Mutual trust between freelance midwives and their clients in the context of interprofessional cooperation and early prevention: a qualitative study

Hintergrund: Für etwa 13% der Familien mit Säuglingen in Deutschland besteht Unterstützungsbedarf im Rahmen Früher Hilfen. Um die Entwicklungsbedingungen für Kinder zu fördern, gewinnt die Kooperation zwischen den Berufsgruppen des Gesundheits- und Sozialwesens an Relevanz. Freiberufliche Hebammen werden als Partnerinnen in den Netzwerken Früher Hilfen angesehen, ihre Perspektive zur Kooperation ist kaum erforscht. Ziel: Die Studie analysiert zentrale Konzepte des Hebammenhandelns Fakultät Wirtschafts- und im Kontext der interprofessionellen Kooperation in den Frühen Hilfen. Sozialwissenschaften, Methodik: 27 problemzentrierte Interviews mit freiberuflichen Hebammen in Deutschland bilden die Basis der qualitativen Untersuchung. Der Feldzugang erfolgte über lokale Mailverteiler, Anzeigen in Hebammenzeitschriften, Besuche von Kongressen und durch Unterstützung von Gatekeepern. Die Interviews wurdenmittels Leitfaden geführt, digital aufgezeichnet und transkribiert. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Kuckartz. Ergebnisse: Als zentrales Konzept der Kooperation von Hebammen in den Frühen Hilfen wurde die Vertrauensbildung zwischen Hebammen und Klientinnen identifiziert. Diese prägt die Arbeitsbeziehung der beiden, sowie die Zusammenarbeit der Hebammen mit den Akteurinnen und Akteuren der Kinder- und Jugendhilfe. Einige Hebammen bauen auf dem Vertrauen der Klientinnen auf, um sie an Angebote des Jugendamtes zu vermitteln, andere nutzen es zur Abgrenzung vom Jugendamt. Schlussfolgerung: Die Herausforderung für die freiberuflichen Hebammen besteht darin, ihre Rolle als Kooperationspartnerin in den Netzwerke Früher Hilfen zu finden, ohne dabei das Vertrauen der Frauen zu verlieren. Dies erfordert klare und verständliche Rahmenbedingungen für alle in die Netzwerke eingebundenen Akteurinnen und Akteure.Background: Around 13 percent of families with newborns in Germany are in need of support from the early prevention networks. Cooperation between the professionals working in healthcare and social welfare is essential for improving children’s development opportunities. Freelance midwives are respected partners in the early prevention networks but there has been very little research on their view of this cooperation. Aim: The study analyses key behavioral concepts of midwives in the context of interprofessional cooperation and early prevention. Method: The qualitative study is based on 27 problem-centered interviews with freelance midwives in Germany. Access to the field was gained through posts on local mailing lists, adverts in professional midwifery journals, participation in conventions and by involving professionals acting as gatekeepers. The interviews were conducted based on a script, were digitally voice recorded and lastly transcribed. Data evaluation was carried out using a qualitative text analysis. Results: Establishing a relationship of trust between midwives and their clients was identified as the focal point for midwives’ cooperation in early prevention networks. This relationship shapes the working relations between midwives and clients as well as between midwives and child and youth welfare professionals. Some midwives build on the women’s trust in order to refer them to services provided by the Youth Welfare Office, others use it to set themselves apart from the latter. Conclusion: The key challenge of freelance midwives is to carve out their role as a cooperation partner within the networks of early prevention without undermining the trust of their clients. This requires a clear and comprehensible framework for all actors involved in these networks

Interprofessionelle Kooperation von Hebammen im Handlungsfeld der ambulanten geburtshilflichen Versorgung: ein integratives Review

