@article{BachfischerBarbosaRojasetal., author = {Bachfischer, Andreas and Barbosa, Martha Cecilia and Rojas, Angel Alberto Riveras and Bechler, Reinaldo and Schwienhorst-Stich, Eva-Maria and Kasang, Christa and Simmenroth, Anne and Parisi, Sandra}, title = {Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned}, series = {International Journal for Equity in Health}, volume = {22}, journal = {International Journal for Equity in Health}, doi = {10.1186/s12939-023-01966-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357261}, abstract = {Background Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. Methods This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. Results A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0\%) and reported knowledge on health care routes (46.0\%). Unemployment (87.9\%) and inadequate housing (57.8\%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). Conclusion People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.}, language = {en} } @phdthesis{Hajduk2024, author = {Hajduk, Maurice Martin}, title = {Darf es etwas mehr sein? Neuroenhancement im Studium - eine Befragung an W{\"u}rzburger Hochschulen}, doi = {10.25972/OPUS-35981}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-359812}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Neuroenhancement (NE) bezeichnet die Einnahme psychotroper Substanzen mit dem Ziel der geistigen Leistungssteigerung oder Beruhigung. NE wird durch gesunde Perso- nen genutzt. Es besteht somit keine Indikation zur Einnahme psychotroper Wirkstoffe. Zum NE genutzte Substanzen sind z.B. Koffeintabletten, verschreibungspflichtige Medi- kamente oder illegale Substanzen. Die bisherige Forschung findet Hinweise auf einen Zusammenhang zwischen NE und ADHS-Symptomen, einigen Aspekten psychischer Gesundheit, sowie Substanzkonsum. Bisher gibt es keine Forschung zu NE am Hoch- schulstandort W{\"u}rzburg. Es wurde eine anonyme online Querschnittsbefragung im ersten Quartal 2021 durchge- f{\"u}hrt. Eingeladen waren 5600 Studierende der Julius-Maximilians-Universit{\"a}t W{\"u}rzburg und der Hochschule f{\"u}r angewandte Wissenschaften W{\"u}rzburg Schweinfurt. Der Frage- bogen bestand aus 53 Items und enthielt u. a. die folgenden validierten Messinstrumente: ASRS, PSS-10, PHQ-4 und AUDIT-C. Die Response Rate lag bei 18\% (n = 1011). Das Wissen {\"u}ber NE war weit unter den Stu- dierenden verbreitet. Die Pr{\"a}valenz f{\"u}r Neuroenhancement im Studium lag bei 12.7\%. Die drei meistgenannten Substanzen waren Koffeintabletten (6.6\%), Cannabis (4.5\%) und Methylphenidat (4.3\%). H{\"a}ufigster Anlass f{\"u}r NE war die Pr{\"u}fungsvorbereitung. Es zeigten sich deutliche Unterschiede zwischen den Fachbereichen, u.a. hinsichtlich der Pr{\"a}valenz von NE. ADHS-Symptomen, Stress, {\"A}ngstlichkeit, und Depressivit{\"a}t waren positiv mit NE assoziiert. Ein st{\"a}rkerer Effekt ergab sich f{\"u}r den Zusammenhang zwi- schen NE und riskanten Alkoholkonsum bzw. Tabakkonsum. Diese Ergebnisse wurden durch eine binomial logistische Regression best{\"a}tigt. Die konsumierten Substanzen, das Wissen {\"u}ber NE, die Pr{\"a}valenz von NE und die Gr{\"u}nde f{\"u}r dessen Nutzung f{\"u}gen sich nahtlos in die bisherige Forschung ein. Auch die Assoziation zwischen ADHS-Symptomen, Stress, {\"A}ngstlichkeit, Depressivit{\"a}t, riskan- tem Alkoholkonsum und Tabakkonsum best{\"a}tigt bisherige Forschungsergebnisse. Es konnte gezeigt werden, dass rund ein Zehntel der Studierenden NE bereits genutzt haben. In Anbetracht der gesundheitlichen Gefahren, die mit NE einhergehen ist die Etab- lierung bzw. der Ausbau von Aufkl{\"a}rung-, Beratungs- und Hilfsangeboten f{\"u}r Studie- rende anzustreben sowie weitere Forschung zum Thema indiziert.}, subject = {Psychische Gesundheit}, language = {de} } @article{SimonParisiWabnitzetal.2023, author = {Simon, Johanna and Parisi, Sandra and Wabnitz, Katharina and Simmenroth, Anne and Schwienhorst-Stich, Eva-Maria}, title = {Ten characteristics of high-quality planetary health education}, series = {Frontiers in Public Health}, volume = {11}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1143751}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313856}, year = {2023}, abstract = {Aim: The climate and ecological crises are considered fundamental threats to human health. Healthcare workers in general and doctors in particular can contribute as change agents in mitigation and