Bewältigung von chronischen Krankheiten und deren Auswirkung auf die Lebensqualität

Ausgehend von einem kontinuierlichen Anstieg chronischer Krankheiten in den letzten Jahrzehenten hat sich auch die Ausrichtung der Gesundheitsversorgung zunehmend gewandelt. Durch diesen Trend ergeben sich zahlreiche Schwierigkeiten, vor allem was die Herausforderung betrifft den Bedürfnissen der PatientInnen und deren Familienmitgliedern bzw. Angehörigen trotz gravierender Veränderungen der Rollen, Aufgabenbereiche oder Lebensbedingungen einigermaßen gerecht zu werden. Der Fokus liegt dabei auf der Erhaltung bzw. Erreichung guter Lebensqualität, wobei die subjektive Sichtweise und das Erleben der chronisch Erkrankten im Mittelpunkt des Interesses stehen. Ziel dieser wissenschaftlichen Literaturarbeit ist die Betonung der Problematik eine einheitliche, präzise Definition von chronisch Kranksein und Lebensqualität zu kreieren, sowie aufzuzeigen, welche (Bewältigungs-)Strategien und (Beratungs-)Möglichkeiten im Umgang mit den (bestehenden und sich ergebenden) Anforderungen durch chronische Krankheiten zukünftig hervorgehoben werden müssen.Due to a continuous increase of chronic diseases in the last few decades, the health care system has undergone significant changes. As a result of this trend several difficulties arose, in particular in regards to the challenge to meet the needs of patients and their family members and relatives despite major changes in their roles, daily tasks or conditions of life. The focus lies on the maintenance or achievement of good quality of life, where the subjects’ perspectives and the experiences of living with a chronic disease stand in the center of attention. The aim of this desk review is the emphasis of the complexity and difficulty to come up with a consistent and precise definition of chronic diseases and quality of life as well as to highlight which (coping) strategies and (counseling) opportunities have to be considered in the future in regards to (existing and upcoming) requirements due to chronic diseases

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

Observer Sensitivity for Detection of Pulmonary Nodules in Ultra-Low Dose Computed Tomography Protocols Using a Third-Generation Dual-Source CT with Ultra-High Pitch—A Phantom Study

This study evaluates ultra-low-dose computed tomography (ULDCT) protocols concerning the detectability of pulmonary nodules. The influence of tube current settings, kernels, strength levels of third-generation iterative reconstruction algorithms, and pitch was investigated. A chest phantom with artificial spherical nodules of different densities and diameters was examined with a third-generation dual-source CT. Scanning and post-processing protocols, tube current levels, and ultra-high and non-high pitch modes were applied. Images were reconstructed with filtered back-projection (FBP) or advanced model-based iterative reconstruction (ADMIRE) algorithms. Sharp (Bl57) or medium-soft (Br36) convolution kernels were applied. The reading was performed by an experienced and an inexperienced reader. The highest observer sensitivity was found using a non-high pitch protocol at tube currents of 120 mAs and 90 mAs with the sharp kernel and iterative reconstruction level of 5. Non-high pitch protocols showed better detectability of solid nodules. Combinations with the medium-soft kernel achieved slightly higher observer sensitivity than with the sharp kernel. False positives (FP) occurred more often for subsolid nodules, at a tube current level of 120 mAs, and with the sharp kernel. A tube current level of 90 mAs combined with the highest iterative reconstruction level achieved the highest accuracy in lung nodule detection regardless of size, density, and reader experience

Regulating Innovation, Trade and Uncertain Risks - Full copy

MaRBLe Research Papers Maastricht Research-Based Learning Project (MaRBLe) Faculty of Law and Faculty of Arts and Social Sciences Maastricht University, 201

Serum neurofilament light chain (sNfL) values in a large cross-sectional population of children with asymptomatic to moderate COVID-19

Background!#!Serum neurofilament light chain (sNfL) is an established biomarker of neuro-axonal damage in multiple neurological disorders. Raised sNfL levels have been reported in adults infected with pandemic coronavirus disease 2019 (COVID-19). Levels in children infected with COVID-19 have not as yet been reported.!##!Objective!#!To evaluate whether sNfL is elevated in children contracting COVID-19.!##!Methods!#!Between May 22 and July 22, 2020, a network of outpatient pediatricians in Bavaria, Germany, the Coronavirus antibody screening in children from Bavaria study network (CoKiBa), recruited healthy children into a cross-sectional study from two sources: an ongoing prevention program for 1-14 years, and referrals of 1-17 years consulting a pediatrician for possible infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We determined sNfL levels by single molecule array immunoassay and SARS-CoV-2 antibody status by two independent quantitative methods.!##!Results!#!Of the 2652 included children, 148 (5.6%) were SARS-CoV-2 antibody positive with asymptomatic to moderate COVID-19 infection. Neurological symptoms-headache, dizziness, muscle aches, or loss of smell and taste-were present in 47/148 cases (31.8%). Mean sNfL levels were 5.5 pg/ml (SD 2.9) in the total cohort, 5.1 (SD 2.1) pg/ml in the children with SARS-CoV-2 antibodies, and 5.5 (SD 3.0) pg/ml in those without. Multivariate regression analysis revealed age-but neither antibody status, antibody levels, nor clinical severity-as an independent predictor of sNfL. Follow-up of children with pediatric multisystem inflammatory syndrome (n = 14) showed no association with sNfL.!##!Conclusions!#!In this population study, children with asymptomatic to moderate COVID-19 showed no neurochemical evidence of neuronal damage