Need for nursing care support in cancer patients: Registry-linkage study in Germany

Aim: In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care. Methods: This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients. Results: In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants. Conclusion: Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed

Machbarkeitsstudie für eine empirische Analyse von Hemmnissen für die Verbreitung der betrieblichen Altersversorgung in kleinen und mittleren Unternehmen (Machbarkeitsstudie BAV in KMU) : Endbericht

Infolge der Rentenreformmaßnahmen in der Vergangenheit kann der Lebensstandard im Alter nicht mehr allein mit den Leistungen der gesetzlichen Rentenversicherung aufrechterhalten werden. Noch mehr als in der Vergangenheit sollte die Altersvorsorge im Rahmen der gesetzlichen Rentenversicherung durch zusätzliche Altersvorsorge im Rahmen der betrieblichen Altersversorgung und/oder der privaten Altersvorsorge ergänzt werden. Vor diesem Hintergrund besteht ein großes Interesse, mehr über die Ursachen der geringeren Verbreitung von BAV-Lösungen in kleinen und mittleren Unternehmen, insbesondere in Kleinstunternehmen, zu erfahren und möglichst konkrete Ansatzpunkte zur Steigerung des Verbreitungsgrades der BAV bei den Unternehmen und deren Arbeitnehmern zu finden

Fabrication-Aware Design of Timber Folded Plate Shells with Double Through Tenon Joints

Integral attachment, the joining of parts through their form rather than additional connectors or adhesives, is a common technique in many industry sectors. Following a renaissance of integral joints for timber frame structures, recent research investigates techniques for the attachment of timber plate structures. This paper introduces double through tenon joints, which allow for the rapid, precise and fully integral assembly of doubly-curved folded surface structures with two interconnected layers of cross-laminated engineered wood panels. The shape of the plates and the assembly sequence allow for an attachment without additional connectors or adhesives. The fabrication and assembly constraint based design is achieved through algorithms, which automatically generate the geometry of the parts and the G-Code for the fabrication. We present the fabrication and assembly of prototypes fabricated with 3D CNC milling and laser cutting systems, comparing and discussing the advantages and disadvantages of the individual techniques

Quality of record linkage in a highly automated cancer registry that relies on encrypted identity data

Objectives: In the absence of unique ID numbers, cancer and other registries in Germany and elsewhere rely on identity data to link records pertaining to the same patient. These data are often encrypted to ensure privacy. Some record linkage errors unavoidably occur. These errors were quantified for the cancer registry of North Rhine Westphalia which uses encrypted identity data. Methods: A sample of records was drawn from the registry, record linkage information was included. In parallel, plain text data for these records were retrieved to generate a gold standard. Record linkage error frequencies in the cancer registry were determined by comparison of the results of the routine linkage with the gold standard. Error rates were projected to larger registries. Results: In the sample studied, the homonym error rate was 0.015%; the synonym error rate was 0.2%. The F-measure was 0.9921. Projection to larger databases indicated that for a realistic development the homonym error rate will be around 1%, the synonym error rate around 2%. Conclusion: Observed error rates are low. This shows that effective methods to standardize and improve the quality of the input data have been implemented. This is crucial to keep error rates low when the registry’s database grows. The planned inclusion of unique health insurance numbers is likely to further improve record linkage quality. Cancer registration entirely based on electronic notification of records can process large amounts of data with high quality of record linkage

Need for nursing care support in cancer patients: Registry-linkage study in Germany

Aim: In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care.Methods: This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients.Results: In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants.Conclusion: Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed.

Reduction of radiation transmission through functionalization of textiles from man-made cellulosic fibers

Both ultraviolet (UV) and infrared (IR) light have negative impact on the human health. With this background it is the main aim of the current research to realize a textile material which is able to protect against both UV light and IR light. For this research, regenerated cellulosic fibers from the Lyocell process are used and modified. Main analytical investigations are done by photo-spectroscopy in arrangement of diffuse transmission for the spectral range from 220 nm to 1400 nm. Additionally, microscopic investigations are done by scanning electron microscopy (SEM). For material development, Lyocell fibers functionalized with TiO2 particles are first processed into yarns and then into knitted fabrics. Compared to non-functionalized textiles, the transmission is reduced in the UV range due to the absorption behavior of TiO2. Subsequent dyeing with anthraquinone or reactive dyes enhanced the UV protective effect. To reduce the transmission in the near IR range (NIR), non-functionalized Lyocell knitted fabrics are functionalized with various IR absorbers in different concen­trations. With increasing concentration, the transmission de­creased. However, a grey coloration of the textile is observed simultaneously, with increased concentration. This must be con­sidered in further processing steps. With these methods for function­alization, it is possible to produce textiles that offer increased protection against UV and IR radiation. These are promising materials for the production of clothing or work wear

CRF binding protein activity in the hypothalamic paraventricular nucleus is essential for stress adaptations and normal maternal behaviour in lactating rats

