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1.
JMIR Aging ; 7: e55471, 2024 Jun 06.
Article in English | MEDLINE | ID: mdl-38842915

ABSTRACT

BACKGROUND: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. OBJECTIVE: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. METHODS: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. RESULTS: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. CONCLUSIONS: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.


Subject(s)
COVID-19 , Nursing Homes , Telemedicine , Humans , Nursing Homes/organization & administration , COVID-19/epidemiology , Telemedicine/organization & administration , Germany/epidemiology , Female , Male , Aged , Pandemics , Television
3.
J Pers Disord ; 38(3): 241-267, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38857161

ABSTRACT

Conceptual work integrating constructs from mainstream personality research (especially so-called "dark" traits) and clinical psychopathology research has been limited. Herein, we propose all socially and/or ethically aversive traits as "flavored" manifestations of the D factor of personality (D). We argue that the D framework provides the commonality of all aversive traits, including the aversive traits from the DSM-5 Alternative Model for Personality Disorders (AMPD), a more thorough theoretical foundation. Moreover, D covers aspects that are not captured by any of the aversive AMPD traits directly (e.g., greed), thus offering indications for possible expansions to the AMPD. We tested our predictions in two online studies (N = 1,781 and N = 2,006) using quota-representative samples of the German population regarding age and gender. Twelve aversive traits from mainstream personality research and eight aversive AMPD traits were assessed together with consequential behavior in an economic game. Analyses using structural equation modeling overall confirmed predictions.


Subject(s)
Personality Disorders , Personality , Humans , Female , Male , Adult , Middle Aged , Young Adult , Adolescent , Aged , Germany
4.
J Safety Res ; 89: 343-353, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38858059

ABSTRACT

PROBLEM: The surge in popularity of electric kick scooters (e-scooters) poses new challenges for traffic planning, demanding a comprehensive understanding of route choice behavior to see how e-scooters are used, how they affect traffic flow, and where improvements can be made to the road infrastructure. Therefore, this study aimed to analyze route choices and preferences of e-scooter riders and cyclists in a quasi-experimental setup with both user groups having the same trip destinations. METHOD: Two groups of participants (n = 52) completed a ride with either a shared e-scooter or bicycle to reach four predefined destinations in Dresden, Germany. The riders were supposed to choose their routes and subsequently reported the difficulty of decision-making and the importance of several route choice factors related to the ride. RESULTS: E-scooter riders rated road surface and safety as significantly more important for route choice than cyclists and tended to perceive the decision-making as more difficult. Riding data revealed broad comparability between the groups, with e-scooter riders tendentially having longer routes for complex decisions (unknown destinations, scenic routes, more turns required). DISCUSSION: The study suggests that the route preferences of e-scooter riders may be influenced by a combination of road surface and safety considerations, highlighting the need for high-quality cycling infrastructure. Limitations exist regarding the naturally occurring differences in riding experience in e-scooter riding versus cycling. Practical implications indicate that planning for e-scooter riders can benefit from insights drawn from activities designed for cyclists. The provision of real-time road quality information is proposed, considering its potential impact on overall road safety. SUMMARY: This study contributes to a better understanding of how e-scooter riders navigate through cities and delivers a valuable foundation for transport planners and engineers considering the rise in cycling and micro-mobility use.


Subject(s)
Bicycling , Choice Behavior , Humans , Male , Adult , Female , Germany , Middle Aged , Young Adult , Decision Making , Safety , Environment Design , Accidents, Traffic/prevention & control
5.
Psychiatr Pol ; 58(1): 7-24, 2024 Feb 28.
Article in English, Polish | MEDLINE | ID: mdl-38852182

ABSTRACT

OBJECTIVES: Anxiety disorders are significant predictors of suicidality and are proposed to be independent risk factors for suicide attempts. They are common in people with type 2 diabetes (T2DM) and are associated with longer duration of diabetes and poorer treatment outcomes. The aim was to examine associations between anxiety disorders and suicidal thoughts and behaviour in people with T2DM, to establish the prevalence of suicidality among people with T2DM in the selected European countries and to examine whether anxiety disorders were predictive of current outcomes of suicidality in this population using data from the International Prevalence and Treatment of Diabetes and Depression study. METHODS: The study sample comprised 1063 adults with T2DM from 6 European countries. The presence of anxiety disorders and suicidality was assessed with the MINI International Neuropsychiatric Interview. The group of participants with current suicidal risk was compared with the group of participants with no suicidal risk. RESULTS: The participants from Germany were more likely to report suicidality than those from other countries, whereas people from Serbia and Ukraine were less likely to report it. Depression and anxiety disorders significantly contributed to the increased presence of suicidality among people with T2DM. Agoraphobia was a significant predictor of suicidality when controlling for depression. The participants with T2DM and comorbid agoraphobia had 4.86 times higher odds to report suicidality than those without agoraphobia. CONCLUSIONS: Agoraphobia was a significant predictor of suicidality in people with T2DM.


