Global migration trends have led to a more diverse population in health care services everywhere, which in turn has set off a paradigm shift away from medical paternalism toward more patient ...autonomy. Consequently, physicians need to provide a more precise patient-centred healthcare. Professional interpreting appears to play a crucial part in tackling the challenges of language barriers adequately. The aim of this study was to conduct process evaluation through the implementing of video remote interpreting (VR) and telephone remote interpreting (TR) within primary care facilities in the northern German metropolis of Hamburg.
We conducted a three-armed exploratory pilot trial, which compared VR to TR and to a control group (CG) in different primary care settings. We assessed feasibility of implementation, as well as the acceptance of interpreting tools among their users. In addition, we compared the quality of communication as perceived by patients and physicians, as well as the enabling of patient-centred medicine over all three study groups using quantitative questionnaires.
13 practices (7 GPs, 3 Gynaecologists, 3 Paediatricians) took part in this trial. 183 interpreting calls were documented, 178 physicians as well as 127 patients answered their respective questionnaires. The implementation of the VR- und TR-tools went smoothly and they were broadly accepted by their users. However, the tools were used significantly less often than we had anticipated. With regards to quantitative questionnaires, VR scored significantly better than the control group in terms of the perceived quality of communication by both, patients and physicians and enabled of patient-centred medicine.
Our main findings were the discrepancy between the assumed high demand of professional interpreting solutions on the one hand and the low willingness of practices to participate on the other. The rather low utilisation rates were also noteworthy. This discrepancy indicates a lack of awareness concerning the adverse effects of using informal or no interpreter in medical settings, which needs to be rectified. Due to the small sample size, all statistical results must be viewed with caution. However, our results show that remote interpreting represents a promising approach to tackling language barriers in primary care settings.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Population-level data on predictors for attitudes towards sexual behavior are missing for Germany. The current study investigated sexual attitudes in the German population with regard to ...sociodemographic and sociocultural factors. Data originated from the German Health and Sexuality Survey (GeSiD; N = 4,955) carried out from October 2018 to September 2019. Computer-assisted face to face interviews were conducted with a large self-administered component due to the sensitive topics of the survey. Public acceptance towards several aspects of sexual behavior (extramarital sex, abortion, same sex sexual activities, sex work, promiscuity, sex without love) was investigated. Age, gender, education, religious aspects and migration background were introduced as predictors into logistic regression analyses. Overall, respondents rather rejected promiscuity (61%) and extramarital sex (81%) and rather supported same sex sexual activities (63-70%). Male respondents more likely rejected same sex sexual activities and abortion. Higher education was associated with more acceptance towards the sexual behaviors whereas first generation migrants, Muslim faith and religious devoutness were associated with less acceptance. Results indicate that gender is relevant in terms of sexual attitudes with male respondents tending to have more traditional and heteronormative gender role values. Furthermore, education, culture and religion play an important role concerning the liberality towards sexual behaviors. Acculturation processes of second generation migrants may lead to an adaptation of values. Comprehensive and culturally sensitive sex education may focus on differences concerning sexuality-related norms and values.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
There is an ongoing debate about anxiety deficits in psychopathy and their possible impact on individual behavior. Data on actual anxiety- and threat-related behavior associated with psychopathy is ...still limited. We performed a mixed reality study using the elevated plus-maze (EPM) in a non-clinical sample (N = 160) to test anxiety-related behavior in relation to psychopathic personality traits measured through the Brief Questionnaire of Psychopathic Personality Traits (FPP). The psychopathy sum score correlated significantly with all measures of anxiety-related behavior on the EPM. Sensation seeking, but not general levels of acrophobia was moreover associated with psychopathic traits. Multivariate analyses revealed that the subscales Fearlessness and Lack of Empathy of the FPP predicted anxious behavior. Our findings are the first to demonstrate the relationship between psychopathic traits and actual behavior in an anxiety-inducing environment. This supports the low-anxiety hypothesis in psychopathy research. Implications for potentially harmful or risky behavior are discussed.
