Suchergebnisse

Das Projekt ´Lebensqualität und Wohlbefinden hochaltriger Menschen in NRW (NRW80+)´, das vom Ministerium für Innovation, Wissenschaft und Forschung Nordrhein-Westfalen gefördert und dem Forschungsverbund CERES an der Universität zu Köln durchgeführt wird, soll repräsentative Aussagen über die Lebensbedingungen hochaltriger Menschen in Nordrhein-Westfalen ermöglichen. Ziel ist es, umfassende Informationen darüber zu erhalten, in welchem Umfeld hochaltrige Personen leben bzw. leben möchten, was ihre gesellschaftliche Rolle ist und wie zufrieden sie mit ihrer Lebenssituation sind.

Im Rahmen des Projekts wurde in zwei Wellen repräsentativ erfasst, unter welchen Umständen hochaltrige Menschen leben. In der zweiten Welle wurden zum einen die zu einer Panelteilnahme bereiten Teilnehmer der ersten Welle erneut befragt. Zusätzlich wurde eine Aufstockungsstichprobe gezogen, um weiterhin repräsentative Aussagen zu ermöglichen.

Der hier vorliegende Datensatz enthält die Daten aller Befragten der Welle 2 (Panel und Aufstockung).

Das Projekt ´Lebensqualität und Wohlbefinden hochaltriger Menschen in NRW (NRW80+)´, das vom Ministerium für Innovation, Wissenschaft und Forschung Nordrhein-Westfalen gefördert und dem Forschungsverbund CERES an der Universität zu Köln durchgeführt wird, soll repräsentative Aussagen über die Lebensbedingungen hochaltriger Menschen in Nordrhein-Westfalen ermöglichen. Ziel ist es, umfassende Informationen darüber zu erhalten, in welchem Umfeld hochaltrige Personen leben bzw. leben möchten, was ihre gesellschaftliche Rolle ist und wie zufrieden sie mit ihrer Lebenssituation sind.