adaptation. Planetary health education (PHE) aims to harness this potential. This study explores perspectives among stakeholders involved in PHE at German medical schools on the characteristics of high-quality PHE and compares them to existing PHE frameworks. Methods: In 2021, we conducted a qualitative interview study with stakeholders from German medical schools involved in PHE. Three different groups were eligible: faculty members, medical students actively involved in PHE, and study deans of medical schools. Recruitment was performed through national PHE networks and snowball sampling. Thematic qualitative text analysis according to Kuckartz was used for the analysis. Results were systematically compared to three existing PHE frameworks. Results: A total of 20 participants (13 female) from 15 different medical schools were interviewed. Participants covered a wide range of professional backgrounds and experience in PHE education. The analysis revealed ten key themes: (1) Complexity and systems thinking, (2) inter- and transdisciplinarity, (3) ethical dimension, (4) responsibility of health professionals, (5) transformative competencies including practical skills, (6) space for reflection and resilience building, (7) special role of students, (8) need for curricular integration, (9) innovative and proven didactic methods, and (10) education as a driver of innovation. Six of our themes showed substantial overlap with existing PHE frameworks. Two of our themes were only mentioned in one of the frameworks, and two others were not explicitly mentioned. Few important elements of the frameworks did not emerge from our data. Conclusions: In the light of increased attention regarding the connections of the climate and ecological crises and health, our results can be useful for anyone working toward the integration of planetary health into medical schools' and any health professions' curricula and should be considered when designing and implementing new educational activities.}, language = {en} } @article{SchraderRuckBorgulyaetal.2023, author = {Schrader, Hanna and Ruck, Jessica and Borgulya, G{\´a}bor and Parisi, Sandra and Ehlers-Mondorf, Jana and Kaduszkiewicz, Hanna and Joos, Stefanie and Grau, Anna and Linde, Klaus and G{\´a}gyor, Ildik{\´o}}, title = {Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic}, series = {Frontiers in Public Health}, volume = {11}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1238144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-327427}, year = {2023}, abstract = {Background: At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020. Methods: From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol. Results: One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5\% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources. Discussion: It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.}, language = {en} } @article{SchmiemannGreserMaunetal.2023, author = {Schmiemann, Guido and Greser, Alexandra and Maun, Andy and Bleidorn, Jutta and Schuster, Angela and Miljukov, Olga and R{\"u}cker, Viktoria and Klingeberg, Anja and Mentzel, Anja and Minin, Vitalii and Eckmanns, Tim and Heintze, Christoph and Heuschmann, Peter and G{\´a}gyor, Ildik{\´o}}, title = {Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial}, series = {BMJ}, volume = {383}, journal = {BMJ}, issn = {1756-1833}, doi = {10.1136/bmj-2023-076305}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349395}, year = {2023}, abstract = {Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was -0.13 (95\% confidence interval -0.21 to -0.06, P\<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of -0.08 (95\% confidence interval -0.15 to -0.02, P\<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389}, language = {en} } @article{KleinertMuellerFuraijatetal.2019, author = {Kleinert, Evelyn and M{\"u}ller, Frank and Furaijat, Ghefar and Hillermann, Nele and Jablonka, Alexandra and Happle, Christine and Simmenroth, Anne}, title = {Does refugee status matter? Medical needs of newly arrived asylum seekers and resettlement refugees - a retrospective observational study of diagnoses in a primary care setting}, series = {Conflict and Health}, volume = {13}, journal = {Conflict and Health}, doi = {10.1186/s13031-019-0223-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-325869}, year = {2019}, abstract = {Background Providing adequate healthcare to newly arrived