[The method of "town hall talks": a study protocol]. / Die Methode der "Rathausgespräche": ein Studienprotokoll.

BACKGROUND AND AIM: Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks". METHOD: In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated. PREVIOUS RESULTS: The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC. CONCLUSION: Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined.

Das Potenzial neuer Technologien zur Unterstützung von Pflege über eine räumliche Distanz - Literaturstand und qualitative Befunde.

The potential of technological assistance to support distance caregiving - literature review and empirical results Abstract.Background: Due to demographic change, increasing labour mobility and changing family patterns, social relationships often exist over long distances. Supporting relatives over a distance is therefore a highly topical issue but still little discussed, also in Germany and Switzerland. Aim: The project "DiCa" (2016 - 2019) with an interdisciplinary research team from Germany (EH Ludwigsburg) and Switzerland (Careum School of Health, Zurich) aims to investigate different dimensions of "Distance Caregiving". This paper deals with the possible use of new technologies to support these care arrangements. Methods: Based on a literature review, qualitative interviews were conducted with "Distance Carers" and partner companies in Germany to investigate the use of new technologies in the context of "Distance Caregiving". Results: There are initial approaches concerning technical solutions in home care and in companies. So far communication options via telephone and smartphone and flexible working time and workplace regulations have played an important role. However, the potential of new technologies does not seem to be fully explored. Conclusions: In order to make the most of the various possibilities of innovative technologies in the context of "Distance Caregiving" for those affected but also for companies, well-researched information and independent advice and counseling are required for all parties involved in the care process.

[Distance caregiving-empirical insights from an employer perspective]. / "Distance Caregiving" ­ empirische Einblicke aus betrieblicher Perspektive.

BACKGROUND AND OBJECTIVE: Labor market mobility and demographic change contribute to higher numbers of people providing care for their family members from a distance. Concerning the reconciliation of work and care the geographic distance between family members becomes more and more important. For progressive employers, this raises the question to what extent their portfolio is sufficient to support distance caregivers. METHODS: Using an interview guideline, 4-6 expert interviews were conducted in 5 partner companies (human resources department, management, executive, works council or employee representative, directors in nursing services; N = 24). The interviews were recorded, transcribed applying standardized procedures, and evaluated using content analysis by means of deductive and inductive categorization. RESULTS: The participating companies had already established numerous reconciliation measures but did not yet focus on distance caregiving. As caregiving issues generally touch on taboo subjects, there is an enhanced need for sensitization and information for all parties involved (management, executives, employees). For distance caregivers, a culture of trust, transparent information and good communication are particularly important. CONCLUSION: To achieve good reconciliation of work and care, working caregivers and executives need a corporate culture which is sensitive to care issues and able to address previously tabooed aspects. In addition, company portfolios for distance caregiving are needed to provide data-driven, thoughtful and timely support for employees and managers.

[Current findings on distance caregiving : What do we know and what do we not (yet) know?] / Aktuelle Befunde zu "distance caregiving" : Was wissen wir und was (noch) nicht?

BACKGROUND: Demographic change, increasing work mobility as well as changed family patterns lead to social relationships over long distances; however, support from relatives from a distance is hardly debated in the German-speaking region. The project "DiCa" (2016-2019) studies various dimensions of long-distance caregiving. OBJECTIVE: This article presents the state of the art in research on specific characteristics of care arrangements from a distance. In addition, it presents the underlying challenges, strategies, and supportive as well as hindering conditions. MATERIAL AND METHODS: Systematic literature review. RESULTS: These studies, conducted largely in the Anglo-American region, draw a clear picture of who distance caregivers are (in general well-educated daughters or daughters-in-law) and that they make a substantial contribution to care in terms of organization, coordination, and emotional support in addition to visits. Distance impedes the flow of information about the health condition of the person in need of care and limits the possibilities to react to the needs at short notice or in crisis situations. Distance caregivers are often faced by financial as well as emotional burdens due to the care situation and lack of control even if there are some support strategies and compatibility between care and occupation, e.g. emergency management, local support networks, flexible working arrangements. CONCLUSION: In the German-speaking region, pertinent studies on long-distance caregiving are missing. Internationally, the numbers of cases are not always clear and there is a lack of sound knowledge on the assessment of the care arrangements on the part of the distance caregiver, the actual role of the distance, specific barriers, conflicts, effective strategies and solution options. This applies to people in family homecare as well primary care facilities and employers.

Mechanisms and time course of neuronal degeneration in experimental autoimmune encephalomyelitis.

Neuronal and axonal damage is considered to be the main cause for long-term disability in multiple sclerosis. We analyzed the mechanism and kinetics of neuronal cell death in experimental autoimmune encephalomyelitis (EAE) induced by myelin oligodendrocyte glycoprotein (MOG) by combining an electrophysiological in vivo assessment of the optic pathway with the investigation of retinal ganglion cell (RGC) counts. In accordance with our previous findings in this animal model, neuritis of the optic nerve (ON) leads to apoptotic RGC death. By further investigating the time course of RGC apoptosis in the present study, we found that neuronal cell death together with decreased visual acuity values occurred before the onset of clinical symptoms. Simultaneously with the time course of RGC apoptosis, we found a down-regulation of phospho-Akt as well as a shift in the relation of 2 proteins of the Bcl-2 family, Bax and Bcl-2, towards a more proapoptotic ratio in these cells. Comparing the kinetics and mechanisms of RGC death during MOG-EAE with those following complete surgical transection of the ON, we found significant agreement. We hypothesize that the main reason for RGC loss in MOG-EAE is the inflammatory attack but RGC death also occurs independently of histopathological ON changes.

Interleukin-1 beta protects neurons via the interleukin-1 (IL-1) receptor-mediated Akt pathway and by IL-1 receptor-independent decrease of transmembrane currents in vivo.

Recently, we have demonstrated that tumor necrosis factor-alpha (TNF-alpha) rescues retinal ganglion cells (RGCs) from retrograde cell death in vivo after axotomy of the optic nerve. The mechanism of RGC rescue was dependent on TNF-receptor I-mediated potassium current reduction and consecutive activation of the phosphatidylinositol 3-kinase (PI3-K)/Akt pathway. Here, we present evidence that interleukin-1 beta (IL-1 beta) also promotes RGC survival, but shows distinct differences with respect to its neuroprotective mechanisms. Using whole-cell and outside-out patch-clamp techniques, we observed that IL-1 beta decreased both inward sodium current amplitudes and outward potassium current amplitudes. Counteracting these effects by sodium or potassium channel opening inhibited the survival-promoting effects of this cytokine. IL-1 beta-induced current reduction could not be abolished by the interleukin-1 receptor antagonist, indicating that the electrophysiological effects of IL-1 beta are independent of interleukin-1 receptor I (IL-1RI) activation. Western blot analysis revealed an IL-1 beta-induced IL-1RI-dependent upregulation of phospho-Akt. Antagonism of the survival-promoting effects of IL-1 beta by PI3-K inhibition revealed the functional relevance of the PI3-K/Akt pathway in IL-1 beta-induced signal transduction in vivo.

[The course of illness and problems of schizophrenic women and men from the relatives' perspective]. / Krankheitsverlauf und Probleme schizophren erkrankter Frauen und Männer aus der Sicht der Angehörigen.

OBJECTIVES: Members of HPE, an Austrian self-help organization for the relatives of mentally ill people, were questioned about their opinion with regard to the situation of families with a mentally ill member. METHODS: A questionnaire was sent to the addresses of members of this self-help organisation. 182 respondents reported to care for 132 male and 50 female sufferers diagnosed as having a psychosis from the schizophrenic spectrum replied. RESULTS: Relatives, who care for male sufferers reported greater distress than those caring for females. Depression and exhaustion are reported significantly more frequently in caregivers of males. Other burdens, for example financial burdens, to assist the sufferer in the household, renunciation of holidays, and the problem of neglect also have a tendency to be more common among those caring for men. These gender differences cannot be accounted for by differences in the course of illness. Our study showed no evidence of gender differences in this regard. Contrary to our expectations women in our study are less compliant with medication and psychosocial treatment. CONCLUSIONS: Despite a better compliance with treatment strategies among men, relatives of males generally experience a greater burden. Our results indicate a greater need for the development of independence strategies for male sufferers and a requirement that professionals support sufferers and carers in this direction.