The main pathways for phosphorus flux from land to sea are particle-associated (erosion) and dissolved runoff (rivers, groundwater, and agricultural drainage systems). These pathways can act as ...diffused sources for aquatic systems and support primary production, therefore, counteracting the efforts aimed at reducing phosphorus input from point sources such as sewage treatment plants. Phosphorus supports primary production in the water column and can elevate phytoplankton and macrophyte growth. Coastal wetlands with emerged (Phragmites australis) and submerged (Stuckenia pectinata and Chara sp.) macrophytes can affect phosphorus fluxes in the land-water transitional zone. The macrophytes have the potential to act as a buffer for phosphorus run-off. The aim of this study was to determine the phosphorus stocks in the transitional land-sea zone of a cold temperate lagoon at the southern Baltic Sea. Phosphorus in macrophytes, water samples, and phytoplankton growth were analyzed along a gradient moving away from the wetland. The phosphorus stocks in the above ground biomass of the Phragmites plants were the highest at the end of August and with more than 8000mgPm−2 in the interior zone of the wetland, threefold the amount of P in Phragmites plant tissue at the wetland fringe. The submerged macrophytes stored only 300mgPm−2, close to the wetland. Concentrations of soluble reactive phosphorus in the water column were higher in the zones of emerged macrophytes than in the zones of submerged macrophytes and decreased along the land-sea transect. Phytoplankton could grow proximal to the wetland during all seasons, but not further away. This study indicates that macrophytes can act as phosphorus sinks. However, short-term releases of phosphate within the Phragmites wetland have the potential to lead to phytoplankton growth. Phytoplankton can use these nutrient pulses either immediately or later, and support high biomass and turbidity within the system.
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•Coastal wetlands covered by emerged and submerged macrophytes are effective nutrient buffers during vegetation growth.•Submerged macrophytes act as buffer only during late summer and Phragmites litter is prone to decomposition during winter.•Concentration of PO4 in the water is higher in the zones of emerged macrophytes than in the zones of submerged macrophytes.•Increased phytoplankton growth close to the wetland edge indicates a nutrient leakage, without fluctuations in PO4.
To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this ...approach were evaluated.
Using Zelen's design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff's Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool).
Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline.
After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.
The trial was registered at the German Clinical Trials Register under DRKS00015463 retrospectively (dated 4 Sept 2018).
Successful interprofessional (IP) collaboration has great potential to improve healthcare delivery. The aim of this study was to evaluate and compare the attitudes towards IP collaboration in young ...health professionals who had not been exposed to IP learning activities. About one year after graduation from their vocational training, 387 graduates from various healthcare professions Nurses (nursing and pediatric nursing), Therapists (physical therapy, speech and language therapy), Diagnostic professionals (biomedical science and radiography), were invited to participate in an online survey. In total, data from 129 graduates were considered for data analyses. The University of Western England Interprofessional Questionnaire was administered to self-assess graduates individual attitude towards IP collaboration and learning using four scales. All health professional groups showed an overall positive attitude in communication and teamwork as well as in IP relationships and expressed a neutral attitude in IP learning and IP interactions. There were no significant differences in the overall scores between the health professional groups. In total, the three health professional groups showed similar attitudes towards IP collaboration and learning, despite their different scope of work. Results may help to design IP learning activities and this may contribute to better communication with and to know more about each other.
Physiotherapy, in comparison to occupational therapy and speech therapy, is the most frequently prescribed treatment in Germany. Nationally there is only scarce information available on indications, ...treatment approaches and development of health condition throughout therapy. Present work encompasses only small sample sizes and insufficient follow-up periods.
To describe, how patients with knee complaints are treated based on a physiotherapy referral and how their health condition changes during therapy.
A descriptive-exploratory secondary analysis of data from a prospective multicentre observational study was conducted. The Bother index of the Musculoskeletal Function Assessment Questionnaire (German, 16-Item version) and an 11-step box scale on pain intensity were utilised as outcome criteria.
Data of 160 patients, age 47.4 (SD 10.8), 51% female, approximately 51% with previous arthroscopy, were analysed. The response rate 6 months after therapy approximately amounted to 50%. Main therapy approaches were strengthening, stretching and manual therapy, combined with home exercises. Impairment in daily life as well as pain improved substantially during therapy (SES range 0.6-1.75).
The conducted study brought up insights for physiotherapy health service for pa-tients with cartilage or meniscal problems, based on a sample size not accessible for Germany before. After reviewing the international literature it may be assumed, that the clearly active character of the therapy and the combination of different treatment approaches are of relevance for the presented reduction of impairment in daily life.
In Germany, in comparison to occupational therapy and speech therapy, physiotherapy is the most often prescribed treatment, with a prescription volume of 3 billion Euro in 2009. The catalogue of ...prescribable therapies (CPT; "Heilmittelkatalog") is a matter of controversial discussion. It represents the rationale which should support the physician in adhering to the efficiency principle.
To describe the coded indications used by physicians to justify a physiotherapy prescription for patients with back pain, in order to verify its plausibility. Furthermore, we aimed to describe the manner in which patient subgroups differ regarding factors given in the CPT to allocate patients to various domains of indication.
A descriptive-exploratory secondary analysis of data from a prospective multicentre (84 private physiotherapy practices) observational trial was conducted. The Bother index of the Musculoskeletal Function Assessment Questionnaire (German, 16-Item version), the Work Ability Index and an 11-step box scale on pain intensity were measured as outcome.
Coded indications related to dysfunction/pain due to joint-blockages dominated clearly (WS1a 30%, WS2a 35.3%). Patients who were allocated to the domains of indication WS1 and WS2 did not differ regarding botherment in daily life at the beginning of therapy (SES=0.05).
It is hardly possible to identify clear prescription patterns. Results did not show any clear differences regarding major criteria for efficient prescription in line with the CPT. The weaknesses discussed should be targeted in future studies and should be considered during subsequent revisions of the CPT.
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