Patientenverfügungen in Deutschland: empirische Evidenz für die Jahre 2005 bis 2007

Informationen zur Verbreitung von Patientenverfügungen in der Gesamtbevölkerung beruhen in Deutschland meist auf nicht-repräsentativen kleinen klinischen Stichproben und anekdotischer Evidenz. Aus wissenschaftlicher Sicht sind repräsentative Untersuchungen bedeutsam, die es neben der Deskription erlauben die Bedingungen zu untersuchen, unter denen Menschen, noch ehe sie persönlich betroffen sind, also im präklinischen Kontext, bereit sind - oder aber für sich selbst ablehnen - eine Patientenverfügung zu hinterlegen. In vier Erhebungen ergeben sich ähnliche Größenordnungen von rund 10 % (Bereich: 7-14%) der Erwachsenen, die eine Patientenverfügung hinterlegt haben. Die aktuellste Erhebung ist eine Sondererhebung der Längsschnittstudie "Sozio-oekonomisches Panel" (SOEP) bei 1000 Erwachsenen im Jahr 2007. Danach hat nur jeder zehnte Erwachsene eine Patientenverfügung erstellt. Kompatibel damit ist der Anteil von 7 %, der in dieser Erhebung für nahe stehende Verstorbene angegeben wird. In einer SOEP Sondererhebung im Sommer 2006 gaben etwa 11 % von 400 Befragten an, eine Patientenverfügung erstellt zu haben. In einer Umfrage der Infratest-Finanzforschung im Auftrag der Deutschen Hospizstiftung gaben dies Ende 2005 14 % an. Wir erläutern, warum dieser Wert vermutlich eine Überschätzung darstellt. Weitere Analysen zeigen die sozialen, biografischen und bildungsbezogenen Bedingungen, die zwischen den Menschen differenzieren, die eine Patientenverfügung erstellt haben oder aber für sich explizit ablehnen, eine Patientenverfügung zu erstellen. Die Befunde zeigen, dass neben dem Alter und schlechterem Gesundheitsstatus vor allem die persönliche Erfahrungen mit dem Tod von Angehörige begünstigt, dass eine Patientenverfügungen erstelltund hinterlegt wurde.

Best practice for arm recovery post stroke: an international application

Objective: To develop an evidence-based application (‘app’) for post-stroke upper extremity rehabilitation that can be used globally by therapists. Participants: Twenty-three experienced neurorehabilitation therapists, applied scientists and physicians, and 10 consultants dedicated to the provision of best practice to stroke survivors. Design: This team evaluated the evidence to support the timely and appropriate provision of interventions and the most defensible outcome measures during a 4-year voluntary information gathering and assimilation effort, as a basis for the sequencing of an algorithm informed by the data and directed by changes in impairment and chronicity. Outcome measures: The primary outcome was the formulation of a testable app that will be available for minimal user cost. The app is for a smartphone, and the comments of a focus group (audience at a World Confederation for Physical Therapy 2015 presentation, approximate n = 175) during a 30-minute ‘Questions and Answers’ session were assessed. Results: Analysis of documented, extensive input offered by the audience indicated a highly favourable disposition towards this novel tool, with provision of concrete suggestions prior to launching the final version. Suggestions centred on: inclusion of instructions; visuals and demonstrations; monitoring of adverse responses; availability of updates; autonomous use by patients; and potential to characterise practice. Conclusions: A simple, user-friendly app for decision making in the treatment of upper extremity impairments following stroke is feasible and welcomed

Prevalence study of abuse and violence against older women: results of a multi-cultural survey conducted in Austria, Belgium, Finland, Lithuania, and Portugal