Knowledge on etiological and risk factors of genito-pelvic pain/penetration disorder, formerly classified as dyspareunia and vaginismus, is limited. The Operationalized Psychodynamic Diagnosis (OPD) ...system offers a valuable basis for developmental considerations, and has not yet been used to research sexual pain difficulties in women. We conducted an exploratory pilot study of psychodynamic motivational conflicts and level of personality functioning as defined by the OPD system by means of an anonymous online survey among 24 women who had been diagnosed with dyspareunia or vaginismus. We matched them with 24 healthy controls and compared groups using paired-samples
t
-tests and Wilcoxon tests. Effect sizes were calculated using Pearson's
r
. Large effect sizes were found for mean or median differences of several OPD Structure Questionnaire (OPD-SQ) scales (self-reflection,
p
= 0.002/
r
= 0.59; affect differentiation,
p
= 0.007/
r
= 0.53; self-perception,
p
= 0.002/
r
= 0.58; impulse control,
p
= 0.007/
r
= 0.53; self-worth regulation,
p
= 0.008/
r
= 0.52; self-regulation,
p
= 0.004/
r
= 0.56; experiencing affect,
p
= 0.009/
r
= 0.53; bodily self,
p
= 0.008/
r
= 0.54; OPD-SQ total score,
p
= 0.007/
r
= 0.52; internal communication,
p
= 0.001/
r
= 0.63) and OPD Conflict Questionnaire (OPD-CQ) scales (guilt conflict active,
p
= 0.004/
r
= 0.60; Oedipal conflict passive,
p
= 0.009/
r
= 0.51; individuation versus dependency conflict active,
p
= 0.01/
r
= 0.52; guilt conflict passive,
p
< 0.001/
r
= 0.70; self-worth conflict passive,
p
= 0.001/
r
= 0.70; passive mode,
p
< 0.001/
r
= 0.68). The problems with personality functioning and more pronounced types of conflicts participants displayed suggest proneness for self-invalidation, internalization and restricted self-perception.
Across European countries, there have been large differences in COVID-19 case fatality risk (CFR) estimates, and considerable variation in these estimates over time. CFR estimates vary depending on ...both the method used for estimation and country-specific characteristics. While crude methods simply use cumulative total numbers of cases and deaths, the CFR can be influenced by the demographic characteristics of the cases, the case detection rates, the time lags between the reporting of infections and deaths and infrastructure characteristics, such as healthcare capacities. We use publicly available weekly data for 11 European countries on the COVID-19 case and death numbers by age group for the year 2020. Moreover, we use data on national weekly test rates to adjust the case numbers, and to investigate the effects of different time lags between the reporting of cases and deaths on the estimation of CFRs. Finally, we describe the association between case fatality rates and the demand for hospital and intensive care unit beds for COVID-19 cases, while taking into account national bed capacities. The crude CFR estimates differ considerably across the investigated countries. In the crude international CFR time series, the differences are smaller when adjusting for the demographics of the cases. Differences in testing policies significantly affect the CFR estimates as well. However, the question of precisely how these testing procedures should be adjusted requires further investigation. Lag adjustments of CFRs do not lead to improvements in estimates of COVID-19 CFRs, and no connection between hospital capacities and CFRs can be found for the countries included in our study.
Abstract
Background
The fetal adrenal gland receives rising awareness as a predictor of spontaneous preterm birth. We hereby provide longitudinal growth assessments of the fetal adrenal gland in a ...low risk population with an additional focus on trajectories in fetuses born preterm.
Methods
Fetal adrenal gland was assessed via transabdominal ultrasound at gestational weeks (gw) 24–26, 28–30, and 34–36 in a low-risk pregnancy cohort. Longitudinal trajectories of the total gland and the mark (so called fetal zone) as well as ratio of fetal zone width/ total widths (w/W) were analyzed using repeated ANOVA analyses. To compare trajectories of the ratio w/W for preterm and term fetuses respectively, as well as women with and without clinical signs of preterm labor, the propensity score method was applied.
