Evaluation of cross-cultural competence among German health care professionals: A quasi-experimental study of training in two hospitals.

Sociocultural diversity in the German health care system is increasingly reflected in multicultural teams and the diversity of patients. To ensure successful collaboration in a multicultural environment and effective care to diverse patients the importance of cross-cultural competence training is growing. There is a lack of evidence-based training approaches for the German health care system, and it is unclear how the theoretical-conceptual promotion of cross-cultural competence can be achieved sustainably. The aim of the study is to evaluate the effectiveness of cross-cultural competence training for German health care professionals. A quasi-experimental evaluation study in two German hospitals was conducted. Cross-cultural competence was examined in an intervention and a control group (n = 196) using the self-reported instrument Cross-Cultural Competence of Healthcare Professionals (CCCHP) and analyzed with SPSS Statistics 25. Cross-cultural training had a cognitive level impact on knowledge, awareness, and attitudes and showed a highly significant reduction in social desirability. On an affective level, cross-cultural motivation and curiosity initially increased at t1 and decreased at t2. Cross-cultural emotion and empathy increased slightly. On a behavioral level, cross-cultural skills decreased after the training. For sustainable effects, cross-cultural training should focus more on practical skills in addition to theoretical content. Training interventions should be long-term. The results show that more needs to be done in the German health care sector to meet the increasing diversity and demands.

Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff.

BACKGROUND: Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care. OBJECTIVES: To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels. DESIGN: Cross-sectional online survey in the form of a full census from May to November 2018. SETTING: Two organisations that run a total of 22 hospitals in Germany. PARTICIPANTS: Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243]. METHODS: Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features. RESULTS: The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff's cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff's assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001]. CONCLUSIONS: The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals.

[Intercultural Opening in Health Care Promotes Solidarity]. / Interkulturelle Öffnung im Gesundheitswesen fördert einen solidarischen Umgang.

AIM: Due to the increase in socio-cultural diversity, the importance of intercultural opening processes is also increasing in the German health care system. The present study examines on the basis of 4 case studies to what extent an organisationally designed intercultural opening (IKÖ) has an effect on the system and social integration level. On the basis of the empirical results, practice-oriented recommendations can be derived. METHODS: Using socio-scientific qualitative methods, a participating observation was carried out on 21 days in 2 hospitals and 2 outpatient care services in NRW. The institutions examined differed in terms of the degree of intercultural openness. The observations were systematically recorded and evaluated using the documentary method with MAXQDA inductive category-based evaluation. The approach is based on Bourdieu's field-habitus theory 7 and the fields of observation were analyzed on a system and social integration level 8 according to Lockwood. RESULTS: The elaborated system of categories consists of 4 main categories (methodology, work organisation, communication, care and medical system) and 918 sub-categories. An intercultural opening of the organisation in the form of an intercultural team and measures offered for intercultural opening are accompanied by a higher degree of solidarity. CONCLUSION: The intercultural opening process in the health care system must be anchored at the system and socialintegration level in order to promote more efficient care processes and solidarity. Since IKÖ involves additional time, financial and personnel resources, a strategic decision, on the one hand, and a consciously controlled opening process from above, on the other hand, is needed on the part of the management. This enables the employees to participate in shaping the traditional organisational culture in a negotiation process.

Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants, Prolactin and Breast Cancer.

Selective serotonin reuptake inhibitors (SSRIs) are a widely prescribed class of antidepressants. Laboratory and epidemiologic evidence suggests that a prolactin-mediated mechanism secondary to increased serotonin levels at neuronal synapses could lead to a potentially carcinogenic effect of SSRIs. In this population-based case-control study, we evaluated the association between SSRI use and breast cancer risk as a function of their relative degree of inhibition of serotonin reuptake as a proxy for their impact on prolactin levels. Cases were 2,129 women with primary invasive breast cancer diagnosed from 2003 to 2007, and controls were 21,297 women randomly selected from the population registry. Detailed information for each SSRI prescription dispensed was compiled using the Saskatchewan prescription database. Logistic regression was used to evaluate the impact of use of high and lower inhibitors of serotonin reuptake and duration of use, as well as to assess the effect of individual high inhibitors on the risk of breast cancer. Exclusive users of high or lower inhibitors of serotonin reuptake were not at increased risk for breast cancer compared with non-users of SSRIs (OR = 1.01, CI = 0.88-1.17 and OR = 0.91, CI = 0.67-1.25 respectively), regardless of their duration of use or menopausal status. While we cannot rule out the possibility of a clinically important risk increase (OR = 1.83, CI = 0.99-3.40) for long-term users of sertraline (≥24 prescriptions), given the small number of exposed cases (n = 12), the borderline statistical significance, and the wide confidence interval, these results need to be interpreted cautiously. In this large population-based case-control study, we found no conclusive evidence of breast cancer risk associated with the use of SSRIs even after assessing the degree of serotonin reuptake inhibition and duration of use. Our results do not support the serotonin-mediated pathway for the prolactin-breast cancer hypothesis.

