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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.
Der Weg von der Diagnose einer Depression, bis hin zu einer adäquaten Therapie, ist oft eine langer. Der Hausarzt ist dabei zumeist der erste Ansprechpartner. Sulz & Deckert (2012) haben zur Durchführung einer psychiatrischen Kurz-Psychotherapie Psychotherapiekarten zur Anwendung durch Ärzte in ihrer Sprechstunde entwickelt. Ihre Wirksamkeit wurde in der ambulanten Psychotherapie bereits bestätigt, jedoch die Möglichkeit ihrer Anwendung im hausärztlichen Bereich bislang noch nicht untersucht. Diese Dissertation soll prüfen, ob sich die Sprechstundenkarten, im hausärztlichen Setting, effektiv einsetzen lassen und ob generell der Bedarf an einer solchen Methodik seitens der Hausärzte besteht.
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.
Background: Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine.
Methods/design: In a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10% absolute difference in the prescribing rate after one year, with a significance level of 5% and a power of 86%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention.
Discussion: If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care.
Darf es etwas mehr sein? Neuroenhancement im Studium – eine Befragung an Würzburger Hochschulen
(2024)
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 Würzburg.
Es wurde eine anonyme online Querschnittsbefragung im ersten Quartal 2021 durchge- führt. Eingeladen waren 5600 Studierende der Julius-Maximilians-Universität Würzburg und der Hochschule für angewandte Wissenschaften Würzburg 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 über NE war weit unter den Stu- dierenden verbreitet. Die Prävalenz für Neuroenhancement im Studium lag bei 12.7%. Die drei meistgenannten Substanzen waren Koffeintabletten (6.6%), Cannabis (4.5%) und Methylphenidat (4.3%). Häufigster Anlass für NE war die Prüfungsvorbereitung. Es zeigten sich deutliche Unterschiede zwischen den Fachbereichen, u.a. hinsichtlich der Prävalenz von NE. ADHS-Symptomen, Stress, Ängstlichkeit, und Depressivität waren positiv mit NE assoziiert. Ein stärkerer Effekt ergab sich für den Zusammenhang zwi- schen NE und riskanten Alkoholkonsum bzw. Tabakkonsum. Diese Ergebnisse wurden durch eine binomial logistische Regression bestätigt.
Die konsumierten Substanzen, das Wissen über NE, die Prävalenz von NE und die Gründe für dessen Nutzung fügen sich nahtlos in die bisherige Forschung ein. Auch die Assoziation zwischen ADHS-Symptomen, Stress, Ängstlichkeit, Depressivität, riskan- tem Alkoholkonsum und Tabakkonsum bestätigt 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 Aufklärung-, Beratungs- und Hilfsangeboten für Studie- rende anzustreben sowie weitere Forschung zum Thema indiziert.
Der Begriff CAM beschreibt ein breites Spektrum von Therapiemethoden, die nicht gänzlich Teil des konventionellen Gesundheitssystems sind. Da CAM häufig als immunstimulierend beworben wird, kann die Nutzung gerade für Patienten mit primärem Immundefekt interessant sein. Aufgrund des erhöhten Infektionsrisikos in diesem Patientenkollektiv empfiehlt das Robert Koch-Institut darüber hinaus spezielle Indikationsimpfungen zur Infektionsprophylaxe.
Ziel dieser Studie war es, Informationen zur Inanspruchnahme von CAM bei Patienten mit primärem Immundefekt zu sammeln sowie einen Überblick über deren Impfstatus zu geben. In dieser multizentrischen Studie wurden 101 Patienten in die Analyse eingeschlossen. Im Zentrum der Studie stand ein selbst entwickelter Fragebogen zur Inanspruchnahme von CAM. Dieser wurde durch etablierte psychologische Tests (MARS-D, WHO-5, PHQ9 und EFK) ergänzt.
Im Rahmen ihrer Erkrankung hatten 72 % der befragten Patienten CAM bereits angewandt. Charakteristisch für den klassischen CAM-Nutzer zeigte sich das weibliche Geschlecht, ein mittleres Alter und mindestens ein Realschulabschluss. Am verbreitetsten waren die Nutzung von Bewegungstraining, Nahrungsergänzungsmitteln sowie Homöopathie.
Ungeachtet der STIKO-Empfehlungen zeigten sich im Patientenkollektiv niedrige Durchimpfungsraten. Allerdings waren die Impfquoten ähnlich hoch wie die der deutschen Allgemeinbevölkerung. Oft waren zudem gerade saisonale Impfungen, wie Influenza, unzureichend erfolgt bzw. dokumentiert.
Bei der Betreuung von Patienten mit Immundefekten sollte daher mehr Wert auf die Um-setzung der Impfempfehlungen gelegt werden. Da auch CAM für das Wohlergehen der Patienten förderlich sein kann, sollten Ärzte im klinischen Alltag eine Plattform zur Diskussion von Bedürfnissen bieten, die über die konventionelle Therapie hinausgehen.
