Child Sexual Abuse by Catholic Priests, Deacons, and Male Members of Religious Orders in the Authority of the German Bishops' Conference 1946-2014.

This study explores the extent of sexual abuse of minors by members of the Catholic Church in Germany. It is the first comprehensive study to examine this extent in a European country. The goals of this study are as follows: (a) to analyze whether the extent and characteristics of sexual abuse in a European country are comparable to those in the United States and Australia and (b) how discrepancies can be explained. The personnel files of 38,156 Catholic Priests, deacons, and male members of religious orders in the authority of the German Bishops' Conference were analyzed. The study period lasted from 1946 to 2014. All 27 German dioceses took part in this study. A total of 4.4% of all clerics (N = 1,670) from 1946 to 2014 were alleged to have committed sexual abuse, and 3,677 children or adolescents were identified as victims. These results are similar to those from comparable studies in the United States. Sexual abuse of minors within the authority of the Catholic Church seems to be a worldwide phenomenon.

[The method of "town hall talks": a study protocol]. / Die Methode der "Rathausgespräche": ein Studienprotokoll.

BACKGROUND AND AIM: Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks". METHOD: In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated. PREVIOUS RESULTS: The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC. CONCLUSION: Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined.

[Self-design and prevention potential for older people in institutional long-term care]. / Selbstgestaltungs- und Präventionspotenziale hochaltriger Menschen in der stationären Langzeitversorgung.

Healthcare in inpatient long-term care facilities (nursing homes) should not be limited to medical curative measures, but should also include strengthening social participation, autonomy, self-responsibility and joint responsibility of the residents. Prevention and rehabilitation should therefore be even more integrated into care concepts.This article first introduces various areas of prevention physical activity, nutrition, cognitive competence, psychosocial health, abuse, and freedom-removing measures and then discusses their evidence. Essential for the implementation and the success of such measures is the ability and willingness of people in need of care to engage actively in these therapies; here, appropriate and motivating information plays an important role.Subsequently, geriatric rehabilitation is referred to. In the 2013-2017 empirical study Organization and Rehabilitation for Residents in the Nursing Home to Improve Independence and Participation (ORBIT), 215 people in need of care participated in three-month therapeutic interventions, which were followed by three-months of rehabilitative care. Improvements in mobility and quality of life (Barthel index, QOL-AD) could be demonstrated compared to a control group (n = 28). The results have to be considered against the background of a worsening health and reduced functional capacities in old age. A stronger integration of prevention and rehabilitation services into long-term institutional care is functional for strengthening participation and independence - an important condition for the residents' certainty that their dignity will be respected, competence and strive for self-responsibility and self-determination.

[Advance care planning (ACP) in the context of dementia : Development of an instrument for exploration of perspectives of affected persons]. / Advance Care Planning im Kontext von Demenz : Entwicklung eines Instruments zur Exploration von Perspektiven der Betroffenen.

BACKGROUND: Since 2015, the Hospice and Palliative Care Act has defined the entitlement of nursing home residents to preventive planning in the final phase of their lives. Nevertheless, the advance care planning (ACP) concept has not yet been sufficiently researched in Germany. The deficient evidence on this topic appears to be even more considerable in connection with dementia. The necessity of such a discussion increases exponentially when dementia is diagnosed, not only for the person affected but also for their relatives and other caregivers and companions. OBJECTIVE: With respect to people with dementia, documents by a prominent German ACP provider were assessed as being insufficient by the authors. The aim of the pilot study presented here was to modify a questionnaire (value anamnesis) frequently used in the national context in order to apply it to this vulnerable group. MATERIAL AND METHODS: The value anamnesis was modified in 11 steps and pre-tested on people with dementia in an early stage. The focus of the document is on attitudes towards life, death and life-prolonging measures. The modification process was carried out in an iterative process based on the grounded theory according to Strauss and Corbin. RESULTS AND CONCLUSION: The stepwise adaptation of the document has created a practicable and low-threshold approach that also enables the vulnerable group of people with dementia to comprehensively deal with existential issues and to exchange views on them. This catalogue of questions is used as a basis document for the subsequent main study: here the life attachment of people with dementia is explored and thus a new perspective is placed on ACP.

Expectations of nursing personnel and physicians on dementia training : A descriptive survey in general hospitals in Germany and Greece.

