Lebenswissenschaften und Ethik
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Against the background of the huge rise in the number of asylum seekers and refugees absorbed into German society over the last couple of years this article examines the innovative Bavarian programme of preparatory classes for asylum seekers between 16 and 21 years of age. The challenges faced by educational and social work professionals working with this target group are documented alongside the particular resources which these highly-motivated young people as a rule bring with them. Specific requirements for psychotherapy professionals are addressed as well as a range of recommendations formulated by the author to enable the longer-term success of this vocational training programme in integrating these young people into the German educational and employment system. It has become apparent that a holistic approach to the lives of the target group by professionals in education, social work and therapy is necessary to enable young asylums seekers to complete vocational training successfully. Transitional management is a key part of the process of setting asylum seekers on the path to an apprenticeship. Coordination with the Labour Office, local authority administration and local decision-makers are further parts of the equation. This must intermesh with civil society engagement to provide the maximum use of resources giving young refugees access to training, the labour market and long term integration into German life.
Physical Education with Eduball Stimulates Non-Native Language Learning in Primary School Students
(2022)
Although the neuronal mechanisms of action and cognition are related, the division of intellectual and physical lessons is standard in schools. This is surprising, because numerous studies show that integrating physical education (PE) with teaching content stimulates critical skills. For example, several experiments indicate that Eduball-based PE (i.e., lessons in a sports hall during which students play team mini-games with educational balls with printed letters, numbers, and other signs) develops mathematical and language competencies. At the same time, the Eduball method does not slow down learners' physical development. However, we have little knowledge about the effects of such techniques on non-native language learning. Consequently, the absence of incorporating core academic subjects into PE in dual-language schools or during foreign language education is exceptionally high. Here, we replicated the Eduball experiment, but with the goal of testing this method for non-native language learning. Thus, the intervention occurred in a dual-language primary school and we evaluated second language (L2) learning. As before, we used the technique of parallel groups (experimental and control); in both groups, there were three 45-min PE classes per week. In the experimental class, two of them were held using Eduball. After a half-year experiment, children from the experimental group (one second-grade, N = 14) improved their non-native language skills significantly more than their peers from the control group (one second-grade, N = 12). These findings demonstrate that Eduball-type intervention stimulates non-native language learning in children. Hence, our report suggests that specific body training forms can support L2 learning.
Background
Older adults in care facilities face a high risk of experiencing depression. The impact that early interventions like biographical work have on the quality of life for older adults in such facilities is unknown.
Aim
To develop and evaluate a tablet-supported intervention for biographical work in long-term residential aged care to increase the quality of life for older adults.
Design
The study will be conducted in a randomized pretest–posttest control group design with follow-up testing in group and single settings. Participants will be randomized to the experimental intervention (tablet-supported biographic work) or the control intervention (planned tablet-supported game playing), each guided by senior volunteers. A total of 80 residents and 16 volunteers will be recruited. The primary outcome for the residents and volunteers will be quality of life as measured with the World Health Organization Quality of Life Assessment-for older adults. Secondary measures will be self-esteem and life satisfaction. In addition, we will examine residents’ ability to communicate and their functional independence.
Method
The first stage of the project involves developing an app. The app is developed in a user-centered, agile development process. It will use multimedia to prepare life history topics and links them to key questions. Next, a workshop is developed for the volunteers who accompany the use of the app in the institutions. During the second phase, biographic work stimulated by the app will be conducted in groups or individually with residents.
Discussion
This is the first known program tailored to older adults in care facilities and senior volunteers that aims to prevent depression by providing digitally supported biographic work.
The study is based on a German single-topic population survey on vaccination willingness against COVID-19 (VWC) by the authors (2020, n = 2014). The single-topic survey allowed us to test several competing explanations for VWC, as discussed in the literature. The VWC in the sample was 67.3%. Logistic regression was used to identify factors affecting VWC. Being at high risk from COVID-19 and having received flu vaccination have a positive impact on VWC. Perceived VWC of friends has a strong positive effect on respondents’ VWC. Bivariate relationships of gender, age, and level of education with VWC were no longer significant in a multivariate analysis. Trust in alternative medicine and belief in conspiracy theories have a negative effect on VWC.
Objectives
Germany has one of the highest numbers of coronary angiography worldwide. Nevertheless, we find a great variation between German regions for both, diagnostic coronary angiographies and percutaneous coronary interventions (PCI). We assume that this variation is not only due to variation in morbidity but also reflects factors such as guideline adherence, physician-patient communication and access to care.
In this mixed method project, we aim to first describe the variation of coronary angiographies and PCIs in different German regions. Secondly, we explore current practices and motives for (non-)adherences to guidelines in the diagnostic process of patients with suspected CHD. Based on these results, we consequently plan to develop a complex intervention (treatment pathway) to improve guideline adherence and thus appropriateness of coronary angiography.
