„Zusammenhänge von Verkalkungsgrad der Epiphyse, Melatoninwerten im Serum und neuropsychiatrischen Symptomen bei Demenzerkrankung„

Zusammenfassung Einleitung Demenzerkrankungen gehören zur Gruppe der organisch psychischen Störungen. Neben der Abnahme der Gedächtnisleistung und mindestens eines weiteren kognitiven Bereiches können weitere neuropsychiatrische Symptome und Verhaltensauffälligkeiten auftreten. Die Epiphyse ist eine endokrine Drüse auf der Rückseite des Mittelhirns im Epithalamus, in der das Hormon Melatonin tagesrythmisch produziert wird. Melatonin koordiniert u.a. circadian-rhythmische Vorgänge und wird u.a. mit neuropsychiatrischen Krankheitsbildern und assoziiert. Methodik In dieser Arbeit beschäftigten wir uns mit den Zusammenhängen von Verkalkungsgrad der Epiphyse, Melatoninwerten im Serum und neuropsychiatrischen Symptomen bei Demenzerkrankungen. Die Datenerhebung fand im Rahmen der Studie „Trainingskarusell in der klinischen gerontopsychiatrischen Demenzforschung“ statt. Die Einschlusskriterien waren: eine Demenzdiagnose laut ICD-10 Kriterien, ein mindestens einwöchiger stationärer Aufenthalt zur Eingewöhnung und zum Ausschluss eines Delirs. Es wurden verschiedene Dimensionen der behavioralen und psychischen Symptome der Demenz mittels Neuropsychiatrischem Inventory (NPI) und Cohen-Mansfield Agitation Inventory (CMAI) erfasst. Des Weiteren wurden den Studienteilnehmern um 08:30 Uhr Blutproben entnommen und die Melatonin-Werte im Serum mittels ELISA bestimmt. Mit Hilfe der quantitativen Computertomographie wurde nach der von Kunz et al. 1998 entwickelten DOC (= degree of calcification)-Methode der unverkalkte Anteil der Zirbeldrüse abgeschätzt. Zur Bearbeitung und Auswertung der Bilder wird die Software ITK-SNAP benutzt. In der Studie nahmen 87 Patienten teil, die Daten von 41 Probanden wurden für diese ausgewertet. Ergebnisse In dieser Arbeit werden die Zusammenhänge zwischen der peripheren Melatonin- Konzentration im Serum, dem Ausmaß der Epiphysenverkalkung und den neuropsychiatrischen Symptomen untersucht. Es konnte kein signifikanter Zusammenhang zwischen dem peripher gemessenen Melatonin-Werten und dem Pinealisverkalkungsgrad, dem unverkalkten Gewebe und neuropsychiatrischen Symptomen bei Demenz Patienten ermittelt werden. Es zeigte sich lediglich eine schwache aber statistisch signifikanten negativen Korrelation des NPI-Schaf Wertes mit dem DOC-Wert. Diskussion Unsere Ergebnisse und die Literatur verstärken die Hypothese, dass die absoluten Messwerte von Melatonin nicht unbedingt ein aussagekräftiger Indikator dafür sind, ob ein Melatonindefizit vorliegt. In unserer Arbeit bei 41 Demenz Patienten konnte diese Hypothese in Bezug auf das Schlafverhalten nicht bestätigt werden. Insgesamt zeigen sich teilweise widersprüchliche Angaben für alle drei Fragestellungen in der Literatur, sodass sicher weitere Forschungsangaben zum Thema erforderlich sind, um hier noch Klarheit zu schaffen. Größere Stichproben, Longitudinalstudien und der gesamte neurodegenerative Prozess zur Entstehung neuropsychiatrischer Symptome bei Demenz sollten berücksichtigt werden. Das Forschungsgebiet rund um Melatonin und Pinealisverkalkung besitzt definitiv ein innovatives Spektrum. Perspektivisch kann weiter untersucht werden, ob Melatonin-Werte eine Rolle in der Früherkennung einer Alzheimer Pathologie oder als therapeutischer Faktor in psychiatrischen Symptomen bei Demenz spielen könnte. Die endgültige Relevanz von Melatonin in der Pathogenese, Diagnostik, Prognose und Therapie unterschiedlicher Erkrankungen bleibt noch zu klären. Ob die Verabreichung von exogenem Melatonin dazu dienen könnten, das Leben zu verlängern, Alterungsprozesse zu verlangsamen und die Wahrscheinlichkeit von altersbedingten Krankheiten zu verringern, sollte auch weiter untersucht werden