Introduction • The study included women aged between 60 and 97 years who were living in private households. The survey asked about violence and abuse in the last 12 months. 2880 women were surveyed across five countries during 2010. • So-called “stranger violence” was ruled out and only perpetrators who were in the women's close circles were considered. • Response rates ranged from 26.1% (Belgium) to 49.1% (Austria). Prevalence of violence and abuse • Overall, 28.1% of older women had experienced some kind of violence or abuse. By country the prevalence rates were as follows: • Portugal 39.4% (postal survey) • Belgium 32.0% (postal survey and face-to-face interviews) • Finland 25.1% (postal survey) • Austria 23.8% (telephone survey (CATI)) • Lithuania 21.8% (face-to-face interviews) • Generally, emotional abuse was the most common form of violence experienced (23.6%) followed by financial abuse (8.8%), violation of rights (6.4%) and neglect (5.4%). Sexual abuse (3.1%) and physical violence (2.5%) were the least reported forms. Perpetrators • In most cases, perpetrators of emotional abuse, financial abuse, sexual abuse and violation of rights were the women's partners or spouses. The exception to this was in relation to neglect, where in most cases older women were abused by their adult children or children-in-law. Intensity of violence • 7.6% of older women had experienced a single form of abuse, but infrequently. • 13.5% had experienced several forms of abuse, but infrequently. • 1.2% had experienced a single form of abuse very often. • 5.8% had experienced multiple forms of abuse very often. Prevalence Study of Abuse and Violence against Older Women – Final Report 8 Risk factors • There were considerable differences between countries with regard to prevalence rates. However, connections between risk factors and abuse and violence were apparent regardless of country. • The likelihood of abuse is lower in higher age groups. • There was a significant association between abuse and violence and reduced physical health, poor mental health, managing poorly with household income, not participating in social activities, living with spouse or partner or with adult children, and loneliness. After the abuse • The most common effects of violence and abuse were tension, anger, hatred and feelings of powerlessness. • Nearly half of the abused women (44.7%) talked with somebody they knew about the most serious incident or reported it to an official agency. In Portugal and Lithuania, however, only a quarter of the abused women talked about the incident with anyone else. • The majority of older women did not talk with anybody else about the abusive incident(s). Mostly women thought the incident was too trivial to report or discuss or considered that nobody could do anything about the situation. Quality of Life • In relation to abuse in overall terms, the findings are unambiguous: older women who had experienced any kind of abuse reported having significantly lower quality of life than older women who had not experienced abuse.Daphne II

Über Gewalt und Misshandlung von älteren Frauen im sozialen Nahraum, ihre Verbreitung und Muster

Ausgehend von konzeptuellen Überlegungen geht der Beitrag Fragen der Verbreitung und Muster von Gewalt und Misshandlung im sozialen Nahraum an älteren Frauen nach. Es wird von den Ergebnissen einer Repräsentativumfrage aus dem Jahr 2010 berichtet, als insgesamt 2.880 zuhause lebende ältere Frauen (60+) in fünf europäischen Ländern zu Gewaltwahrnehmung und -erleben innerhalb der vergangenen zwölf Monate interviewt wurden. Drei von zehn älteren Frauen (30,1 Prozent) waren von Nahraumgewalt in unterschiedlicher Form und Ausmaß betroffen, die mit Konsequenzen im Handeln und Erleben verbunden war. Gewalt an und Misshandlung von älteren Frauen hat viele Gesichter und tritt in subtilen Gestalten auf. Weil die häusliche Gewalt von individuellen, sozialen und kulturellen (Risiko-) Faktoren (mit-) determiniert wird, sind bei Präventionsmaßnahmen unbedingt auch die gesellschaftlichen Strukturen, in denen die Gewalt eingebettet ist, sowie die kulturellen Praktiken, an die sie rückgebunden ist, zu berücksichtigen. (Autorenreferat)Based on conceptual considerations, this article deals with the prevalence and patterns of domestic violence and abuse against older women. Results of a representative survey from 2010 will be reported, where a total number of 2,880 home-dwelling older women (60+) from five European countries were interviewed about their perception and experiences of violence and abuse within the past 12 months. 3 out of 10 of the older women (30.1 percent) were affected by incidents of domestic violence and abuse, differing in form and extent, but also with consequences for their actions and feelings. Violence and abuse against older women has many faces and occurs in subtle forms. Because the problem is (co-) determined by individual, social and cultural (risk-) factors, -preventative measures must take into account the societal structures, in which violence and abuse are embedded, as well as the cultural practices, to which they are linked back. (author's abstract

Single cell immune profiling by mass cytometry of newly diagnosed chronic phase chronic myeloid leukemia treated with nilotinib