To ensure the unrestricted expression of maternal behaviour peripartum, activity of the corticotropin-releasing factor (CRF) system needs to be minimised. CRF binding protein (CRF-BP) might be crucial for this adaptation, as its primary function is to sequester freely available CRF and urocortin1, thereby dampening CRF receptor (CRF-R) signalling. So far, the role of CRF-BP in the maternal brain has barely been studied, and a potential role in curtailing activation of the stress axis is unknown. We studied gene expression for CRF-BP and both CRF-R within the paraventricular nucleus (PVN) of the hypothalamus. In lactating rats, Crh-bp expression in the parvocellular PVN was significantly higher and Crh-r1 expression in the PVN significantly lower compared to virgin rats. Acute CRF-BP inhibition in the PVN with infusion of CRF(6–33) increased basal plasma corticosterone concentrations under unstressed conditions in dams. Furthermore, while acute intra-PVN infusion of CRF increased corticosterone secretion in virgin rats, it was ineffective in vehicle (VEH)-pre-treated lactating rats, probably due to a buffering effect of CRF-BP. Indeed, pre-treatment with CRF(6–33) reinstated a corticosterone response to CRF in lactating rats, highlighting the critical role of CRF-BP in maintaining attenuated stress reactivity in lactation. To our knowledge, this is the first study linking hypothalamic CRF-BP activity to hypothalamic-pituitary-adrenal axis regulation in lactation. In terms of behaviour, acute CRF-BP inhibition in the PVN under non-stress conditions reduced blanket nursing 60 min and licking/grooming 90 min after infusion compared to VEH-treated rats, while increasing maternal aggression towards an intruder. Lastly, chronic intra-PVN inhibition of CRF-BP strongly reduced maternal aggression, with modest effects on maternal motivation and care. Taken together, intact activity of the CRF-BP in the PVN during the postpartum period is essential for the dampened responsiveness of the stress axis, as well as for the full expression of appropriate maternal behaviour

Wirkungen des SGB II auf Personen mit Migrationshintergrund: Projekt IIa1 - 04/06 ; Jahresbericht zum 31.12.2008 - Hauptband

Auf Grundlage von Geschäftsdaten, von repräsentativen telefonischen Befragungen und von qualitativen Interviews mit Betroffenen und Fallmanagern wurden die Wirkungen der "Grundsicherung für Arbeitsuchende" auf Migrant/innen untersucht. Ihr Anteil an allen ALG-II Beziehenden beträgt im bundesweiten Durchschnitt 28 Prozent. Im Vergleich zu denjenigen ohne Migrationshintergrund sind sie im Durchschnitt jünger und haben häufiger keinen, aber auch häufiger höhere (Aus-)Bildungsabschlüsse. Die häufig fehlende Anerkennung ausländischer Abschlüsse wirkt sich auf die Arbeitsmarktchancen ebenso negativ aus wie das Fehlen jeglicher Ausbildung. Migrant/innen erhalten bei den Grundsicherungsstellen im Vergleich zu Deutschen ohne Migrationshintergrund mehr Beratungsgespräche, schließen jedoch seltener Eingliederungsvereinbarungen ab und nehmen seltener an Maßnahmen teil. Einige Herkunftsgruppen werden deutlich häufiger mit Sanktionen belegt, andere Herkunftsgruppen deutlich seltener

Scleroderma and related disorders: 223. Long Term Outcome in a Contemporary Systemic Sclerosis Cohort

Background: We have previously compared outcome in two groups of systemic sclerosis (SSc) patients with disease onset a decade apart and we reported data on 5 year survival and cumulative incidence of organ disease in a contemporary SSc cohort. The present study examines longer term outcome in an additional cohort of SSc followed for 10 years. Methods: We have examined patients with disease onset between years 1995 and 1999 allowing for at least 10 years of follow-up in a group that has characteristics representative for the patients we see in contemporary clinical practice. Results: Of the 398 patients included in the study, 252 (63.3%) had limited cutaneous (lc) SSc and 146 (36.7%) had diffuse cutaneous (dc) SSc. The proportion of male patients was higher among the dcSSc group (17.1% v 9.9%, p = 0.037) while the mean age of onset was significantly higher among lcSSc patients (50 ± 13 v 46 ± 13 years ± SD, p = 0.003). During a 10 year follow-up from disease onset, 45% of the dcSSc and 21% of the lcSSc subjects developed clinically significant pulmonary fibrosis, p < 0.001. Among them approximately half reached the endpoint within the first 3 years (23% of dcSSc and 10% of lcSSc) and over three quarters within the first 5 years (34% and 16% respectively). There was a similar incidence of pulmonary hypertension (PH) in the two subsets with a steady rate of increase over time. At 10 years 13% of dcSSc and 15% of lcSSc subjects had developed PH (p=0.558), with the earliest cases observed within the first 2 years of disease. Comparison between subjects who developed PH in the first and second 5 years from disease onset demonstrated no difference in demographic or clinical characteristics, but 5-year survival from PH onset was better among those who developed this complication later in their disease (49% v 24%), with a strong trend towards statistical significance (p = 0.058). Incidence of SSc renal crisis (SRC) was significantly higher among the dcSSc patients (12% v 4% in lcSSc, p = 0.002). As previously observed, the rate of development of SRC was highest in the first 3 years of disease- 10% in dcSSc and 3% in lcSSc. All incidences of clinically important cardiac disease developed in the first 5 years from disease onset (7% in dcSSc v 1% in lcSSc, p < 0.001) and remained unchanged at 10 years. As expected, 10-year survival among lcSSc subjects was significantly higher (81%) compared to that of dcSSc patients (70%, p = 0.006). Interestingly, although over the first 5 years the death rate was much higher in the dcSSc cohort (16% v 6% in lcSSc), over the following years it became very similar for both subsets (14% and 13% between years 5 and 10, and 18% and 17% between years 10 and 15 for dcSSc and lcSSc respectively). Conclusions: Even though dcSSc patients have higher incidence for most organ complications compared to lcSSc subjects, the worse survival among them is mainly due to higher early mortality rate. Mortality rate after first 5 years of disease becomes comparable in the two disease subsets. Disclosure statement: The authors have declared no conflicts of interes