Effect of nutrition counseling and self-monitoring mobile application (MyFitnessPal) on iron and calcium intake among overweight and obese college students

ABSTRAK Latar Belakang: Prevalensi obesitas terus mengalami peningkatan hingga saat ini. Penelitian terkini memperlihatkan bahwa orang dengan status gizi obesitas cenderung memiliki asupan kalsium dan kadar serum besi lebih rendah dibandingkan dengan orang yang memiliki status gizi normal. Pengaturan pola makan yang kurang tepat menjadi salah satu penyebab tingginya prevalensi obesitas. Oleh karena itu, perlu adanya pengendalian asupan makan pada individu obesitas dengan memanfaatkan kombinasi konseling gizi dan pengendalian asupan makanan harian dengan bantuan aplikasi self-monitoring (MyFitnessPal).Tujuan: Penelitian ini bertujuan untuk mengetahui asupan zat besi dan kalsium pada subyek overweight dan obesitas dan pengaruh penggunaan konseling gizi dan aplikasi self-monitoring asupan (MyFitnessPal).Metode: Rancangan penelitian experimental dibuat dengan pretest-posttest with control group design pada 68 mahasiswa (32 mahasiswa setiap kelompok) di Universitas Alma Ata Yogyakarta. Analisis statistik yang digunakan adalah uji Wilcoxon Signed Rank Test dan Mann Whitney.Hasil: Hasil penelitian ini ditemukan bahwa ada perbedaan yang signifikan antara asupan zat besi sebelum dan sesudah intervensi pada kelompok eksperimen (p=0,001) sedangkan pada kelompok kontrol tidak terdapat perbedaan yang signifikan (p=0,417). Ada perbedaan yang signifikan antara asupan kalsium sebelum dan sesudah intervensi pada kelompok eksperimen (p=0,002) sedangkan pada kelompok kontrol tidak terdapat perbedaan yang signifikan (p=0,126). Terdapat perbedaan yang signifikan pada asupan zat besi (p=0,005) dan kalsium (p=0,001) antara kelompok eksperimen dan kontrol.Kesimpulan: Ada pengaruh konseling gizi dan self-monitoring asupan (MyFitnessPal) memengaruhi asupan zat besi dan kalsium pada mahasiswa overweight dan obesitas.KATA KUNCI: asupan kalsium; asupan zat besi; konseling gizi; MyFitnessPal; self-monitoring  ABSTRACT Background: Prevalence of obesity gradually increasing in the worldwide. People who had obesity status tend to have lower calcium and iron intake levels compared to non-obese people. Unhealthy diet practice is one of the causes of high prevalence of obesity. Therefore, it is necessary to control food intake of obese individuals by utilizing a combination of nutritional counseling and monitoring food intake using mobile apps MyFitnessPal.Objectives: This study aimed to determine intake of iron and calcium among overweight and obese student and whether effect of nutritional counseling and self-monitoring mobile application (MyFitnessPal) associated with their food intake.Methods: This experimental study was made by pretest-posttest with control group design. Of 68 students (34 subjects in each groups) at Alma Ata University Yogyakarta were recruited. Wilcoxon Signed Rank Test and the Mann Whitney test created to assess the statistical analysis.Results: The results of this study found that there was a significant difference between iron intake before and after the intervention in the experimental group (p = 0.001), however, there was not significant difference in the control group (p = 0.417). There was a significant difference between calcium intake before and after intervention in the experimental group (p = 0.002), but not in the control group (p = 0.126). This study found a significant difference between intake of iron (p = 0.005) and calcium (p = 0.001) in each group.Conclusions: Using mobile apps for self-monitoring intake in combination with nutritional counseling could be considered as it was proven to be associated with iron and calcium intake among overweight and obese students in this study. Further studies are required to confirm our findings.KEYWORDS: calcium intake; iron intake; MyFitnessPal; nutrition counselling; self-monitorin

