Typ IV-Sensibilisierungen bei chronischen Wunden: retrospektive Untersuchung am Modell des Ulcus cruris der Häufigkeit und Therapieauswirkung kutaner Sensibilisierungen

Bei der vorliegenden Arbeit handelt es sich um eine retrospektive Untersuchung am Modell des Ulcus cruris, um Häufigkeit und Therapieauswirkung kutaner Sensibilisierungen festzustellen. Sie befaßt sich mit der Häufigkeit und der Veränderung der Kontaktallergien bei Ulcus cruris-Patienten in Jena und im Vergleich dazu in Gesamtdeutschland im Verlauf der Jahre 1992-97. Ziel ist es zum einen, eventuelle Abweichungen der Sensibilisierungshäufigkeiten in Jena von Gesamtdeutschland zu erklären und zum anderen, aus der Interpretation der Epikutantestergebnisse gesamt klinische Auswirkungen und Empfehlungen bezüglich Therapieoptimierung und Therapiekosten aufzuzeigen. Weitere wichtige Punkte der Arbeit behandeln Besonderheiten im Vergleich zum Bundesdurchschnitt, u.a. auch Ost-West-Unterschiede, und ob mit Hilfe eines mathematischen Modells die Dynamik der Sensibilisierungen einer Gruppe beschrieben werden kann und welche Schlußfolgerungen daraus bezüglich der untersuchten Gruppe gezogen werden können

Efficacy of a strategy to prevent neonatal early-onset group B streptococcal (GBS) sepsis

Background: Existing guidelines recommend different strategies to prevent early-onset neonatal GBS sepsis. In 1997, using our own data on incidence and risk factors, we established a new prevention strategy which includes GBS screening at 36 weeks' gestation and intrapartum antibiotic prophylaxis (IAP) in women with positive or unknown GBS colonization with at least one risk factor. The present study evaluates the efficacy of the new prevention strategy. Methods: Retrospective study of the incidence of early-onset GBS sepsis among all live births at the University Women's Hospital Basel between 1997 and 2002. Additional analysis of delivery and post partum period of all GBS sepsis cases, including GBS screening, risk factors during labor (prematurity, rupture of membranes (ROM) <12 h, intrapartum signs of infection), and IAP. Comparison of this group's characteristics G2 (9,385 live births, using the new strategy) with the previous group, G1 (1984-1993, 16,126 live births, without GBS screening or routine IAP) was performed. Results: The incidence of early-onset GBS sepsis was reduced from 1/1000 (G1) to 0.53/1000 (G2). We observed a significant reduction of overall intrapartum riskfactors in cases of GBS sepsis. Conclusion: This study suggests that our new prevention strategy is effective in reducing the incidence of early-onset GBS sepsis in neonates. In comparison, implementation of the CDC's prevention strategy might have prevented 2 additional cases in 9385 live births. However, this would have required treating a much larger number of pregnant women with IAP with consequential increasing costs, side effects and complication

Psychologische Widersprüche und Wählerverhalten: eine Anwendung des mikrosoziologischen Ansatzes und des Retrospective-Voting-Modells

"Die Erklärung des Wahlverhaltens gehört zu den meist beschriebenen Feldern in den Sozialwissenschaften. Wahlverhalten ist durch seinen ständigen Wandel und seine Komplexität immer von aktuellem Interesse. Der folgende Beitrag beschäftigt sich mit zwei Ansätzen der Wahlforschung, die auf unterschiedliche Weise die Auswirkungen psychologischer Widersprüche, sogenannter cross pressures, auf die Konstanz von Wahlverhalten erklären. Hierbei wird eine Variante des in der Wahlforschung etablierten mikrosoziologischen Ansatzes der Columbia School vorgeschlagen. Mit den Daten des Bayernbarometers 2011 werden die cross pressures des sozialen Umfelds nicht über soziale Stratifikatoren, sondern über die ideologische Verortung des Netzwerkes erfasst. Zudem wird anhand eines eher seltener angewandten Modells, dem Retrospective-Voting-Modell von Morris P. Fiorina, untersucht, inwiefern Inkonsistenzen bei Einstellungen zu politischen Streitfragen (issues) im Verhältnis zur vergangenen Parteiwahl, die Chance zur Wechselwahl beeinflussen. Auf Basis der vorliegenden Analysen werden die Hypothesen Fiorinas bestätigt, wobei kein Einfluss der cross pressures in den politischen Einstellungen des sozialen Netzwerkesfestgestellt werden kann." (Autorenreferat

Osteoarticular and musculoskeletal disorders, chronic pain, quality of life and physical activity level distributed by age and gender in elderly people participating in a water aerobics program

The study aims to describe osteoarticular and musculoskeletal disorders, chronic pain, quality of life (QOL) and physical activity level (PAL) distributed by age group and gender in the elderly. The design was quantitative, descriptive and cross-sectional. The non-probabilistic sample, for convenience, comprised 101 elderly people, over 60 years old, who regularly participate in water aerobics activities in the municipality of Dois Irmãos, RS. The instruments used were: Multidimensional Pain Assessment Scale, Survey of Pain Attitudes, IPAQ and EUROHIS-QOL. Descriptive frequency analyzes were performed, which showed the predominance of women in water aerobics activities, most frequently in the age group of 70 years. Similarly, the presence of osteoarticular and musculoskeletal disorders and chronic pain intensity (moderate and severe) were more expressive in females and in the age group of 70 years. The distribution of QOL and pain intensity in relation to age, gender and PAL shows in the age group of 60 years, the male, irregularly active with higher average, with higher occurrence of pain (moderate) in the active elderly. Active females, on the other hand, show better QOL scores and higher pain intensity in irregularly active aspect. In conclusion, the actions promoted by the municipality have a positive impact on QOL. However, there is a need for greater involvement of participants to achieve more adequate levels of regular physical activity, taking into account the significant presence of pain complaints in females and in the age group of 70 years

Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care in British Columbia: Phase I.

