Housing situation and healthcare for patients in a psychiatric centre in Berlin, Germany: a cross-sectional patient survey

OBJECTIVE: To determine the housing situation among people seeking psychiatric treatment in relation to morbidity and service utilisation. DESIGN: Cross-sectional patient survey. SETTING: Psychiatric centre with a defined catchment area in Berlin, Germany, March-September 2016. PARTICIPANTS: 540 psychiatric inpatients including day clinics (43.2% of all admitted patients in the study period (n=1251)). MAIN OUTCOME MEASURES: Housing status 30 days prior the interview as well as influencing variables including service use, psychiatric morbidity and sociodemographic variables. RESULTS: In our survey, 327 participants (68.7%) currently rented or owned an own apartment; 62 (13.0%) reported to be homeless (living on the street or in shelters for homeless or refugees); 87 (18.3%) were accommodated in sociotherapeutic facilities. Participants without an own apartment were more likely to be male and younger and to have a lower level of education. Homeless participants were diagnosed with a substance use disorder significantly more often (74.2%). Psychotic disorders were the highest among homeless participants (29.0%). Concerning service use, we did neither find a lower utilisation of ambulatory services nor a higher utilisation of hospital-based care among homeless participants. CONCLUSIONS: Our findings underline the need for effective housing for people with mental illness. Despite many sociotherapeutic facilities, a concerning number of people with mental illness is living in homelessness. Especially early interventions addressing substance use might prevent future homelessness

Schulden und Überschuldung bei voll- und teilstationären psychiatrischen Patient*innen in Berlin

Hintergrund: Überschuldung ist häufig mit psychischen sowie körperlichen Belastungen und Erkrankungen assoziiert und betrifft in Deutschland circa 6,85 Millionen Personen. Die vorliegende Arbeit ist die erste umfassende Erhebung der finanziellen Belastungen von Patient*innen in teilstationärer und stationärer psychiatrischer Behandlung in Deutschland. Ziel: Die Untersuchung der finanziellen Belastungen, der Inanspruchnahme von Unterstützungseinrichtungen und klinischer Faktoren von stationären und teilstationären Patient*innen der psychiatrischen Gesundheitsversorgung im Bezirk Berlin Mitte. Methodik: Durchführung einer interviewbasierten Querschnittserhebung auf den Stationen und Tageskliniken der psychiatrischen Universitätsklinik der Charité des St. Hedwig-Krankenhauses im Jahr 2016. Die Analyse umfasste Datensätze von 488 Teilnehmer*innen. Die Auswertung erfolgten explorativ unter Verwendung von deskriptiver Statistik, Gruppenvergleichen und Regressionsmodellen. In Form von Subgruppen wurden Teilnehmer*innen mit Schulden, Krediten oder unbezahlten Rechnungen und dem Vorliegen einer Abhängigkeitserkrankung und überschuldete Teilnehmer*innen untersucht. Ergebnisse: 55,1% der Teilnehmer*innen wiesen Schulden, Kredite oder unbezahlte Rechnungen auf. Der Median der Schulden- und Kredithöhe lag bei 5.000€. 50,2% der Teilnehmer*innen mit Schulden, Krediten oder unbezahlten Rechnungen hatten während der letzten 6 Monate unterschiedliche außerklinische Unterstützungsangebote genutzt im Vergleich zu 35,2% der Teilnehmer*innen ohne Schulden, Kredite oder unbezahlte Rechnungen. Im Rahmen der Regressionsanalysen stellte sich das Vorliegen einer Abhängigkeitserkrankung sowohl als Einflussfaktor für das Vorliegen von Schulden, Krediten oder unbezahlten Rechnungen als auch für das Vorliegen einer Überschuldung heraus. Schlussfolgerung: Aufgrund des großen Anteils von Patient*innen mit Schulden, Krediten oder unbezahlten Rechnungen sowie des Zusammenhangs zu psychischen Erkrankungen erscheint es sinnvoll, Mitarbeiter*innen mit Patientenkontakt in Einrichtungen der teilstationären und stationären psychiatrischen Versorgung für diesen Zusammenhang zu sensibilisieren und ein routinemäßiges Screening von Patient*innen auf das Vorliegen einer Überschuldungssituation und finanzieller Belastungen zu implementieren. Zukünftige Forschungsarbeiten zur Überschuldung von Patient*innen in psychiatrischer Versorgung könnten die vorliegende Arbeit ergänzen durch die Erfassung von Haushaltseinkommen, bestehenden Vermögenswerten, der Anzahl der Gläubiger, einer zeitlichen Dimension der finanziellen Situation und Sorgen und Ängsten bezogen auf die finanzielle Situation.Background: Over-indebtedness is often associated with mental and physical stress and illness and affects approximately 6.85 million people in Germany. This study is the first comprehensive survey of the financial burden of patients in inpatient and day-care psychiatric treatment in Germany. Objective: To examine the financial burden, use of support services, and clinical factors of inpatient and day-care psychiatric patients in the Berlin Mitte district. Methods: Implementation of an interview-based cross-sectional survey on the wards and day clinics of the Psychiatric University Hospital Charité at St. Hedwig Hospital in 2016. The analysis included data sets of 488 participants. The analysis was explorative using descriptive statistics, group comparisons and regression models. Subgroups included participants with debts, loans, or unpaid bills and the presence of a dependence disorder and over-indebted participants. Results: 55.1% of the participants had debts, loans or unpaid bills. The median amount of debts and loans was 5,000€. 50.2% of the participants with debts, loans or unpaid bills had used different out-of-hospital support services during the last 6 months compared to 35.2% of the participants without debts, loans or unpaid bills. In the regression analyses, the presence of a dependency disorder emerged as an influential factor for both the presence of debts, loans, or unpaid bills and the presence of over-indebtedness. Conclusion: Due to the large proportion of patients with debts, loans, or unpaid bills and the association with mental illness, it seems reasonable to sensitize staff with patient contact in inpatient and day-care mental health care settings to this association and to implement routine screening of patients for the presence of over-indebtedness and financial stress. Future research on over-indebtedness of patients in psychiatric care could complement the present work by recording household income, existing assets, the number of creditors, a temporal dimension of the financial situation, and worries and fears related to the financial situation