Актуальність. Інтеграція України в європейську спільноту можлива лише через розвиток ефективної системи місцевого самоврядування на основі Європейської хартії місцевого самоврядування. Понад 20 років система державного управління України перебуває в стані перманентного реформування.У 2015 році в Україні розпочався новий етап децентралізації, реформи місцевого самоврядування та адміністративно-територіальної реформи водночас. Метою публікації є аналіз дійсної ситуації в сімейній медицині в умовах реформування та вивчення нормативно-правових ­передумов роботи первинної ланки медичної допомоги в об'єднаних територіальних громадах (ОТГ). Матеріали та методи. Аналітичне дослідження з висвітленням досвіду роботи сімейної медицини Прикарпаття. Результати. Висвітлено сучасний стан закладів первинної медичної допомоги в ОТГ. Акцентовано увагу на заходах покращання медико-технічного оснащення і фінансового розподілу медичної субвенції. Подано також переваги та проблеми діяльності сімейної медицини громад. Установлено, що залучення медичної субвенції в ОТГ дало низку позитивних зрушень щодо розвитку та матеріально-технічного забезпечення первинної ланки. Висновки. Фінансове забезпечення охорони здоров'я на первинному рівні на прикладі Печеніжинської ОТГ вказує на збільшення коштів субвенції, наданих Печиніжинській ОТГ на розвиток та підтримання системи охорони здоров'я, які використані для усунення актуальних проблем первинное медико-санітарної допомоги Печеніжинської ОТГ. Очікуємо, що реформи дадуть можливість створити громади, що здатні взяти на себе відповідальність за свою розбудову, отримавши не лише додаткові повноваження, але й юридичні та фінансові можливості для їх реалізації. ; Актуальность. Интеграция Украины в европейское сообщество возможна только через развитие эффективной системы местного самоуправления на основе Европейской хартии местного самоуправления. Более 20 лет система государственного управления Украины находится в состоянии перманентного реформирования. В 2015 году в Украине начался новый этап децентрализации, реформы местного самоуправления и административно-территориальной реформы одновременно. Целью публикации является анализ действительной ситуации в семейной медицине в условиях реформирования и изучения нормативно-правовых предпосылок работы первичного звена медицинской помощи в объединенных территориальных общинах (ОТО). Материалы и методы. Аналитическое исследование с освещением опыта работы семейной медицины Прикарпатья. Результаты. Изучено современное состояние учреждений первичной медицинской помощи в ОТО. Акцентировано внимание на мероприятиях по улучшению медико-технического оснащения и финансового распределения медицинской субвенции. Представлены также преимущества и проблемы деятельности семейной медицины общин. Установлено, что привлечение медицинской субвенции в ОТО дало ряд положительных сдвигов по развитию и материально-техническому обеспечению первичного звена. Выводы. Финансовое обеспечение здравоохранения на первичном уровне на примере Печенижинской ОТО указывает на увеличение средств субвенции, предоставленных Печинижинской ОТГ на развитие и поддержание системы здравоохранения, которые использованы для устранения актуальных проблем первичной медико-санитарной помощи Печенижинской ОТО. Ожидаем, что реформы дадут возможность создать общины, которые способны взять на себя ответственность за свое развитие, получив не только дополнительные полномочия, но и юридические и финансовые возможности для их реализации. ; Background. The Ukraine integration into the ­European community is possible only through the development of an effective system of local self-government that is based on the European Charter of Local Self-Government. For more than 20 years, the system of government administration of Ukraine has been in a state of 'permanent reformation'. Ukraine began a new phase of decentralization, local self-government and administrative-territorial reforming at the same time in 2015. The purpose of the publication is to analyze the real situation in family medicine in the context of reforming and studying the legal and regulatory preconditions of the primary health care in the united territorial communities (UTC). Materials and methods. It is an analytical study of the experience of family medicine in the Subcarpathian Region. Results. The article deals with the current state of primary health care facilities in UTC. The focus is on measures to improve medical and technical equipment and the financial distribution of medical subventions. The advantages and problems of community family medicine are also presented. It was established that the involvement of medical subvention in UTC resulted in a number of positive changes in the development and logistics of the primary link. Conclusions. The financial provision of the primary health care, as an example of Pechenizhynsk UTC, indicates an increase in the subvention provided to Pechenizhynsk UTC for the development and maintenance of the health care system used to eliminate the actual problems. We expect the reforms to create communities that are capable of assuming responsibility for their development, not only having additional powers, but also legal and financial opportunities for their implementation.

IntroductionGlobal HIV‐1 prevalence is 35.3 million [1]; women comprise >50% of those infected. The majority of women may lack regular care and only one‐fourth are virologically suppressed [2]. ELLA is a cross‐sectional, non‐interventional study conducted across Europe, Latin America, Canada and Asia that describes barriers to care for HIV‐infected women and associations with disease stage, symptoms and health‐related quality of life (HRQoL).MethodsHIV‐infected women eligible for ELLA (≥18 years) completed: Barrier to Care Scale (BACS) comprising 12 items in four domains (Index range 0–12, Overall range 1–4, greater=more barriers, Overall score ≥2 considered severe); AIDS Clinical Trials Group (ACTG) Health Status Assessment comprising 21 items assessing 9 HRQoL domains (range 0–100, greater=better); and ACTG Symptom Distress Module comprising 20 symptoms rated on bother (range 0–4, greater=more bother). Healthcare providers documented medical history and HIV clinical data. Correlations of BACS response and last reported VL/CD4 count with HIV symptoms and HRQoL were analyzed. Spearman rank order was used to test correlations with statistical significance set at p<0.05.ResultsEnrollment: 1931 women from 30 countries; mean age 40 years (16.9% >50 years); 47.7% education <12 years; 36% unemployed; 82.9% urban residence. HIV was acquired heterosexually in 83.0%; 88.2% of subjects were on ART; 57.5% had VL<50 c/ml; mean CD4 was 540.5 c/µL. Mean [SD] BACS Index and Overall scores were 6.19 [3.47] (N=1818) and 2.09 [0.71] (N=1922), respectively. Stigma was a prominent barrier. Lower (better) BACS Index and Overall scores correlated with better HRQoL on all nine domains (p<0.0001). Lower VL and greater CD4 count were both correlated with better HRQoL for eight of nine domains (p<0.04, p≤0.0002, respectively) excepting pain. Lower BACS Index and Overall scores correlated with fewer symptom count and less symptom bother (p<0.0001). Fewer symptom count and less symptom bother correlated with better HRQoL on all nine domains (p<0.0001). While greater CD4 count correlated with fewer HIV symptoms and less bother (p<0.0001), VL did not significantly correlate with either.ConclusionsIn HIV‐infected women, reduced barriers to care correlated with fewer symptoms, less symptom bother and better HRQoL. Improved HRQoL may be mediated by greater CD4 counts and fewer symptoms. Better access to care may improve HRQoL outcomes in this population.

