trends and confounding

Ergebnisse zur Dekubitusprävalenz sind wichtige Indikatoren für das Ausmaß der Erkrankung in unterschiedlichen Sektoren und Bereichen des deutschen Gesundheitswesens. Valide und präzise Zahlen zur Prävalenz sind zur Bewertung des Ressourcenbedarfs und Planung von Gesundheitsleistungen dringend erforderlich. Durch die vorliegenden Studien kann das Ausmaß der Dekubitushäufigkeit in bundesdeutschen Pflegeheimen und Krankenhäusern bestimmt werden. Es bestehen Hinweise, dass von einer externen Validität der Studienergebnisse ausgegangen werden kann. Dabei muss die bisherig angenommene hohe Prävalenz von 30% in Pflegeheimen deutlich nach unten korrigiert werden. Die standardisierten jährlichen Erhebungen lassen den Schluss zu, dass sich die Dekubitusprävalenz seit 2001 sowohl in Pflegeheimen als auch in Krankenhäusern reduziert hat. War vor 10 Jahren noch jeder zehnte Bewohner/ Patient von Dekubitus betroffen, so ist es im Jahre 2011 nur noch jeder 20. Kranken-hauspatient und nur noch jeder 25. Pflegeheimbewohner. Der Vergleich von institutsbezogener Prävalenz sollte ausschließlich risikoadjustiert erfolgen, da nur dadurch faire Vergleiche zwischen unterschiedlichen Sektoren, Bereichen und Einrichtungen möglich sind und der Einfluss von Confoundern weitestgehend reduziert wird. Die durchgeführten Studien ermöglichen die Weiterentwicklung von statistischen Modellen. Analog zu dem im Rahmen dieser Studie vorgestellten SRISAG Modell sollten derartige Modelle einfach und handhabbar sein und dadurch eine sinnvolle Problem- und Qualitätsbestimmung des Pflegeproblems Dekubitus in unterschiedlichen Institutionen des deutschen Gesundheitswesens ermöglichen.Results of studies about pressure ulcer prevalence are important parameters about the size of the problem in different sectors and areas of the German health care services, because valid and precise figures about its prevalence are necessary for the adequate planning of actual care needs. The provided studies of this Habilitation provide this information for German Hospitals and nursing homes. The results can be considered as sufficiently external valid. Former estimation of a high pressure ulcer prevalence of about 30 percent in German nursing homes have to be adjusted downwards notably. The standardized annual studies lead to the conclusion, that the pressure ulcer prevalence has dropped since 2001 in nursing homes and hospitals. Ten years ago, every 10th hospital patient and nursing home resident had at least one pressure ulcer. In the year 2011 this is only the case in every 20th hospital patient and every 25th nursing home residents. The comparison of institutional related prevalence rates should always be done by applying risk adjustment measures. Thus fair comparison between different sectors, areas and institutions will be guaranteed and the influence of possible confounders will be minimized. The preformed studies allow the further development of statistical models. Alike the in this habilitation proposed SRISAG-Modell, these models should be easy and manageable and can be used to determine the size of the problem and the quality of the nursing problem pressure ulcer in different institutions of the German health care system

Smart@home – supporting safety and mobility of elderly and care dependent people in their own homes through the use of technical assistance systems and conventional mobility supporting tools: a cross-sectional survey

Background: The use of technical solutions and conventional mobility supporting aids can support the independence of people into old age in their own homes. However, we found relatively few empirical investigations on the effects and costs of these systems. Methods: The aim of the study was to investigate usability, user satisfaction and the correlation between costs and benefits of different built-in smart home solutions and conventional mobility supporting tools in the home of elderly, partially care-dependent tenants (> 65 years). A cross-sectional survey was conducted from February to March 2018 with tenants of a housing association in apartments equipped with smart home technology and conventional mobility supporting tools. The response rate in the intervention group was n = 37 persons (out of 46 tenants with installed smart home and conventional solutions) and in the control group n = 64 persons (out of 100 tenants without built-in smart home and conventional solutions). Data were collected by a written questionnaire regarding usability and satisfaction of the tenants with the built-in smart home solutions and conventional mobility supporting tools. In addition, both the intervention and the control group were asked general questions about communication, safety and how to deal with the need for long-term care in their own living environment. Results: Results showed that with regard to usability, satisfaction and price performance ratio of the installed smart home solutions, the installation of the corresponding solutions with an overall score of 1.41 (on a scale of 1 (very good) to 6 (unsatisfactory)) was mostly positively evaluated by the tenants. Overall, users rated the installed smart home solutions better than the conventional mobility supporting tools (such as handholds and increased balcony floor level). Conclusions: Analysis of the price performance ratio showed that smart home solutions are generally more expensive than conventional tools, but also contribute significantly to an increased security of the tenants, and thus may enable longer living in a familiar environment. We recommend modularized offers consisting of various components of smart home solutions, since this significantly reduces installation costs and allows for an individual composition according to requirements. Moreover, smart home solutions should be considered to be listed as medical aids