Schulden, Kredite und unbezahlte Rechnungen unter Nutzer*Innen teilstationärer und stationärer psychiatrischer Behandlung in Berlin

Hintergrund: Bisherige Studien der Allgemeinbevölkerung weisen auf eine Assoziation zwischen psychischen Erkrankungen und verschiedenen Formen finanzieller Schwierigkeiten wie Verschuldung hin. Ziel der Arbeit: Untersuchung der finanziellen Belastungen und assoziierter Faktoren bei Patient*Innen in (teil-)stationärer psychiatrischer Behandlung. Material und Methoden: Insgesamt 488 Teilnehmer*Innen einer querschnittlichen Patientenbefragung mittels eines strukturierten Interviews zu soziodemografischen sowie klinischen Variablen in (teil- )stationärer psychiatrischer Behandlung in der psychiatrischen Universitätsklinik der Charité im St. Hedwig, zuständig für einen spezifischen Versorgungsbereich in Berlin, gaben Auskunft zu finanziellen Belastungen. Ergebnisse: Insgesamt 269 (55,1 %) Teilnehmer*Innen wiesen Schulden, Kredite oder offene Rechnungen auf. Unter den Teilnehmer*Innen, die Auskunft zur Kredit oder Schuldenhöhe machten (n= 215), wies der größte Teil (47,0 %) Schulden oder Kredite in der Höhe zwischen 1000 und 9999 $e auf, gefolgt von 36,3$e. In den Regressionsmodellen hinsichtlich des Vorliegens von Schulden erwiesen sich ein jüngeres Alter und das Vorliegen einer Substanzabhängigkeit als signifikant assoziierte Faktoren. 22,3 % der Befragten wiesen Schulden in Höhe >10.000 $e auf und lebten von Sozialleistung, sodass eine Überschuldung angenommen werden könnte. Diskussion: Finanzielle Belastungen und bestehende Schulden sollten im psychiatrischen Bereich stärker in der Praxis erfragt und beachtet werden. Geeignete Unterstützungsformen sollten entwickelt und evaluiert werden

Debts, loans and unpaid bills among day patients and inpatients in psychiatric care in Berlin, Germany

