Exploring Housing Policies in Five Swedish Municipalities: Alternatives and Priorities

IntroductionHousing shortage due to population growth within metropolitan areas, combined with an ageing population has put pressure on current housing provision policies in Sweden. Thus, there is an urgent need to develop sustainable housing policies to accommodate the growing number of seniors in accessible home environments. This study aimed to gain an in-depth understanding of how municipalities currently address housing accessibility issues and to explore what types of policy solutions they consider for the future.Material and methodsFive Swedish municipalities were selected to represent a diversity of population, housing situations and geographical areas. Two key actors from each municipality (public officials, housing adaptation grant managers, city architects etc.) participated in semi-structured interviews (N=10). Data were analysed using content analysis, i.e. inductive category formation, described by Mayring (2014). ResultsImportant themes included how such factors as the organizational structure of the municipality and the level of collaboration between municipal and private actors impacted the goals and ambitions of current housing policies. Emerging themes concerning possible measures and policies for the future were innovative types of housing and the need for economic incentives for older people to move from housing with poor accessibility to housing designed to better meet their needs. ConclusionMunicipalities struggle with the lack of accessible and affordable housing for the ageing population. The results suggest there is a need to consider how to prevent organizational issues from hampering policy initiatives and implementation and how to improve collaboration between municipal and private actors involved in housing provision

Art-Making During a Global Pandemic: A Collaborative Autoethnography

Between March 11, 2020 and May of 2021, the World Health Organization (WHO) counted over 100 million cases of COVID-19, resulting in three million deaths worldwide (WHO, 2021). In order to examine the effects of art-making on social and psychological well-being, seven graduate students from the Marital and Family Art Therapy Program at LMU conducted the following study utilizing a qualitative, arts-based research approach through collaborative autoethnography (CAE). The research question — What are the effects of personal art-making on well-being during the COVID-19 pandemic? — was posed by the seven graduate student authors. The data revealed that pandemic-time art-making impacted well-being through three primary avenues: by acting as a means to cope, to adapt, and to process. Each of our emerging themes highlighted the use of art-making as a tool, and each theme described this phenomenon in a unique and pointed way. First, our art-making impacted our well-being during the pandemic by serving as a tool to cope with the stressors of the pandemic by minimizing, banishing, or making them tolerable. Going one step further than coping, art-making also served as a tool for adapting. It acted as the mediating force between the pandemic’s external impacts and our ensuing internal experiences. Finally, art-making impacted well-being throughout the pandemic by serving as a tool to process corporeal experiences, emotional experiences, and other personal realities. In order to build upon our findings, we propose future research on the impacts of personal art-making on wellness through collaborative autoethnography by participant-researchers representing diverse cultures within their social and environmental contexts

Posttraumatic cerebral venous sinus thrombosis: retrospective evaluation of risk factors, management and complications [Abstract]

Oral e-Poster Presentations - Booth 2: Trauma A, September 26, 2023, 1:00 PM - 2:30 PM Background: Up to date, there is no clear consensus on the management of posttraumatic cerebral venous sinus thrombosis (CVST). The challenge to establish a guideline in this disease is complicated by various coexisting injuries. This evaluation aims to identify risk factors, management and associated complications of posttraumatic CVST. Methods: A retrospective chart review of 341 traumatic brain injury patients admitted to the neurosurgical clinic from 2020 to 2022 was performed. Of those, 13 were diagnosed with posttraumatic CVST. In these patients, trauma mechanism, associated injuries, location of the CVST as well as treatment and possible complications were evaluated. Results: Mean age was 48 years (range: 23-84), with mainly male patients (n=8; 61.5%). Trauma mechanisms are illustrated in figure 1. Skull fractures, even though not dislocated were diagnosed in 11 patients (84.5%). Only two patients (15.3%) had CVST of the sagittal superior sinus, while most were diagnosed with CVST of the transverse (n=3, 23.0%), the sigmoid (n=4, 30.6%), or both, transverse and sigmoid sinus (n=4, 30.6%). These CVST were highly associated with skull base fractures p=0.02. Traumatic intracranial hemorrhage was evident in all patients, requiring surgery in half of the cases (Table 1). Half of all cases were treated with thrombosis prophylaxis only, while the remaining 6 (46.1%) received intravenous heparin being started at day 3 on average (range 1-8), leading to a progressive bleeding with the need for hemicraniectomy in 1 patient (7.6%). Conclusions: This study addresses the difficulty and inconsistency of the posttraumatic ST treatment. Due to the association with skull base fractures, we advocate performing a CT with contrast agent in a venous phase in these patients

Publikumsinklusion bei der Süddeutschen Zeitung: Fallstudienbericht aus dem DFG-Projekt "Die (Wieder-)Entdeckung des Publikums"