Patient safety. Factors for and perceived consequences of nursing errors by nursing staff in home care services

Aim: To identify factors for and perceived consequences of nursing errors by nursing staff in home care services in correlation with qualification, work experience, working hours and trainings. Background: Patient safety has increasingly been brought into focus of politics and care practices over the past few years. However, little evidence has been provided yet on nursing errors in out-of-hospital settings. Design: A cross-sectional study. Methods: Randomized sample of 107 home care services and 656 nurses and nursing assistants recruited from all 16 federal states in Germany. Results: Missing trainings on error management within the past 2 years were identified to be an important factor for mistakes regarding hygienic measures and medication administration. However, most errors arose in documentation without any significant differences in qualification, work experience, training and working hours. Conclusion: Findings indicate that insufficient hygiene and medication administration might be reduced by implementing error management trainings on a regular basis in home care services

A Multicenter Study

PURPOSE The purpose of this study was to evaluate associations among use of walking aids, mobility status, and occurrence of urinary incontinence (UI) in geriatric patients residing in nursing homes, and to examine associations between UI severity (frequency and amount) and its impact on health-related quality of life (QoL). DESIGN Multicenter descriptive cross-sectional prevalence study. SUBJECTS AND SETTING A total of 2044 patients from nursing homes were included in the study. A majority were female (72.0%), the mean age of participants was 82.1 years (SD 11.2), their mean body mass index was 26.1 (SD 5.4), and their mean Care Dependency Scale score was 46.0 (SD 18.2), indicating a medium to high care dependency. The study setting was 30 nursing homes throughout Germany from 2014 to 2015. METHODS Data were collected by trained nurses using a standardized data collection form to collect information about demographic characteristics, health conditions, mobility status measured according to the Elderly Mobility Scale (EMS), UI, and QoL measured using the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF). RESULTS The prevalence of UI was 69.7% (n = 1804). Analysis of variance showed that, in 1659 nursing home residents with information on UI, 572 reported a medium amount of leakage with a mean impact on health-related QoL of 2.2 (SD 2.2, P < .001) on a scale from 0 (no impact) to 10 (very high impact). The mean of the impact on QoL in 235 residents who reported a large amount of leakage was 2.4 (SD 3.0, P < .001). In 1741 residents with information on the frequency of UI, 637 reported being urinary incontinent more than once a day with a mean impact on QoL of 2.2 (SD 2.1, P < .001) and 359 residents with permanent UI stated a mean impact on QoL of 2.1 (SD 2.8, P < .001). According to the bivariate association of UI with use of walking aids, the highest prevalence of UI (61.2%) was in patients who did not use any walking aids. The Chi-square Automatic Interaction Detector (CHAID) of the relationship between mobility according to the EMS and UI indicated that 71.1% of all patients with UI did not use any walking aids, although their mobility status had been reduced. CONCLUSIONS Findings indicate a significant association between impaired mobility and UI in nursing home residents. Chronic, severe urinary incontinence exerted the greatest impact on health-related QoL. Therefore, we recommend measures to preserve or regain mobility to minimize or prevent UI in geriatric residents and patients and, thus, increase their health-related QoL

Conception and evaluation of a washable multimodal smart textile

Smart textiles can support people with specific needs and diseases, such as diabetes or heart disease. Currently there are efforts to combine continuous mobile monitoring with other health-related conditions. On this basis, algorithms could be developed that can be used to detect unusual or critical conditions. A study was to investigate whether a previously developed washable Multi-Modal Smart Textile (MMST), based on inexpensive materials, would provide valid and reliable results with regard to the vital parameters of pulse, temperature and mobility. The measurement of the vital parameters was carried out with the developed prototype MMST as well as with validated devices. All electronics including the rechargeable NiMH has been washed more than 30 times with different methods and it remained fully functional. The intraclass correlation coefficients (ICC) for pulse (temperature) measurement ranged between 0.036 and 0.232 (0.077 and 0.817) depending on the activity of the tested individuals (standing, sitting, lying down, moving). Cohen's Kappa for the detection of the body position was 0.765. For the parameter of pulse, the results indicated an insufficient derivation for both validity and reliability. Due to flaws in the methodology applied, the validly and reliably for the parameter of temperature could not be determined. Valid and reliable results were obtained for the parameter mobility/change of position. If the MMST (after modification of the prototype) achieves reliable results, there are many advantages for people giving and receiving care on a budget price, even in threatening emergency situations

Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV - positive women: Evidence from government facilities in Kenya

Introduction: Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women. Methods: We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a �95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. Results: The participants’ mean age was 38.6 (range: 18–69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (� 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72–80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34–0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31–0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34– 0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. Conclusion: IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence

A Cross‐Sectional Study

The burdens caused by chronic wounds on the affected persons themselves and also on the health care system are well recognised. The aim of this study was to investigate the prevalence and risk factors of chronic wounds in German nursing homes. An annual cross-sectional study was conducted in nursing home residents from 2012 to 2018. The proportion of men affected by chronic wounds was to some extent higher than that of women, 9.0% males vs 7.5% females. In total, 7.8% of all residents were affected by chronic wounds. Of all residents with a chronic wound, 50.5% were affected by pressure ulcer. Male residents were twice as often affected by diabetic foot ulcer than female residents (18.0% vs 8.9%; P = 0.002). Bivariate analysis showed that chronic wounds were highly associated with poor nutrition, urinary incontinence, stool incontinence, diabetes mellitus, and limited mobility (P = 0.000). According to multivariate analysis, the strongest predictors for chronic wounds were limited mobility and diabetes mellitus. The highest prevalence of chronic wounds was in residents who were not restricted in their mobility, had diabetes, were male, and lived in a metropolitan region (23.7%). This study identified the prevalence and risk factors of chronic wounds in nursing home residents. Further research is needed to identify causal factors of the gender difference in the prevalence of chronic wounds. This may have an impact on the choice of prophylactic and therapeutic measures

Population-Wide National Survey Data Emphasize the Importance of Work-Related Factors

Unintentional injuries cause much of the global mortality burden, with the workplace being a common accident setting. Even in high-income economies, occupational injury figures remain remarkably high. Because risk factors for occupational injuries are prone to confounding, the present research takes a comprehensive approach. To better understand the occurrence of occupational injuries, sociodemographic factors and work- and health-related factors are tested simultaneously. Thus, the present analysis aims to develop a comprehensive epidemiological model that facilitates the explanation of varying injury rates in the workplace. The representative phone survey German Health Update 2010 provides information on medically treated occupational injuries sustained in the year prior to the interview. Data were collected on sociodemographics, occupation, working conditions, health-related behaviors, and chronic diseases. For the economically active population (18–70 years, n = 14,041), the 12-month prevalence of occupational injuries was calculated with a 95% confidence interval (CI). Blockwise multiple logistic regression was applied to successively include different groups of variables. Overall, 2.8% (95% CI 2.4–3.2) of the gainfully employed population report at least one occupational injury (women: 0.9%; 95% CI 0.7–1.2; men: 4.3%; 95% CI 3.7–5.0). In the fully adjusted model, male gender (OR 3.16) and age 18–29 (OR 1.54), as well as agricultural (OR 5.40), technical (OR 3.41), skilled service (OR 4.24) or manual (OR 5.12), and unskilled service (OR 3.13) or manual (OR 4.97) occupations are associated with higher chances of occupational injuries. The same holds for frequent stressors such as heavy carrying (OR 1.78), working in awkward postures (OR 1.46), environmental stress (OR 1.48), and working under pressure (OR 1.41). Among health-related variables, physical inactivity (OR 1.47) and obesity (OR 1.73) present a significantly higher chance of occupational injuries. While the odds for most work-related factors were as expected, the associations for health-related factors such as smoking, drinking, and chronic diseases were rather weak. In part, this may be due to context-specific factors such as safety and workplace regulations in high- income countries like Germany. This assumption could guide further research, taking a multi-level approach to international comparisons

Predictors of falling events in nursing homes: a cross-sectional study in Germany