Subject(s)
Anxiety Disorders , Diabetes Mellitus, Type 2 , Suicidal Ideation , Humans , Diabetes Mellitus, Type 2/psychology , Diabetes Mellitus, Type 2/epidemiology , Female , Male , Middle Aged , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Adult , Europe/epidemiology , Risk Factors , Comorbidity , Aged , Suicide, Attempted/statistics & numerical data , Suicide, Attempted/psychology , Prevalence , Ukraine/epidemiology , Germany/epidemiology
6.
J Dtsch Dermatol Ges ; 22(6): 894-895, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38857076
8.
J Dtsch Dermatol Ges ; 22(6)2024 Jun.
Article in Turkish | MEDLINE | ID: mdl-38857092
12.
Z Rheumatol ; 83(5): 425-426, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38829413
13.
Z Rheumatol ; 83(5): 428, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38829415
15.
J Headache Pain ; 25(1): 90, 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38825722

ABSTRACT

BACKGROUND: Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway have shown good efficacy in migraine prophylaxis. However, a subset of patients does not respond to the first mAb treatment and switches among the available mAbs. The goal of this study is to characterize the switching pattern of migraine patients treated with anti-CGRP(-receptor, -R) mAbs, and to describe the headache burden of those who did not switch, switched once, and switched twice. METHODS: This study used real world data from the NeuroTransData Cohort, a registry of migraine patients treated at outpatient neurology clinics across Germany. Patients who had received at least one anti-CGRP(-R) mAb were included. Headache diaries were collected at baseline and during treatment, along with quality of life measures every three months. Results were summarized for the subgroups of patients who did not switch and those with one and two switches. RESULTS: Of the 655 eligible patients, 479 did not switch, 135 switched once, 35 twice, and 6 three or more times. The ≥ 50% response rates for monthly migraine days were 64.7%, 50.7%, and 25.0% for the no switch, one switch, and two switches groups in their last treatment cycles, respectively. Quality of life measures improved for the no switch and one switch groups, but not for the two switches group. CONCLUSION: Patients who switched among anti-CGRP(-R) mAbs during the course of their treatment still benefited overall but to a lesser extent than those who did not switch. Treatment response in patients who switched twice was markedly lower compared to the no switch and one switch subgroup.


Subject(s)
Antibodies, Monoclonal , Calcitonin Gene-Related Peptide , Migraine Disorders , Registries , Humans , Migraine Disorders/drug therapy , Migraine Disorders/immunology , Female , Male , Antibodies, Monoclonal/therapeutic use , Germany/epidemiology , Middle Aged , Adult , Calcitonin Gene-Related Peptide/immunology , Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use , Calcitonin Gene-Related Peptide Receptor Antagonists/administration & dosage , Quality of Life , Drug Substitution/statistics & numerical data , Cost of Illness , Receptors, Calcitonin Gene-Related Peptide/immunology , Receptors, Calcitonin Gene-Related Peptide/metabolism
16.
J Law Health ; 37(3): 225-248, 2024.
Article in English | MEDLINE | ID: mdl-38833605

ABSTRACT

Medical research plays a vital role in advancing human knowledge, developing new therapies and procedures, and reducing human suffering. Following the atrocities committed in the name of medical research by German physicians during the Nazi era, the Nuremberg trials were held, and an ethical code was created to establish the limits within which medical research can operate. Consequently, legal regimes built upon this ethical foundation to develop laws that ensure the integrity of medical research and the safety of human subjects. These laws sought to protect human subjects by minimizing conflicts of interest that may arise during the process. Furthermore, conflicts of interest may be financial such as monetary gain, or nonfinancial such as promotion and career advancement. However, with a $1.1 billion median cost of developing a new drug, the focus of these laws was directed towards financial conflicts of interest. But should we expand these laws to include nonfinancial conflicts of interest? This Article highlights prominent arguments in favor of and against the regulation of nonfinancial conflicts of interest in medical research. It further concludes that adequate institutional policies--not additional regulations--strike the right balance between the need to safeguard against the harmful effects of nonfinancial conflicts of interest on the one hand and avoiding the drawbacks of overregulation on the other.