refugees is considered one of the significant challenges for the German healthcare system. These refugees can be classified mainly into two groups: asylum seekers (who have applied for asylum after arrival in Germany and are waiting for the refugee-status decision) and resettlement refugees (who have already been granted asylum status before arriving in Germany). Whereas earlier studies have explored the health status of asylum seekers especially in terms of mental and behavioural disorders and infectious diseases without distinguishing between these two groups, our study aims to evaluate possible relationships of asylum status and medical needs of these two groups with a special focus on mental and behavioural disorders and infectious diseases. Methods In this retrospective observational study, collected data on all asylum-seeker and resettlement-refugee patients (N = 2252) of a German reception centre (August 2017 to August 2018) is analysed by absolute and relative frequencies and medians. Patient data, collected by chart review, include age, gender, country of origin, asylum status, and diagnoses (ICD-10). To describe the relationship between sociodemographic factors (including asylum status) and diagnoses, we used tests of significance and bivariate correlations with Spearman correlation coefficients. All collected data are pseudonymised. Results Of all 2252 patients, 43\% were resettlement refugees. In almost all ICD-10 categories, asylum seekers received significantly more diagnoses than resettlement refugees. According to our data, asylum seekers presented with mental and behavioural disorders nine times more often (9\%) than resettlement refugees (1\%). In the case of infectious diseases, the results are mixed: asylum seekers were twice as frequently (11\%) diagnosed with certain infectious and parasitic diseases than resettlement refugees (5\%), but resettlement refugees were treated twice as often (22\% of the asylum seekers and 41\% of the resettlement refugees) for diseases of the respiratory system, of which 84\% were acute respiratory infections (in both groups). Conclusion This study indicates that patients with unregulated migration more frequently present symptoms of psychiatric diseases and somatoform symptoms than resettlement refugees. A health policy approach within migration policy should aim to enable persecuted persons to migrate under regulated and safe conditions. Trial registration German Clinical Trials Register: DRKS00013076, retrospectively registered on 29.09.2017.}, language = {en} } @article{DreischulteSanftenbergHennigsetal.2023, author = {Dreischulte, Tobias and Sanftenberg, Linda and Hennigs, Philipp and Z{\"o}llinger, Isabel and Schwaiger, Rita and Floto, Caroline and Sebastiao, Maria and K{\"u}hlein, Thomas and Hindenburg, Dagmar and Gagyor, Ildik{\´o} and Wildgruber, Domenika and Hausen, Anita and Janke, Christian and H{\"o}lscher, Michael and Teupser, Daniel and Gensichen, Jochen}, title = {Detecting medication risks among people in need of care: performance of six instruments}, series = {International Journal of Environmental Research and Public Health}, volume = {20}, journal = {International Journal of Environmental Research and Public Health}, number = {3}, issn = {1660-4601}, doi = {10.3390/ijerph20032327}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304921}, year = {2023}, abstract = {Introduction: Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting. Objectives: This cross sectional study compares six validated tools in terms of PIM and PPO detection. Methods: We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa. Results: We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95\% CI, 87.2-94.9)\% and the overall PPO prevalence was 63.7 (57.1-69.9\%)\%. The detected PIM prevalence ranged from 76.5\%, for FORTA-C/D, to 6.6\% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7\%) and FORTA-A (62.8\%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1\%), and increased to 79.2\% when distinct items from STOPP were added. Conclusion: Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.