Pflegerische Versorgung in Zeiten von Corona - Drohender Systemkollaps oder normaler Wahnsinn? Wissenschaftliche Studie zu Herausforderungen und Belastungen aus der Sichtweise von Leitungskräften

Das Thema COVID-19/SARS-CoV-2 ist derzeit in aller Munde. Angesichts der dynamischen Entwicklungen und Folgen für die Versorgung der Risikogruppe pflegebedürftiger Menschen geraten Pflegeeinrichtungen zunehmend in das Blickfeld der Medien. Infektions- und Sterberaten sowie die Einhaltung von strengen Regelungen zu Besuchszeiten oder mangelnder Infektionsschutz stehen dabei oft im Fokus. Doch wie sind die Sichtweisen der Leitungskräfte von Pflegeeinrichtungen auf die Herausforderungen? Inwiefern belasten diese Herausforderungen die Pflegeeinrichtungen? Und wie geht es Leitungskräften? Handelt es sich bei der Corona-Situation nur um die Fortsetzung des "normalen Wahnsinns", der bereits vor der Corona-Zeit gegeben war oder steuert das System einem Kollaps entgegen? Hierzu führt das IMVR eine Onlinebefragung von Leitungskräften in deutschen Pflegeeinrichtungen durch. Mit unserer Studie möchten wir die speziellen Herausforderungen und Belastungen für Pflegeeinrichtungen und Pflegekräfte in Zeiten der COVID-19/SARS-CoV-2-Pandemie aufgreifen. Im Zuge der Feststellung, dass sich das pflegerische Versorgungssystem in Deutschland bereits vor der Ausbreitung des Virus an der Belastungsgrenze zur Leistungs- und Arbeitsfähigkeit befand, werden zudem generelle Herausforderungen und Belastungen sowie ein Anstieg dieser in Folge der Pandemie betrachtet. Befragt werden Leitungskräfte aus ambulanten Pflege- und Hospizdiensten sowie stationären Pflegeinrichtungen und Hospizen. Nach wissenschaftlicher Auswertung der Ergebnisse sollen diese in zusammengefasster Form den teilnehmenden Einrichtungen zurückgemeldet werden. Zudem werden Fachbeiträge für Praxis (z. B. Verbände, Ministerien, Presse) und Wissenschaft (z. B. Fachzeitschriften) erstellt

Decreases in adolescent weekly alcohol use in Europe and North America: evidence from 28 countries from 2002 to 2010

Background: This study examined trends in adolescent weekly alcohol use between 2002 and 2010 in 28 European and North American countries. Methods: Analyses were based on data from 11-, 13- and 15-year-old adolescents who participated in the Health Behaviour in School-Aged Children (HBSC) study in 2002, 2006 and 2010. Results: Weekly alcohol use declined in 20 of 28 countries and in all geographic regions, from 12.1 to 6.1% in Anglo-Saxon countries, 11.4 to 7.8% in Western Europe, 9.3 to 4.1% in Northern Europe and 16.3 to 9.9% in Southern Europe. Even in Eastern Europe, where a stable trend was observed between 2002 and 2006, weekly alcohol use declined between 2006 and 2010 from 12.3 to 10.1%. The decline was evident in all gender and age subgroups. Conclusions: These consistent trends may be attributable to increased awareness of the harmful effects of alcohol for adolescent development and the implementation of associated prevention efforts, or changes in social norms and conditions. Although the declining trend was remarkably similar across countries, prevalence rates still differed considerably across countrie

Relative deprivation and risk factors for obesity in Canadian adolescents

Research on socioeconomic differences in overweight and obesity and on the ecological association between income inequality and obesity prevalence suggests that relative deprivation may contribute to lifestyle risk factors for obesity independently of absolute affluence. We tested this hypothesis using data on 25,980 adolescents (11-15 years) in the 2010 Canadian Health Behaviour in School-aged Children (HBSC) study. The Yitzhaki index of relative deprivation was applied to the HBSC Family Affluence Scale, an index of common material assets, with more affluent schoolmates representing the comparative reference group. Regression analysis tested the associations between relative deprivation and four obesity risk factors (skipping breakfasts, physical activity, and healthful and unhealthful food choices) plus dietary restraint. Relative deprivation uniquely related to skipping breakfasts, less physical activity, fewer healthful food choices (e.g., fruits, vegetables, whole grain breads), and a lower likelihood of dieting to lose weight. Consistent with Runciman's (1966) theory of relative deprivation and with psychosocial interpretations of the health consequences of income inequality, the results indicate that having mostly better off schoolmates can contribute to poorer health behaviours independently of school-level affluence and subjective social status. We discuss the implications of these findings for understanding the social origins of obesity and targeting health interventions

Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP)

Introduction As trend studies have shown, health inequalities by income and occupation have widened or remained stable. However, research on time trends in educational inequalities in health in Germany is scarce. The aim of this study is to analyse how educational inequalities in health evolved over a period of 21 years in the middle-aged population in Germany, and whether the trends differ by gender. Methods Data were obtained from the German Socio-Economic Panel covering the period from 1994 to 2014. In total, n=16 339 participants (106 221 person years) aged 30–49 years were included in the study sample. Educational level was measured based on the ‘Comparative Analysis of Social Mobility in Industrial Nations’ (CASMIN) classification. Health outcomes were self-rated health (SRH) as well as (mental and physical) health-related quality of life (HRQOL, SF-12v2). Absolute Index of Inequality (Slope Index of Inequality (SII)) and Relative Index of Inequality (RII) were calculated using linear and logarithmic regression analyses with robust SEs. Results Significant educational inequalities in SRH and physical HRQOL were found for almost every survey year from 1994 to 2014. Relative inequalities in SRH ranged from 1.50 to 2.10 in men and 1.25 to 1.87 in women (RII). Regarding physical HRQOL, the lowest educational group yielded 4.5 to 6.6 points (men) and 3.3 to 6.1 points (women) lower scores (SII). Although educational level increased over time, absolute and relative health inequalities remained largely stable over the last 21 years. For mental HRQOL, only few educational inequalities were found. Discussion This study found persistent educational inequalities in SRH and physical HRQOL among adults in Germany from 1994 to 2014. Our findings highlight the need to intensify efforts in social and health policies to tackle these persistent inequalities.Peer Reviewe

Socioeconomic inequalities in adolescent health 2002–2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study

The study was supported by research grants from the Canadian Institutes for Health Research, the Social Sciences and Humanities Research Council of Canada, and the Canada Research Chairs programme awarded to FJE. The Health Behaviour in School-aged Children study is a WHO collaborative study and funded by public sources in each member country.Background Information about trends in adolescent health inequalities is scarce, especially at an international level. We examined secular trends in socioeconomic inequality in five domains of adolescent health and the association of socioeconomic inequality with national wealth and income inequality. Methods We undertook a time-series analysis of data from the Health Behaviour in School-aged Children study, in which cross-sectional surveys were done in 34 North American and European countries in 2002, 2006, and 2010 (pooled n 492 788). We used individual data for socioeconomic status (Health Behaviour in School-aged Children Family Affluence Scale) and health (days of physical activity per week, body-mass index Z score [zBMI], frequency of psychological and physical symptoms on 0–5 scale, and life satisfaction scored 0–10 on the Cantril ladder) to examine trends in health and socioeconomic inequalities in health. We also investigated whether international differences in health and health inequalities were associated with per person income and income inequality. Findings From 2002 to 2010, average levels of physical activity (3·90 to 4·08 days per week; p<0·0001), body mass (zBMI −0·08 to 0·03; p<0·0001), and physical symptoms (3·06 to 3·20, p<0·0001), and life satisfaction (7·58 to 7·61; p=0·0034) slightly increased. Inequalities between socioeconomic groups increased in physical activity (−0·79 to −0·83 days per week difference between most and least affluent groups; p=0·0008), zBMI (0·15 to 0·18; p<0·0001), and psychological (0·58 to 0·67; p=0·0360) and physical (0·21 to 0·26; p=0·0018) symptoms. Only in life satisfaction did health inequality fall during this period (−0·98 to −0·95; p=0·0198). Internationally, the higher the per person income, the better and more equal health was in terms of physical activity (0·06 days per SD increase in income; p<0·0001), psychological symptoms (−0·09; p<0·0001), and life satisfaction (0·08; p<0·0001). However, higher income inequality uniquely related to fewer days of physical activity (−0·05 days; p=0·0295), higher zBMI (0·06; p<0·0001), more psychological (0·18; p<0·0001) and physical (0·16; p<0·0001) symptoms, and larger health inequalities between socioeconomic groups in psychological (0·13; p=0·0080) and physical (0·07; p=0·0022) symptoms, and life satisfaction (−0·10; p=0·0092). Interpretation Socioeconomic inequality has increased in many domains of adolescent health. These trends coincide with unequal distribution of income between rich and poor people. Widening gaps in adolescent health could predict future inequalities in adult health and need urgent policy action.PostprintPeer reviewe

