Living Well with Dementia: Feeling Empowered through Interaction with Their Social Environment.

This study was designed to advance our understanding of how feelings of empowerment in people living with dementia still residing at home can be promoted. We conducted qualitative interviews with 12 participants with mild-to-moderate stages of dementia in Germany and Spain as part of a European study on mindful design for dementia. A qualitative thematic content analysis was performed to elicit the key features of the experience reported by the interviewees. Three overarching categories were identified: the first category 'experiencing changes in personal life and coping with changes in life' covered losses and coping strategies; the second category 'retaining a sense of usefulness' included social participation and the need for activities with others; the third category 'feeling empowered' covered reflections on lifetime achievements, accomplishments in the present life, being in control and self-worth. Participants placed a strong emphasis on continuity and on the importance of making active decisions and meaningful social contributions. Empowerment within the person living with dementia was achieved through their interactions with their social environment, including the significance of communication about their needs and wishes and enabling shared decision-making and interactions with others in reciprocity.

Ask Patients What They Expect! A Survey Among Patients Awaiting Total Hip Arthroplasty in Germany.

BACKGROUND: Total hip arthroplasty (THA) is an elective surgery. Therefore, patient satisfaction with the results of surgery is paramount. The association between fulfillment of patients' expectations and satisfaction is well known. The aim of this study was to identify key expectations of patients with hip osteoarthritis awaiting THA. METHODS: A mixed-methods approach was used, consisting of two sequential parts. The questionnaire was developed based on literature review and focus group interviews. A nationwide survey was conducted in 21 orthopedic departments within Germany. RESULTS: Out of 691 obtained questionnaires, 636 were analyzed (mean age = 65.7 years (±11.3), 56.1% female). A majority of patients (≥75%) reported more than 20 complaints as 'present' due to hip osteoarthritis. A total of 9 key expectations were identified, which were reported by more than 75% of the patients as 'mandatory' for a successful THA. The identified key expectations were related to pain, range of motion, walking abilities, gait pattern, transitions, leisure and sports activities, awareness of the affected hip, satisfaction with health or life, and compensatory posture. A consistently high correlation was found between the complaints and the corresponding expectations. CONCLUSION: The expectations of patients have greatly expanded. In this study, a set of mandatory key expectations shared by the majority of patients was identified. The likelihood of fulfillment of key expectations should be assessed for weighing benefits and harms of available treatment options during the indication process. In addition, the results of this study might be used as a resource for shared decision-making.

Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study.

BACKGROUND: The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. OBJECTIVE: We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? METHODS: We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. RESULTS: Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. CONCLUSIONS: The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps.

[Association between Socioeconomic Status and Developmental Status: Data Linkage of Results of the Daycare and School Entry Health Examinations of a Saxon Birth Cohort Study]. / Zusammenhang zwischen sozioökonomischem Status und Entwicklungsstand ­ Datenlinkage von Ergebnissen der Kita- und Schulaufnahmeuntersuchung mit einer sächsischen Geburtskohortenstudie.

BACKGROUND: Child development is determined by both biological (e. g. gender, natal maturity) and psychosocial (e. g. socioeconomic status, daycare) factors. OBJECTIVES: To examine how familial socioeconomic status (SES) as well as biological and other psychosocial factors are associated with the state of development of 4- and 6-year-old children. METHODS: Data linkage of primary data from a birth cohort study and routine data from the Saxon public health departments on children born between 2007 and 2008, who underwent both daycare health examination and school entry health examination (N=615), was used to examine speech and motor skills, both fine and gross, for associations with psychosocial and biological factors. Potential associations were tested for significance and shown as odds ratios by using binary logistic regression. RESULTS: There were no noticeable problems in the development of the majority of Saxon children until school entry. Nevertheless, language seems to be a sensitive area of development, since 37% of the children showed problems at both time-points. Furthermore boys, preterm infants and children from a lower socio-economic class were more often affected by developmental delays, with preterm infants with low SES being at very high risk. Furthermore, the point of time of entering daycare seems to be of relevance for child development. CONCLUSIONS: The results are in line with national and international findings. An important new finding is the significantly increased likelihood of having developmental problems when biological and psychosocial risk factors coincide. However, longitudinal analyses are required to study developmental courses and to evaluate measures initiated to combat these issues.