Method
The projects will be organized according to the recommendation of the Medical Research Council for the development and evaluation of complex interventions. The first study will use descriptive methods based on routine data of three German Health Care Insurances and registry data to describe status quo and associated factors of coronary angiography. The second study will use qualitative methods to understand barriers and facilitators of guideline adherence and medical decision making. Furthermore, we will discuss variations in care and thereby identify implementation targets for the planned treatment pathway. Based on this information, we will develop local treatment pathways in four selected regions. Relevant peers will develop the local pathway in group discussions. Using this bottom-up approach, we directly address implementation challenges.
Older adults in long-term care homes are at high risk of experiencing
reduced quality of life (QoL) and depression. Technology-assisted biography work can have a positive impact on QoL and mood, but there is little research on its use with this target group. The purpose of this paper is to examine the effect of tablet-based biography work conducted by volunteers on the QoL of residents and volunteers. A pretest-posttest control group design with an intervention period of 3 months and a 3-month follow-up was used. Results show a significant increase in participation for volunteers and residents after
the intervention, which is stable for residents until follow-up. Volunteers also show significant improvement in mental QoL immediately after the intervention. There were no significant effects for life satisfaction, self-esteem, or depression. No significant changes were found for the control group. Digitally conducted tablet-based biography work appears to have effects on QoL-associated outcomes.
The utilization of virtual reality (VR) technology has shown promise in various therapeutic applications, particularly in exposure therapy
for reducing fear of certain situations objects or activities, e.g. fear of height, or negative evaluation of others in social situations. VR has been shown to yield positive outcomes in follow-up studies, and provides a safe and ecological therapeutic environment for therapists and their patients. This paper presents a collaborative
effort to develop a VR speech therapy system which simulates a virtual audience for users to practice their public speaking skills. We describe a novel web-based graphica user interface that enables
therapists to manage the therapy session using a simple timeline. Lastly, we present the results from a qualitative study with therapists and teachers with functional dysphonia, which highlight the potential of such an application to support and augment the therapists’ work and the remaining challenges regarding the design of natural interactions, agent behaviours and scenario customisation for patients.
OBJECTIVES:
To assess the quantity and evaluate the quality of policies and curricula focusing on conflicts of interests (COI) at medical schools across Germany.
DESIGN:
Cross-sectional study, survey of medical schools, standardised web search.
SETTING:
Medical schools, Germany.
PARTICIPANTS:
38 German medical schools. - INTERVENTIONS: We collected relevant COI policies, including teaching activities, by conducting a search of the websites of all 38 German medical schools using standardised keywords for COI policies and teaching. Further, we surveyed all medical schools' dean's offices. Finally, we adapted a scoring system for results we obtained with 13 categories based on prior similar studies. MAIN OUTCOMES AND MEASURES:
Presence or absence of COI-related policies, including teaching activities at medical school. The secondary outcome was the achieved score on a scale from 0 to 26, with high scores representing restrictive policies and sufficient teaching activities.
RESULTS:
We identified relevant policies for one medical school via the web search. The response rate of the deans' survey was 16 of 38 (42.1%). In total, we identified COI-related policies for 2 of 38 (5.3%) German medical schools, yet no policy was sufficient to address all COI-related categories that were assessed in this study. The maximum score achieved was 12 of 26. 36 (94.7%) schools scored 0. No medical school reported curricular teaching on COI.
CONCLUSIONS:
Our results indicate a low level of action by medical schools to protect students from undue commercial influence. No participating dean was aware of any curriculum or instruction on COI at the respective school and only two schools had policies in place. The German Medical Students Association and international counterparts have called for a stronger focus on COI in the classroom. We conclude that for German medical schools, there is still a long way to go.
The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research.
What is the current state of SDM in health policy?
The "Patients' Rights Act" from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership.
What is the current state of SDM interventions and patient decision support tools?
SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care, specifically for national cancer screening programs.
What is the current state of research and routine implementation?
The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts.
What does the future look like?
With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.
The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.
This field report presents and discusses methodological issues and challenges encountered in a mixed-methods research project on asylum seekers in Bavaria, Germany. It documents the research design of, and field experiences in, a quantitative survey based on a quota sampling procedure and a qualitative study, both of which were conducted in collective accommodation for asylum seekers at selected locations in that federal state. Standardized PAPI multiple-topic questionnaires were completed by asylum seekers from Syria, Afghanistan, Eritrea, and Iraq (N = 779); most of the questionnaires were self-administered. In addition, 12 qualitative face-to-face biographical interviews were conducted in order to gain an in-depth understanding of attitudes and experiences of asylum seekers. This report focuses on the following aspects: the use of gatekeepers to facilitate participant recruitment; sampling procedures; the involvement of interpreters in the data collection process; response bias and response behaviors among asylum seekers; and the experiences gained from data collection in collective accommodation for asylum seekers.