Versorgung in Zeiten von Corona - Drohender Systemkollaps oder normaler Wahnsinn? 2. wissenschaftliche Studie zu Herausforderungen und Belastungen aus der Sichtweise von Leitungskräften

Der vorliegende Ergebnisbericht fokussiert auf die Entwicklung der Herausforderungen und Belastungen ambulanter und stationärer Pflegeeinrichtungen im Verlauf der Pandemie. Hierzu wurden sowohl zu Beginn der ersten Pandemiewelle im April 2020 wie auch im Verlauf der zweiten Pandemiewelle zwischen Dezember 2020 und Januar 2021 Leitungskräfte aus ambulanten und stationären Pflegeeinrichtungen in Deutschland online befragt. Die Ergebnisse der vorliegenden Untersuchung zeigen eine leichte Verschiebung der allgemeinen und pandemiebedingten Herausforderungen und Belastungen über die zwei Befragungswellen hinweg. Die Herausforderungen und Belastungen bleiben allgemein auf einem konstant hohen Niveau und haben sich mit Bezug auf das Wohlbefinden von Mitarbeiter*innen und dem Personalmangel im Zuge der zweiten Befragungswelle verstärkt. Wesentlich für die Bewältigung der Herausforderungen und Belastungen waren in der zweiten Befragungswelle die Inanspruchnahme finanzieller Hilfeleistungen, Vorsorgemaßnahmen, strukturelle Veränderungsmaßnahmen wie auch die Schulung, Beratung und Aufklärung von Mitarbeiter*innen und Pflegebedürftigen und ihren Angehörigen. Darüber hinaus wurden auch der Austausch und die Unterstützung durch bspw. Träger*innen, Verbände, Unternehmen, Vereine oder Privatpersonen als wesentlich für die Bewältigung der Herausforderungen und Belastungen genannt wie auch das soziale Miteinander, die Kommunikation und das Arbeitsklima. Schließlich verdeutlichen die Ergebnisse, dass sich das selbst eingeschätzte Wohlbefinden im Zuge der Pandemie verschlechtert hat und der Wunsch, den Beruf zu verlassen, unter den Leitungskräften größer geworden ist. Der vorliegende Untersuchungsbericht liefert neue Erkenntnisse hinsichtlich der Herausforderungen und Belastungen von ambulanten und stationären Pflegeeinrichtungen im Verlauf der Pandemie. Es werden weiterhin strukturelle Defizite im deutschen Pflegesystem deutlich, die in weiten Teilen durch die Aufopferungsbereitschaft der im Pflegesystem tätigen Mitarbeiter*innen aufgefangen werden

Adolescents’ psychological health during the economic recession: does public spending buffer health inequalities among young people?

Abstract Background Many OECD countries have replied to economic recessions with an adaption in public spending on social benefits for families and young people in need. So far, no study has examined the impact of public social spending during the recent economic recession on health, and social inequalities in health among young people. This study investigates whether an increase in public spending relates to a lower prevalence in health complaints and buffers health inequalities among adolescents. Methods Data were obtained from the 2009/2010 “Health Behaviour in School-aged Children (HBSC)” study comprising 11 – 15-year-old adolescents from 27 European countries (N = 144,754). Socioeconomic position was measured by the Family Affluence Scale (FAS). Logistic multilevel models were conducted for the association between the absolute rate of public spending on family benefits per capita in 2010 and the relative change rate in family benefits (2006–2010) in relation to adolescent psychological health complaints in 2009/2010. Results The absolute rate of public spending on family benefits in 2010 did not show a significant association with adolescents’ psychological health complaints. Relative change rates of public spending on family benefits (2006–2010) were related to better health. Greater socioeconomic inequalities in psychological health complaints were found for countries with higher change rates in public spending on family benefits (2006–2010). Conclusions The results partially support our hypothesis and highlight that policy initiatives in terms of an increase in family benefits might partially benefit adolescent health, but tend to widen social inequalities in adolescent health during the recent recession