The central objective of early prevention in Germany is an improved cooperation between professional groups of the health services and child and youth welfare in interprofessional networks. This objective derives from the realisation that proper care for families with infants can only be achieved if the various groups act in close integration. The ‘Federal Initiative early prevention’ explicitly calls for freelance midwives to be integrated in this context. However, only a few scientific findings on midwives’ cooperation in networks of early prevention have been published to date. This integrative review aims to identify the central themes of interprofessional cooperation of midwives in out-of-hospital obstetrical care from national and international research literature. A systematic search of five research databases for publications between 2005 and 2015 was performed, complemented by a manual search. 25 studies were identified describing various contexts where midwives in out-of-hospital obstetrical care cooperate with other professional groups. Four key themes were analysed: contexts of cooperation, benefits of cooperation, facilitating and restrictive factors of cooperation, and competencies of cooperation. The studies show that there is only limited research coverage of the midwives’ perspective regarding interprofessional cooperation. The existing studies examine the cooperation of midwives primarily with health care professionals, and secondarily with professionals in the social services. In order to expand knowledge on the cooperation of freelance midwives in the networks of early prevention, future research should focus on the perspective of midwives regarding cooperation with other professional groups, both in the health care sector and in the field of social services.Ein zentrales Ziel der “Frühen Hilfen” in Deutschland ist die Kooperation zwischen den Berufsgruppen des Gesundheitswesens und der Kinder- und Jugendhilfe in interprofessionellen Netzwerken. Diese Zielsetzung basiert auf der Erkenntnis, dass eine ausreichende Versorgung von Familien mit Säuglingen und Kleinkindern nur durch eine enge Vernetzung unterschiedlicher Sektoren erlangt werden kann. Freiberufliche Hebammen sind im Rahmen der „Bundesinitiative Frühe Hilfen“ als einzubindende Akteurinnen aus dem Gesundheitswesen aufgeführt. Wissenschaftliche Erkenntnisse zu ihrer Kooperation in den Netzwerken “Frühen Hilfen” liegen bislang jedoch kaum vor. Ziel dieses integrativen Reviews ist es aus der nationalen und internationalen Forschungsliteratur zentrale Themen zur interprofessionellen Kooperation von Hebammen der ambulanten Versorgung zu identifizieren. Im Rahmen einer systematischen Recherche für den Zeitraum 2005 bis 2015 wurde in fünf Datenbanken recherchiert, sowie eine Handsuche durchgeführt. Es wurden 25 Studien identifiziert, welche die vielfältigen Kontexte aufzeigen, in denen Hebammen der ambulanten Versorgung mit anderen Berufsgruppen kooperieren. Die Auseinandersetzung mit diesen führte zur Analyse von vier zentralen Themen: Kontexte von Kooperation, Gewinn durch Kooperation, fördernde und hemmende Faktoren von Kooperation sowie Kompetenzen zur Kooperation. Die Studien verdeutlichen das nur eingeschränkte vorhandene Forschungsbild zur Perspektive der Hebammen zur interprofessionellen Kooperation. Die Kooperation von Hebammen wird vor allem mit Berufsgruppen des Gesundheitswesens, seltener mit Berufsgruppen des Sozialwesens untersucht. Um fundierte Erkenntnisse zur Kooperation freiberuflicher Hebammen in Netzwerken der “Frühen Hilfen” zu erlangen, sollten zukünftige Forschungsarbeiten die Sichtweise von Hebammen zur Kooperation mit anderen Berufsgruppen sowohl aus dem Gesundheits- als auch dem Sozialwesen genauer untersuchen

Die Kooperation von Hebammen im Kontext der ambulanten Versorgung – Ergebnisse einer Literaturstudie

U ovom radu je pojašnjena slojevita arhitekturu u višeuslužnim mrežama po primjerima OSI referentnog modela i TCP/IP protokolarnog složaja, svrha raspodijele na slojeve te svrhe pojedinačnih slojeva pri slanju podataka kroz mrežu. Na svakom od slojeva su opisani ključni protokoli koji se koriste u prijenosu podataka TCP/IP protokolarnim složajem, te njihova zaglavlja. Opisana je i svrha modela poslužitelj-klijent te razlozi implementacije unutar TCP/IP-a naspram komunikacije na istoj razini. Uz to je opisan cijeli proces spajanja na pojedinu Internet stranicu, od korištenja DNS-a do dobivanja potvrde od servera o uspješno uspostavljenoj vezi, te enkapsulacija cjelokupnih paketa pri slanju sa de-enkapsulacijom na odredištu.In this thesis it is explained use of multiple layer architecture inside OSI model and TCP/IP suite, as well as use of each layer in dana transmission. On each of layer it is explained use of most important protocols in TCP/IP suite as well as their headers. Use of server/client model and its benefits over peer-to-peer model. With detailed description of protocols used it is explained process of establishment of virtual link, from searching for it IP address over DNS, to getting confirmation from server about established virtual link. On the end it is described encapsulation of data on client side, as well as it is deencapsulated on server side

A Listeria monocytogenes ST2 clone lacking chitinase ChiB from an outbreak of non-invasive gastroenteritis