Use of non-steroidal anti-inflammatory drugs and prostate cancer risk: a population-based nested case-control study.

BACKGROUND: Despite strong laboratory evidence that non-steroidal anti-inflammatory drugs (NSAIDs) could prevent prostate cancer, epidemiological studies have so far reported conflicting results. Most studies were limited by lack of information on dosage and duration of use of the different classes of NSAIDs. METHODS: We conducted a nested case-control study using data from Saskatchewan Prescription Drug Plan (SPDP) and Cancer Registry to examine the effects of dose and duration of use of five classes of NSAIDs on prostate cancer risk. Cases (N = 9,007) were men aged ≥40 years diagnosed with prostatic carcinoma between 1985 and 2000, and were matched to four controls on age and duration of SPDP membership. Detailed histories of exposure to prescription NSAIDs and other drugs were obtained from the SPDP. RESULTS: Any use of propionates (e.g., ibuprofen, naproxen) was associated with a modest reduction in prostate cancer risk (Odds ratio = 0.90; 95%CI 0.84-0.95), whereas use of other NSAIDs was not. In particular, we did not observe the hypothesized inverse association with aspirin use (1.01; 0.95-1.07). There was no clear evidence of dose-response or duration-response relationships for any of the examined NSAID classes. CONCLUSIONS: Our findings suggest modest benefits of at least some NSAIDs in reducing prostate cancer risk.

Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's disease.

PURPOSE: To estimate the risk (and determinants) of discontinuing cholinesterase inhibitors (ChEIs) in a population-based sample of Alzheimer's disease (AD) patients. METHODS: This is a retrospective cohort study based on linked de-identified administrative health data from the province of Saskatchewan, Canada. The cohort included all AD patients receiving a ChEI prescription during the first year of provincial coverage (2000-2001). Persistence was defined as no gap of 60+ days between depletion and subsequent refill of a ChEI prescription. Kaplan-Meier analysis was used to estimate the risk of discontinuation over 40 months. Cox regression with time-varying covariates was used to assess risk factors for ChEI discontinuation. RESULTS: The sample included 1080 patients (64% female, average age 80 +/- 7 years). Baseline mean (SD) Mini-Mental State Examination (MMSE) and Functional Activities Questionnaire (FAQ) scores were 20.8 (4.4) and 17.5 (7.7), respectively. Over 40 months, 84% discontinued therapy. The 1-year risk of discontinuation was 66.4% (95%CI 63.5-69.3%). Discontinuation was significantly more likely for females (adjusted HR 1.34, 95%CI 1.16-1.55) and among those with lower MMSE scores (2.52, 2.01-3.17 if <15), not receiving social assistance (1.25, 1.07-1.45), and paying at least 65% of total prescription costs (1.51, 1.30-1.74). It was significantly less likely for patients with frequent physician visits (0.78, 0.66-0.93, for 7-19 vs. <7 visits), higher Chronic Disease Scores (0.74, 0.61-0.89, for 7+ vs. <4), and FAQ scores of 9+ (0.82, 0.69-0.99). CONCLUSION: The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors.

Liberação do músculo depressor do septo nasal para tratamento do sorriso gengival / Release of the nasal septum depressor muscle for treatment of gummy smile

A liberação do músculo depressor do septo nasal, aplicada principalmente para tratamento da ponta nasal e sua relação com o lábio, foi utilizada neste estudo para tratamento de pacientes com sorriso gengival. O objetivo foi demonstrar a utilização desta técnica com a finalidade de corrigir alterações estéticas do sorriso, realizando a contenção da elevação do lábio superior e menor exposição gengival ao sorrir. Vinte pacientes foram selecionados segundo o critério de exposição de mais de um terço da faixa gengival marginal superior em comparação ao tamanho do incisivo central, ou mais de 4 mm de exposição gengival superior. Os pacientes não tinham sido submetidos a nenhum outro tipo de tratamento anterior para correção do sorriso gengival. Em todos os pacientes operados observou-se alongamento do lábio superior na posição em repouso, bem como redução importante do seu encurtamento ao sorrir. Acompanhado a isso, notou-se elevação da ponta nasal ao repouso e aumento da espessura do vermelhão labial durante o sorriso. A correção da linha de sorriso alta se fez sem comprometimento da harmonia do lábio, mantendo-se o perfil labial original dos pacientes. Alto grau de satisfação foi manifestado pelos pacientes após a cirurgia. Não obstante a multicausalidade do sorriso gengival, esse estudo apresenta mais uma opção terapêutica efetiva, duradoura e de baixa morbidade para obtenção de um sorriso natural e harmonioso.