BACKGROUND: The number of dementia training programs in hospital settings is steadily increasing. The way training sessions are designed influences the way the learning content is implemented in practice. To develop a successful training it is important to meet the needs of the target group; however, not much is known about staff preferences and expectations relevant to future dementia training programs in hospitals in Germany and Greece. OBJECTIVE: The aim of this survey was to explore staff training needs relevant to the topic of dementia, in general hospitals in Germany and Greece. This study analyzed the interests of staff members, preferences and expectations with respect to dementia training. MATERIAL AND METHODS: This was a descriptive survey based on a 54-item questionnaire conducted with 61 nursing staff, head nurses and physicians (Germany: n = 25, Greece: n = 36) recruited from 5 hospitals (Germany: n = 3, Greece: n = 2). Parts of the questionnaire explored participants' previous education regarding dementia and their expectations towards future dementia programs. RESULTS: Although staff attendance in educative programs was high in the last 5 years for both countries, participation in dementia training programs was low (Germany 24%, Greece 5.5%). Additionally, the great majority of participants were willing to be trained in future dementia training programs (Germany 96%, Greece 100%). Employees from both countries expect increased clinical skills as a result of participation in such training programs. In Greece, staff members hope for better handling of people with dementia, while in Germany, concrete practical advice is preferred. CONCLUSION: There seems to be a strong willingness to participate in further dementia training programs where not only theoretical knowledge is provided but also practical advice.

[Sexual Abuse of Minors: Development in Light Field Statistics and Dark Field Research Since 1953 and Implications For The Health Care System]. / Sexueller Missbrauch an Kindern ­ Entwicklungen im Hell- und Dunkelfeld seit 1953 und Implikationen für das Gesundheitswesen.

Data on sexual abuse of minors can be obtained from official Police Crime Statistics and from dark field surveys. This article deals with the longitudinal development of the offense in the last 63 years in Germany. The criminal offenses of sexual abuse of children according to § 176 StGB (German Criminal Code) in the Police Crime Statistics show a decrease of frequency in the reporting period (1953-2016). The empirical results of the dark field research are inconsistent, but partially show a decline in frequency. In this study, the importance of these findings for prevention and health policy is discussed.

The A Priori Design and Selection of Ionic Liquids as Solvents for Active Pharmaceutical Ingredients.

In this paper we derive a straightforward computational approach to predict the optimal ionic liquid (IL) solvent for a given compound, based on COSMO-RS calculations. These calculations were performed on 18 different active pharmaceutical ingredients (APIs) using a matrix of 210 hypothetical ILs. These results indicated that the 18 APIs could be classified into three distinct categories based on their relative hydrogen bond donating or accepting ability, with similar optimal IL solvent predictions within each class. Informed by these results, a family of strongly hydrogen bond donating ILs based on the N-alkylguanidinium cation were prepared and characterized. The solubility of the APIs in each of these classes was found to be qualitatively consistent with the predictions of the COSMO-RS model. The suitability of these novel guanidinium salts as crystallization solvents was demonstrated by the use of N-butylguanidinium bis(trifluoromethanesulfonyl)imide for the purification of crude fenofibrate using dimethylsulfoxide as an antisolvent, which resulted in good yields and excellent purities. Finally, a simple descriptor based model is proposed to suggest the best IL solvent for arbitrary APIs.

Impact of childhood asthma on growth trajectories in early adolescence: Findings from the Childhood Asthma Prevention Study (CAPS).

BACKGROUND AND OBJECTIVE: Understanding the associations between childhood asthma and growth in early adolescence by accounting for the heterogeneity of growth during puberty has been largely unexplored. The objective was to identify sex-specific classes of growth trajectories during early adolescence, using a method which takes the heterogeneity of growth into account and to evaluate the association between childhood asthma and different classes of growth trajectories in adolescence. METHODS: Our longitudinal study included participants with a family history of asthma born during 1997-1999 in Sydney, Australia. Hence, all participants were at high risk for asthma. Asthma status was ascertained at 8 years of age using data from questionnaires and lung function tests. Growth trajectories between 11 and 14 years of age were classified using a latent basis growth mixture model. Multinomial regression analyses were used to evaluate the association between asthma and the categorized classes of growth trajectories. RESULTS: In total, 316 participants (51.6% boys), representing 51.3% of the entire cohort, were included. Sex-specific classes of growth trajectories were defined. Among boys, asthma was not associated with the classes of growth trajectories. Girls with asthma were more likely than girls without asthma to belong to a class with later growth (OR: 3.79, 95% CI: 1.33, 10.84). Excluding participants using inhaled corticosteroids or adjusting for confounders did not significantly change the results for either sex. CONCLUSION: We identified sex-specific heterogeneous classes of growth using growth mixture modelling. Associations between childhood asthma and different classes of growth trajectories were found for girls only.