Monitoring of single cell signal transduction in leukemic cellular subsets has been proposed to provide deeper understanding of disease biology and prognosis, but has so far not been tested in a clinical trial of targeted therapy. We developed a complete mass cytometry analysis pipeline for characterization of intracellular signal transduction patterns in the major leukocyte subsets of chronic phase chronic myeloid leukemia. Changes in phosphorylated Bcr-Abl1 and the signaling pathways involved were readily identifiable in peripheral blood single cells already within three hours of the patient receiving oral nilotinib. The signal transduction profiles of healthy donors were clearly distinct from those of the patients at diagnosis. Furthermore, using principal component analysis, we could show that phosphorylated transcription factors STAT3 (Y705) and CREB (S133) within seven days reflected BCR-ABL1(IS) at three and six months. Analyses of peripheral blood cells longitudinally collected from patients in the ENEST1st clinical trial showed that single cell mass cytometry appears to be highly suitable for future investigations addressing tyrosine kinase inhibitor dosing and effect. (clinicaltrials. gov identifier: 01061177)Peer reviewe

Short assessment of the Big Five: robust across survey methods except telephone interviewing

We examined measurement invariance and age-related robustness of a short 15-item Big Five Inventory (BFI–S) of personality dimensions, which is well suited for applications in large-scale multidisciplinary surveys. The BFI–S was assessed in three different interviewing conditions: computer-assisted or paper-assisted face-to-face interviewing, computer-assisted telephone interviewing, and a self-administered questionnaire. Randomized probability samples from a large-scale German panel survey and a related probability telephone study were used in order to test method effects on self-report measures of personality characteristics across early, middle, and late adulthood. Exploratory structural equation modeling was used in order to test for measurement invariance of the five-factor model of personality trait domains across different assessment methods. For the short inventory, findings suggest strong robustness of self-report measures of personality dimensions among young and middle-aged adults. In old age, telephone interviewing was associated with greater distortions in reliable personality assessment. It is concluded that the greater mental workload of telephone interviewing limits the reliability of self-report personality assessment. Face-to-face surveys and self-administrated questionnaire completion are clearly better suited than phone surveys when personality traits in age-heterogeneous samples are assessed

Determinanten der Lebensqualität älterer Frauen: zum Stellenwert der wahrgenommenen Sicherheit und Eingebundenheit

"Neuere sozialgerontologische und soziologische Forschungen legen nahe, dass nicht lediglich personale, sondern auch sozial-räumliche Faktoren für die Lebensqualität älterer Menschen verantwortlich zeichnen. Zusammen machen sie den objektiven Handlungskontext für subjektive Wahrnehmungen und Bewertungen eines Individuums aus, die handlungsrelevant sind. Mit Hilfe von Daten einer im Jahr 2010 durchgeführten Umfrage unter 593 zuhause lebenden älteren Frauen (60+) werden die sozial-räumlichen Aspekte als Erklärungsvariablen für die subjektive Lebensqualität untersucht. Die Analyse erweist: Die subjektive Lebensqualität älterer Frauen hängt in hohem Maße von der wahrgenommenen Sicherheit, sozialen Eingebundenheit und vom Gesundheitsstatus ab. Während Lebensqualität überwiegend durch sozial-räumliche Aspekte der Gemeinde/ Nachbarschaft erklärt werden kann, ist Unsicherheit von der Gemeindegröße und dem Ausmaß sozialer Aktivitäten/ Partizipation abhängig sowie zusätzlich bei vulnerablen Älteren mit niedriger Bildung und Gesundheit verbreiteter." (Autorenreferat)"Recent social gerontology and sociological research suggest that not only personal factors but also the socio-spatial context is assumed to be a factor in explaining quality of life. Together they make up the objective action context for subjective perceptions and evaluations of an individual, which are relevant for behavior. Using survey data from 2010 with 593 older women living at home (60+), the social and spatial aspects are considered as explanatory variables for the subjective quality of life. The analysis shows: subjective life quality of older women depends largely on the perception of safety, social embeddedness and their health status. While quality of life can mainly be explained by socio-spatial aspects of the community or neighborhood, feelings of insecurity depend on the size of the community, the extent of social activities (participation) and are also common among vulnerable groups of older people with low education and health." (author's abstract