Partnerschaftliche Lebensformen im internationalen Vergleich

Der vorliegende Beitrag analysiert die Verteilung partnerschaftlicher Lebensformen in den westlichen Industrieländern sowie deren Entwicklung in der Lebensverlaufsperspektive. Die Untersuchung, basiert auf den Daten des "Fertility and Family Survey". Im Ergebnis zeigt sich mit wenigen Ausnahmen eine zunehmende Etablierung außerehelicher Formen des Zusammenlebens, wobei (abgesehen von den südeuropäischen Ländern) die Ausbreitung der nichtehelichen Lebensgemeinschaft den wohl wichtigsten Aspekt des Wandels partnerschaftlicher Lebensformen beschreibt. Aus der Perspektive des Lebensverlaufs zeigen sich dabei in den verschiedenen Ländern unterschiedliche Entwicklungen, die vor allem zwei Muster erkennen lassen: das der nichtehelichen Lebensgemeinschaft als Vorphase der Ehe und das der nichtehelichen Lebensgemeinschaft als dauerhafte Alternative. Als ein übergreifendes Ergebnis lässt sich zudem festhalten, dass verbindliche Formen der Partnerschaft, wie sie durch das Zusammenleben in einem gemeinsamen Haushalt zum Ausdruck gebracht werden, eine im Zuge der Individualisierungsdebatte fast erstaunlich konstante Verbreitung aufweisen, wobei der Rückgang der Ehen durch eine Zunahme nichtehelicher Lebensgemeinschaften teilweise oder ganz kompensiert wird. Man kann daher in den meisten Ländern eher von einer Strukturverschiebung in Bezug auf formale Gesichtspunkte des Zusammenlebens sprechen denn von einer Umwälzung real praktizierter Lebensformen.This article analyses the distribution of living arrangements based on partnership throughout the Western industrialised countries, as well as their development in a life course perspective. This study is based on data from the "Fertility and Family Survey". As a result, it has demonstrated with few exceptions an increasing spread of non-marital forms of co-habitation, in which (apart from the Southern European countries) the spread of consensual unions is probably the most important aspect of the change in living arrangements based on partnership. From the point of view of the life course, differing trends can be identified in the various countries, which make it possible to identify two main patterns: that of consensual unions as a preliminary to marriage, and that of consensual unions as a long-term alternative. It is also possible to come to the overall conclusion that binding forms of partnership as expressed by living together in a shared household show an occurrence that is almost astonishingly constant as the debate on increasing individualism continues, whilst the fall in the number of marriages is partly or completely compensated for by an increase in consensual unions. In most countries, therefore, it is possible to speak of a structural shift in the formal aspects of co-habitation, rather than a transformation in living arrangements as they are actually practised

A multi-site single-blind clinical study to compare the effects of STAIR Narrative Therapy to treatment as usual among women with PTSD in public sector mental health settings: study protocol for a randomized controlled trial

Background: This article provides a description of the rationale, design, and methods of a multisite clinical trial which evaluates the potential benefits of an evidence-based psychosocial treatment, STAIR Narrative Therapy, among women with posttraumatic stress disorder (PTSD) related to interpersonal violence who are seeking services in public sector community mental health clinics. This is the first large multisite trial of an evidence-based treatment for PTSD provided in the context of community settings that are dedicated to the treatment of poverty-level patient populations. Methods: The study is enrolling 352 participants in a minimum of 4 community clinics. Participants are randomized into either STAIR Narrative Therapy or Treatment As Usual (TAU). Primary outcomes are PTSD, emotion management and interpersonal problems. The study will allow a flexible application of the protocol determined by patient need and preferences. Secondary analyses will assess the relationship of outcomes to different patterns of treatment implementation for different levels of baseline symptom severity. Discussion The article discusses the rationale and study issues related to the use of a flexible delivery of a protocol treatment and of the selection of treatment as it is actually practiced in the community as the comparator. Trial registration Clinicaltrials.gov identifier: NCT01488539