[The special requirements of old age in terms of dying]. / Die besonderen Anforderungen des hohen Alters im Hinblick auf das Sterben.

It is expected that the rising average life expectancy will leave ever more people with chronic progressive diseases of the body and brain. This then means not only having to deal with increasingly longer periods of care, but also possibly distinct neurocognitive disorders in the years prior to death and dying. The aim of this study is to report epidemiological data on the causes of death, as well as on the places of death. In addition, the attitudes and behaviour towards death and dying, as well as the different places of death will be discussed. Expecting support in the process of dying, as well as factors that have a more conducive effect on the internal processing of dying, are mentioned. At the same time, the attitudes and behaviours in respect of the accompaniment of dying people, which can be seen in the staff in clinical inpatient facilities, are addressed. Personal intense grappling with dying and death actually has a positive effect on these behaviours and attitudes. Finally, the contribution turns to the question of to what extent the theory of compression of morbidity may be perceived as valid, especially in view of the rising average life expectancy. It is emphasised that chronic diseases, even when no functional loss is present, place not only great demands on the patient, but also on the care system and financial resources. Furthermore, it is demonstrated that frailty can often cause mental disorders. Specific requirements with a view to the care of people with dementia are given.

[Gerontological policy advice : Possibilities and limits of scientific counseling]. / Gerontologische Politikberatung : Möglichkeiten und Grenzen wissenschaftlicher Beratung.

In the first part of this article a comprehensive understanding of political advice is explicated. In this context reference is made to the value judgement dispute in German sociology and a differentiation between an enlightening and a critical function of scientific policy advice. Development of social scientific policy advice is considered against the background of the distinction between technocratic, decisionistic and pragmatic models of counseling. In the second part of the article, the committee of inquiry on demographic change, the national reports on aging and the reviews on the development of the healthcare system are considered as practical examples of policy advice.

Absorption and Oxidation of Nitrogen Oxide in Ionic Liquids.

A new strategy for capturing nitrogen oxide, NO, from the gas phase is presented. Dilute NO gas is removed from the gas phase by ionic liquids under ambient conditions. The nitrate anion of the ionic liquid catalyzes the oxidation of NO to nitric acid by atmospheric oxygen in the presence of water. The nitric acid is absorbed in the ionic liquid up to approximately one mole HNO3 per mole of the ionic liquid due to the formation of hydrogen bonds. The nitric acid can be desorbed by heating, thereby regenerating the ionic liquid with excellent reproducibility. Here, time-resolved in-situ spectroscopic investigations of the reaction and products are presented. The procedure reveals a new vision for removing the pollutant NO by absorption into a non-volatile liquid and converting it into a useful bulk chemical, that is, HNO3 .

[Social inequality, health and nursing care in old age]. / Soziale Ungleichheit, Gesundheit und Pflege im höheren Lebensalter.

BACKGROUND: Health and care services are an important aspect of public services as a basic obligation of the welfare state. Particularly in old-age, social inclusion, relatedness and integrity become the aims of health and care services beyond independence and autonomy. OBJECTIVES: Provide an overview of inequalities related to socio-economic status, gender, and immigrant background in the context of health and care services. MATERIALS AND METHODS: Analysis of differences in risks and problem situations, access to prevention measures, ambulatory and in-patient treatment, availability of social support, and care services in middle and older adulthood. Thereby, the contribution proceeds from our own contributions to prevention and rehabilitation research as well as from representative surveys. RESULTS: People with lower socio-economic status, women, and migrants more often suffer from risks and problem situations and have less access to prevention measures and medical specialist care. Regarding in-patient treatment, people with private health insurance have a higher probability of being admitted to hospital. Migrants more often visit emergency rooms and less often get rehabilitation measures. The availability of social support depends on age, gender, and education; applicants from higher status groups more often receive services from nursing care insurance. CONCLUSION: The results point to the necessity of status-, milieu- and culture-sensitive counselling, particularly focusing on patient rights and usefulness of optional health and nursing care services. Qualified professionals could take responsibility for respective tasks.

Informal Caregivers' Attitude Toward Dementia: The Impact of Dementia Knowledge, Confidence in Dementia Care, and the Behavioral and Psychological Symptoms of the Person with Dementia. A Cross-Sectional Study.