This study examines attitudes toward assisted reproductive technologies (ART) among immigrant women and non-migrants in Germany. The social relevance of ART is increasing in Western countries due to overall low birth rates, a high rate of childlessness, and a gap between the desired and the actual numbers of children. Previous literature has been scarce, however, on attitudes toward ART, and immigrant minorities have rarely been included in studies on ART.
Our working hypotheses are drawn from theoretical considerations on political socialisation and cultural integration. The analysis is based on data collected in a pilot study in 2014 and 2015. The sample includes 960 women aged 18 to 50 living in Germany. About 81 percent of the sample are immigrants who originate from Turkey, Poland, the Balkan countries, or countries of the (Russian) Commonwealth of Independent States (CIS). We study the social norm to use ART to have a child, the personal attitude of whether a woman would use ART herself, and the methods that they would consider for their own use.
Our results show that ART is overall socially acceptable, and the majority of women said that they would use it if necessary. There is significant variation between the origin groups, however. Non-migrants show the lowest acceptance rates and migrants from Poland and Turkey the highest approval. There is also variation in the ART procedures considered for use with the migrants more approving of heterologous methods than non-migrants. The differences between the origin groups diminish only partly when controlling for further explanatory variables, i.e. gender-role attitudes, religiosity, and socio-demographic characteristics of the respondents.
We conclude that attitudes toward ART are shaped less by socio-demographic characteristics, but rather by cultural factors and the socialization in the migrants' countries of origin. The diversity in attitudes toward ART by cultural background should be acknowledged in research and public discourses on ART as well as in regulating policies.
This study examines attitudes toward assisted reproductive technologies (ART) among immigrant women and non-migrants in Germany. The social relevance of ART is increasing in Western countries due to overall low birth rates, a high rate of childlessness, and a gap between the desired and the actual numbers of children. Previous literature has been scarce, however, on attitudes toward ART, and immigrant minorities have rarely been included in studies on ART.
Our working hypotheses are drawn from theoretical considerations on political socialisation and cultural integration. The analysis is based on data collected in a pilot study in 2014 and 2015. The sample includes 960 women aged 18 to 50 living in Germany. About 81 percent of the sample are immigrants who originate from Turkey, Poland, the Balkan countries, or countries of the (Russian) Commonwealth of Independent States (CIS). We study the social norm to use ART to have a child, the personal attitude of whether a woman would use ART herself, and the methods that they would consider for their own use.
Our results show that ART is overall socially acceptable, and the majority of women said that they would use it if necessary. There is significant variation between the origin groups, however. Non-migrants show the lowest acceptance rates and migrants from Poland and Turkey the highest approval. There is also variation in the ART procedures considered for use with the migrants more approving of heterologous methods than non-migrants. The differences between the origin groups diminish only partly when controlling for further explanatory variables, i.e. gender-role attitudes, religiosity, and socio-demographic characteristics of the respondents.
We conclude that attitudes toward ART are shaped less by socio-demographic characteristics, but rather by cultural factors and the socialization in the migrants’ countries of origin. The diversity in attitudes toward ART by cultural background should be acknowledged in research and public discourses on ART as well as in regulating policies.
Hintergrund/Zielsetzung
Der Beitrag befasst sich mit dem Wissenstand und der Einstellung der Bevölkerung. Betrachtet werden die Übermittlung und Verfügbarkeit von Gesundheitsdaten, Gesundheitsregister, die elektronische Patientenakte, Einwilligungsverfahren für die Übermittlung von Daten und der Zugriff auf Gesundheitsdaten zu Forschungszwecken.
Methoden
Die Studie basiert auf einer computergestützten Telefonbefragung (Dual-Frame) bei einer Zufallsstichprobe der Bevölkerung in Deutschland im Zeitraum 01.-27.06.2022 (n = 1.308).
Ergebnisse
Der Wissensstand zur Übermittlung von Gesundheitsdaten an Krankenkassen ist hoch, wohingegen das Vorhandensein zentraler Sterbe-, Impf- und Gesundheitsregister sowie der Zugriff auf Gesundheitsdaten durch behandelnde Ärztinnen und Ärzte überschätzt werden. Die Akzeptanz medizinischer Register ist sehr hoch. Die elektronische Patientenakte ist bei der Hälfte der Bevölkerung unbekannt, die Nutzungsbereitschaft ist eher gering ausgeprägt; bei der Übertragung von Daten wird eine Zustimmungsoption bevorzugt, und über achtzig Prozent würden die Daten der elektronischen Patientenakte zur Forschung freigeben. Drei Viertel würden ihre Gesundheitsdaten allgemein zur Forschung freigeben, insbesondere an Universitäten in Deutschland, wobei meist Anonymität Bedingung ist. Die Bereitschaft zur Datenfreigabe steigt mit der Höhe des Vertrauens in die Presse sowie in Universitäten und Hochschulen, und sie sinkt, wenn ein Datenleck als schwerwiegend erachtet wird.