Subject(s)
Biomedical Research , Conflict of Interest , Conflict of Interest/legislation & jurisprudence , Humans , Biomedical Research/ethics , Biomedical Research/legislation & jurisprudence , Germany
19.
Clin Oral Investig ; 28(6): 349, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38822870

ABSTRACT

OBJECTIVE: This cross-sectional pilot study evaluated the impact of age on masticatory performance among individuals aged 65 to 106 years, as part of the Heidelberg Dental Centenarian Study (HD-100Z) conducted in South-Western Germany. MATERIALS AND METHODS: A total of 31 centenarians were recruited, alongside 31 individuals each from the age groups 75-99 and 65-74, matched based on sex, prosthetic status, and number of teeth. Masticatory performance was assessed using a two-colored chewing gum test and digital image processing. Multiple linear regression analysis was performed to assess the effect of age, sex, number of teeth, type of prosthesis on the masticatory performance. RESULTS: Masticatory performance, as measured by the standard deviation of hue in the chewing gum test, decreased significantly in centenarians compared to individuals aged 75-99 years (-0.112, p = 0.037) and those aged 65-74 years (-0.274, p < 0.001). The effects of sex, number of teeth, and type of prosthesis on masticatory performance were not significant associations (p ≥ 0.135). CONCLUSION: The findings suggest that age may have a significant influence on masticatory performance in the studied age groups, challenging previous notions that aging itself has little impact on masticatory ability. The inclusion of centenarians in the study highlights the need for further investigation into masticatory function in age groups reaching up to 100 years or more. CLINICAL RELEVANCE: This study contributes to the understanding of how ageing affects oral function, which may guide dental treatment approaches for older individuals, and set the stage for more in-depth investigations in this field in the future.


Subject(s)
Mastication , Humans , Female , Mastication/physiology , Cross-Sectional Studies , Male , Aged, 80 and over , Aged , Pilot Projects , Germany , Age Factors , Chewing Gum
20.
BMC Musculoskelet Disord ; 25(1): 427, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38824507

ABSTRACT

BACKGROUND: There has long been discussion regarding the impact of medial malleolar osteotomies (MMO) as an adjunctive treatment for osteochondral lesions of the talus (OCLT). MMO may improve the visibility and accessibility of the talus, but they also pose a risk of periprocedural morbidity. There is a lack of research about the prevalence and consequences of MMO in the surgical treatment of OCLT. METHODS: This study retrospectively evaluated data from the German Cartilage Register (KnorpelRegister DGOU) from its implementation in 2015 to December 2020. The impact of MMO on patient-reported outcome measures (PROMs) was investigated. Wherever possible, subgroups were built and matched using a propensity score which matched a group undergoing OCLT without MMO. Matching included age, sex, weight, localization of the OCLT, the international cartilage repair society (ICRS) grading, surgical procedure and preoperative symptoms using the Foot and Ankle Ability Measure (FAAM) and the Activities of Daily Living Subscale (ADL). RESULTS: The prevalence of MMO in the operative treatment of OCLT was 15.9%. Most of the osteotomies were performed in OCL of the medial talar dome (76.8%) and in more serious lesions with an ICRS grade of III (29.1%) and IV (61.4%). More than half of the osteotomies (55.6%) were performed during revision surgery. A matched pair analysis of n = 44 patients who underwent AMIC® via arthrotomy and MMO vs. arthrotomy alone showed no significant differences in patient-reported outcome measures (PROMs, i.e. FAAM-ADL, and FAOS) at 6,12 and 24 months. CONCLUSIONS: MMO are mostly used in the treatment of severe (≥ ICRS grade 3) OCL of the medial talar dome and in revision surgery. Functional and patient-reported outcome measures are not significantly affected by MMO compared to arthrotomy alone. TRIAL REGISTRATION: The German Cartilage Register (KnorpelRegister DGOU) was initially registered at the German Clinical Trials Register ( https://www.drks.de , register number DRKS00005617, Date of registration 03.01.2014) and was later expanded by the ankle module.


Subject(s)
Osteotomy , Patient Reported Outcome Measures , Registries , Talus , Humans , Female , Male , Osteotomy/methods , Osteotomy/adverse effects , Talus/surgery , Retrospective Studies , Adult , Germany/epidemiology , Middle Aged , Treatment Outcome , Cartilage, Articular/surgery , Young Adult , Incidence , Ankle Joint/surgery , Activities of Daily Living , Adolescent , Recovery of Function
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