Analyzing mechanisms of interdisciplinary cooperation in promoting students' health at university.

BACKGROUND: Interdisciplinary cooperation among university actors and resulting intersectoral synergies are considered cornerstones in the process of incorporating health promotion practices in everyday university life in order to break down barriers and provide better access to health promotion services. To date, no network of a health-promoting university has been examined regarding the processes underlying tie formation, network emergence, and maintenance. OBJECTIVES AND METHODS: The goals of this study are to obtain insight into the mechanisms of cooperation between university actors in a health-promoting network and to identify the structural and attributive factors associated with establishing cooperation between actors in the observed network in order to better understand how to build and develop successful networks in the future. For this purpose, a social network analysis was carried out and exponential random graph models were estimated to test corresponding hypotheses. RESULTS: The network at hand consists of 33 actors (e.g. University Sports Center, General Student Committee) and shows a flat, non-hierarchical structure. Data reveal that attributed competence predicts cooperation (0.32; p < 0.05). Significant homophily effects among student actors (1.31; p < 0.05) and among university actors (0.59; p < 0.05) were found. All structural predictors examined were significant (0.22-5.40; p < 0.05) and are therefore essential in determining the likelihood of cooperation between actors involved in the network. CONCLUSION: The results of this study provide for a better understanding of the mechanisms of cooperation and can be used to further develop the network at hand (e.g. selection of key actors for information dissemination or integration of peripheral actors). In addition, the findings offer starting points for sustained network development at other universities (e.g. significance of network governance form or goal consensus). Knowing the factors that influence the network structure, here the conditions of cooperation, results in opportunities to encourage empowerment among actors. However, the analysis of the network undertaken does not directly bear on the success of the network.

Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project.

BACKGROUND: Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. METHODS: The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). RESULTS: Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. DISCUSSION AND CONCLUSION: Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance. TRIAL REGISTRATION: Trial registration number: DRKS00014957.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships.

BACKGROUND: According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately. OBJECTIVE: Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships. DESIGN, SETTING, AND PARTICIPANTS: An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'. METHODS: The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling. RESULTS: The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern. CONCLUSIONS: Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241); August 9, 2018. TWEETABLE ABSTRACT: Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Students on stairs: a participatory approach using decisional cues in the form of motivational signs to promote stair use.

Objective: The authors assessed whether an intervention using motivational signs designed in a participatory manner to promote stair use resulted in changes to the proportion of stair to elevator use. Participants: Students of a German university were observed in three different academic buildings. Methods: The study design consisted of direct observations during a pre-intervention period, an intervention phase introducing motivational signs promoting stair use at points of decision and a post-intervention period. Results: The proportion of students who took the stairs on average differed significantly between baseline and intervention phase I (χ2(1) = 12.2; p = .001; Phi = 0.078), baseline and intervention phase II (χ2(1) = 17.3; p = .001; Phi = 0.093), and baseline and post-intervention (χ2(1) = 9.9; p = .002; Phi = 0.074). Conclusions: Simple and cost-effective interventions can increase stair use of university students.

Promoting Students' Health at University: Key Stakeholders, Cooperation, and Network Development.

Background: Cooperation among university units is considered a cornerstone for the promotion of students' health. The underlying mechanisms of health-promoting networks at universities have rarely been examined so far. Shedding light on partnerships is generally limited to the naming of allied actors in a network. Objectives and Methods: In this study, we used network analysis intending to visualize and describe the positions and characteristics of the network actors, and examine organizational relationships to determine the characteristics of the complete network. Results: The network analysis at hand provides in-depth insights into university structures promoting students' health comprising 33 organizational units and hundreds of ties. Both cooperation and communication network show a flat, non-hierarchical structure, which is reflected by its low centralization indices (39-43%) and short average distances (1.43-1.47) with low standard deviations (0.499-0.507), small diameter (3), and the non-existence of subgroups. Density lies between 0.53 and 0.57. According to the respondents, the University Sports Center is considered the most important actor in the context of students' health. Presidium and Institute of Sport and Sports Science play an integral role in terms of network functionality. Conclusion: In the health-promoting network, numerous opportunities for further integration and interaction of actors exist. Indications for transferring results to other universities are discussed. Network analysis enables universities to profoundly analyze their health-promoting structures, which is the basis for sustained network governance and development.

Health Literacy Among University Students: A Systematic Review of Cross-Sectional Studies.

OBJECTIVE: The aim of this systematic review was to provide an overview of cross-sectional studies that examined health literacy among university students and to identify possible determinants related to health literacy. METHOD: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three databases (PubMed, Scopus, and Web of Science) were systematically searched for cross-sectional studies that examined health literacy among university students. Results of included studies were narratively summarized. RESULTS: The systematic review includes twenty-one research studies. The majority of studies report health literacy scores among university students that are lower compared to reference samples. The health literacy of students is influenced by different variables (age, gender, number of semesters, course of studies/curriculum, parental education, and socioeconomic background). DISCUSSION: Health literacy activities should target all students. Universities should make use of their resources and offer health literacy courses for students in which content is used from disciplines available at the university (e.g., medicine, health, or psychology). To increase effectiveness, health literacy courses should be adapted according to the different needs and characteristics of the student subgroups.