Assessing the generalisability of a multicentre qualitative dementia research: the experience and challenges faced by the MinD project in Europe.

Background: Generalisation of findings is an important aspect of research and essential for evidence-based practice. While generalisation is common in quantitative research, there is a lack of generalisability in qualitative research. This paper presents the experience and challenges faced by the Designing for People with Dementia (MinD) project in meeting the requirements to strengthen the generalisation of findings on the lived experience of people living with dementia and their engagement to co-create designs to empower their everyday living.   Methods: Polit and Beck (2010)'s strategies to generalise qualitative findings were applied: (1) replication in sampling; (2) replication of studies; (3) meta-synthesis of findings; (4) reflexivity and conceptualization; (5) immersion with the data; and (6) thick description. Results: While it is possible to increase the generabilisabilty of qualitative evidence through the replication of the sampling to attain a large, heterogeneous sample in different and multiple contexts and environments; implementation of sound and robust research; conducting in-depth analysis and interpretation collaboratively for emergent themes; and meeting the thick description requirement, there are challenges that the project team faced in implementing some of the Polit and Beck's strategies because of the condition, namely dementia, that our participants are having. Other challenges faced were: the language and cultural diversity in the team; diverse  work and organisational procedures; and the inter-disciplinary differences relating to the methods of enquiry, approaches and techniques to conduct research. These challenges will need to be identified and addressed at the start of the project with a strong leadership to ensure a seamless journey to complete the project successfully. Trust between the researchers and participants, and time to build this trust are critical to recruitment and participation in the study; these factors are of utmost important in research involving participants with condition such as dementia.

Individual-Level Linkage of Primary and Secondary Data from Three Sources for Comprehensive Analyses of Low Birthweight Effects.

AIM OF THE STUDY: The linkage of primary and secondary data is becoming an increasingly popular approach in healthcare research, but involves some challenges for all involved parties, for example due to data protection requirements. The aim of this article is to systematically outline the methods used and experiences made during a cohort study in the field of pediatric health care research (EcoCare-PIn) that involved access to and linkage of three different data sources. Particular focus is placed on the necessary regulatory measures with regard to data access and data linkage as well as on data validation to ensure a correct linkage. METHODS: While complying with all relevant data protection requirements, the study realized an individual-level linkage of a) pseudonymized administrative health insurance data from a statutory health insurance on Saxon children born between 2007 and 2013, b) primary data collected via postal questionnaires from parents/caregivers and c) medical data from kindergarten- and school-entry-examinations of Saxon health authorities. The fundamental principle of the concept of data linkage was to strictly separate the sites of data collection and data analysis, which was realized through the involvement of a trust center. RESULTS: Challenges especially pertained to the extensive regulatory pre-requirements for data access as well as to data protection requirements while performing the study. Technical aspects and data validation also required a considerable share of attention and resources. A number of validation routines were applied to avoid incorrect data linkage and to ensure the high quality of the final dataset. Data validation included both plausibility checks within the primary data and consistency checks of information given in primary and secondary data. CONCLUSION: The linkage of primary and secondary data on the individual level offers great opportunities for using the strengths of different data sources synergistically and overcoming some of their limitations. Statutory health insurance data and medical data from kindergarten- and school-entry-examinations of Saxon health authorities are examples of already existing data sources that can complement cost-consuming primary data collections by valuable data sets and open up opportunities for longitudinal analysis.

Impact of birthweight on health-care utilization during early childhood - a birth cohort study.