Hintergrund: Die Studie ermittelte die Einflussfaktoren auf hausärztliches Verord¬nungs-verhalten bei der Therapie von akuten unkomplizierten HWI in Deutschland. Methodik: In offenen Leitfadeninterviews mit Hausärztinnen und Hausärzten in Stadt und Region Würzburg wurde untersucht, wie diese ihre Verordnungsentscheidung treffen und durch welche Faktoren sie dabei beeinflusst werden. Von besonderem Interesse wa-ren der Umgang mit Patientenerwartungen, Gründe für Abweichungen vom üblichen Thera¬pie¬verhalten, Unsicherheiten bei der Verordnungsentscheidung und Wünsche nach Un¬ter¬stützung bei der Behandlung von HWI. Die Interviews wurden mithilfe der Soft-ware MAXQDA anonymisiert transkribiert und anhand der inhaltlich strukturierenden qualitativen Inhaltsanalyse nach Kuckartz ausgewertet. Ergebnisse: Die Studie zeigte, dass Hausärztinnen und Hausärzte bei der Behandlung von Patientinnen mit HWI aufgrund der Notwendigkeit, wirtschaftlich zu agieren, Zeit-druck empfinden. Dies erschwert ausführliche Beratungsgespräche, was sich auf das Ver-ordnungsverhalten auswirkt. Hohen Beratungsbedarf sahen die Teilnehmenden insbeson-dere bezüglich der Prävention von HWI, aber auch im Umgang mit Erwartungen, Erfah-rungen und hohem Leidensdruck der Patientinnen. Die genannten Faktoren wurden für die Verordnungsentscheidung teilweise als wichtiger angesehen als die Leitlinienemp-fehlungen. Die Vermeidung finanzieller Belastung der Patien¬tinnen wurde ebenfalls als relevanter Faktor gesehen, da bei HWI Präparate zur symptomatischen The¬rapie anders als Antibio¬tika durch die Krankenkassen nicht finanziert werden. Der Wunsch nach vali-den In¬formationen zur lokalen Resistenzlage uropathogener Erreger weist zudem darauf hin, dass Ärztinnen und Ärzte ihr Verordnungsverhalten an Informa¬tionen zur Resistenz-situ¬ation orientieren würden. Diskussion: Wirtschaftlichkeit und Zeitdruck sowie Erwartungen und hoher Beratungs-bedarf der Patien¬tinnen wirken einer leitliniengerechten Behandlung von HWI nach Ein-schätzung der Hausärztinnen und Hausärzte entgegen. Diese Faktoren bieten Ansatz-punkte zum Abbau von Hindernissen für Hausärztinnen und Hausärzte und zur Steige-rung der Leitlinienad¬hä¬renz. Die Studienergebnisse können als Basis für Interventionen zur Förderung einer rationalen Antibiotikaverordnung dienen.
Objectives
Virtual reality exposure therapy (VRET) is a promising treatment for patients with fear of driving. The present pilot study is the first one focusing on behavioral effects of VRET on patients with fear of driving as measured by a post-treatment driving test in real traffic.
Methods
The therapy followed a standardized manual including psychotherapeutic and medical examination, two preparative psychotherapy sessions, five virtual reality exposure sessions, a final behavioral avoidance test (BAT) in real traffic, a closing session, and two follow-up phone assessments after six and twelve weeks. VRE was conducted in a driving simulator with a fully equipped mockup. The exposure scenarios were individually tailored to the patients’ anxiety hierarchy. A total of 14 patients were treated. Parameters on the verbal, behavioral and physiological level were assessed.
Results
The treatment was helpful to overcome driving fear and avoidance. In the final BAT, all patients mastered driving tasks they had avoided before, 71% showed an adequate driving behavior as assessed by the driving instructor, and 93% could maintain their treatment success until the second follow-up phone call. Further analyses suggest that treatment reduces avoidance behavior as well as symptoms of posttraumatic stress disorder as measured by standardized questionnaires (Avoidance and Fusion Questionnaire: p < .10, PTSD Symptom Scale–Self Report: p < .05).
Conclusions
VRET in driving simulation is very promising to treat driving fear. Further research with randomized controlled trials is needed to verify efficacy. Moreover, simulators with lower configuration stages should be tested for a broad availability in psychotherapy.
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.
The reversibility of bacterial resistance to antibiotics is poorly understood. Therefore, the aim of this study was to determine, over a period of five years, the effect of fluoroquinolone (FQ) use in primary care on the development and gradual decay of Escherichia coli resistance to FQ. In this matched case–control study, we linked three sources of secondary data of the Health Service of the Autonomous Province of Bolzano, Italy. Cases were all those with an FQ-resistant E. coli (QREC)-positive culture from any site during a 2016 hospital stay. Data were analyzed using conditional logistic regression. A total of 409 cases were matched to 993 controls (FQ-sensitive E. coli) by the date of the first isolate. Patients taking one or more courses of FQ were at higher risk of QREC colonization/infection. The risk was highest during the first year after FQ was taken (OR 2.67, 95%CI 1.92–3.70, p < 0.0001), decreased during the second year (OR 1.54, 95%CI 1.09–2.17, p = 0.015) and became undetectable afterwards (OR 1.09, 95%CI 0.80–1.48, p = 0.997). In the first year, the risk of resistance was highest after greater cumulative exposure to FQs. Moreover, older age, male sex, longer hospital stays, chronic obstructive pulmonary disease (COPD) and diabetes mellitus were independent risk factors for QREC colonization/infection. A single FQ course significantly increases the risk of QREC colonization/infection for no less than two years. This risk is higher in cases of multiple courses, longer hospital stays, COPD and diabetes; in males; and in older patients. These findings may inform public campaigns and courses directed to prescribers to promote rational antibiotic use.