BACKGROUND: Dementia is rapidly increasing worldwide due to demographic aging. More than two-thirds of patients are cared by family members. The quality of care depends on the caregivers' attitude toward dementia influencing patient care decisions. OBJECTIVE: The aim of this study is to examine the factors that influence the caregivers' attitude and whether there is an association between participation in a psycho-educational program and attitude. METHODS: We performed a cross-sectional study using a structured closed-ended questionnaire to retrieve socio-demographic information from caregivers and the persons with dementia (N = 86). The study included validated scales such as the Dementia Attitude Scale, the Dementia Knowledge Assessment Tool 2, the Positive Aspects of Caregiving, the Zarit Burden Interview, the Confidence in Dementia Scale, and Spielberger's State-Trait Anxiety Inventory, as well as a neuropsychological battery to assess the condition of people with dementia. RESULTS: Our final model explains 55.6% of the total variance and shows a significant correlation of five factors with attitude toward dementia: confidence, behavioral and psychological symptoms of dementia, anxiety as a trait, positive aspects of caregiving, and dementia knowledge. The caregivers who participated in a psycho-educational program showed a significantly more positive attitude toward dementia, better dementia knowledge, higher confidence in dementia care, and lower anxiety as a state. CONCLUSION: The strong correlation of attitude and knowledge, as well as confidence in dementia care, supports the tripartite model of attitude, which hypothesizes the interrelation of affect, cognition, and behavior.

Glutamatergic dysfunction in Schizophrenia.

The NMDA-R hypofunction model of schizophrenia started with the clinical observation of the precipitation of psychotic symptoms in patients with schizophrenia exposed to PCP or ketamine. Healthy volunteers exposed to acute low doses of ketamine experienced mild psychosis but also negative and cognitive type symptoms reminiscent of the full clinical picture of schizophrenia. In rodents, acute systemic ketamine resulted in a paradoxical increase in extracellular frontal glutamate as well as of dopamine. Similar increase in prefrontal glutamate was documented with acute ketamine in healthy volunteers with 1H-MRS. Furthermore, sub-chronic low dose PCP lead to reductions in frontal dendritic tree density in rodents. In post-mortem ultrastructural studies in schizophrenia, a broad reduction in dendritic complexity and somal volume of pyramidal cells has been repeatedly described. This most likely accounts for the broad, subtle progressive cortical thinning described with MRI in- vivo. Additionally, prefrontal reductions in the obligatory GluN1 subunit of the NMDA-R has been repeatedly found in post-mortem tissue. The vast 1H-MRS literature in schizophrenia has documented trait-like small increases in glutamate concentrations in striatum very early in the illness, before antipsychotic treatment (the same structure where increased pre-synaptic release of dopamine has been reported with PET). The more recent genetic literature has reliably detected very small risk effects for common variants involving several glutamate-related genes. The pharmacological literature has followed two main tracks, directly informed by the NMDA-R hypo model: agonism at the glycine site (as mostly add-on studies targeting negative and cognitive symptoms); and pre-synaptic modulation of glutamatergic release (as single agents for acute psychosis). Unfortunately, both approaches have failed so far. There is little doubt that brain glutamatergic abnormalities are present in schizophrenia and that some of these are related to the etiology of the illness. The genetic literature directly supports a non- specific etiological role for glutamatergic dysfunction. Whether NMDA-R hypofunction as a specific mechanism accounts for any important component of the illness is still not evident. However, a glutamatergic model still has heuristic value to guide future research in schizophrenia. New tools to jointly examine brain glutamatergic, GABA-ergic and dopaminergic systems in-vivo, early in the illness, may lay the ground for a next generation of clinical trials that go beyond dopamine D2 blockade.

Validation of the Adapted German Versions of the Dementia Knowledge Assessment Tool 2, the Dementia Attitude Scale, and the Confidence in Dementia Scale for the General Population.

BACKGROUND: There are almost no validated tools in German that assess dementia knowledge, attitude toward dementia, and confidence in the general population. OBJECTIVE: Translation and validation of the German version of the Dementia Knowledge Assessment Tool 2 (DKAT2), the Dementia Attitude Scale (DAS), and the Confidence in Dementia Scale (CODE). METHODS: Instruments were translated into German and adapted for the general public. A convenience sample of 263 persons was recruited via an online platform. Validation of the tools' psychometric properties consisted of an assessment of its reliability (internal consistency and 4-week test-retest reliability of a subgroup with n = 110), an analysis of its construct validity through principal component analysis and known-group analysis, convergent validity, and an item analysis for DKAT2-D. This study used the STROBE checklist for reporting. RESULTS: Acceptable to excellent internal reliability was found for DAS-D (α= 0.90), DKAT2-D (α= 0.78), and CODE-D (α= 0.93). The principal component analysis confirmed the two-factor model for the DAS-D as well as the one-factor solution for CODE-D. The intra-class correlation coefficient between the first and the 4-week retest was good (CODE-D: 0.897; 0.849-0.929) to excellent (DKAT2-D: 0.918; 0.879-0.945 and DAS-D: 0.940; 0.910-0.960). Known-group analysis revealed that DAS-D, DKAT-D, and CODE-D could distinguish between individuals with or without experience with people with dementia and with or without participation in a dementia course. CONCLUSION: The German versions DAS-D, DKAT2-D, and CODE-D are reliable and valid tools to measure knowledge, attitude, and confidence in dementia in the German-speaking general population.