Vorwort -- Mit bestem Dank -- Über die Autorin -- Inhaltsverzeichnis -- I -- Teil I Beziehung und Effizienz -- Kapitel-1 -- Regieren oder Dienen? Geschichten von Macht und Ohnmacht -- 1.1 Führungsenergie mobilisieren -- 1.2 Geschichte der Pflege: Ein Auszug -- 1.3 Mutige Frauen in der Pflege -- 1.4 Aus der Geschichte lernen -- 1.5 Vom Umgang mit der Macht -- 1.5.1 Aktuelle Machtentwicklungen in Krankenhäusern -- 1.6 Gestalterrolle statt Opferrolle -- 1.7 Ich-Entwicklung von Führungskräften -- Literatur -- Kapitel-2 -- Work-Life-Balance -- 2.1 Krank zum Dienst? -- 2.2 Ergebnisse der NEXT-Studie -- 2.3 Ausbalancieren der vier Waagschalen -- 2.4 Work-Life-Balance als Führungsaufgabe -- 2.5 Work-Life-Balance als Aufgabe des Unternehmens -- Literatur -- Kapitel-3 -- Richtig zielen: die kleine Jagdkunde! -- 3.1 Grundkenntnisse zielorientierten Führens -- 3.2 Komponenten des Führens -- 3.3 Ziele mit Zukunft -- 3.4 Entwicklung von Zielen -- 3.5 Ziele positiv formulieren -- 3.6 Bedeutung der Leitbilder für eine zielorientierte Führung -- 3.7 Mitarbeiter sind bei Zielvereinbarungen unterschiedlich motiviert -- Literatur -- Kapitel-4 -- Frauen führen anders … Männer auch -- 4.1 Gender und Führung -- 4.2 Umgang mit Macht -- 4.3 Vorurteile gegenüber Frauen im Topmanagement -- 4.3.1 Das Vorurteil der Rolleninkongruenz -- 4.3.2 Das Phänomen des Glass-Ceiling -- 4.3.3 Vorurteil einer notwendigen männlichen Dominanzkultur -- 4.3.4 Vorurteil gegen Teilzeitführung -- 4.4 Führen im Gesundheitswesen -- 4.5 Besetzung von Führungspositionen in der Pflege -- 4.6 Entwicklungspotenzial bei führenden Frauen -- 4.6.1 Thema: Understatement -- 4.6.2 Thema: Delegation -- 4.6.3 Thema: Durchsetzungsvermögen -- 4.7 Entwicklungspotenzial bei führenden Männern -- 4.7.1 Thema: Kommunikation -- 4.7.2 Thema: Mitarbeiterorientierung -- 4.7.3 Thema: Umgang mit Konflikten.