Surgical treatment of the nasal septum depressor muscle, indicated mainly for the treatment of the nasal tip and its relation with the upper lip, was performed in this study for correction of “gingival smile”. The aim of this paper was to demonstrate the effectiveness of this technique for correction of non-aesthetic smiling due to excessive gingival exposure. Twenty patients were selected based on the following criteria: a gingival exposure higher than 4mm or more than one-third of the superior central incisor height. In the post-operative period, every patient had elongation of the upper lip on neutral position, as well as important reduction of its shortening while smiling. Also, elevation of the nasal tip on neutral position and enlargement of the vermillion of the upper lip when smiling was observed. These changes were achieved maintaining the original characteristics without compromising the harmony of the smile. The patients demonstrated a high level of satisfaction with the results achieved. Besides the large spectrum of etiologies leading to a gingival smile, this paper presents an effective and durable therapeutic option for achievement of a natural and harmonious smile.

1,3-Disubstituted-imidazo[1,5-a]pyrazines as insulin-like growth-factor-I receptor (IGF-IR) inhibitors.

A series of novel 8-amino-1,3-disubstituted-imidazo[1,5-a]pyrazines was designed and synthesized as IGF-IR inhibitors.

PGR +331 A/G and increased risk of epithelial ovarian cancer.

Childbearing and use of oral contraceptives are known to lower the risk of ovarian cancer, and it has been suggested that progesterone or progestin exposures play a role in these associations. The effects of progesterone may be mediated in part through the progesterone receptor, which exists in two functionally distinct protein isoforms, hPR-A and hPR-B. It is known that individuals carrying the A allele of the progesterone receptor gene (PGR) polymorphism, +331 A/G (rs10895068), have greater production of the hPR-B receptor isoform. We therefore examined the association between PGR +331 A/G genotype and risk of ovarian cancer in a population-based study of 490 cases and 534 controls in the state of Connecticut. Adjusted for various reproductive and other factors, a statistically significant increased risk was seen for carriage of the A allele compared with GG genotype [odds ratio (OR), 1.68; 95% confidence interval (95% CI), 1.09-2.59]. When subjects were considered separately according to menopausal status, no increased risk with the A allele was seen for premenopausal women (OR, 0.96; 95% CI, 0.46-2.02) but significantly increased risk was found for postmenopausal women (OR, 2.31; 95% CI, 1.31-4.06). Similar increased risks particularly among postmenopausal women were seen for all histologic tumor types. These findings have been observed before for breast and endometrial cancer, although not for ovary, but still suggest that an hPR-B mechanism may be involved in ovarian neoplasia.

A multiplex assay for the detection and mapping of complex glycerol kinase deficiency.

BACKGROUND: Glycerol kinase deficiency (GKD) is an X-linked recessive disorder that presents in both isolated and complex forms. The contiguous deletion that leads to GKD also commonly affects NR0B1 (DAX1), the gene associated with adrenal hypoplasia congenita, and DMD, the Duchenne muscular dystrophy gene. Molecular testing to delineate this deletion is expensive and has only limited availability. METHODS: We designed a multiplex PCR assay for the detection and mapping of a contiguous deletion potentially affecting the IL1RAPL1, NR0B1, GK, and DMD genes in a 29-month-old male patient with GKD. RESULTS: Multiplex PCR detected a contiguous deletion that involved the IL1RAPL1, NR0B1, GK, and DMD genes. Although the patient had a creatine kinase concentration within the reference interval, further mapping with PCR revealed that exon 74 was the last intact exon at the 3' end of the DMD gene. CONCLUSIONS: Multiplex PCR is an effective and inexpensive way to detect and map the contiguous deletion in cases of complex GKD. The extension of a deletion to include DMD exon 75 in a patient with a creatine kinase concentration within the reference interval suggests that this region of the gene may not be essential for protein function.

3-[6-(2-Dimethylamino-1-imidazol-1-yl-butyl)-naphthalen-2-yloxy]-2,2-dimethyl-propionic acid as a highly potent and selective retinoic acid metabolic blocking agent.

3-[6-(2-Dimethylamino-1-imidazol-1-yl-butyl)-naphthalen-2-yloxy]-2,2-dimethyl-propionic acid and analogs were designed and synthesized as highly potent and selective CYP26 inhibitors, serving as retinoic acid metabolic blocking agents (RAMBAs), with demonstrated in vivo efficacy to increase the half-life of exogenous atRA.

Inhaled vanadium pentoxide decrease gamma-tubulin of mouse testes at different exposure times.