Physical activity and health promotion for nursing staff in elderly care: a study protocol for a randomised controlled trial.

INTRODUCTION: Nursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness. METHODS AND ANALYSIS: A randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20-30 min) and subsequently, back-fitness training (12 weeks, once a week for 45-60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up). ETHICS AND DISSEMINATION: The study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241).

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project.

BACKGROUND: Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life. METHODS: A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only). DISCUSSION: This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents. TRIAL REGISTRATION: The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

Open data models for smart health interconnected applications: the example of openEHR.

BACKGROUND: Smart Health is known as a concept that enhances networking, intelligent data processing and combining patient data with other parameters. Open data models can play an important role in creating a framework for providing interoperable data services that support the development of innovative Smart Health applications profiting from data fusion and sharing. METHODS: This article describes a model-driven engineering approach based on standardized clinical information models and explores its application for the development of interoperable electronic health record systems. The following possible model-driven procedures were considered: provision of data schemes for data exchange, automated generation of artefacts for application development and native platforms that directly execute the models. The applicability of the approach in practice was examined using the openEHR framework as an example. RESULTS: A comprehensive infrastructure for model-driven engineering of electronic health records is presented using the example of the openEHR framework. It is shown that data schema definitions to be used in common practice software development processes can be derived from domain models. The capabilities for automatic creation of implementation artefacts (e.g., data entry forms) are demonstrated. Complementary programming libraries and frameworks that foster the use of open data models are introduced. Several compatible health data platforms are listed. They provide standard based interfaces for interconnecting with further applications. CONCLUSION: Open data models help build a framework for interoperable data services that support the development of innovative Smart Health applications. Related tools for model-driven application development foster semantic interoperability and interconnected innovative applications.

Modular ICT-based patient empowerment framework for self-management of diabetes: Design perspectives and validation results.

INTRODUCTION: It is estimated that more than 382 million people suffer from diabetes across the globe, most of which are between the age of 40 and 59 years. ICT can play a key role in better management of diabetes and in patient empowerment. Patient empowerment involves patients to a greater extent in their own healthcare process and disease management becomes an integrated part of their daily life. Self-management opens the possibility for patients to contribute to their own healthcare as well as to be more in control of their disease. OBJECTIVES: The objective of our study was to explore the impact of an ICT-based patient empowerment framework in diabetes self-management. METHODS: A modular patient empowerment framework that fosters diabetes self-management was designed and implemented. The framework incorporates expert knowledge in the form of clinical guidelines, and it supports patients in the specification of personalized activities that are based on medical recommendations and personal goals, and in the collection of observations of daily living. The usability and usefulness of the proposed framework were assessed in a pilot study with the participation of 60 patients and 12 health professionals. RESULTS: The study revealed that a patient empowerment approach based on self-management ICT tools is useful and accepted by both the patients and the physicians. For those patients who were already disciplined in their disease management the piloted solution served as a facilitator for data logging. For the rest, it served as an incentive for better adherence to disease management principles. The ICT tools prompted many patients into becoming more physically active and into making dietary habits' adjustments. However, this impact proved to be tightly correlated with the sociocultural background of the subjects. The study also demonstrated that even in patient-centric self-management interventions the physicians still have a key role to play. However, the acceptance of such interventions by the healthcare professionals depends not only on the level of impact in their patients' disease management but also on the level of impact in their workflow. CONCLUSIONS: It is evident that a patient empowerment approach based on self-management ICT tools is useful and accepted by patients and physicians. Further, there are clear indications that ICT frameworks such as the one presented in this paper support patients in behavioral changes and in better disease management. Finally, it was realized that self-management solutions should be built around the objective not only to educate and guide patients in disease self-management, but also to assist them in exploring the decision space and to provide insight and explanations about the impact of their own values on the decision.

EMPOWER--pathways for supporting the self-management of diabetes patients.

Diabetes is a serious world-wide medical challenge and there is a recognised need for improved diabetes care outcomes. This paper describes results of the EMPOWER project, to foster the self-management of diabetes patients by integration of existing and new services offered to patients after having been diagnosed with diabetes. The Self-Management Pathway described in this paper helps patients in the specification of personalized activities based on medical recommendations and personal goals, as well as self-monitoring of the results. The whole process is supported by innovative ICT services that motivate patients to change their lifestyle and adhere to defined medication and activity plans. We describe the approach and present the findings of the validation phase in Germany and Turkey.

Technical requirements of a social networking platform for senior citizens.

Feeling an integrative part of a social community adds to the quality of life. Elderly people who find it more difficult to actively join activities are often threatened by isolation. Social networking can enable communication and sharing activities makes it easier to set up and maintain contacts. This paper describes the development of a social networking platform and activities like gaming and exergaming all of which aim to facilitate social interaction. It reports on the particular challenges that need to be addressed when creating a social networking platform specially designed to meet the needs of the elderly.