Background: Previous studies among the general population indicated an association between mental illnesses and different forms of financial difficulties, such as indebtedness. Objective: Investigation of the financial burden and associated factors among inpatients and day clinic patients in psychiatric care. Material and methods: A total of 488 patients in psychiatric care in the catchment area of the Psychiatric University Hospital Charité at St. Hedwig Hospital participated in a cross-sectional patient survey carried out with a structured interview regarding financial burden, sociodemographic and clinical variables. Results: Of the participants 269 (55.1%) showed outstanding debts, loans or unpaid bills. Among the participants who were willing to give information about the amount of debts, the majority (47.0%) had debts between 1000 € and 9999 € and 36.3% between 10,000 € and 99,999 €. In the binary regression models, younger age and substance use disorders were factors significantly associated with outstanding debts. Of the participants 22.3% had outstanding debts >10,000 € and were depending on social welfare, so that indebtedness could be assumed. Conclusion: Financial burdens and outstanding debts among patients in psychiatric care should be inquired about and considered more intensively in practice. Suitable models of support need to be developed and evaluated.Hintergrund Bisherige Studien der Allgemeinbevölkerung weisen auf eine Assoziation zwischen psychischen Erkrankungen und verschiedenen Formen finanzieller Schwierigkeiten wie Verschuldung hin. Ziel der Arbeit: Untersuchung der finanziellen Belastungen und assoziierter Faktoren bei Patient*Innen in (teil-)stationärer psychiatrischer Behandlung. Material und Methoden: Insgesamt 488 Teilnehmer*Innen einer querschnittlichen Patientenbefragung mittels eines strukturierten Interviews zu soziodemografischen sowie klinischen Variablen in (teil-)stationärer psychiatrischer Behandlung in der psychiatrischen Universitätsklinik der Charité im St. Hedwig, zuständig für einen spezifischen Versorgungsbereich in Berlin, gaben Auskunft zu finanziellen Belastungen. Ergebnisse: Insgesamt 269 (55,1 %) Teilnehmer*Innen wiesen Schulden, Kredite oder offene Rechnungen auf. Unter den Teilnehmer*Innen, die Auskunft zur Kredit- oder Schuldenhöhe machten (n = 215), wies der größte Teil (47,0 %) Schulden oder Kredite in der Höhe zwischen 1000 und 9999 € auf, gefolgt von 36,3 % mit Schulden/Krediten zwischen 10.000 und 99.999 €. In den Regressionsmodellen hinsichtlich des Vorliegens von Schulden erwiesen sich ein jüngeres Alter und das Vorliegen einer Substanzabhängigkeit als signifikant assoziierte Faktoren. 22,3 % der Befragten wiesen Schulden in Höhe >10.000 € auf und lebten von Sozialleistung, sodass eine Überschuldung angenommen werden könnte. Diskussion: Finanzielle Belastungen und bestehende Schulden sollten im psychiatrischen Bereich stärker in der Praxis erfragt und beachtet werden. Geeignete Unterstützungsformen sollten entwickelt und evaluiert werden

On the Beneficial Impact of Li 2 CO 3 as Electrolyte Additive in NCM523 ∥ Graphite Lithium Ion Cells Under High‐Voltage Conditions

Lithium ion battery cells operating at high‐voltage typically suffer from severe capacity fading, known as ‘rollover’ failure. Here, the beneficial impact of Li2CO3 as an electrolyte additive for state‐of‐the‐art carbonate‐based electrolytes, which significantly improves the cycling performance of NCM523 ∥ graphite full‐cells operated at 4.5 V is elucidated. LIB cells using the electrolyte stored at 20 °C (with or without Li2CO3 additive) suffer from severe capacity decay due to parasitic transition metal (TM) dissolution/deposition and subsequent Li metal dendrite growth on graphite. In contrast, NCM523 ∥ graphite cells using the Li2CO3‐containing electrolyte stored at 40 °C display significantly improved capacity retention. The underlying mechanism is successfully elucidated: The rollover failure is inhibited, as Li2CO3 reacts with LiPF6 at 40 °C to in situ form lithium difluorophosphate, and its decomposition products in turn act as ‘scavenging’ agents for TMs (Ni and Co), thus preventing TM deposition and Li metal formation on graphite

Understanding the Role of Commercial Separators and Their Reactivity toward LiPF 6 on the Failure Mechanism of High‐Voltage NCM523 || Graphite Lithium Ion Cells

