Die Implementierung komplexer medizinischer Interventionen in der Hausarztpraxis

Die erfolgreiche Implementierung komplexer medizinischer Interventionen in die hausärztliche Praxis leistet einen wichtigen Beitrag zu einer wissenschaftlich fundierten und nachhaltigen Patientenversorgung. Trotz des Nutzens, der sich durch den Einsatz der Interventionen ergibt, stellt deren langfristige Verankerung in den Praxisalltag oftmals eine große Herausforderung dar. Vor diesem Hintergrund widmet sich die vorliegende Dissertation ausgewählten Fragestellungen im Kontext der Implementierung komplexer medizinischer Interventionen mit dem Ziel, Ergebnisse der bestehenden Implementierungsforschung zu verifizieren und um weiterführende Ansätze zu ergänzen. In der Mantelschrift wird zunächst der theoretische Hintergrund und wissenschaftliche Bezugsrahmen der drei Originalarbeiten aufgezeigt. Die sich anschließende erste Originalarbeit beschäftigte sich mit der qualitativen Evaluation eines lokalen Behandlungspfades bei Patienten mit koronarer Herzkrankheit (KHK) hinsichtlich wesentlicher Einflussfaktoren für die Implementierung. Neben praktischen Implikationen, die auf Grundlage der Daten abgeleitet wurden und den Einsatz des Behandlungspfades im Praxisalltag fördern sollen, wurden die eruierten Faktoren in einem mehrdimensionalen theoretischen Modell zusammengefasst. In der zweiten Originalarbeit wurden die Zusammenhänge verschiedener demographischer, krankheits- und pfadbezogener Variablen mit der gesundheitsbezogenen Lebensqualität von KHK-Patienten dreier Studienarme (Pfadentwickler, Anwender, Kontrolle) im Rahmen gemischter linearer Regressionsmodelle untersucht und konnten mit Ausnahme der Pfadvariablen verifiziert werden. Aufgrund ihres explorativen Pilotcharakters konnte die Studie wichtige methodische und inhaltliche Impulse für weitere Forschungsarbeiten liefern. Die dritte Originalarbeit stellt die Entwicklung und Validierung eines auf der Theorie des geplanten Verhaltens basierenden generischen Fragebogeninstrumentes am Beispiel von arriba-lib, einer elektronischen Bibliothek der Entscheidungshilfen, dar. Die postulierte Faktorenstruktur konnte anhand der durchgeführten konfirmatorischen Faktorenanalyse nicht bestätigt werden. Auch bezüglich des prädiktiven Wertes der Theoriekomponenten für das Zielverhalten konnten die Annahmen in den Analysen (Strukturgleichungsmodell, multinomiale logistische Regression) nicht belegt werden. Im letzten Abschnitt der Mantelschrift werden die wesentlichen Erkenntnisse aus den drei Originalarbeiten zusammenfassend diskutiert und weiterführende Forschungsvorhaben angeregt

'For the poor, sleep is leisure': understanding perceptions, barriers and motivators to mosquito net care and repair in southern Tanzania.

BACKGROUND: The rate of physical deterioration of long-lasting insecticidal nets (LLINs) varies by household practices, net brand and environment. One way to sustain the protection provided by LLINs against malaria is through day-to-day care, and repairing holes as and when they occur. To ensure LLIN coverage is high between mass campaigns and, as international donor funds decrease, personal responsibility to maintain nets in good condition is becoming more important. This study aimed to understand local barriers and motivators to net care and repair in southern Tanzania in a community that receives free LLINs through a school-based distribution mechanism. METHODS: Qualitative research methods were applied in a rural and peri-urban village in Ruangwa district. Focus group discussions (FGDs) were conducted for five groups of 8-12 participants; (1) key informants, (2) young men (18-24 years old), (3) women (> 18 years) with children under the age of five, (4) older men (> 25 years), and (5) older women with or without children (> 25 years). In each village, five men, five women with or without children, and five women with children under the age of five were recruited for in-depth interviews (IDIs). After each IDI and FGD with women with young children, participants were guided through a participatory activity. The study also counted the number and size of holes in nets currently used by IDI participants to determine their physical degradation status. RESULTS: A general willingness to care and repair mosquito nets was observed in Ruangwa district for the love of a good night's sleep free of mosquito bites or noises. Net care was preferred over repair, especially among women who were the primary caretakers. The main motivation to look after nets was protection against mosquito bites and malaria. Washing nets occurred as frequently as every other week in some households to ensure cleanliness, which prevented other dirt-related problems such as sneezing and headaches. Barriers to net care included care not being a priority in the day-to-day activities and lack of net retreatment kits. Net repair was reported to be a temporary measure and necessary as soon as a hole was identified. However, during the net assessment and participatory activity, it became clear that people did not actually repair smaller holes. Protection against mosquitoes, malaria and cost saving from replacing nets were identified as motivators for net repair. Barriers to net repair included it not being a priority to repair holes that could be tucked under the mattress and lack of knowledge on when to repair nets. CONCLUSION: In Ruangwa, net care was defined as overall net maintenance, such as cleanliness, and not directly associated with the prevention of damage as reported in other studies. Net repair was reported as a temporary measure before the acquisition of a new net, hence not a priority in a busy household. Inconsistencies were observed between reported intentions to repair mosquito nets and current net condition. Targeted education through health facilities and community change agents are potential means to overcome barriers to net care and repair

Mosquito net coverage in years between mass distributions: a case study of Tanzania, 2013.

