KMUs & Nachhaltige Lebensmittel Versorgung in Städten

Kernbotschaften Die Aufnahme und Implementation von Innovationen in städtischen Ernährungssysteme setzt ein aktives Engagement von KMUs voraus. Die Entwicklung verschiedener Arten von kommerziellen oder sozialen Unternehmen bietet Einkommen und Arbeitsplätze für verschiedene Akteurinnen und Akteure entlang der Nahrungskette. Die meisten KMUs haben das klare soziale Ziel, das Ernährungssystem zugunsten der Produzentinnen und Produzenten als auch der Konsumentinnen und Konsumenten zu verändern. KMUs sollten ihre geschäftlichen Chancen in kurzen Versorgungsketten, multifunktionaler Landnutzung und Landbau, sowie Ressourcenrecycling in städtischen und stadtnahen Gebieten prüfen. Von gegenseitigen Erfahrungen können alle profitieren und lernen. KMUs müssen auch neue und diversifizierte Geschäftsstrategien anwenden, um Innovationen zu schaffen. Erfolgreich kombiniert und angewandt, machen diese Strategien die städtischen Unternehmen und Projekte in der Ernährungswirtschaft wettbewerbsfähig, trotz Bedingungen, in denen die „klassische“ Agrarwirtschaft nicht als profitabel oder nachhaltig gilt. Staatliche Stellen müssen Strategien anwenden, die das Wachstum, die Entwicklung und die Unterstützung dieses Sektors erleichtern. Durch aktiven Support der Stadtverwaltung können KMUs ihre Innovationen effektiver verbessern und vollumpfänglich von ihrem Unternehmungsgeist profitieren

Reconstructing the Effectiveness of Policy Measures to Avoid Next-Wave COVID-19 Infections and Deaths Using a Dynamic Simulation Model:Implications for Health Technology Assessment

OBJECTIVE: The goal of this study was to dynamically model next-wave scenarios to observe the impact of different lockdown measures on the infection rates (IR) and mortality for two different prototype countries, mimicking the 1st year of the COVID-19 pandemic in Europe. METHODS: A dynamic simulation SIRD model was designed to assess the effectiveness of policy measures on four next-wave scenarios, each preceded by two different lockdowns. The four scenarios were (1) no-measures, (2) uniform measures, (3) differential measures based on isolating > 60 years of age group, and (4) differential measures with additional contact reduction measures for the 20–60 years of age group. The dynamic simulation model was prepared for two prototype European countries, Northwestern (NW) and Southern (S) country. Both prototype countries were characterized based on age composition and contact matrix. RESULTS: The results show that the outcomes of the next-wave scenarios depend on number of infections of previous lockdowns. All scenarios reduce the incremental deaths compared with a no-measures scenario. Differential measures show lower number of deaths despite an increase of infections. Additionally, prototype S shows overall more deaths compared with prototype NW due to a higher share of older citizens. CONCLUSION: This study shows that differential measures are a worthwhile option for controlling the COVID-19 epidemic. This may also be the case in situations where relevant parts of the population have taken up vaccination. Additionally, the effectiveness of interventions strongly depends on the number of previously infected individuals. The results of this study may be useful when planning and forecasting the impact of non-pharmacological interventions and vaccination campaigns

The development and psychometric evaluation of an interprofessional identity measure:extended Professional Identity Scale (EPIS)

The purpose of this study was to develop and evaluate an interprofessional identity measurement instrument based on Extended Professional Identity Theory (EPIT). The latter states that interprofessional identity is a social identity superordinate to a professional identity consisting of three interrelated interprofessional identity characteristics: belonging, commitment and beliefs. Scale development was based on five stages: 1) construct clarification, 2) item pool generation, 3) review of initial item pool, 4) shortening scale length (EFA to determine top four highest factor loadings per subscale; 97 dental and dental hygiene students), and 5) cross-validation and construct validity confirmation (CFA; 152 students and 48 teachers from six curricula). Explained variance of the EPIS was 65%. Internal consistency of the subscales was 0.79, 0.81 and 0.80 respectively and 0.89 of the overall scale. CFA confirmed three-dimensionality as theorized by EPIT. Several goodness-of-fit indexes showed positive results: CFI = 0.968 > 0.90, RMSEA = 0.039 < 0.05, and SRMR = 0.056 ≤ 0.08. The factor loadings of the CFA ranged from 0.58 to 0.80 and factors were interrelated. The Extended Professional Identity Scale (EPIS) is a 12-item measurement instrument with high explained variance, high internal consistency and high construct validity with strong evidence for three-dimensionality

Discomfort and factual recollection in intensive care unit patients

INTRODUCTION: A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients' stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection? METHODS: All ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire. RESULTS: A total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min–max) score for factual recollection in the ICU patients was 15 (0–28). The median (min–max) score for factual recollection in the reference group was 25 (19–28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients. CONCLUSION: Among postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort

Understanding behavioral mechanisms for physical activity in head and neck cancer patients: a qualitative study

Rationale: Head and neck cancer (HNC) patients often have adverse changes in body composition. Loss of muscle mass and strength frequently occur, even when dietary intake is adequate. Nascent evidence suggests that a healthy lifestyle, including adequate physical activity (PA) and diet, may prevent muscle wasting. HNC patients often show suboptimal health behavior pre-diagnosis, and additional barriers to PA can arise from cancer treatment. Better understanding of the behavioral mechanisms of PA in this mostly sedentary group is needed to design effective individualized PA-supporting interventions. This qualitative study explored the perspective of HNC patients on PA. Methods: We conducted 9 semi-structured interviews in HNC patients, 6-8 weeks after treatment (surgery +/-(chemo)radiation). The interviews were guided by the Theory of Planned Behavior (TPB) key concepts, including: attitude; social norm (with emphasis on role of healthcare professionals); self-efficacy; intention; barriers/facilitators, knowledge/skills; and current PA behaviour. Interviews were analysed by directed content analysis. Results: Important themes identified for PA were: physical barriers, health as stimulus, role of habits, and lack of interest. While all themes could be fitted within the key concepts of TBP, there was little interaction between intention and other concepts. In fact, PA intention was not an explicit consideration for most patients. Conclusion: HNC patients perceived physical barriers, health, habits, and lack of interest as important themes with regard to PA. Our tentative results suggest that the TPB may not be the most appropriate model for explaining PA in HNC patients. For future research aiming to understand PA in HNC patients, theories less focused on rational reasoning and more on autonomy, such as Self Determination Theory, may be better suited