Improvement of cross-sector communication in the integrated health environment.

Patient care is a complex process with different providers located in various institutions co-operating within an integrated health environment. In spite of technical improvements in medical care, patient information is usually exchanged by paper. Digital and timely communication between regional care providers can improve the exchange of information. Different systems and missing data standards are challenges that have to be met. ByMedConnect, a project sponsored by the Bavarian State Ministry of the Environment and Public Health, develops and demonstrates a communication solution based on the EN 13606 standard. In a first step the dataset, which will be exchanged by the care providers, is defined. ByMedConnect develops the dataset in cooperation with practicing clinicians and converts it via modeling tools into archetypes that provide the base for reliable cross-sector communication. Existing heterogeneous systems are integrated via a dedicated module that transforms legacy data into a normalized representation. Information provided in a standardized form thereby enables semantic interoperability between different systems and allows medical add-on applications to connect. A secure digital communication network guarantees easy and direct data sharing. ByMedConnect aims to evaluate the achieved theoretical preliminary work in practice and to draft approaches, which can be applied beyond the pilot application.

Standardized and flexible health data management with an archetype driven EHR system (EHRflex).

To build a semantically interoperable Electronic Health Record is one of the most challenging research fields in health informatics. In order to reach this objective, EHR standards that formally describe health data structures have to be used. CEN EN13606 is one of the most promising approaches. It covers the technical needs for semantic interoperability and, at the same time, it incorporates a mechanism (archetype model) that enables clinical domain experts to participate in building an EHR system. In this paper we present EHRflex, a generic system based on archetypes. It empowers the clinician and allows him to manage his own EHR system in a simple and generic way, assuring that the user works with underlying standardized data structures. These can be exchanged with other people and systems when needed. EHRflex introduces EHR standards into the clinical routine delivering a technical platform which works directly on archetype based data.

How can the German Electronic Health Card support patient's role in care management.

All types of advanced communication, collaboration, and cooperation in healthcare require a strong involvement of all addressed parties including health professionals and patients. Modern healthcare aims at involving patients having them take over responsibility for their own health status. Allowing them to take on their changed roles as emancipated partners in advanced care management, health professionals need to be educated and patients need to be empowered. From a security viewpoint, health issues have to be communicated via trusted health networks. To provide communication and cooperation between professionals and patients as well as to guarantee the required level of involvement of patients in shared care management environments, cards are widely used as person identifiers, on the one hand, and as security tokens, on the other. Being introduced as storage media and portable personalized application system, cards enable a patient controlled access to personalized health services as well as proper use and exchange of personal health data for specific purposes such as emergency. Furthermore, cards allow access to the wider electronic patient record via pointers or tickets. Cards can empower patients. The German Electronic Health Card (eGK) shall thus support care management and specific workflow processes e.g. for prescription and disease management. Regardless whether designed as data or pointer card - international standardization is a prerequisite also for national solutions. The more information patients have regarding different procedures and processes in healthcare, the more are they able to play their dedicated role within care management. Cards can and will contribute by allowing patients to get controlled access to administrative and medical data stored either on cards or in networks. Card holders determine who has access to their health information.

The role of patients and their health cards in integrated eHealth environments.

Communication and co-operation processes in healthcare and welfare require the involvement of all parties involved, including health professionals as well as patients. Generally, professionals can and will easily communicate via trusted health networks. To enforce both communication and co-operation between professionals and patients and to guarantee the required degree of involvement of patients in shared care environments, smart cards are widely used. They serve as person identifiers on the one hand and as security token on the other hand. Acting as storage media and portable application systems, patient data cards enable patient-controlled exchange and the use of personal health data for specific purposes such as prescription and disease management. Additionally, patient status data such as the emergency data or the immunisation record may be stored in and communicated by patient data cards.

BioHealth--the need for security and identity management standards in eHealth.

The experience gained in these last years and the several lesson learned have clearly shown that eHealth is more than just a simple change from paper records to electronic records. It necessitates a change of paradigms, on the one hand and the use of new technologies and introduction of new procedures on the other. Interoperability becomes a crucial issue. Security and confidentiality are vital for the acceptance of the new approaches and for the support of eHealth. Shared care and across-border interactions require a reliable and stable normative framework based on the application of standardized solutions, which are often not yet sufficiently known, diffused and implemented. Feeling this gap, a group of international experts in the medical area proposed to the EC the BioHealth project whose main aim is to create awareness about standardization in eHealth and to facilitate its practical implementation. The project will address all the stakeholders concerning their respective domain. It will evaluate the socio-economic and cultural aspects concerning eHealth with particular reference to the growing introduction of emerging technologies such as health cards, biometrics, RFID (radio-frequency identification) and NFC (Near field communication) tags. By providing information and expert advice on standardization and best practices it will raise the acceptance on standardization. Furthermore, the project will deeply approach the ethical and accessibility issues connected to identity management in eHealth, which -together with privacy- represent probably the most significant obstacles for the wide diffusion of eHealth procedures.