Der Bericht stellt Ergebnisse einer Fallstudie bei Süddeutsche Zeitung (SZ) und süddeutsche.de vor, die im Rahmen eines Forschungsprojekts zur Rolle von Publikumsbeteiligung im professionellen, redaktionell organisierten Journalismus in Deutschland durchgeführt wurde. Auf Grundlage eines theoretisch-analytischen Modells, das Partizipation als Zusammenspiel von Inklusionsleistungen und Inklusionserwartungen auf Seiten des Journalismus und des Publikums versteht, werden Befunde aus qualitativen Interviews mit Redaktionsmitgliedern (n= 10) und Lesern bzw. Nutzern unterschiedlichen Aktivitätsgrads (n= 8) sowie aus standardisierten Befragungen der Journalisten (n= 139) sowie der Nutzer von süddeutsche.de (n= 525) vorgestellt. Auf journalistischer Seite kann so nachgezeichnet werden, wie ein etabliertes und reichweitenstarkes nachrichtenjournalistisches Format im Konvergenzbereich von Print und Online Publikumsbeteiligung organisiert und wie sich im Hinblick hierauf journalistische Einstellungen und Selbstbilder darstellen. Hierbei lassen sich sowohl Anzeichen von Konvergenz als auch Komplementarität beobachten: Einerseits erzeugen die vorrangig online relevanten Formen der Publikumsbeteiligung auch "Ausstrahlungseffekte" in Printredaktion und -produkt. Andererseits folgen beide Angebote unterschiedlichen Ausrichtungen, die sich insbesondere aus nicht deckungsgleichen Publika sowie den jeweiligen Medienspezifka und Produktionsroutinen ergeben bzw. redaktionsseitig mit diesen begründet werden. Sie führen zu unterschiedlichen Zuständigkeiten für und Einstellungen gegenüber Publikumsbeteiligung. Auf Publikumsseite lässt sich außerdem rekonstruieren, in welchem Umfang partizipative Angebote wahrgenommen werden, wie sich das Publikumsbild der Nutzer gestaltet, welche Beteiligungsmotive vorherrschen sowie welche Erwartungen an die journalistischen Leistungen der Süddeutschen und an Formen der Publikumsbeteiligung bestehen. Der Abgleich beider Seiten erlaubt es zudem, Aussagen über das Inklusionslevel und die Inklusionsdistanz zu treffen: Das Inklusionslevel ist durch eine "moderate" Schieflage gekennzeichnet, da die von der SZ insbesondere online zugänglich gemachten und mit erheblichem redaktionellen Arbeitsaufwand begleiteten partizipativen Angebote tatsächlich auch von einem vergleichsweise großen Teil des Publikums in Anspruch genommen werden. Allerdings betreffen die meisten Beteiligungsformen eher sogenannte "Low-Involvement-Aktivitäten", die mit niedrigem Aufwand verbunden sind. Die Inklusionsdistanz ist im Großen und Ganzen gering, da weitgehende Übereinstimmung im Hinblick auf die vom Publikum erwarteten und die redaktionsseitig angestrebten journalistischen Aufgaben besteht: Zu den beidseitig als am wichtigsten eingeschätzten Aufgaben gehören insbesondere die klassischen journalistischen Informations- und Vermittlungs- sowie Kritikleistungen. Gleichwohl tendieren die befragten Journalisten dazu, die Erwartungen ihres Publikums an partizipative Beteiligungsangebote z. T. deutlich zu überschätzen und sie auch sehr viel stärker als ihr Publikum selbst als unverzichtbaren (und strategisch erforderlichen) Bestandteil der Süddeutschen Zeitung und ihrer Online-Angebote zu betrachten

Simulation der Letalität nach verschiedenen Ex-ante- und Ex-post-Triage-Verfahren bei Menschen mit Behinderungen und Vorerkrankungen

Der stetige Anstieg an zu behandelnden Patienten während der COVID-19-Pandemie hat das Gesundheitssystem vor eine Vielzahl an Herausforderungen gestellt. Die Intensivstation ist einer der in diesem Zusammenhang besonders stark betroffenen Bereiche. Nur durch umfangreiche Infektionsschutzmaßnahmen sowie einen enormen logistischen Aufwand konnten in Deutschland selbst in Hochphasen der Pandemie die Behandlung aller Intensivpatienten ermöglicht und eine Triage auch in Regionen mit hohem Patientendruck bei gleichzeitig geringen Kapazitäten verhindert werden. Im Hinblick auf die Pandemievorsorge hat der Deutsche Bundestag ein Gesetz zur Triage verabschiedet, das eine Ex-post-Triage explizit untersagt. Bei einer Ex-post-Triage werden auch Patienten, die bereits auf der Intensivstation behandelt werden, in die Triage-Entscheidung einbezogen und Behandlungskapazitäten nach individueller Erfolgsaussicht verteilt. In der Literatur finden sich rechtliche, ethische und soziale Überlegungen zur Triage bei Pandemien, eine quantitative Bewertung im Hinblick auf verschiedene Patientengruppen auf der Intensivstation gibt es hingegen nicht. Der Fokus der Arbeit liegt auf dieser Forschungslücke, und es wird eine quantitative simulationsbasierte Evaluation von Ex-ante- und Ex-post-Triage-Politiken unter Berücksichtigung von Überlebenswahrscheinlichkeiten, Beeinträchtigungen und Vorerkrankungen durchgeführt. Die Ergebnisse zeigen, dass eine Anwendung von Ex-post-Triage, basierend auf Überlebenswahrscheinlichkeiten in allen Patientengruppen, zu einer Reduktion der Mortalität auf der Intensivstation führt. In dem Szenario, das der realen Situation wohl am nächsten kommt, wird eine Reduktion der Mortalität auf der Intensivstation um ca. 15 % schon bei einer einmaligen Anwendung der Ex-post-Triage erreicht. Dieser mortalitätsreduzierende Effekt ist umso größer, je mehr Patienten auf eine intensivmedizinische Behandlung warten