Diskussion und Schlussfolgerung
In Deutschland besteht, wie in anderen europäischen Ländern, eine große Bereitschaft zur Freigabe von Gesundheitsdaten zu Forschungszwecken. Dagegen ist der Wunsch zur Nutzung der elektronischen Patientenakte eher gering. Ebenso niedrig ist die Akzeptanz einer Widerspruchsoption, die jedoch als Voraussetzung für eine erfolgreiche Einführung einer elektronischen Patientenakte gilt. Vertrauen in die Forschung und staatliche Stellen, die Gesundheitsdaten verarbeiten, sind zentrale Faktoren.
The professional requirements in Software Engineering have become highly volatile due to the complexities of project development and rapid and innovative changes occurring in the field. Therefore, the development of inter-personal and social competences has gained central importance in the training of software developers. This paper will present a concept allowing to acquire competences by using Case Method and Role Play as instruments in several lectures of Software Engineering. By approaching the issue of competence acquisition on a technical as well as on an educational and social level, life-long learning is facilitated and supported.
Choosing wisely in Germany - adapting an international initiative to a national healthcare agenda
(2016)
Overuse and underuse in healthcare is a chronic problem in most healthcare systems. Inspired by the North American Choosing Wisely Initiative, the Association of Scientific Medical Societies in Germany (AWMF), which actually counts 173 member organisations, decided to address the problem. The aim of the German “Gemeinsam klug entscheiden” (deciding together wisely)-initiative is to reduce overuse, underuse and misuse of health interventions in areas where recommendations of clinical practice guidelines (CPG) are not adequately implemented or missing. Starting point are the positive and negative recommendations of the CPGs, which the AWMF-member societies have developed for more than 20 years, following the manual and rules set up by AWMF. To identify and select recommendations methodological criteria have been developed by a working group in a consensus-based process. The development of AWMF-CPGs follows a methodology that aims to ensure the full integration of evidence, an interdisciplinary and interprofessional perspective, the prevention of bias as a consequence of conflicts of interest and full transparency of the development process.
Background:
With the prevalence of burnout among surgeons posing a significant threat to healthcare outcomes, the mental toughness of medical professionals has come to the fore. Mental toughness is pivotal for surgical performance and patient safety, yet research into its dynamics within a global and multi-specialty context remains scarce. This study aims to elucidate the factors contributing to mental toughness among surgeons and to understand how it correlates with surgical outcomes and personal well-being.
Methods:
Utilizing a cross-sectional design, this study surveyed 104 surgeons from English and German-speaking countries using the Mental Toughness Questionnaire (MTQ-18) along with additional queries about their surgical practice and general life satisfaction. Descriptive and inferential statistical analyses were applied to investigate the variations in mental toughness across different surgical domains and its correlation with professional and personal factors.
Results:
The study found a statistically significant higher level of mental toughness in micro-surgeons compared to macro-surgeons and a positive correlation between mental toughness and surgeons' intent to continue their careers. A strong association was also observed between general life satisfaction and mental toughness. No significant correlations were found between the application of psychological skills and mental toughness.
Conclusion:
Mental toughness varies significantly among surgeons from different specialties and is influenced by professional dedication and personal life satisfaction. These findings suggest the need for targeted interventions to foster mental toughness in the surgical community, potentially enhancing surgical performance and reducing burnout. Future research should continue to explore these correlations, with an emphasis on longitudinal data and the development of resilience-building programs.
Thinking like a Lawyer - Human Rights and Their Association with the Plastic Surgeon of Today
(2022)
Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal
interpretation falls within the remit of legal experts.
However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights
(ECHR).
Three-dimensional Medical Printing and Associated Legal Issues in Plastic Surgery: A Scoping Review
(2023)
Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon’s workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes.
BACKGROUND
Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, we aimed to synthesize the available literature and investigate the impact of sarcopenia on peri- and postoperative outcomes across all surgical specialties.
METHODS
We systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Our primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at one, three, and five years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population, and on those of higher quality or prospective study design.
RESULTS
A total of 294 studies comprising 97,643 patients, of which 33,070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P<0.00001). A significantly lower survival rate in patients with sarcopenia was noted at one, three, and five years (all P<0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P<0.00001), cardiovascular (both P<0.00001), and emergency (P=0.03 and P=0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia (P<0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients (P=0.007). Sensitivity analysis based on higher-quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P<0.00001).