NCM523 || graphite lithium ion cells operated at 4.5 V are prone to an early “rollover” failure, due to electrode cross-talk, that is, transition metal (TM = Mn, Ni, and Co) dissolution from NCM523 and deposition at graphite, subsequent formation of Li metal dendrites, and, in the worst case, generation of (micro-)short-circuits by dendrites growing to the cathode. Here, the impact of different separators on the high-voltage performance of NCM523 || graphite cells is elucidated focusing on the separators’ structural properties (e.g., membrane vs fiber) and their reactivity toward LiPF6 (e.g., ceramic-coated separators). First, the separator architecture has a major impact on cycle life. Fiber-structured separators can prevent the “rollover” failure by a more homogeneous deposition of TMs and formation of Li metal dendrites, thus, hindering penetration of dendrites to the cathode. In contrast, porous membrane-structured separators cannot prevent the cell failure due to inhomogeneous TM deposits/Li metal dendrites. Second, it is demonstrated that different types of ceramic-coated separators (Boehmite (γ-AlO(OH)) vs α-Al2O3) exhibit different reactivities toward LiPF6. While α-Al2O3 shows a minor reactivity toward LiPF6, the γ-AlO(OH) coating leads to in situ formation of the beneficial difluorophosphate anion in high amounts due the high reactivity toward LiPF6 decomposition, which significantly improves cycle life

Nature 4.0: A networked sensor system for integrated biodiversity monitoring

Zeuss D, Bald L, Gottwald J, et al. Nature 4.0: A networked sensor system for integrated biodiversity monitoring. Global Change Biology. 2024;30(1): e17056.**Abstract** Ecosystem functions and services are severely threatened by unprecedented global loss in biodiversity. To counteract these trends, it is essential to develop systems to monitor changes in biodiversity for planning, evaluating, and implementing conservation and mitigation actions. However, the implementation of monitoring systems suffers from a trade‐off between grain (i.e., the level of detail), extent (i.e., the number of study sites), and temporal repetition. Here, we present an applied and realized networked sensor system for integrated biodiversity monitoring in the Nature 4.0 project as a solution to these challenges, which considers plants and animals not only as targets of investigation, but also as parts of the modular sensor network by carrying sensors. Our networked sensor system consists of three main closely interlinked components with a modular structure: sensors, data transmission, and data storage, which are integrated into pipelines for automated biodiversity monitoring. We present our own real‐world examples of applications, share our experiences in operating them, and provide our collected open data. Our flexible, low‐cost, and open‐source solutions can be applied for monitoring individual and multiple terrestrial plants and animals as well as their interactions. Ultimately, our system can also be applied to area‐wide ecosystem mapping tasks, thereby providing an exemplary cost‐efficient and powerful solution for biodiversity monitoring. Building upon our experiences in the Nature 4.0 project, we identified ten key challenges that need to be addressed to better understand and counteract the ongoing loss of biodiversity using networked sensor systems. To tackle these challenges, interdisciplinary collaboration, additional research, and practical solutions are necessary to enhance the capability and applicability of networked sensor systems for researchers and practitioners, ultimately further helping to ensure the sustainable management of ecosystems and the provision of ecosystem services

Nature 4.0: A networked sensor system for integrated biodiversity monitoring

Ecosystem functions and services are severely threatened by unprecedented global loss in biodiversity. To counteract these trends, it is essential to develop systems to monitor changes in biodiversity for planning, evaluating, and implementing conservation and mitigation actions. However, the implementation of monitoring systems suffers from a trade‐off between grain (i.e., the level of detail), extent (i.e., the number of study sites), and temporal repetition. Here, we present an applied and realized networked sensor system for integrated biodiversity monitoring in the Nature 4.0 project as a solution to these challenges, which considers plants and animals not only as targets of investigation, but also as parts of the modular sensor network by carrying sensors. Our networked sensor system consists of three main closely interlinked components with a modular structure: sensors, data transmission, and data storage, which are integrated into pipelines for automated biodiversity monitoring. We present our own real‐world examples of applications, share our experiences in operating them, and provide our collected open data. Our flexible, low‐cost, and open‐source solutions can be applied for monitoring individual and multiple terrestrial plants and animals as well as their interactions. Ultimately, our system can also be applied to area‐wide ecosystem mapping tasks, thereby providing an exemplary cost‐efficient and powerful solution for biodiversity monitoring. Building upon our experiences in the Nature 4.0 project, we identified ten key challenges that need to be addressed to better understand and counteract the ongoing loss of biodiversity using networked sensor systems. To tackle these challenges, interdisciplinary collaboration, additional research, and practical solutions are necessary to enhance the capability and applicability of networked sensor systems for researchers and practitioners, ultimately further helping to ensure the sustainable management of ecosystems and the provision of ecosystem services