BACKGROUND: Comprehensive data are needed to evaluate the burden of low birthweight. Analysis of routine data on health-care utilization during early childhood were used to test the hypothesis that infants with low birthweight have (i) increased inpatient health-care utilization, (ii) higher hospital costs and (iii) different morbidity pattern in early childhood when compared with normal birthweight infants. METHODS: Children born between 2007 and 2013 that were insured at birth with the statutory health insurance AOK PLUS were included (N = 118,166, equaling 49% of the Saxon newborns) and classified into very low (< 1500 g, VLBW), low (1500-2499 g, LBW) birthweight and reference group (> 2500 g). Outcomes were: inpatient health-care utilization quantified by number and length of hospital stays; costs of hospitalizations including medication; reasons of hospitalizations for each year of life (YOL). RESULTS: 72, 38 and 22% of VLBW-, LBW- and reference group were hospitalized after perinatal period within the first YOL with a more than 5-fold increased risk in VLBW to be hospitalized for hemangioma, convulsions, hydrocephalus, hernia and respiratory problems. Median (IQR) cumulative cost of inpatient care during the first four YOLs was 2953 (1213-7885), 1331 (0-3451) and 0 (0-2062) Euro for respective groups. Inpatient early childhood health-care utilization (after first YOL) was higher in VLBW compared to healthy, normal birth weight infants (RR 3.92 [95%-CI 3.63, 4.23]), residents of rural areas (RR 1.37 [95%-CI 1.35, 1.40]) and in boys (RR 1.31 [95%-CI 1.29, 1.33]). CONCLUSION: This large population-based birth-cohort study indicates a high clinical and economic burden of low birthweight which is not restricted to the first year of life.

Health status of long-term sick leave and working female teachers in Germany: A cross-sectional study.

OBJECTIVES: Limited research on the health situation of teachers on long-term sick leave is available. The aim of this study has been to describe the health status of female teachers on long-term sick leave (LSFT) in comparison to working female teachers (WFT) and to determine predictors for their state of mental health (MH) and cardiovascular fitness (CF). MATERIAL AND METHODS: Twenty-eight LSFT and 300 WFT (average age: 53±5 years old) participated in a screening diagnostic inventory. Mental health, CF, blood pressure (BP), body mass index (BMI), body fat mass (BFM), health behavior (smoking, alcohol intake, physical activity) and disease burden (DB - number of medical diagnoses) were analyzed for the purpose of characterization of the health status. The multiple linear regression analysis was performed to identify predictors for the state of MH and CF. RESULTS: Adverse values for the MH but also for CF, BFM and the DB (median of medical diagnoses: LSFT: 5; WFT: 2) among the LSFT in comparison to the WFT were confirmed. Additionally, the part of smokers among LSFT (25%) was higher (WFT: 8%). In contrast, the WFT (61%) were much more affected by an elevated BP (LSFT: 26%). Disease burden proved as the strongest predictor for MH of the female teachers. Age, BMI and DB proved as predictors for CF. CONCLUSIONS: Health-related differences between long-term sick leave and working teachers were particularized and a link between physical and mental health among teachers was quantified. Therefore, health-related concepts for teachers should equally focus on physical and psychological aspects. The relevance of regular well-structured occupational health check-ups should be brought to the attention of the profession to prevent diseases and early retirements. Int J Occup Med Environ Health 2018;31(2):227-242.

Work-related exposures and disorders among physical therapists: experiences and beliefs of professional representatives assessed using a qualitative approach.

BACKGROUND: According to international study results, physical therapists are afflicted with work-related musculoskeletal, psychosocial and dermal disorders as well as infections. The few existing studies in German-speaking regions focus mainly on dermal and psychosocial exposures and resulting complaints. An overview of all relevant work-related exposures and complaints of physical therapists is currently lacking. We sought to identify work-related exposures based on the subjective experiences and beliefs of physiotherapeutic representatives, in order to identify relevant work-related complaints and diseases. Likewise we aimed to compare the international evidence with the actual situation of physical therapists in Germany. METHODS: Two complementary qualitative approaches were used: 1) a focus group discussion with representatives of professional physiotherapy associations as well as health and safety stakeholders and 2) qualitative semi-structured telephone interviews incorporating currently employed physical therapists. The group discussion was conducted applying a moderation technique, and interviews were analyzed using the content analysis approach by Mayring. RESULTS: The focus group discussion with five participants and the 40 semi-structured interviews with physical therapists identified comparable results. The main exposures of physiotherapeutic work were considered to be musculoskeletal (e.g., awkward body postures during treatment, patient transfers, passive mobilization), psychosocial (e.g., statutory audit of prescriptions and the associated conflicts with doctors and health insurance providers) and partly dermal and infectious (e.g., wet work and risk of infection) factors. Diseases of the spine, wrist or finger joints, burnout syndrome and infections were mentioned as possible consequences. CONCLUSIONS: The subjective data generated by both groups (focus group discussion and interviews) were comparable and consistent with the current state of research. The results provide new insight regarding work-related exposures and diseases of physical therapists working in Germany. These findings aided the design of a German-wide representative survey of practicing physical therapists.