Are We Prepared for the Next Pandemic? Management, Systematic Evaluation and Lessons Learned from an In-Hospital COVID-19 Vaccination Centre for Healthcare Workers

Background: the organisation of a COVID-19 vaccination campaign for healthcare workers (HCWs) within a university hospital presents a challenge of a particularly large scale and urgency. Here, we evaluate the in-hospital vaccination process and centre for HCWs at LMU University Hospital in Munich, Germany. Methods: We executed a mixed-method process evaluation of the vaccination centre at LMU University Hospital during the first COVID-19 vaccination campaign. In a programme monitoring, we continuously assessed the implementation of the centre’s operational management including personnel resources. In evaluating the outreach to and satisfaction of the target group with the centre and process, we executed two anonymous surveys aimed at the HCWs vaccinated at the in-hospital centre (1) as well as centre staff members (2). Results: staff numbers and process time per person were reduced several times during the first vaccination campaign. Lessons concerning appointment scheduling were learned. HCWs vaccinated at the in-hospital centre were satisfied with the process. A longer waiting time between admission and inoculation, perceived dissatisfying accessibility as well as an increased frequency of observed adverse events were linked to a reduced satisfaction. Comparatively subpar willingness to adhere to non-pharmaceutical measures was observed. Centre staff reported high satisfaction and a workload relatively equal to that of their regular jobs. Our outcomes provide references for the implementation of an in-hospital vaccination centre in similar settings

COVID-19 Vaccination Intent, Barriers and Facilitators in Healthcare Workers: Insights from a Cross-Sectional Study on 2500 Employees at LMU University Hospital in Munich, Germany

Considering the role of healthcare workers (HCW) in promoting vaccine uptake and previously recorded hesitancy among HCW, we aim to examine the COVID-19 vaccination intent and status of HCW through a cross-sectional anonymous online survey at LMU University Hospital in Munich. Data collection was informed by the Health Belief Model (HBM) and focused on vaccination intent, status and on potential factors affecting the decision-making process. In total, 2555 employees completed the questionnaire. Our data showed that an approving attitude towards recommended vaccines and having received an influenza vaccine in the previous winter were strongly associated with COVID-19 vaccination intent. Further, a positive COVID-19 vaccination status was associated with a higher likelihood of approving the extension of the validity of non-pharmaceutical interventions at the workplace. Our HBM-analysis demonstrated strong associations between the perceived benefits and barriers and COVID-19 vaccination intent. Unchanged or low perceived susceptibility and severity were associated with refusal or indecisiveness. Our findings highlight the factors associated with the decision regarding a COVID-19 vaccine and indicate a pattern-like behavior in the acceptance of novel vaccines by HCW. These insights can help inform the communication aims of vaccination campaigns among HCW within similar organizational contexts or in future outbreaks

The chemokine CXCL13 is a key regulator of B cell recruitment to the cerebrospinal fluid in acute Lyme neuroborreliosis

