[Does the nursing shortage in neonatal intensive care units (NICU) threaten the warranty of healthcare for newborns? : The "Mary and Joseph" project]. / Gefährdet der Pflegepersonalmangel auf neonatologischen Intensivstationen die Versorgungssicherheit Neugeborener? : Das Projekt "Maria und Josef".

BACKGROUND: Germany has been experiencing a dramatic shortage of nursing staff for years that particularly affects neonatal intensive care units (NICUs). It is assumed that this situation leads to reductions in bed capacities, resulting in negative effects on the healthcare of newborns. These were investigated through a retrospective observational study using the example of three NICUs at the University Hospital of Munich (LMU). METHODS: For the four-year observation period from August 2017 to May 2021, time series data from the "Quality Assurance Guideline for Premature and Mature Infants" (QFR-RL) of the Federal Joint Committee, bed resource analysis, planned personnel statistics, clinical logout data, and rescue service data were mutually examined using descriptive statistics and regression analysis. RESULTS: During the observation period, around 21% of the necessary nursing staff positions were vacant, although the quality of nursing care for newborns seemed to have been guaranteed. However, to ensure quality, given the staff shortage, several available beds had to be blocked. In this context, both an increase in the number of hours the wards were logged off from population care and an increase in the relative risk of neonatal intensive care transfer were observed, resulting in a transfer every three days on average. DISCUSSION: A shortage of nursing staff reduces the neonatal hospital bed capacity, since neonatal nursing care quality is regulated by strict legally binding guidelines, the QFR-RL. This is why the consequences for the security of care for the population through hospital cancellations and a risk of transfer must be accepted on a regular basis.

[Tele-emergency physician : New care concept in emergency medicine]. / Telenotarzt : Neues Versorgungskonzept in der Notfallmedizin.

BACKGROUND: Telemedical concepts, already successfully established in various clinical areas, such as radiology, are increasingly being implemented in the preclinical setting throughout Germany (tele-emergency physician). OBJECTIVE: The aim of the article is to present the objectives and requirements as well as the practical implementation and the potential indications for a telemedical emergency system in the preclinical situation. MATERIAL AND METHODS: Discussion of scientific facts and expert recommendations, specifically from experiences of the tele-emergency physician (Telenotarzt) project in an urban environment (City of Aachen). In addition, reference is made to a second pilot project in a rural region (Straubing, Bavaria). RESULTS: The successful implementation of a prehospital telemedical emergency system requires a specific framework, in particular of a legal and technical nature. In order to achieve optimal process quality it is important to establish a comprehensive concept that takes aspects of patient safety into account. The entire dispatch process in the control center as well as the training of all involved personnel must also be taken into consideration. CONCLUSION: With its special structures and processes, the overall concept of the telemedical emergency physician meets the changing challenges in the preclinical healthcare system and opens up new possibilities for patient care that meet the current requirements.

Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle-Income Countries.

OBJECTIVE: The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent. RESEARCH DESIGN AND METHODS: We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample, major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics. RESULTS: Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI 161.2-162.3), and the crude prevalence of diabetes was 7.5% (95% CI 6.9-8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2 out of 50). Results were robust to alternative model specifications. CONCLUSIONS: Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.

Shorter Height is Associated with Diabetes in Women but not in Men: Nationally Representative Evidence from Namibia.

OBJECTIVE: This study aimed to test the hypothesis that attained adult height, as an indicator of childhood nutrition, is associated with diabetes in adulthood in Namibia, a country where stunting is highly prevalent. METHODS: Data from 1,898 women and 1,343 men aged 35 to 64 years included in the Namibia Demographic and Health Survey in 2013 were analyzed. Multiple logistic regression models were used to calculate odds ratios (ORs) and 95% CIs of having diabetes in relation to height. The following three models were considered: Model 1 included only height, Model 2 included height as well as demographic and socioeconomic variables, and Model 3 included body mass index in addition to the covariates from Model 2. RESULTS: Overall crude diabetes prevalence was 6.1% (95% CI: 5.0-7.2). Being taller was inversely related with diabetes in women but not in men. In Model 3, a 1-cm increase in women's height was associated with 4% lower odds of having diabetes (OR, 0.96; 95% CI: 0.94-0.99; P = 0.023). CONCLUSIONS: Height is associated with a large reduction in diabetes in women but not in men in Namibia. Interventions that allow women to reach their full growth potential may help prevent the growing diabetes burden in the region.