BACKGROUND: The Government of Tanzania is the main source of long-lasting insecticidal nets (LLINs) for its population. Mosquito nets (treated and untreated) are also available in the commercial market. To sustain investments and health gains in the fight against malaria, it is important for the National Malaria Control Programme to monitor LLIN coverage especially in the years between mass distributions and to understand what households do if their free nets are deemed unusable. The aim of this paper was to assess standard LLIN indicators by wealth status in Tanzania in 2013, 2 years after the last mass campaign in 2011, and extend the analysis to untreated nets (UTNs) to investigate how households adapt when nets are not continuously distributed. METHODS: Between October-December 2013, a household survey was conducted in 3398 households in eight districts in Tanzania. Using the Roll Back Malaria indicators, the study analysed: (1) household net ownership; (2) access to nets; (3) population net use and (4) net use:access ratio. Outcomes were calculated for LLINs and UTNs. Results were analysed by socio-economic quintiles and by district. RESULTS: Only three of the eight districts had household LLIN ownership of more than 80%. In 2013, less than a quarter of the households had one LLIN for every two people and only half of the population had access to an LLIN. Only the wealthier quintiles increased their net ownership and access to levels above 80% through the addition of UTNs. Overall net use of the population was low (LLINs: 32.8%; UTNs: 9.5%) and net use:access ratio was below target level (LLINs: 0.66; UTN: 0.50). Both measures varied significantly by district. CONCLUSIONS: Two years after the last mass campaign, the percentage of households or population with access to LLINs was low. These findings indicate the average rate at which households in Tanzania lose their nets is higher than the rate at which they acquire new nets. The wealthiest households topped up their household net ownership with UTNs. Efforts to make LLINs available through commercial markets should be promoted, so those who can afford to buy nets purchase LLINs rather than UTNs. Net use was low around 40% and mostly explained by lack of access to nets. However, the use:access ratio was poor in Mbozi and Kahama districts warranting further investigations to understand other barriers to net use

From Craft to industry

In this paper, we discuss the potential of using traditional knowledge of natural dyes for more sustainable development processes in textile design. Our aim is to help foster a green transition through responsible consumption and production. We investigate the potential for implementing natural dye processes from craft to industrial processes to replace synthetic dyes. We adopt a systematic approach to dyeing and printing with food waste, including walnut shells, avocado skins and onion skins, specifically exploring colourfastness. We have observed that craft methods tend to be ‘forgotten’ due to the zeal for industry­alization and the standardizing of products to ensure quality requirements. From students and business partners, we experience requests for natural dyes; however, we are challenged to document colour­fastness. Knowledge and documentation are of high importance when we intend to convince industry to learn from traditional crafts. Through a systematic investigation testing traditional recipes and variations in dyed textiles, we experience how textiles perform. Through iterations based on the results, we continue with further experiments and simultaneously discuss whether both the consumer and the industry have to look at quality requirements from a conventional perspective. We argue that current expectations regarding colours and standards must change. Facing radical changes to the way we live, produce and use products, it is important to critically examine our approach to conventional industrial production. In our research, we built knowledge generation on cultural heritage and traditional craft. We argue how this becomes a societal asset influencing users’ behaviour and creates awareness towards sustainable changes in the design and use of textiles. 

Design of Specific Mammalian Promoters by in silico Prediction

The purpose of this RFC is to provide a) a method for the design of rational synthetic promoter sequences based on a statistical analysis about the spatial preference of transcription factor binding sites in human promoter sequences and b) further introduce standards to provide compatibility with data formats introduced in this RFC. Description of promoters generated by this method can be found at http://2009.igem.org/Team:Heidelberg/HEARTBEAT_database

Prediction and Optimal Scheduling of Advertisements in Linear Television

Advertising is a crucial component of marketing and an important way for companies to raise awareness of goods and services in the marketplace. Advertising campaigns are designed to convey a marketing image or message to an audience of potential consumers and television commercials can be an effective way of transmitting these messages to a large audience. In order to meet the requirements for a typical advertising order, television content providers must provide advertisers with a predetermined number of impressions in the target demographic. However, because the number of impressions for a given program is not known a priori and because there are a limited number of time slots available for commercials, scheduling advertisements efficiently can be a challenging computational problem. In this case study, we compare a variety of methods for estimating future viewership patterns in a target demographic from past data. We also present a method for using those predictions to generate an optimal advertising schedule that satisfies campaign requirements while maximizing advertising revenue

Prediction and Optimal Scheduling of Advertisements in Linear Television

Advertising is a crucial component of marketing and an important way for companies to raise awareness of goods and services in the marketplace. Advertising campaigns are designed to convey a marketing image or message to an audience of potential consumers and television commercials can be an effective way of transmitting these messages to a large audience. In order to meet the requirements for a typical advertising order, television content providers must provide advertisers with a predetermined number of impressions in the target demographic. However, because the number of impressions for a given program is not known a priori and because there are a limited number of time slots available for commercials, scheduling advertisements efficiently can be a challenging computational problem. In this case study, we compare a variety of methods for estimating future viewership patterns in a target demographic from past data. We also present a method for using those predictions to generate an optimal advertising schedule that satisfies campaign requirements while maximizing advertising revenue