Cover -- Contents -- List of Contributors -- Foreword -- Introduction -- Acknowledgements -- Disclaimer -- Part I Clinical and Communication Skills -- Chapter 1 Professionalism -- Chapter 2 The consultation -- Chapter 3 Health promotion -- Chapter 4 Clinical reasoning -- Chapter 5 Communication with colleagues -- Chapter 6 Medical records -- Chapter 7 Prioritising time -- Part II Legal and Ethical Issues in Healthcare -- Chapter 8 Capacity and consent -- Chapter 9 The Mental Health Act and common law -- Chapter 10 Confidentiality -- Chapter 11 Death certification and the coroner -- Chapter 12 Fitness to drive -- Chapter 13 Adult and child protection -- Chapter 14 Ethical principles in healthcare -- Chapter 15 Advance directives -- Chapter 16 End of life issues -- Chapter 17 NHS complaints procedure -- Part III Clinical Governance and Patient Safety -- Chapter 18 Why things go wrong -- Chapter 19 Human factors -- Chapter 20 Safe prescribing -- Chapter 21 Infection control -- Chapter 22 Use of evidence and guidelines -- Chapter 23 Audit -- Part IV Teaching and Training -- Chapter 24 Learning about learning -- Chapter 25 Teaching large groups -- Chapter 26 Teaching small groups -- Chapter 27 Presentations -- Chapter 28 Teaching a skill -- Chapter 29 How to give feedback -- Chapter 30 How doctors are assessed -- Index.

ch. 1. The slippery slope argument -- ch. 2. It started from small beginnings -- ch. 3. The sanctity of life -- ch. 4. The contagiousness of killing -- ch. 5. Voluntary euthanasia -- ch. 6. The right to refuse treatment -- ch. 7. Beneficient euthanasia -- ch. 8. Cost-benefit arguments -- ch. 9. In vitro fertilisation, genetic engineering, and the slippery slope -- ch. 10. Voluntary termination of pregnancy and the slippery slope -- ch. 11. Conclusion.

Testimonials that bind : organizing communities with HIV -- Confessional technologies : conjuring the self -- Soldiers of God : together and apart -- Life itself : triage and therapeutic citizenship -- Biopower : fevers, tribes, and bulldozers -- The crisis : economies, warriors, and the erosion of sovereignty -- Uses and pleasures : the republic inside out.

The genesis and evolution of extracorporeal membrane oxygenation / Benjamin Smood, Asad A. Usman, Mark Helmers, Christian Bermudez and Rita Carrie Karianna Milewski -- An introduction to VA-ECMO : physiology, indications, and principles of management / Benjamin Smood, Matthew Woods, Jason J. Han, Christian Bermudez and Rita Carrie Karianna Milewski -- Disaster preparedness for ECMO programs and adapting ECMO programs to face the COVID19 pandemic / Allison Ferreira and Kim Delacruz -- Special consideration for ECMO cannulation and decannulation for COVID-19 patient / Joseph Dovidio and Hitoshi Hirose -- The use of ECMO for treatment of severe ARDS due to coronavirus disease 2019 / Olivia Giddings and Rana Hejal -- Frontline experience with extracorporeal life support for COVID-19 patients / Vitali Karaliou, Jennifer Hanna, Matthew N. Libby, Courtney Petersen, William M. Novick and Michael S. Firstenberg -- Extracorporeal membrane oxygenation (ECMO) in COVID-19 : the role of lung transplantation / Asishana Osho, Jerome Crowley, Philip J. Spencer, Masaki Funamoto, Nathaniel Langer and Mauricio Villavicencio.

IntroductionThere is new emphasis on identifying and treating HIV in the first days of life and also an appreciation that low birth weight (LBW) and preterm delivery (PTD) frequently accompany HIV‐related pregnancy. Even in the absence of HIV, PTD and LBW contribute substantially to neonatal and infant mortality. HIV‐exposed and ‐infected infants with these characteristics have received little attention thus far. As HIV programs expand to meet the 90‐90‐90 target for ending the HIV pandemic, attention should focus on newborn infants, including those delivered preterm or of LBW.DiscussionIn high prevalence settings, infant diagnosis of HIV is usually undertaken after the neonatal period. However, as in utero infection may be diagnosed at birth, earlier initiation of therapy may limit viral replication and prevent early damage. Globally, there is growing awareness that preterm and LBW infants constitute a substantial proportion of births each year. Preterm infants are at high risk for vertical transmission. Feeding difficulties, apnoea of prematurity and vulnerability to sepsis occur commonly. Feeding intolerance, a frequent occurrence, may compromise oral administration of medications. Although there is growing experience with post‐exposure prophylaxis for HIV‐exposed term newborn infants, there is less experience with preterm and LBW infants. For treatment, there are even fewer options for preterm infants. Only zidovudine has adequate dosing recommendations for treating term and preterm infants and has an intravenous formulation, essential if feeding intolerance occurs. Nevirapine dosing for prevention, but not treatment, is well established for both term and preterm infants.HIV diagnosis at birth is likely to be extremely stressful for new parents, more so if caring for preterm or LBW infants. Programs need to adapt to support the medical and emotional needs of young infants and their parents, where interventions may be lifesaving.ConclusionsNew focus is required for the newborn baby, including those born preterm, with LBW or small for gestational age to consolidate gains already made in early diagnosis and treatment of young children.