Rethinking a Traditional Method of Participation: "Town-Hall Meetings" to Support Family Carers of People with Dementia.

A growing number of people with dementia, a simultaneous decline of professional caregivers, and changing family structures clearly illustrate the societal relevance of the question of how dementia care can be arranged and delivered in the future. The demand for innovative solutions especially to support family carers requires a deeper insight into their life situation and a focused perception of their needs. This article presents the main hypothesis that specific forms of social integration and participation based on an equal dialogue between family caregivers, the public, and policymakers is needed to achieve that. Therefore, the main point here is to give family caregivers of people with dementia a voice to learn how to better support them in caring as well as self-care. A learning process triggered by a dialogue might result in a higher level of community readiness to implement new forms of support or social innovations. The hypothesis will be supported by John Dewey's theory of political and democratic learning and the model of transformative learning according to Jack Mezirow indicating that learning particularly succeeds in interpersonal communication. In this context, the Town-Hall Meeting method and its potential to promote interpersonal communication and reflexive learning is discussed. The article addresses an important debate, namely that of how dementia care and support of family carers can succeed. It also sets the direction for future empirical research as the Town-Hall Meeting method might be applicable for gerontological action and participatory research.

Evaluation and Effectiveness of a Two-Day Dementia Training Program for Hospital Staff Working in an Emergency Department.

BACKGROUND: Entering the hospital via an Emergency Department (ED) is a pivotal moment in the life of People with Dementia (PwD) and often starts an avoidable downward spiral. Therefore, it is required to further educate ED staff to raise awareness of the needs of PwD. Although there are many studies about existing dementia training programs for the hospital setting, empirical evidence for the ED setting and cross-level training evaluations are lacking. OBJECTIVE: The study aims to evaluate a two-day dementia training course for ED staff on the outcome levels of learning, individual performance, and organizational performance. Furthermore, the study examines whether the training fulfilled participants' expectations. METHODS: Mixed methods were used to assess data from head nurses, nursing, and administrative staff working in EDs. We conducted semi-structured interviews three weeks before (N = 18) and eight months after (N = 9) the training. Questionnaire data were assessed before the training, three months, and six months after the training (N = 44). A qualitative content analysis was conducted to analyze qualitative data; quantitative data was described descriptively. RESULTS: The intervention seems to be effective on both learning and individual performance levels. However, we did not observe any changes in the organizational performance. The training program met attendees' expectations only partly. The working environment of EDs needs to be taken more into account. CONCLUSION: Hospital staffs' expectations of a dementia training program depend on the work area in which they operate. Results support the implementation of intervention bundles to enable sustainable cross-level changes.

I-CARE-An Interaction System for the Individual Activation of People with Dementia.

I-CARE is a hand-held activation system that allows professional and informal caregivers to cognitively and socially activate people with dementia in joint activation sessions without special training or expertise. I-CARE consists of an easy-to-use tablet application that presents activation content and a server-based backend system that securely manages the contents and events of activation sessions. It tracks various sources of explicit and implicit feedback from user interactions and different sensors to estimate which content is successful in activating individual users. Over the course of use, I-CARE's recommendation system learns about the individual needs and resources of its users and automatically personalizes the activation content. In addition, information about past sessions can be retrieved such that activations seamlessly build on previous sessions while eligible stakeholders are informed about the current state of care and daily form of their protegees. In addition, caregivers can connect with supervisors and professionals through the I-CARE remote calling feature, to get activation sessions tracked in real time via audio and video support. In this way, I-CARE provides technical support for a decentralized and spontaneous formation of ad hoc activation groups and fosters tight engagement of the social network and caring community. By these means, I-CARE promotes new care infrastructures in the community and the neighborhood as well as relieves professional and informal caregivers.