräften (N=366) derzeit gestaltet und erlebt wird. Die Mehrheit der Fachkräfte schenkte dem Bildungsbereich viel Beachtung („trifft zu“: 52,4%; „trifft eher zu“: 28,2%), wobei alltagsintegrierte Fördermethoden (Emotion Talk, induktiver Erziehungsstil) deutlich häufiger eingesetzt wurden als spezifische Fördermaterialien und -programme zum Erwerb von sozial-emotionaler Kompetenz. Mehr als jede zweite Fachkraft nahm den Umgang mit Kindern, die bereits Verhaltensauffälligkeiten zeigen, als besonders herausfordernd wahr („große fachliche Herausforderung“: 39,6%; „sehr große fachliche Herausforderung“: 15,0%), wobei Fachkräfte mit einem Studienabschluss sich weniger herausgefordert fühlten als solche mit einer Berufsausbildung (U=2568,5; p≤0,05). Eine längere Berufszeit ging dagegen mit einem höheren Herausforderungserleben einher (rSp=0,24; p≤0,01). Insgesamt wünschten sich die Fachkräfte in diesem Bildungsbereich eine stärkere kollegiale Unterstützung sowie Fort- und Weiterbildungsangebote seitens der Einrichtungsträger. Zukünftige Aufgaben für Träger von Kindertageseinrichtungen sowie Planungsverantwortliche in Städten und Kommunen liegen darin, sozial-emotionale Bildungsprozesse stärker zu fokussieren, den Einsatz effektiver Fördermethoden auszubauen und das Personal kontinuierlich weiter zu qualifizieren.
Purpose
In a knowledge-based society, one of the main driving forces of prosperity at city and regional levels is the ability to attract students and recently qualified graduates. The purpose of this paper is to identify the urban factors that contribute to “attractiveness” from a student perspective and to subsequently analyse the influence of these factors on students’ location choices. In the corresponding case study, the criteria identified were used to evaluate student satisfaction with the German city of Osnabrück.
Design/methodology/approach
A multi-level empirical research concept was used to analyse the relevant criteria. Focus group discussions served as the basis to design and conduct a survey of almost 2,300 students in the university city of Osnabrück at the end of 2016. A follow-up study in November 2017 at two universities in Berlin provided data for comparison.
Findings
Accessible – safe – clean and with affordable housing: these terms sum up the core expectations that students have of an attractive city. In contrast to the findings of Richard Florida regarding the creative class, cultural opportunities, exciting nightlife and a multicultural population were not important factors among the survey participants.
Research limitations/implications
As the study was conducted in two cities only, the findings cannot be generalised. It should be replicated in at least five other cities to validate and compare the research findings presented here. Furthermore, this study focused on the factors influencing the attractiveness of the city as a whole. However, the attractiveness of a specific neighbourhood may be of greater relevance to the decision-making process. As housing plays a major role, students’ particular needs with regard to accommodation should also be examined at greater depth.
Practical implications
Insights generated by the empirical study provide relevant information that may assist city stakeholders in taking effective measures regarding place management to attract and retain students.
Originality/value
To date, little research has been undertaken to empirically examine the specific factors that German students look for when deciding where to study and live. The goal of this paper is to present new empirical insights concerning the quality-of-life factors that influence students’ decision-making processes.
Ohne Worte
(2019)
Introduction
Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity.
Method
A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI.
Results
The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.
Discussion
Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.
Ein Silvesterböller verletzt ein Kind schwer im Gesicht. Trotz Operation und Physiotherapie bleiben schlimmste Schmerzen und gravierende zentralnervöse Störungen. Der Elfjährige kann sich nur schwerlich mimisch artikulieren oder die Gesichtsausdrücke seiner Eltern interpretieren. Geholfen hat ihm eine Kombination aus Hands-on-Techniken und zeitgemäßen Behandlungsmethoden auf neurowissenschaftlicher Basis.
Facets of Website Content
(2019)
Content is of primary importance in the World Wide Web. In particular, subjective perceptions of content are known to influence a variety of user evaluations, thereby altering attitudes and behavioral outcomes. Thus, it is essential that individually experienced facets of content can be adequately assessed. In a series of seven studies, we create, validate, and benchmark a measure for users' subjective view on web content. In the first six studies, a total of 3106 participants evaluated a sum of 60 websites. The resulting Web-CLIC questionnaire is a 12-item measure based on prior research on web content. It encloses four main facets of users' content experience: clarity, likeability, informativeness, and credibility – jointly representing a general factor subjective content perception. Very high internal consistencies and high short- to medium-term retest reliabilities are demonstrated. Strong evidence for construct validity in terms of factorial, convergent, divergent, discriminative, concurrent, experimental, and predictive validity is found. In a seventh study, encompassing 7379 ratings on 120 websites, benchmarks for 10 different content domains and optimal cut points are provided. Overall, the present research suggests that the Web-CLIC is a sound measure of subjective content perception of both practical and theoretical benefit.
Background and aims
In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q.
Methods
In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools.
Results
The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%).
Conclusions
The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice.
Implications
Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.