CONCLUSION
Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons to identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical sub-specialties.
Background:
People with aphasia (PWA) often suffer from reduced participation and quality of life. Nevertheless, there are currently only a few specific interventions that respond to this problem. Participation and quality of life could be increased by interacting with peers who have similar experiences. Digital social networks could stimulate an autonomous interaction. However, digital social networks need to be adapted to the specific needs of PWA. Therefore, a participatory, agile process involving the target group should be chosen to develop such a olution, i.e., an app. The research project consists of a total of three phases. In the first phase—app development—the app was developed and programmed including the target group. In the second phase—app testing—the usability and user-friendliness of the app were evaluated with four PWA. In the third phase—feasibility and preliminary effcacy—that will be described in the article, the impact of the app on PWA will be evaluated.
Aims:
The overarching aim of our study is to provide preliminary effcacy of the intervention. Digital social interaction with other PWA can lead to increased social integration. In addition to digital interaction, personal encounters between PWA should be encouraged. As a result, we expect an improvement in quality of life of PWA. Additionally, we focus on identification of the most appropriate measurements to discover changes associated with the intervention.
Methods:
The evaluation, which is described in this paper, takes place in a pre-test - post-test design with a total of n = 48 PWA. Participants will be recruited in regional clusters to facilitate face-to-face meetings. Half of the participants will be assigned to the delayed intervention group and the other half to the immediate intervention group. Participants in the delayed intervention group will go through a 3-month waiting period before using the app, while the participants of the immediate intervention group will start using the app for 3 months right away. Inclusion criteria are the presence of chronic aphasia (at least 6 months) and possession of a smartphone with internet access. Questionnaires on quality of life (SAQOL-39, GHQ-12), depression (GDS, DISCs), communicative participation (CPIB), and social support (F-SozU) will be conducted at inclusion (t0), after 3 months of app use (t1), and after another 3 months for follow-up (t2). Participants in the delayed intervention group will be assessed twice before the intervention, before the 3-month waiting period (t0a) and after the waiting period (t0b). In addition to the quantitative measures, interviews will take place with 6 to 8 selected participants after 3 months of app use. Responses will be analysed using Thematic Analysis.
Discussion:
The app will be the first social network tool that is systematically developed with PWA. Initial indications from the first phases are that the app can be used by PWA, so that the evaluation of this app version can take place in the third phase. Results of this study can provide an initial indication of whether social network support is a suitable intervention. Findings will help provide information on the feasibility of digital connectivity for PWA. Preliminary findings on its impact on the participation and quality of life of PWA could be made available.
The progress of medical genetics leads to a significant increase in genetic knowledge and a vast expansion of genetic diagnostics. However, it is still unknown how these changes will be integrated into medical practice and how they will change patients' and healthy persons' perception and evaluation of genetic diagnoses and genetic knowledge. Therefore, we carried out a comprehensive questionnaire survey with more than 500 patients, clients seeking genetic counseling, health care staff, and healthy persons (N = 523). The questionnaire survey covered detailed questions on the value of genetic diagnoses for the different groups of study participants, the right to know or not to know genetic diagnoses, possible differences between genetic and other medical diagnoses, and the practical use and implications of genetic knowledge with a special focus on hereditary neuropsychiatric diseases. A huge majority of the participants (90.7%) stated to have a right to learn every aspect of her or his genetic make-up. Similarly, study participants showed high interest (81.8%) in incidental health care findings-independent of whether the diseases are treatable or not. One can derive from the data outcome that study participants did not follow the implications of a "genetic exceptionalism" and often considered genetic findings as equivalent in relation to other medical diagnoses.
Hintergrund
Inhalte von Public Health werden in Deutschland in gesundheitsbezogenen Studiengängen an Hochschulen und Universitäten gelehrt. Ziel dieser Studie war es, Daten zur Lehre und zur Kooperation von Lehrenden von Public Health in gesundheitsbezogenen Studiengängen in Deutschland zur Verfügung zu stellen.