Two-level frame aggregation scheme under unreliable channel conditions for IEEE 802.11n WLANs: a survey

Frame Aggregation schemes defined by IEEE 802.11n is the combination of the Aggregate MAC Service Data Unit (A-MSDU) and MAC Protocol Data Unit (A- MPDU). The units are aimed at maximizing Wireless Local Area Networks (WLANs) efficiency at Media Access Control (MAC) level, via the sharing of headers and timing overheads. Moreover, the combination of A-MSDU and A-MPDU is known as Two-level frame aggregation. In spite of their abilities in improving the throughput of MAC Layer, the scheme is still limited by other overheads as a result of aggregation which affects the system performance. Block Acknowledgement (Block ACK) and Frame aggregation were introduced in order to minimize MAC Layer overheads. Still, there are some parameters that affect the aggregation performance, such as aggregate length, sub frame size and channel condition overheads. A-MPDU in other hand minimizes the effect of error condition through sub frame transmission. Therefore, A- MPDU aggregation performances, its limitations, and its promising performances motivated this survey to focus on enhancing Aggregation Mac Protocol Data Unit (eA-MPDU) performance by minimizing the headers overheads of the Two-Level Frame Aggregation Scheme, for the reduction of the channel noise, which by its role will increase the Signal Noise Ratio (SNR) and improve the throughput

Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture

<p>Abstract</p> <p>Background</p> <p>The Agency for Healthcare Research and Quality (AHRQ) <it>Hospital Survey on Patient Safety Culture </it>was designed to assess staff views on patient safety culture in hospital settings. The purpose of this study was to examine the multilevel psychometric properties of the survey.</p> <p>Methods</p> <p>Survey data from 331 U.S. hospitals with 2,267 hospital units and 50,513 respondents were analyzed to examine the psychometric properties of the survey's items and composites. Item factor loadings, intraclass correlations (ICCs), design effects, internal consistency reliabilities, and multilevel confirmatory factor analyses (MCFA) were examined as well as intercorrelations among the survey's composites.</p> <p>Results</p> <p>Psychometric analyses confirmed the multilevel nature of the data at the individual, unit and hospital levels of analysis. Results provided overall evidence supporting the 12 dimensions and 42 items included in the AHRQ <it>Hospital Survey on Patient Safety Culture </it>as having acceptable psychometric properties at all levels of analysis, with a few exceptions. The Staffing composite fell slightly below cutoffs in a number of areas, but is conceptually important given its impact on patient safety. In addition, one hospital-level model fit indicator for the Supervisor/Manager Expectations & Actions Promoting Patient Safety composite was low (CFI = .82), but all other psychometrics for this scale were good. Average dimension intercorrelations were moderate at .42 at the individual level, .50 at the unit level, and .56 at the hospital level.</p> <p>Conclusions</p> <p>Psychometric analyses conducted on a very large database of hospitals provided overall support for the patient safety culture dimensions and items included in the AHRQ <it>Hospital Survey on Patient Safety Culture</it>. The survey's items and dimensions overall are psychometrically sound at the individual, unit, and hospital levels of analysis and can be used by researchers and hospitals interested in assessing patient safety culture. Further research is needed to study the criterion-related validity of the survey by analysing the relationship between patient safety culture and patient outcomes and studying how to improve patient safety culture.</p

The smartphone app (MyFitnessPal) reduce sugar-sweetened beverages intake among overweight and obese college students