This study examines Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to: 1) worst pain intensity from a numerical pain rating 0-10 scale, 2) 24-item Roland-Morris Disability Questionnaire (RMDQ); and 3) global improvement (modified visual analog scale). A pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC). 3 military treatment facilities. 750 active-duty military personnel with low back pain. Linear mixed effects regression models estimated the treatment group differences. Coefficient of repeatability to estimate significant individual change. We found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the RMDQ score. Area under the curve estimates for global improvement for the PROMIS®-29 scales and the RMDQ, ranged from 0.79 to 0.83. Findings from this pre-planned secondary analysis demonstrate that chiropractic care impacts health-related quality of life beyond pain and pain-related disability. Further, comparable findings were found between the 24-item RMDQ and the PROMIS®-29 v1.0 briefer scales.

Preface -- Introduction / Wolfgang U. Eckart -- "You should not use our Senegalese infantrymen as guinea pigs" : human vaccination experiments in the French army, 1916-1933 / Christian Bonah -- First principles : Julius Moses and medical experimentation in the late Weimar Republic / Wolfgang U. Eckart, Andreas Reuland -- Nutritional physiology in the "Third Reich" 1933-1945 / Alexander Neumann -- Pervitin (Metamphitamine) tests, use and misuse in the German Wehrmacht / Peter Steinkamp -- Funding the scientific foundations of race policies : Ernst Rüdin and the impact of career resources on pyschiatric genetics, ca. 1910-1945 / Volker Roelcke -- The Deutsche Forschungsgemeinschaft (German Research Found) and the "backwardness" of German human genetics after World War II : scientific controversy over a proposal for sponsoring the discipline / Anne Cottebrune -- Flying bodies, enforcing states : German aviation medical research from 1925 to 1975 and the Deutsche Forschungsgemeinschaft / Karl Heinz Roth -- Otto Bickenbach's human experiments with chemical warfare agents and the concentration camp Natzweiler / Florian Schmaltz -- Disregard for human life : hypothermia experiments in the Dachau concentration camp / Wolfgang U. Eckart, Hana Vondra -- Barbaric research, Japanese human experiments in occupied China : relevance, alternatives, ethics / Till Bärnighausen -- From deputy to "Reichsbevollmächtiger" and defendant at the Nuremberg medical trials : Dr. Kurt Blome and cancer research in National Socialist Germany / Gabriele Moser -- German malariology experiments with humans, supported by the DFG until 1945 / Marrion Hulverscheidt -- From medical war crimes to compensation : the plight of the victims of human experiments / Paul Weindling -- The Tuskegee syphilis experiment / James H. Jones -- Darkened by the shadow of the atom : burn research in 1950s America / Susan E. Lederer -- Back to first principles : First World research in Third World countries / David Rothman -- Contributors -- Register

Over the past decades, infectious disease epidemics have come to increasingly pose major global health challenges to humanity. The Anthropology of Epidemics approaches epidemics as total social phenomena: processes and events which encompass and exercise a transformational impact on social life whilst at the same time functioning as catalysts of shifts and ruptures as regards human/non-human relations. Bearing a particular mark on subject areas and questions which have recently come to shape developments in anthropological thinking, the volume brings epidemics to the forefront of anthropological debate, as an exemplary arena for social scientific study and analysis.