Methode
Eine Querschnittsuntersuchung wurde online-basiert vom 01.06. bis 15.09.2015 an 93 Hochschulen/Universitäten in Deutschland mit 351 Studiengangsverantwortlichen aus gesundheitsbezogenen Studiengängen durchgeführt. Einbezogen wurden Public Health Studiengänge und gesundheitsbezogene Studiengänge, deren Hochschulen bzw. Universitäten entweder Mitglied in der "Deutschen Gesellschaft für Sozialmedizin und Prävention" (DGSMP) oder in der Gesellschaft "Hochschulen für Gesundheit" (HOGE) sind. Teilgenommen an dieser Studie haben N=104 Studiengangsverantwortliche (43% Männer, 57% Frauen). In Public Health Studiengängen wurden „Global Health" und "Umwelt und Gesundheit" als Studieninhalte häufiger als in gesundheitsbezogenen Studiengängen benannt; in gesundheitsbezogenen Studiengängen wurden häufiger "Ethik" und "Gesundheitspsychologie" als Lehrinhalte benannt. Finanzielle Unterstützungen durch die Hochschulen/ Universitäten sowie strukturierte Partnerschaften zwischen Hochschulen und/ oder Universitäten werden von Lehrenden an Hochschulen (36%) und an Universitäten (40%) gewünscht. Lehrende an Hochschulen wünschen darüber hinaus Promotionspartnerschaften.
Schlussfolgerung
Bisher gibt es in Deutschland keine einheitlichen fachlichen Qualitätskriterien für Absolvierende von Public Health bzw. gesundheitsbezogenen Studiengängen. Zudem gibt es nach Aussage der Studiengangsverantwortlichen dieser Studiengänge wenig Kooperation zwischen Lehrenden der Public Health bzw. der gesundheitsbezogenen Studiengänge.
The elite sport movement for athletes with hearing impairments, namely Deaflympics, differs from the Paralympic and Olympic sport movements because it exhibits a variety of distinct sociocultural and organisational characteristics. Yet, mental training with Deaflympic athletes receives little to no attention from the scientific community. Little is known about sport psychology consultants’ (SPCs) work with Deaflympic athletes. In this study, we explored SPCs’ exposure to so called Deaf sport as well as their experiences, attitudes, and assumptions regarding the utility of psychological skills training (PST) with Deaflympic athletes. A self-constructed questionnaire with closed and semi-open questions was completed by 93 (58.8% female) SPCs in European German-speaking countries. Analyses revealed SPCs had limited exposure to Deaflympic sport but indicated readiness to work with Deaflympic athletes. SPCs shared no reasons as to why PST skills and techniques would not be effective with Deaflympic athletes. However, SPCs regarded communication challenges as a major obstacle. We conclude that the integration of elite Deaf sport in SPCs’ training programmes is vital, considering SPCs’ lack of exposure and experience with Deaflympic athletes as well as their communication insecurities. In addition, further empirical research on PST effectiveness in Deaflympics athletes should provide the foundation for evidence-based utility of applied sport psychology in Deaflympic sport.
Background and Objectives
Older adults in long-term residential aged care experience loneliness and reduced quality of life (QoL). Biographical approaches use the recall of the past events to increase self-efficacy, promote acceptance, and improve QoL. The aim of the systematic review was to examine the effectiveness of biographical approaches in improving the QoL of older adults in long-term residential aged care.
Research Design and Methods
This systematic review was conducted in accordance with PRISMA guidelines, using databases Medline, CINAHL, and the Cochrane Library. A 2-phase search strategy was used to identify research literature relating to the use of biographical interventions. Narrative analysis was used to synthesize results.
Results
Twenty-one studies met inclusion criteria for this review, comprising both group and individual interventions. The findings were inconsistent. Subjective elements of QoL of older adults improved in a narrow majority of the studies. Of a total of 21 outcomes investigated in group interventions, 11 resulted in significant improvements in QoL. The 16 outcomes of the individual interventions resulted in 10 significant improvements. The most significant influence was observed in life satisfaction. Group reminiscence also had a particularly strong influence on self-esteem.
Discussion and Implications
Although benefits were observed, it remains unclear why some interventions led to improvements in subjective elements of QoL and others did not. Exploration of the participant perspective through qualitative data collection and more detailed description of interventions in future studies could lead to a better understanding of the treatment components that are related to improved outcomes for older adults.
Physical inactivity is a problem in Europe, contributing to various non-communicable diseases (NCDs). While health sciences offer data and models for preventing the development of NCDs through health promotion, they do not explain the dynamics between the different institutions and actors in the health field. Neofunctionalism refers to these different actors and suggests that their interaction leads to the construction of a supranational authority, allowing the actors to cooperate on common policies, rules and institutions, resulting in integration and Europeanization. Indeed, there are a variety of European Union (EU) institutions and policies concerned with physical activity (PA), however, the purpose of this paper is to analyze if Europeanization and integration are happening in PA promotion, through the lens of neofunctionalism. Analysis uses process tracing for investigating the emergence of PA on the EU agenda, the legal background, existing policies and institutions. Findings indicate that Europeanization and integration of PA promotion are happening, although the opportunity for actions of the EU are restricted to voluntary actions of the EU Member States due to the agreements in the Treaty of Lisbon. This only allows the EU institutions to apply soft law approaches on PA promotion, which seems to be implemented in some Member States despite its non-binding character. The findings are discussed and further implications for public health professionals and policies outlined.