ABSTRAKLatar Belakang: Peningkatan prevalensi obesitas dapat disebabkan oleh konsumsi sugar-sweetened beverages (SSBs). Sugar-sweetened beverages mengandung gula yang tinggi, sehingga berkontribusi pada meningkatnya asupan energi dan berkorelasi dengan obesitas. Kombinasi strategi pengaturan diet diperlukan untuk mengendalikan asupan makan terutama konsumsi SSBs dan mencegah terjadinya peningkatan berat badan. Tujuan: Penelitian ini bertujuan untuk mengetahui perbedaan rata-rata asupan energi dan gula dari SSBs setelah diberikan intervensi konseling gizi dan self-monitoring menggunakan aplikasi smartphone (MyFitnessPal) pada mahasiswa dengan status gizi overweight dan obese di Universitas Alma Ata Yogyakarta. Metode: Penelitian ini merupakan penelitian pretest-posttest with control group design. Populasi penelitian adalah mahasiswa Universitas Alma Ata Yogyakarta. Subjek penelitian berjumlah 68 orang mahasiswa (34 eksperimen dan 34 kontrol). Pengambilan subjek penelitian untuk menemukan mahasiswa overweight dan obese dengan teknik purposive sampling dan pengambilan subjek penelitian untuk eksperimen dan kontrol menggunakan teknik random sampling. Data asupan energi dan gula dari SSBs dengan formulir semi-quantitative food frequency questionnaire (SQ-FFQ). Analisis univariat menggunakan distribusi frekuensi dan analisis bivariat menggunakan uji Wilcoxon dan Mann-Whitney. Data dianalisis dengan menggunakan SPSS versi 20 dan nutrisurvey. Hasil: Hasil analisis menunjukkan terdapat perbedaan yang bermakna pada asupan energi dan gula dari SSBs antara kelompok eksperimen dan kelompok kontrol (p&lt;0.05). Penurunan asupan energi dan gula dari SSBs pada kelompok eksperimen lebih besar daripada kelompok kontrol. Kesimpulan: Terdapat perbedaan yang bermakna pada rata-rata asupan energi dan gula dari SSBs setelah diberikan intervensi pada mahasiswa overweight dan obese. Konseling gizi dan self-monitoring asupan makan menggunakan aplikasi smartphone (MyFitnessPal) memperbaiki asupan energi dan gula dari SSBs.  KATA KUNCI: Konsumsi Sugar-Sweetened Beverages; Konseling Gizi; MyFitnessPal; Self-Monitoring  ABSTRACTBackground: The increase in obesity prevalence can be caused by the consumption of sugar-sweetened beverages (SSBs). Sugar-sweetened beverages contain high levels of sugar, which contribute to increased energy intake and obesity risks. A combination of dietary strategies is needed to control food intake, especially consumption of SSBs, and prevent weight gain. Objectives: This study aimed to investigate the difference between the energy and sugar intake of SSBs after being given nutritional counseling intervention and self-monitoring using smartphone app (MyFitnessPal) among overweight and obese students at Alma Ata University Yogyakarta. Methods: This study was a pre-test-post test with control group design. We recruited students as our subjects. A total of 68 students (34 experiments and 34 controls) were obtained. Subjects were divided into two groups using the random sampling technique. Energy and sugar intake data from SSBs were assessed by a semi-quantitative food frequency questionnaire (SQ-FFQ). Data were analyzed using SPSS version 20 and nutrisurvey. Results: The results of the analysis showed that there were significant differences between the energy and sugar intake of SSBs in the experimental group and control group (p&lt;0.05). The decrease in energy and sugar intake from SSBs in the experimental group was greater than in the control group. Conclusions: There is a significant difference in the average energy and sugar intake of SSBs after being given intervention among overweight and obese students. Nutritional counseling intervention and self-monitoring of food intake using smartphone app (MyFitnessPal) improve energy and sugar intake of SSBs. KEYWORDS: Sugar-Sweetened Beverages Consumption; Nutrition Counseling; MyFitnessPal; Self-Monitoring