An outbreak with a remarkable Listeria monocytogenes clone causing 163 cases of non-invasive listeriosis occurred in Germany in 2015. Core genome multi locus sequence typing grouped non-invasive outbreak isolates and isolates obtained from related food samples into a single cluster, but clearly separated genetically close isolates obtained from invasive listeriosis cases. A comparative genomic approach identified a premature stop codon in the chiB gene, encoding one of the two L. monocytogenes chitinases, which clustered with disease outcome. Correction of this premature stop codon in one representative gastroenteritis outbreak isolate restored chitinase production, but effects in infection experiments were not found. While the exact role of chitinases in virulence of L. monocytogenes is still not fully understood, our results now clearly show that ChiB-derived activity is not required to establish L. monocytogenes gastroenteritis in humans. This limits a possible role of ChiB in human listeriosis to later steps of the infection.Peer Reviewe

Towards a Laser-driven polarized 3He Ion-Beam Source

In order to investigate the polarization degree of laser-accelerated 3He ions from a pre-polarized 3He gas-jet target, several challenges have to be overcome beforehand. One of these includes the demonstration of the feasibility of laser-induced ion acceleration out of gas-jet targets. In particular, the ion-emission angles as well as the ion-energy spectra have to be determined for future polarization measurements. Such an experiment was performed at the PHELIX Petawatt Laser Facility, GSI Darmstadt. As laser target, both 4He, and in a second step, unpolarized 3He gas were applied

An Arylazopyrazole-Based N-Heterocyclic Carbene as a Photoswitch on Gold Surfaces: Light-Switchable Wettability, Work Function, and Conductance

A novel photoresponsive and fully conjugated N-heterocyclic carbene (NHC) has been synthesized that combines the excellent photophysical properties of arylazopyrazoles (AAPs) with an NHC that acts as a robust surface anchor (AAP-BIMe). The formation of self-assembled monolayers (SAMs) on gold was proven by ToF-SIMS and XPS, and the organic film displayed a very high stability at elevated temperatures. This stability was also reflected in a high desorption energy, which was determined by temperature-programmed SIMS measurements. E-/Z-AAP-BIMe@Au photoisomerization resulted in reversible alterations of the surface energy (i.e. wettability), the surface potential (i.e. work function), and the conductance (i.e. resistance). The effects could be explained by the difference in the dipole moment of the isomers. Furthermore, sequential application of a dummy ligand by microcontact printing and subsequent backfilling with AAP-BIMe allowed its patterning on gold. To the best of our knowledge, this is the first example of a photoswitchable NHC on a gold surface. These properties of AAP-BIMe@Au illustrate its suitability as a molecular switch for electronic devices

An Arylazopyrazole‐Based N‐Heterocyclic Carbene as a Photoswitch on Gold Surfaces: Light‐Switchable Wettability, Work Function, and Conductance

A novel photoresponsive and fully conjugated N-heterocyclic carbene (NHC) has been synthesized that combines the excellent photophysical properties of arylazopyrazoles (AAPs) with an NHC that acts as a robust surface anchor (AAP-BIMe). The formation of self-assembled monolayers (SAMs) on gold was proven by ToF-SIMS and XPS, and the organic film displayed a very high stability at elevated temperatures. This stability was also reflected in a high desorption energy, which was determined by temperature-programmed SIMS measurements. E-/Z-AAP-BIMe@Au photoisomerization resulted in reversible alterations of the surface energy (i.e. wettability), the surface potential (i.e. work function), and the conductance (i.e. resistance). The effects could be explained by the difference in the dipole moment of the isomers. Furthermore, sequential application of a dummy ligand by microcontact printing and subsequent backfilling with AAP-BIMe allowed its patterning on gold. To the best of our knowledge, this is the first example of a photoswitchable NHC on a gold surface. These properties of AAP-BIMe@Au illustrate its suitability as a molecular switch for electronic devices

A <i>Listeria monocytogenes</i> ST2 clone lacking chitinase ChiB from an outbreak of non-invasive gastroenteritis

An outbreak with a remarkable Listeria monocytogenes clone causing 163 cases of non-invasive listeriosis occurred in Germany in 2015. Core genome multi locus sequence typing grouped non-invasive outbreak isolates and isolates obtained from related food samples into a single cluster, but clearly separated genetically close isolates obtained from invasive listeriosis cases. A comparative genomic approach identified a premature stop codon in the chiB gene, encoding one of the two L. monocytogenes chitinases, which clustered with disease outcome. Correction of this premature stop codon in one representative gastroenteritis outbreak isolate restored chitinase production, but effects in infection experiments were not found. While the exact role of chitinases in virulence of L. monocytogenes is still not fully understood, our results now clearly show that ChiB-derived activity is not required to establish L. monocytogenes gastroenteritis in humans. This limits a possible role of ChiB in human listeriosis to later steps of the infection.</p