Hintergrund: Neuere Studienergebnisse zeigen, dass Sturzereignisse in Pflegewohnheimen bisher nicht in ausreichendem Maße verhindert werden können. Der Zusammenhang zwischen Sturzereignissen sowie Mobilitätseinschränkungen, Erkrankungen und Body-Mass-Index (BMI) wurde für jeden Faktor bisher einzeln beschrieben; eine komplexere Analyse fehlt. Ziel: Ziel dieser Studie ist es, neben der Sturzinzidenz, Sturzprädiktoren in deutschen Pflegewohnheimen zu ermitteln. Die Untersuchung fokussiert auf das Vorliegen möglicher Sturzprädiktoren von Pflegeheimbewohnern/Pflegeheimbewohnerinnen ab 65 Jahren und versucht, evtl. vorhandene, besonders vulnerable Personengruppen zu identifizieren. Material und Methode: Querschnittserhebung mit 2427 Pflegeheimbewohnern/Pflegeheimbewohnerinnen im 3. und 4. Lebensalter aus 17 deutschen Pflegewohnheimen im Untersuchungszeitraum von 2014 bis 2016. Es wurden umfangreiche Daten zur Mobilität, zu Erkrankungen und BMI sowie zur Versorgung mit Mobilitätshilfsmitteln erhoben und statistisch ausgewertet. Zur Ermittlung multivariater Zusammenhänge wurde ein „classification and regression tree“ angewendet. Ergebnisse: Die Gruppe der Proband*innen stellt sich mit einem Median von 85 Jahren und einem Frauenanteil von 73,8 % dar. Im Erhebungszeitraum von 2014 bis 2016 stürzten 5,5 % der Pflegeheimbewohner*innen. Als mögliche Prädiktoren für Sturzereignisse konnten Einschränkungen in mehreren spezifischen komplexen Bewegungsabläufen sowie ein geringer BMI ≤21,5 kg/m2 ermittelt werden. Die Gruppe der Pflegeheimbewohner*innen mit geringem BMI zeigt Einschränkungen in anderen Bewegungsabläufen als Pflegeheimbewohner*innen der Gruppe, die einen BMI >21,5 kg/m2 aufweisen. Pflegeheimbewohner*innen mit diesen Merkmalen wurden als besonders vulnerable Gruppen identifiziert. Schlussfolgerung: Da die Einschätzung des Sturzrisikos von Pflegeheimbewohnern/Pflegeheimbewohnerinnen auf Basis bisheriger Risikofaktoren nur teilweise erfolgreich erfolgt, scheint die Anwendung geeigneter Testverfahren zur Bestimmung der Mobilität und des BMI angezeigt, um das Sturzrisiko von Pflegeheimbewohnern/Pflegeheimbewohnerinnen belastbar bestimmen und geeignete Maßnahmen ergreifen zu können.Background: The results of recent studies showed that falls in nursing homes cannot be sufficiently prevented. The correlation between falls as well as restriction in mobility, diseases and body mass index (BMI) were so far individually described for each factor but a more complex analysis is lacking. Aim: The aim of this study was to determine fall predictors in German nursing homes in addition to the incidence of falls. The study focused on the presence of possible fall predictors of nursing home residents aged 65 years and over and attempted to identify any particularly vulnerable groups of persons. Material and methods: Overall, 2427 residents living in 17 German nursing homes starting from the age of 65 years were part of a cross-sectional study between 2014 and 2016. Comprehensive data on mobility, supply of walking aids, diseases and BMI were documented and statistically evaluated. A classification and regression tree was used to determine multivariate relationships. Results: The group of participants had a median age of 85 years and a proportion of women of 73.8%. During the survey period 5.5% of the residents fell. As possible predictors for fall events, restrictions in several specific complex movement sequences as well as a low BMI of ≤21.5 kg/m2 could be determined. The group of nursing home residents with a low BMI showed restrictions in other movement sequences than nursing home residents in the group with a BMI >21.5 kg/m2. Nursing home residents with these characteristics were identified as particularly vulnerable groups. Conclusion: The assessment of the risk of falling of nursing home residents on the basis of previous risk factors seems to be only partially successful. Therefore, the application of suitable test procedures to determine mobility and the BMI appears to be appropriate in order to be able to determine the risk of falling of nursing home residents in a reliable manner and to take appropriate measures

Dry skin and the use of leave-on products in nursing care: A prevalence study in nursing homes and hospitals

Aims: To describe the prevalence of dry skin in nursing homes and hospitals and to describe relationships between topical skincare interventions and dry skin. Design: Two multicentre descriptive cross-sectional prevalence studies. Methods: The studies were performed in German nursing homes and hospitals in 2015 and 2016. Data were collected by trained nurses based on a standardized data collection form. The severity of dry skin was measured using the Overall Dry Skin Score. Results: In total, 1,662 nursing home residents and 1,486 hospital patients participated. The prevalence of dry skin was 41.2% in nursing homes and 55.2% in hospitals. In case of skincare dependency, the proportions of participants with dry skin were higher, particularly in hospitals (70.2%). In both institutions, the application of leave-on products increased when dry skin was present but remained lower in hospitals. Considering the high amount of skin dryness in skincare-dependent participants, interventions seem not to be successful. Results indicate a need for skincare improvement in future