Early comprehensive care of preterm infants-effects on quality of life, childhood development, and healthcare utilization: study protocol for a cohort study linking administrative healthcare data with patient reported primary data.

BACKGROUND: About 9 % of all children in Germany are born preterm. Despite significant improvements of medical care, preterm infants are at a greater risk to develop short and long term health complications. Negative consequences of preterm birth include neurodevelopmental disabilities, behavioral problems or learning disorders. Most data on effects of prematurity are derived from single or multi-center studies and not population-based. Since some of the long term problems of preterm delivery are associated with a disturbed parent-child interaction originating in the neonatal period, several intervention programs became available aiming to strengthen the early parent-child relationship. However, there is insufficient knowledge regarding the psychosocial and socioeconomic impact of these interventions. Prior to introducing them into routine care, those effects have to be rigorously evaluated. The population-based cohort study EcoCare-PIn (Early comprehensive Care of Preterm Infants-effects on quality of life, childhood development, and healthcare utilization) will investigate the following primary research questions: 1) What are the short- and long-term consequences of preterm birth with regard to parental stress, parent-child relationship, childhood development, quality of life and healthcare utilization including costs? 2) Does early family-centered psychosocial care prevent the hypothesized negative consequences of preterm birth on the above mentioned outcomes? METHODS/DESIGN: EcoCare-PIn examines the research questions by means of a linkage of a) pseudonymized administrative individual-level claims data from the German statutory health insurance AOK PLUS on approximately 140,000 children born between 2007 and 2013 in Saxony, and b) primary data collected from the parents/caregivers of all very low birth weight (<1,500 g; n = 1,000) and low birth weight infants (1,500 to 2,500 g; n = 5,500) and a matched sample of infants above 2,500 g birth weight (n = 10,000). DISCUSSION: In Saxony, approximately 50 % of all individuals are insured at the AOK PLUS. The linkage of patient-level administrative and primary data is a novel approach in neonatal research and probably the only way to overcome shortcomings of studies solely relying on one data source. The study results are based on an observation period of up to 8 years and will directly inform perinatal healthcare provision in Saxony and Germany as a whole.

Predictors of mental health in female teachers.

OBJECTIVE: Teaching profession is characterised by an above-average rate of psychosomatic and mental health impairment due to work-related stress. The aim of the study was to identify predictors of mental health in female teachers. MATERIAL AND METHODS: A sample of 630 female teachers (average age 47 ± 7 years) participated in a screening diagnostic inventory. Mental health was surveyed with the General Health Questionnaire GHQ-12. The following parameters were measured: specific work conditions (teacher-specific occupational history), scales of the Effort-Reward-Imbalance (ERI) Questionnaire as well as cardiovascular risk factors, physical complaints (BFB) and personal factors such as inability to recover (FABA), sense of coherence (SOC) and health behaviour. RESULTS: First, mentally fit (MH(+)) and mentally impaired teachers (MH(-)) were differentiated based on the GHQ-12 sum score (MH(+): < 5; MH(-): ≥ 5); 18% of the teachers showed evidence of mental impairment. There were no differences concerning work-related and cardiovascular risk factors as well as health behaviour between MH(+) and MH(-). Binary logistic regressions identified 4 predictors that showed a significant effect on mental health. The effort-reward-ratio proved to be the most relevant predictor, while physical complaints as well as inability to recover and sense of coherence were identified as advanced predictors (explanation of variance: 23%). CONCLUSION: Contrary to the expectations, classic work-related factors can hardly contribute to the explanation of mental health. Additionally, cardiovascular risk factors and health behaviour have no relevant influence. However, effort-reward-ratio, physical complaints and personal factors are of considerable influence on mental health in teachers. These relevant predictors should become a part of preventive arrangements for the conservation of teachers' health in the future.