Background:
Adolescent substance use is a global and local (Hawaii) problem. Therefore, the study goal was to develop and investigate the effect of an adolescent substance use prevention intervention website in Hawaii.
Methods:
A website was developed including drug overviews, health effects, how to stay away, external prevention and treatment resources, and an evaluation. Three grade 11 classes completed a baseline (T1) survey based on website content and a follow-up (T2) assessment after a 15-minute website interaction. - Results: At T1, 63/72 and at T2, 62 students participated (16–17 years old; 92% female; 87.2% Filipino). The number correct increased from 48.0% (SD = 14.5) at T1 to 82.0% (SD = 15.3) at T2 (t(59) = 13.5, p < .001). Eleven of twelve topics improved (p < .5) which addressed mental disorder drug use, workplace meth-use in Hawaii, Americans in need of drug/alcohol treatment, stimulant drugs, side effects of drugs, drug related domestic/child abuse, short-term drug effects, Hawaii and national methuse, chemicals in drugs, how to stay away, and ways of treatment.
Conclusions:
Adolescents improved their substance use prevention understanding. This is promising considering the brief, inexpensive, potentially scalable intervention which can be implemented within high school curricula.
Gemeinsam Klug Entscheiden – Initiative der AWMF und ihrer
Fachgesellschaften – ein Werkstattberich
(2017)
Gemeinsam Klug Entscheiden ist eine Initiative der AWMF und ihrer
Fachgesellschaften, mit dem Ziel, Empfehlungen zu Versorgungsaspek-
ten in die Versorgung zu bringen, für die ein großes Verbesserungspoten-
tial besteht. Der Impuls dafür wurde durch die TOP-5-Listen der Choosing
Wisely Kampagne gegeben. Ziel des Posters ist es das Vorgehen und die
Methodik für eine evidenzbasierte Entwicklung bekannt zu machen und
zu diskutieren im Hinblick auf Machbarkeit und Verbesserungspotential.
Im Rahmen des Projektes AUT-1A wurden 123 Arbeitgeber*innen mittels Fragebogen zu ihren Erfahrungen mit der Beschäftigung von autistischen Mitarbeiter*innen befragt. Ziel war es, die beschäftigungsfördernden und -hindernden Faktoren herauszuarbeiten. Die Studie deutet darauf hin, dass sich die berufliche Qualifizierung in den Berufsbildungswerken positiv auf die nachhaltige Beschäftigung von Menschen mit Autismus-Spektrum-Diagnose (ASD) auswirkt, die Unterstützungsleistungen für Betriebe aber noch nicht hinreichend sind. Auch konnte eine mangelnde Aufklärung in Bezug auf eine autismusfreundliche Umgebungsgestaltung sowie eine mangelnde Aufklärung über die Diagnose Autismus der direkten Kolleg*innen herausgearbeitet werden.
This article presents results of the social-scientific evaluation of an established care model for people with dementia developed by the professionals as a result of acute problems in care in north-east Germany. In addition to the central elements of the model, the conditions of intersectoral and interprofessional cooperation as well as the qualification profile requirements of the professional groups involved are presented in detail. The results can give suggestions for the organization of integrated care for people with dementia in other countries. Further, the author would hereby like to highlight the gain from the scientific examination of solutions to problems in the field.
Defining Criteria for Guiding Cancer Patients to Find a Reputable Complementary Medicine Provider
(2020)
Purpose: Even in cases of positive evidence for complementary medicine (CM) therapies, it is still difficult for cancer patients to identify reputable providers. The aim of this study was to develop and evaluate a criteria list to provide guidance to cancer patients seeking a reputable CM provider.
Methods: The design combined a literature review, an expert consensus procedure (n=15) and an assessment from three stakeholder perspectives (patients (n=18), CM providers (n=26) and oncology physicians (n=20)).
Results: A total of 30 existing CM criteria were extracted from the literature, and 12 more were added by the experts. The main challenge was to define criteria that could easily be applied by the patients. A final comprehensive list of 8 criteria guiding cancer patients to find a reputable CM provider was developed.
Conclusion: Health professionals and cancer information services might find the criteria list helpful when aiming to strengthen patients' awareness of quality-related factors associated with CM providers. The criteria developed might be helpful when standards are established for quality assurance in CM in oncology.
Old wine in new wineskins?