BACKGROUND: Over 30% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. OBJECTIVE: This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women's preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. METHODS: The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women's abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. RESULTS: A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94% (47/50) owned a smartphone, 85% (41/48) used their personal phones to go online, and 85% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. CONCLUSIONS: A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion

Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion: User-Centered Design.

BACKGROUND: Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. OBJECTIVE: The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. METHODS: The study design was based on the "development-evaluation-implementation" process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. RESULTS: We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. CONCLUSIONS: This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care

Development and pilot testing of the 2019 Canadian Abortion Provider Survey

BACKGROUND: Substantial changes in abortion care regulations, available medications and national clinical practice guidelines have occurred since a 2012 national Canadian Abortion Provider Survey (CAPS). We developed and piloted the CAPS 2019 survey instrument to explore changes of the abortion provider workforce, their clinical care as well as experiences with stigma and harassment. METHODS: We undertook development and piloting in three phases: (1) development of the preliminary survey sections and questions based on the 2012 survey instrument, (2) content validation and feasibility of including certain content aspects via a modified Delphi Method with panels of clinical and research experts, and (3) pilot testing of the draft survey for face validity and clarity of language; assessing usability of the web-based Research Electronic Data Capture platform including the feasibility of complex skip pattern functionality. We performed content analysis of phase 2 results and used a general inductive approach to identify necessary survey modifications. RESULTS: In phase 1, we generated a survey draft that reflected the changes in Canadian abortion care regulations and guidelines and included questions for clinicians and administrators providing first and second trimester surgical and medical abortion. In phase 2, we held 6 expert panel meetings of 5-8 participants each representing clinicians, administrators and researchers to provide feedback on the initial survey draft. Due to the complexity of certain identified aspects, such as interdisciplinary collaboration and interprovincial care delivery differences, we revised the survey sections through an iterative process of meetings and revisions until we reached consensus on constructs and questions to include versus exclude for not being feasible. In phase 3, we made minor revisions based on pilot testing of the bilingual, web-based survey among additional experts chosen to be widely representative of the study population. Demonstrating its feasibility, we included complex branching and skip pattern logic so each respondent only viewed applicable questions based on their prior responses. CONCLUSIONS: We developed and piloted the CAPS 2019 survey instrument suitable to explore characteristics of a complex multidisciplinary workforce, their care and experience with stigma on a national level, and that can be adapted to other countries

Dietary behavior : An interdisciplinary conceptual analysis and taxonomy

The preparation of this paper was supported by the DEterminants of DIet and Physical ACtivity (DEDIPAC) knowledge hub. This work was supported by the Joint Programming Initiative “Healthy Diet for a Healthy Life.” The funding agencies supporting this work are (in alphabetical order of participating Member State): France: Institut National de la Recherche Agronomique (INRA); Germany: Federal Ministry of Education and Research (BMBF); Italy: Ministry of Education, University and Research/Ministry of Agriculture Food and Forestry Policies; Norway: The Research Council of Norway, Division for Society and Health; and The United Kingdom: The Medical Research Council (MRC).Peer reviewedPublisher PD

Telemedicine for First-Trimester Medical Abortion in Canada: Results of a 2019 Survey.

Telemedicine has the potential to improve abortion access disparities in Canada. We aimed to explore the provision of telemedicine for first-trimester medical abortion and related barriers in 2019. Methods: We conducted a national, cross-sectional, anonymized, web-based survey of clinicians who provided abortion care in 2019 in Canada. We distributed our survey through professional health organizations to maximize identification of possible eligible respondents and used a modified Dillman technique to foster responses. Questions elicited provider demographics, clinical characteristics, including telemedicine first-trimester medical abortion and perceived related barriers. Descriptive statistics were analyzed using R software. Results: Among 465 respondents, 388 reported providing first-trimester medical abortion across Canada; 44.0% reported experience using telemedicine for some components of care: 49.3% of primary care clinicians and 28.7% of specialists. Telemedicine was used for initial consultation (86.0%), prescription (82.2%), or follow-up (92.2%). The median percentage of telemedicine providers' patients who underwent a dating ultrasound was 90.0. The majority usually followed up with patients through quantitative human chorionic gonadotropin (hCG) (84.2%). Seventy-eight percent perceived barriers to telemedicine; the most common being inability to confirm gestational age with ultrasound (43.0%), and lack of provincial telemedicine abortion fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Discussion: In 2019, fewer than half of respondents reported providing some aspects of first-trimester medical abortion through telemedicine and the majority perceived barriers. Our results can inform knowledge translation activities to reduce barriers and increase telemedicine abortion care in Canada