Vanadium is an important environmental and industrial pollutant whose concentrations have increased in the last decades. Due to its status as reproductive toxicant and a microtubule damaging agent, the present study investigated by immunohistochemistry the effect of the inhalation of vanadium pentoxide on gamma-tubulin within somatic and testicular germ cells. Male mice inhaled vanadium pentoxide (V2O5) (0.02 M) 1 h/twice a week for 12 weeks. Our results demonstrated that vanadium accumulates in the testes starting with the initial inhalation (24 h), and this pattern remained until the last week of treatment. In general, vanadium was capable of significantly decreasing the percentage of gamma-tubulin in all analyzed testicular cells (Sertoli, Leydig and germ cells) starting with the first week of treatment. For all cell types studied, regression analysis revealed a negative and significant relationship between the percentage of immunopositive cells to gamma-tubulin and exposure time, showing a time dependent response in all cases. Our findings suggest that alterations on this protein might imply changes in microtubule-involved function such as cell division, which in the testes might lead to damage in the spermatogenesis, leading probably to infertility.

Potent and selective [2-imidazol-1-yl-2-(6-alkoxy-naphthalen-2-yl)-1-methyl-ethyl]-dimethyl-amines as retinoic acid metabolic blocking agents (RAMBAs).

A series of [2-imidazol-1-yl-2-(6-alkoxy-naphthalen-2-yl)-1-methyl-ethyl]-dimethyl-amines were designed and synthesized as CYP26 inhibitors, serving as retinoic acid metabolic blocking agents (RAMBA's).

Precipitation of bovine rotavirus by polyethylene [corrected] glycol (PEG) and its application to produce polyclonal and monoclonal antibodies.

Many protocols are available to produce monoclonal antibodies (MAbs) against bovine rotavirus (BRV) using purified virus particles but those methods are time-consuming and produce substantial loss of virus structure or infectivity. Polyethylene gycol (PEG) viral precipitation was investigated as a possible alternative method to obtain purified virus and viral antigen for monoclonal and polyclonal antibodies production. The antigenic mass inoculated into rabbits was sufficient to obtain a polyclonal hyperimmune serum with neutralizing activity and a wide range of humoral responses to different viral proteins with minimum cellular contamination. This antigenic mass inoculated into mice was capable of producing seven MAbs with different biochemical characteristics (Western-blot; indirect immunofluorescence and serum neutralization assays). When evaluated as diagnostic tools to detect BRV antigen in feces the MAbs were effective for detecting rotavirus in naturally infected calves. This work demonstrate that PEG precipitation could be an useful procedure for obtaining viral antigen to produce polyclonal and MAbs against BRV. The antigenic mass obtained, the viral infectivity, and the conserved protein pattern suggest that this methodology could be applied to this and to other viruses, reducing time or possible loss of antigens involved in viral purification.

Regio- and stereospecific syntheses of syn- and anti-1,2-imidazolylpropylamines from the reaction of 1,1'-carbonyldiimidazole with syn- and anti-1,2-amino alcohols.

The regio- and stereospecific conversion of syn- and anti-1,2-amino alcohols to their respective syn- and anti-1,2-imidazolylpropylamines via treatment with 1,1'-carbonyldiimidazole is described. The rationale behind the regio- and stereospecific nature as well as the generality of the reaction is discussed.

Statin use and the risk of breast cancer.

The study objective was to investigate a possible association between statin use and breast cancer (BRCA). An historical cohort design based on Saskatchewan's population health services databases was used. All eligible women with > or = 1 statin prescription from 1989 to mid-1997 and an age-sex-matched nonexposed group were followed up to 8.5 years (mean 4.2 years). Relative rates (RR) of BRCA were estimated and stratified by age, statin exposure time, and prior hormone use. Thirteen thousand five hundred ninety-two statin users and 53,880 nonexposed subjects were identified. Eight hundred seventy-nine incident BRCA cases were identified. Statins were not associated with BRCA risk in women < or = 55 years. Among subjects >55 years, the RR for BRCA was 1.15 (0.97, 1.37). Stratified analyses revealed increases in risk in short-term statin users and statin users with long-term hormone replacement therapy (HRT) exposure. More studies are needed to determine if short-term statin use and statin use with long-term HRT exposure increases postmenopausal BRCA risk. Published by Elsevier Science Inc.

Chromophore formation in resorcinarene solutions and the visual detection of mono- and oligosaccharides.

The colorimetric properties of resorcinarene solutions had not been investigated since Baeyer's initial synthesis. We recently reported that solutions containing resorcinarene macrocycles develop color upon heating or standing. In the presence of saccharides, these solutions exhibit significant color changes which are easily seen. We herein present strong evidence that the solution color is due to macrocycle ring opening and oxidation. The optical responses to saccharides are due to complexation of the sugar with the acyclic chromophores. We apply these mechanistic insights toward the challenging problem of the visual detection of neutral oligosaccharides by simple chromogens. In addition, we also report the first single-crystal X-ray crystal structure determination of a rarely observed "diamond" resorcinarene stereoisomer.