(2013)
In the mid 2000s, a fundamental labour market reform has been carried out in Germany. The so-called Hartz-reforms were supposed to implement the paradigms of “activation” and “individual responsibility”. It was also discussed, whether in this context the “adult worker model” and more gender equality in the labour market should and could be achieved. This article clarifies the reforms ambivalent impact on women: there is a stronger but only partial labour market inclusion predominantly into the low-wage sector. Women´s responsibility in private care remains unchanged. Besides, in both fields, gender equality is not only a matter of quantity but also of quality. In other words, it is not about work inclusion at any cost, but rather the circumstances for female employment must be critically analyzed. The labour market reforms have so far done little to oppose the gender specific structures of the labour market.
Purpose
The purpose of this study was to gather data about physical activity and quality of life (QoL) for people of working age with visual impairments to optimize upcoming physical activity-based interventions in vocational rehabilitation.
Methods
Two hundred and seventy-seven former participants of four vocational rehabilitation centres in Germany answered an online questionnaire. The health-related QOL has been assessed by means of the WHOQOL-BREF questionnaire. The data were analysed via multivariate analysis of covariances (MANCOVAs), univariate analysis of covariances (ANCOVAs) and discriminant function analysis.
Results
Compared to a normative group of adults aged 36-45, the study group showed lower values in all domains of QOL. The MANCOVA (visual acuity) produced no multivariate significant effect. Also, the ANCOVA showed no significant effect for the global dimension of the WHOQOL-BREF. The MANCOVA (leisure time activity) produced a multivariate significant effect. Post-hoc ANCOVAS revealed significant effects for all four domains of QoL. The ANCOVA analysing the global domain showed a similar significant effect as well. The active persons had higher values in all domains of QoL compared to the more passive participants.
Conclusion
Interventions in vocational rehabilitation should focus on leisure time activity to enhance QoL. At this stage, the role of physical activity is still unclear and further studies are needed.
Implications for rehabilitation People with visual impairments often show a worse quality of life than normal-sighted people.
The degree of severity of the visual impairment does not affect quality of life.
Sport and physical activity are effective means of improving quality of life.
An active leisure time activity supports the improvement of the quality of life of visual-impaired people that participated in a vocational rehabilitation.
The purpose of this study was to empirically analyze the sports background, personality dimensions, attitudes, and social competencies of adult head coaches and young assistant coaches involved in the German Einfach Fußball ( Just Soccer) program, which promotes the participation of pupils with intellectual disabilities in soccer/sports and society. Methods. The study recruited 28 head coaches and 29 assistant coaches who completed a questionnaire battery of standardized instruments (NEO Five-Factor Inventory, Interpersonal Reactivity Index, Social Self-Efficacy) as well as self-developed instruments. Analysis of the data involved descriptive and inferential statistical procedures. A descriptive comparison of the assistant coaches with a normative sample of males aged 16–20 years was performed. Results. The head coaches were found with little soccer/sports experience with persons with disabilities prior to participation in the Just Soccer program. However, the majority were familiar with these persons through personal/vocational contacts. Overall, the head coaches were differentiated by formal coaching levels and playing backgrounds, with very few holding any additional formal qualifications in special education. The assistant coaches pre
sented below average scores in the analyzed five personality dimensions when compared with the normative sample. Their attitudes
and social competencies did not change during their 8-month involvement in Just Soccer . Conclusions. The findings highlight
the important role of the coaching staff in the success of the Just Soccerprogram. coaches involved in such activities should be familiarized with needs of people with disabilities, be stress-resistant, and possess a balanced set of personality traits. In addition, the results suggest that such individuals should be coaches/players from conventional soccer clubs instead of special school physical education teachers.
esearch was and still is involved in the controversial issue about innate talent or extensive practice as the determinants of excellent performance in a range of domains. This study aims to contribute by presenting an analysis of practice activities in a domain that appears to be particularly suitable—orchestral conducting. Most conductors usually attain expertise in instrument playing prior to commencing conducting studies. Twenty-seven students of German study programs of orchestral conducting (approximately 18.7% of the population) responded to a questionnaire about their practice activities in conducting programs and their instrumental experiences. Descriptive results show the wealth of prestudy experiences conducting students have. A clear influence on practice activities cannot be stated. During study, students rated conducting-specific practice activities as more demanding and devoted more time to them than to general music practice activities. Therefore, conducting-specific practice activities might have been practiced more deliberately than general music practice activities.
The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely campaign in 2012 and until today convinced more than 50 US specialist societies to develop lists of interventions that may not improve people’s health but are potentially harmful. We suggest combining these new efforts with the already existing efforts in clinical practice guideline development. Existing clinical practice guidelines facilitate a more participatory and evidence-based approach to the development of top 5 lists. In return, adding top 5 lists (for overuse and underuse) to existing clinical practice guidelines nicely addresses a neglected dimension to clinical practice guideline development, namely explicit information on which Do or Don’t do recommendations are frequently disregarded in practice.