Results
Fetal zone width increased over the course of pregnancy (
p
< 0.0001), while the ratio w/W decreased (
p
< 0.0001) (
n
= 327). Comparing the trajectories of the ratio w/W in fetuses born preterm (
n
= 11) with propensity-score matched term born fetuses (
n
= 22), a decrease between gw 24–26 and 28–30 was observed in both groups, which continued to decrease for the term born fetuses. However, in preterm born fetuses, the ratio increased above the term born values at gw 34–36.
Conclusion
Our study provides for the first time longitudinal growth data on the fetal adrenal gland and supports the hypothesis that fetal zone enlargement is associated with preterm birth which could play an important role in risk-prediction.
Objective:
Audio-visual interventions have been used to provide relevant patient information to reduce pre-operative anxiety in children. The aim of the study was to investigate whether self-reported ...state anxiety in children could be reduced by presenting a child-friendly educational video on the day of surgery.
Methods:
A prospective, single-blinded, two-armed, randomized controlled study was designed with three measurement time points including 90 children (6–17 years) and their parents. In the intervention group (IG), the children and their parents were shown a child-friendly video explaining the perioperative procedures that would be applied during the hospital stay, in addition to receiving standard information. In the control group (CG), children and parents received standard information provided by the nursing staff. The primary outcome was any change in the children's pre-operative state anxiety levels, as measured by the State-Trait Operation Anxiety Inventory (STOA). A secondary outcome was patient satisfaction regarding the received information.
Results:
Anxiety was significantly reduced in both groups after receiving either the intervention plus standard information or the standard information only. No significant difference in anxiety reduction was observed between the IG and the CG. However, the children and parents in the IG reported fewer worries than those in the CG.
Conclusion:
A child-friendly, educational video can be an additional tool for providing patient information and reducing pre-operative anxiety in children and their parents. Further studies should focus on the timing of the intervention and on age- and developmentally appropriate information formats and contents to address children's pre-operative anxiety.
Clinical Trial Registration:
Patient Anxiety Reduction in Children by Using Simple Explanation Videos, ID: NCT0441377;
www.clinicaltrials.gov
, Data Sharing Statement: Deidentified individual participant data will not be made available.
To compare health service use (HSU) between migrants and non-migrants in Germany.
Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, ...medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU.
In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants.
We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.
We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic ...position (SEP) and social relations.
The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models.
Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups.
The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.
Even though several SARS-CoV-2 vaccines have shown high effectiveness in the prevention of COVID-19 in healthy subjects, vaccination response in patients with plasma-cell-related disorders (PCD) ...remains widely unknown. Here, we report on an analysis describing the serological response after prime-boost SARS-CoV-2 vaccination in PCD patients, as compared to a healthy control group, and on possible influencing factors of serological responses. Blood samples were analyzed for the presence of quantitative anti-SARS-CoV-2 spike RBD Ig. A total of 82 patients were included; 67 received mRNA-, eight vector-based and four heterologous vaccinations. SARS-CoV-2 antibody titers (SP-AbT) were assessed in a mean of 23 days (SD ± 11 days) after the first and in a mean 21 days (SD ± 9) after prime-boost vaccination. A positive SP-AbT was detected in 31.9% of PCD patients after the first vaccination, and in 88.9% (44/49) after prime-boost vaccination, which was significantly less likely than that in the control group (100%, 78/78) (p = 0.008). Furthermore, we have been able to validate our previously suggested threshold of 30 CD19+ B lymphocytes/µL as being predictive for SP-AbT development. Despite anti-CD38 directed therapy, quadruplet treatment, higher age and missing deep remission, which correlated negatively with SP-AbT appearance, SP-AbT formation is possible in a majority of myeloma patients after prime-boost vaccination.
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