Validity and reliability of Turkish version of "Hospital Survey on Patient Safety Culture" and perception of patient safety in public hospitals in Turkey

<p>Abstract</p> <p>Background</p> <p>The Hospital Survey on Patient Safety Culture (HSOPS) is used to assess safety culture in many countries. Accordingly, the questionnaire has been translated into Turkish for the study of patient safety culture in Turkish hospitals. The aim of this study is threefold: to determine the validity and reliability of the translated form of HSOPS, to evaluate physicians' and nurses' perceptions of patient safety in Turkish public hospitals, and to compare finding with U.S. hospital settings.</p> <p>Methods</p> <p>Physicians and nurses working in all public hospitals in Konya, a large city in Turkey, were asked to complete a self-administrated patient safety culture survey (n = 309). Data collection was carried out using the Turkish version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Data were summarized as percentages, means, and SD values. Factor analysis, correlation coefficient, Cronbach's alpha, ANOVA, and t tests were employed in statistical analyses. Items on patient safety were categorized into 10 factors. Factor loadings and internal consistencies of dimension items were high.</p> <p>Results</p> <p>Most of the scores related to dimensions, and the overall patient safety score (44%) were lower than the benchmark score. "Teamwork within hospital units" received the highest score (70%), and the lowest score belonged to the "frequency of events reported" (15%). The study revealed that more than three quarters of the physicians and nurses were not reporting errors.</p> <p>Conclusion</p> <p>The Turkish version of HSOPS was found to be valid and reliable in determining patient safety culture. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Turkey.</p

Improving Evidence-Based Grouping of Transitional Care Strategies in Hospital Implementation Using Statistical Tools and Expert Review

BACKGROUND: As health systems transition to value-based care, improving transitional care (TC) remains a priority. Hospitals implementing evidence-based TC models often adapt them to local contexts. However, limited research has evaluated which groups of TC strategies, or transitional care activities, commonly implemented by hospitals correspond with improved patient outcomes. In order to identify TC strategy groups for evaluation, we applied a data-driven approach informed by literature review and expert opinion. METHODS: Based on a review of evidence-based TC models and the literature, focus groups with patients and family caregivers identifying what matters most to them during care transitions, and expert review, the Project ACHIEVE team identified 22 TC strategies to evaluate. Patient exposure to TC strategies was measured through a hospital survey (N = 42) and prospective survey of patients discharged from those hospitals (N = 8080). To define groups of TC strategies for evaluation, we performed a multistep process including: using ACHIEVE\u27S prior retrospective analysis; performing exploratory factor analysis, latent class analysis, and finite mixture model analysis on hospital and patient survey data; and confirming results through expert review. Machine learning (e.g., random forest) was performed using patient claims data to explore the predictive influence of individual strategies, strategy groups, and key covariates on 30-day hospital readmissions. RESULTS: The methodological approach identified five groups of TC strategies that were commonly delivered as a bundle by hospitals: 1) Patient Communication and Care Management, 2) Hospital-Based Trust, Plain Language, and Coordination, 3) Home-Based Trust, Plain language, and Coordination, 4) Patient/Family Caregiver Assessment and Information Exchange Among Providers, and 5) Assessment and Teach Back. Each TC strategy group comprises three to six, non-mutually exclusive TC strategies (i.e., some strategies are in multiple TC strategy groups). Results from random forest analyses revealed that TC strategies patients reported receiving were more important in predicting readmissions than TC strategies that hospitals reported delivering, and that other key co-variates, such as patient comorbidities, were the most important variables. CONCLUSION: Sophisticated statistical tools can help identify underlying patterns of hospitals\u27 TC efforts. Using such tools, this study identified five groups of TC strategies that have potential to improve patient outcomes

Development and Psychometric Properties of Surveys to Assess Provider Perspectives on the Barriers and Facilitators of Effective Care Transitions

Background The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services. Methods We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites’ psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items. Results Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71). Conclusions We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings