Ethics in times of physical distancing: virtual training of ethical competences

Ethics teaching in medicine, nursing and other health care professions does not only consist of knowledge transfer that can be easily implemented digitally. Rather, it focuses on specific ethical competences (such as arguing and articulating one's own moral position) and attitudes (such as empathic patient orientation, critical self-reflection, and ambiguity tolerance), for whose development interactive formats are superior. Competence-oriented ethical learning goals are important for the development of professionalism, but require time, space and personal exchange. Due to contact restrictions and the widespread cancellation of (face-to-face) courses in the wake of the corona pandemic, ethics teaching was forced to keep its distance in many places, which posed great challenges. This article is based on an exchange of experiences from members of the working group ethik learning of the Academy for Ethics in Medicine about ethics teaching in times of physical distancing. Recommendations will be given on how ethical competence can be successfully taught in the context of exclusively digital teaching. Starting with the question what is at risk of being lost in digital teaching, the potentials of digital formats are explored and illustrated with concrete practical examples. Beyond ethics teaching, the article also aims to provide ideas and suggestions for other specialist and cross-sectional areas where interactive formats are central.Ethik-Lehre in Medizin, Pflege und anderen Gesundheitsberufen besteht nicht allein aus Wissensvermittlung, die digital gut umzusetzten ist. Im Mittelpunkt stehen vielmehr spezifische ethische Fertigkeiten (etwa Argumentieren und Artikulieren der eigenen moralischen Position) und Haltungen (etwa empathische Patientenorientierung, kritische Selbstreflexion und Ambiguitätstoleranz), für deren Entwicklung interaktive Formate besser geeignet sind. Kompetenzorientierte ethische Lernziele sind für die Entwicklung des professionellen Rollen- und Selbstverständnisses wichtig, erfordern jedoch Zeit, Raum und vor allem den persönlichen Austausch. Durch die Kontaktbeschränkungen und den fächendeckenden Ausfall von (Präsenz-)Lehrveranstaltungen im Zuge der Corona-Pandemie war die Ethik-Lehre vielerorts gezwungen, auf Abstand zu gehen, was grosse Herausforderungen mit sich brachte. Der Beitrag basiert auf einem Erfahrungsaustausch von Mitgliedern der Arbeitsgruppe ethik lerning der Fachgesellschaft Akademie für Ethik in der Medizin über Ethhik-Lehre in Zeiten von physical distancing. Es werden Empfehlungen gegeben, wie ethische Kompetenzvermittlung im Rahmen ausschliesslich digital stattfindender Lehre gelingen kann. Ausgehend davon, was bei digitalem Unterricht verlohren zu gehen droht, werden die Potentziale digitaler Formate ausgelotet und mit konkreten Praxisbeispielen illustriert. Über die Ethik-Lehre hinaus möchte der Beitrag auch Ideen und Anregungen für andere Fach-Querschnittsbereiche geben, bei denen interaktive Formate zentral sind.ISSN:2366-501

Seroprevalence of Hantavirus in Forestry Workers, Northern France, 2019–2020

We aimed to estimate the seroprevalence of Puumala orthohantavirus (PUUV) among forestry workers in northern France, and to explore sociodemographic risk factors. We conducted a random cross-sectional seroprevalence survey among 1777 forestry workers in 2019–2020. The presence of immunoglobulin G against PUUV antigens in serum was assessed using enzyme-linked immunosorbent assay and confirmed using immunofluorescence assay. Poisson regression models were used to explore factors associated with seropositivity. Weighted seroprevalence was 5% (3–6) in northeastern France, 4% (2–6) in north central France, and 1% in two regions located in the center of the country (Auvergne and Limousin). There were no seropositive workers detected in northwestern France. Seropositivity was associated with age, sex, and cumulative seniority in the forestry sector. Seroprevalence was highest in known endemic areas of the northeast and lowest in the northwest. Nevertheless, we found serological evidence of PUUV infection in two regions located in the center of the country, suggesting circulation of the virus in these regions, previously thought to be non-endemic

Development and validation of the deep brain stimulation impairment scale (DBS-IS)

Background: Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has considerable influence on motor and non-motor symptoms in Parkinson's disease (PD). While improvements in motor functioning can be easily assessed with general quality of life questionnaires, the measurement of specific STN-DBS-associated impairments often remains insufficient. Hence, we aimed to develop a questionnaire that measures STN-DBS-related impairments. Methods: The development of the (STN-)DBS Impairment Scale (DBS-IS) consisted of four steps. First, 30 semi-structured interviews before, three and twelve months after STN-DBS-surgery were performed to create 76 items that relate to motor and non-motor functioning in STN-DBS PD patients. Second, pilot testing led to a rewording of the questions for better understanding. Third, a first multicentre survey was performed to reduce items by applying principal component analysis (PCA). Fourth, a second multicentre survey was conducted to examine factor structure, reliability (internal consistency) and validity. Results: After the first survey (N = 215), the PCA lead to a reduction of 54 items. After the second survey (N = 391), exploratory factor analysis determined six factors with 22 items: 1. Postural instability and gait difficulties (5 items), 2. Cognitive impairment (5 items), 3. Speaking problems (3 items), 4. Apathy (3 items), 5. Impulsivity (3 items), and 6. Difficulties related to the DBS device (3 items). High reliability was reported for all subscales (Cronbach's alpha 0.71-0.90). Similarly, construct validity was high (r > 0.50, p < 0.001). Conclusions: With this new questionnaire patients can be followed-up and STN-DBS-specific problems might be adequately measured. Also, comparisons between patients with and without STN-DBS might be possible.(C) 2017 Elsevier Ltd. All rights reserved

The Deep Brain Stimulation Impairment Scale: A useful complement in assessment of well-being and functioning in DBS-patients - Results from a large multicentre survey in patients with Parkinson's disease

Background: Deep Brain Stimulation (DBS) has been proven to alleviate motor symptoms in Parkinson's Disease (PD). Regarding non-motor symptoms, however, inconsistencies have been reported, on whether DBS causes reductions in well-being and functioning. To assess motor and non-motor impairment in DBS-patients, the Deep Brain Stimulation Impairment Scale (DBS-IS) has been developed. Yet, the extent to which the DBS-IS detects impairment in DBS-patients and thus could serve as a useful tool that complements the PDQ-39 (gold standard) in assessment of well-being and functioning in PD-patients has not been shown. Objectives: By comparing DBS and non-DBS-patients we aimed to identify DBS-specific symptoms. We thereby aimed to show in how far the DBS-IS complements the PDQ-39 in assessing well-being and functioning in PD patients under DBS. Methods: In a cross-sectional study, 186 DBS-patients were matched (for age, disease duration and sex) to 186 non-DBS-patients (N = 372) and the two groups were compared regarding well-being and functioning: Impairment was assessed via DBS-IS and overall Quality of Life (QoL) was assessed via PDQ-39. Additionally, we analyzed differences in impairment between age and disease duration clusters. Results: DBS-patients showed significantly higher total impairment (DBS-IS) and significantly higher impairment on the subscales Postural Instability and Gait difficulties and speaking difficulties than non-DBS-patients. Impairment increased with age and disease duration and, overall, differences in impairment rose by age. Overall QoL (PDQ-39) was non-significantly lower in DBS-patients. Conclusion: Since there is evidence that the PDQ-39 misses some DBS-specific symptoms, the DBS-IS is recom-mended to complement the PDQ-39 when assessing DBS-patients

Cross-disorder analysis of bipolar risk genes: further evidence of DGKH as a risk gene for bipolar disorder, but also unipolar depression and adult ADHD

Recently, several genome-wide association studies (GWAS) on bipolar disorder (BPD) suggested novel risk genes. However, only few of them were followed up and further, the specificity of these genes is even more elusive. To address these issues, we genotyped SNPs in ANK3, CACNA1C, CMTM8, DGKH, EGFR, and NPAS3, which were significantly associated with BPD in previous GWAS, in a sample of 380 BPD patients. Replicated SNPs were then followed up in patients suffering from unipolar depression (UPD; n=387) or adult attention-deficit/hyperactivity disorder (aADHD; n=535). While we could not confirm an association of ANK3, CACNA1C, and EGFR with BPD, 10 SNPs in DGKH, CMTM8, and NPAS3 were nominally associated with disease, with two DGKH markers surviving correction for multiple testing. When these were followed up in UPD and aADHD, seven DGKH SNPs were also associated with UPD, while one SNP each in NPAS3 and CMTM8 and four in DGKH were linked to aADHD. Furthermore, a DGKH haplotype consisting of rs994856/rs9525580/rs9525584 GAT was associated with all disorders tested, while the complementary AGC haplotype was protective. The corresponding haploblock spans a 27-kb region covering exons coding for amino acids 65–243, and thus might include functional variants yet to be identified. We demonstrate an association of DGKH with BPD, UPD, and aADHD by applying a two-stage design. These disorders share the feature of mood instability, so that this phenotype might be associated with genetic variation in DGKH.Heike Weber, Sarah Kittel-Schneider, Alexandra Gessner, Katharina Domschke, Maria Neuner, Christian P Jacob, Henriette N Buttenschon, Andrea Boreatti-Hümmer, Julia Volkert, Sabine Herterich, Bernhard T Baune, Silke Gross-Lesch, Juliane Kopf, Susanne Kreiker, Thuy Trang Nguyen, Lena Weissflog, Volker Arolt, Ole Mors, Jürgen Deckert, Klaus-Peter Lesch and Andreas Rei