Programa Nacional de Vigilância em Saúde Ambiental Relacionada à Qualidade da Água para Consumo Humano (Vigiagua): lacunas entre a formulação do programa e sua implantação na instância municipal

A avaliação e o acompanhamento das ações do Programa Nacional de Vigilância em Saúde Ambiental Relacionada à Qualidade da Água para Consumo Humano (Vigiagua) são importantes para validar o processo de trabalho, identificar nós e sugerir mudanças objetivando o avanço do Programa. Trabalhos sobre o Vigiagua geralmente exploram aspectos quantitativos e metas atingidas, inexistindo uma avaliação qualitativa sobre a sua implantação na instância municipal. Assim, práticas rotineiras preconizadas pelo Ministério da Saúde referentes à identificação e ao cadastramento das formas de abastecimento de água, à espacialização e ao compartilhamento de informações, intraorganizacional e intersetorialmente, são analisadas por meio de falas captadas em entrevistas com profissionais do Vigiagua em três municípios de diferentes portes populacionais. Recorreu-se ao método da análise de conteúdo de Bardin (1994) para o tratamento e a análise dos relatos, que revelou persistir dificuldades para cadastramento e vigilância a instalações de abastecimento de água, a não realização de séries temporais, a deficiência de instrumentos de georreferenciamento e a integração incipiente entre setores. Ainda, a integração entre a prática dos profissionais do Vigiagua e da Vigilância Epidemiológica é incipiente nos três municípios, restringindo-se basicamente a situações de surto. A implantação muito recente do Vigiagua aponta para a importância de avaliações visando, assim, seu aprimoramento.The monitoring and evaluation of Vigiagua - Brazil's drinking-water quality surveillance programme (Vigiagua) - are a potentially important source of programme improvements. Published documentation on Vigiagua refers mainly to its quantitative aspects and achievements, but we present here the results of a qualitative evaluation of the programme's functioning at municipal level, seeking to validate the methodology, identify constraints and suggest improvements. We analysed practices established by the Ministry of Health for the identification and survey of the various types of water supply, for the compilation of geographic information systems, and for the allocation of responsibilities between organisations and sectors, taking as our data the statements made during interviews by Vigiagua professional staff in one large, one small and one intermediate sized municipality. Content analysis applied to the interview transcripts brought to light persisting difficulties in registering and monitoring water supply infrastructure, failure to collect data at appropriate time intervals, lack of GPS and other equipment, and inadequate cross-sectoral coordination. The planned integration of the work of Vigiagua with the health sector's Epidemiological Surveillance is not yet functional in the three studied municipalities, being limited in practice to outbreaks. Further evaluations are necessary aiming at its improvement

A keratin scaffold regulates epidermal barrier formation, mitochondrial lipid composition, and activity.

Keratin intermediate filaments (KIFs) protect the epidermis against mechanical force, support strong adhesion, help barrier formation, and regulate growth. The mechanisms by which type I and II keratins contribute to these functions remain incompletely understood. Here, we report that mice lacking all type I or type II keratins display severe barrier defects and fragile skin, leading to perinatal mortality with full penetrance. Comparative proteomics of cornified envelopes (CEs) from prenatal KtyI(-/-) and KtyII(-/-)(K8) mice demonstrates that absence of KIF causes dysregulation of many CE constituents, including downregulation of desmoglein 1. Despite persistence of loricrin expression and upregulation of many Nrf2 targets, including CE components Sprr2d and Sprr2h, extensive barrier defects persist, identifying keratins as essential CE scaffolds. Furthermore, we show that KIFs control mitochondrial lipid composition and activity in a cell-intrinsic manner. Therefore, our study explains the complexity of keratinopathies accompanied by barrier disorders by linking keratin scaffolds to mitochondria, adhesion, and CE formation

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action ‘Mental health promotion and prevention’ indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study.

BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642