}, language = {en} } @article{PerraRiccardoDeLorenzoetal.2023, author = {Perra, Alessandra and Riccardo, Chiara Laura and De Lorenzo, Valerio and De Marco, Erika and Di Natale, Lorenzo and Kurotschka, Peter Konstantin and Preti, Antonio and Carta, Mauro Giovanni}, title = {Fully immersive virtual reality-based cognitive remediation for adults with psychosocial disabilities: a systematic scoping review of methods intervention gaps and meta-analysis of published effectiveness studies}, series = {International Journal of Environmental Research and Public Health}, volume = {20}, journal = {International Journal of Environmental Research and Public Health}, number = {2}, issn = {1660-4601}, doi = {10.3390/ijerph20021527}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304948}, year = {2023}, abstract = {Background: Cognitive Remediation (CR) programs are effective for the treatment of mental diseases; in recent years, Virtual Reality (VR) rehabilitation tools are increasingly used. This study aimed to systematically review and meta-analyze the published randomized controlled trials that used fully immersive VR tools for CR programs in psychiatric rehabilitation. We also wanted to map currently published CR/VR interventions, their methods components, and their evidence base, including the framework of the development intervention of CR in fully immersive VR. Methods: Level 1 of evidence. This study followed the PRISMA extension for Scoping Reviews and Systematic Review. Three electronic databases (Pubmed, Cochrane Library, Embase) were systematically searched, and studies were included if they met the eligibility criteria: only randomized clinical trials, only studies with fully immersive VR, and only CR for the adult population with mental disorders. Results: We found 4905 (database) plus 7 (manual/citation searching articles) eligible studies. According to inclusion criteria, 11 studies were finally reviewed. Of these, nine included patients with mild cognitive impairment, one with schizophrenia, and one with mild dementia. Most studies used an ecological scenario, with improvement across all cognitive domains. Although eight studies showed significant efficacy of CR/VR, the interventions' development was poorly described, and few details were given on the interventions' components. Conclusions: Although CR/VR seems to be effective in clinical and feasibility outcomes, the interventions and their components are not clearly described. This limits the understanding of the effectiveness and undermines their real-world implementation and the establishment of a gold standard for fully immersive VR/CR.}, language = {en} } @article{PerraGalettiZacchedduetal.2023, author = {Perra, Alessandra and Galetti, Alessia and Zaccheddu, Rosanna and Locci, Aurora and Piludu, Federica and Preti, Antonio and Primavera, Diego and Di Natale, Lorenzo and Nardi, Antonio Egidio and Kurotshka, Peter Konstantin and Cossu, Giulia and Sancassiani, Federica and Stella, Giusy and De Lorenzo, Valerio and Zreik, Thurayya and Carta, Mauro Giovanni}, title = {A recovery-oriented program for people with bipolar disorder through virtual reality-based Cognitive Remediation: results of a feasibility randomized clinical trial}, series = {Journal of Clinical Medicine}, volume = {12}, journal = {Journal of Clinical Medicine}, number = {6}, issn = {2077-0383}, doi = {10.3390/jcm12062142}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-311201}, year = {2023}, abstract = {Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021}, language = {en} } @phdthesis{BraeunlingverhRiegel2023, author = {Br{\"a}unling [verh. Riegel], Lisa-Marie}, title = {Durchf{\"u}hrung und Evaluation einer psychiatrischen Kurz-Psychotherapie zur Behandlung von depressiven Patienten in der haus{\"a}rztlichen Praxis: eine Machbarkeitsstudie}, doi = {10.25972/OPUS-33024}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-330248}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Der Weg von der Diagnose einer Depression, bis hin zu einer ad{\"a}quaten Therapie, ist oft eine langer. Der Hausarzt ist dabei zumeist der erste Ansprechpartner. Sulz \& Deckert (2012) haben zur Durchf{\"u}hrung einer psychiatrischen Kurz-Psychotherapie Psychotherapiekarten zur Anwendung durch {\"A}rzte in ihrer Sprechstunde entwickelt. Ihre Wirksamkeit wurde in der ambulanten Psychotherapie bereits best{\"a}tigt, jedoch die M{\"o}glichkeit ihrer Anwendung im haus{\"a}rztlichen Bereich bislang noch nicht untersucht. Diese Dissertation soll pr{\"u}fen, ob sich die Sprechstundenkarten, im haus{\"a}rztlichen Setting, effektiv einsetzen lassen und ob generell der Bedarf an einer solchen Methodik seitens der Haus{\"a}rzte besteht.}, subject = {Kurzpsychotherapie}, language = {de} }