<p>Abstract</p> <p>Background</p> <p>The chemokine CXCL13 is known to dictate homing and motility of B cells in lymphoid tissue and has been implicated in the formation of ectopic lymphoid tissue in chronic inflammation. Whether it influences B cell trafficking during acute infection, is largely unclear. In previous studies, we showed that (I) CXCL13 levels are markedly increased in the B cell-rich cerebrospinal fluid (CSF) of patients with acute Lyme neuroborreliosis (LNB), and (II) CXCL13 is released by monocytes upon recognition of borrelial outer surface proteins by Toll-like receptor 2. Here, we assessed the role of CXCL13 - in comparison to other chemokines - in the recruitment of B cells to the CSF of patients with acute LNB.</p> <p>Methods</p> <p>Measurement of chemokines was done by ELISA. B cells were isolated from whole blood using magnetic cell separation (MACS). For migration experiments, a modified Boyden chamber assay was used and the migrated B cells were further analysed by FACS. The migration was inhibited either by preincubation of the CSF samples with neutralizing antibodies, heating to 60°C, removal of proteins >3 kDa, or by pre-treatment of the B cells with pertussis toxin. The principal statistical tests used were one-way analysis of variance and Bonferroni test (chemokine measurements) as well as paired Student's t-test (migration experiments).</p> <p>Results</p> <p>Measurements of chemokine levels revealed an increase in three of the four known major B cell chemoattractants CXCL13, CCL19 and CXCL12 in LNB CSF. The CXCL13 CSF:serum ratio, as a measure of the chemotactic gradient, was substantially higher than that of CCL19 and CXCL12. Moreover, the chemotactic activity of LNB CSF was reduced up to 56% after preincubation with a neutralizing CXCL13 antibody, while combined preincubation with antibodies against CXCL13, CCL19, and CXCL12 did not lead to further reduction. Since treatment with pertussis toxin, heating to 60°C, and removal of proteins >3 kDa abrogated the chemotactic activity, further not yet identified chemokines seem to be involved in B cell recruitment to LNB CSF.</p> <p>Conclusion</p> <p>Combined, our study suggests a key role of CXCL13 in B cell migration to sites of infection as shown here for the CSF of LNB patients.</p

Estimating the global root exudate carbon flux

Root exudation, the export of low-molecular weight organic carbon (C) from living plant roots to soil, influences microbial activity, nutrient availability, and ecosystem feedbacks to climate change, but the magnitude of this C flux at ecosystem and global scales is largely unknown. Here, we synthesize in situ measurements of root exudation rates and couple those to estimates of fine root biomass to estimate global and biome-level root exudate C fluxes. We estimate a global root exudate flux of 13.4 (10.1–20.2) Pg C y−1, or about 9% (7–14%) of global annual gross primary productivity. We did not find differences in root mass-specific exudation rates among biomes, though total exudate fluxes are estimated to be greatest in grasslands owing to their high density of absorptive root biomass. Our synthesis highlights the global importance of root exudates in the terrestrial C cycle and identifies regions where more in situ measurements are needed to improve future estimates of root exudate C fluxes

Implementing a psychosocial care approach in pediatric inpatient care: process evaluation of the pilot Child Life Specialist program at the University Hospital of Munich, Germany

BackgroundChild Life Specialists (CLSs) are psychosocial care professionals of child development and health who focus on the individual needs and rights of young patients. CLSs accompany sick children and focus on the children's perspective and their reality of life. CLS programs are already established in clinical settings in the United States and other Anglophone countries but have not yet been piloted in the German health care setting, neither has their implementation been evaluated in this context. This study aimed to explore the factors influencing the implementation of a pilot CLS program in pediatric inpatient care at the Dr. von Hauner Children's Hospital at the University Hospital of Munich, Germany.MethodsBuilding on methods commonly employed in the evaluation of complex interventions, we developed a logic model to guide the process evaluation of our program. Semi-structured interviews with four groups of stakeholders were conducted in person or via videoconferencing between June 2021 and January 2022. Data was analyzed collectively using the method of qualitative content analysis by Mayring.ResultsFifteen individual interviews were conducted with patients (children aged 5–17 years, n = 4), parents (n = 4), CLSs (n = 4) and other health professionals (n = 3). Factors influencing the implementation were identified on three levels: system, staff and intervention. On the system level, a clearer definition of CLSs’ tasks and responsibilities was perceived as important and would likely lead to a delineation from other (psychosocial) professions and a reduction of potential resistances. On the staff level, lacking training opportunities and feelings of being insufficiently skilled were limiting the CLSs professional self-confidence. On the intervention level, the emergence of a unique characteristic of the CLSs’ work (i.e., preparation for medical procedures) supported the acceptance of the new program.ConclusionsThe implementation of a CLS program into an established hospital system with existing psychosocial care services is challenging. Our results contribute to a better understanding of implementation processes of such an additional psychosocial care approach and provide recommendations for addressing upcoming challenges