Factors for Successful Implementation of a Preventive Counseling Program in Routine Prenatal Care in Germany – a Process Evaluation

Background: Overweight and obesity are major health challenges and risk factors for subsequent diseases in both children and adults. There is an urgent need for effective preventive interventions and suitable settings in which they can be provided to a wide public. Research on perinatal programming indicates that maternal lifestyle during pregnancy influences the risks for pregnancy and birth complications, as well as the risks of obesity and chronic disease in children in the long term. There is evidence that lifestyle counseling interventions during pregnancy can be effective in improving maternal and infant health outcomes. In Germany, however, lifestyle topics are not consistently discussed during regular prenatal care. Methods: The GeMuKi intervention enhances prenatal care by embedding lifestyle counseling in routine checkup visits during pregnancy in different regions of the southern German state Baden-Württemberg. Supported by a novel shared telehealth platform, gynecologists and midwives provide lifestyle counseling to pregnant women using motivational interviewing (MI) techniques. Alongside the effectiveness trial, a process evaluation is conducted to identify factors that facilitate or inhibit the implementation of the intervention and to investigate the extent to which the intervention is implemented as intended. The cumulative dissertation addresses these objectives by providing three studies (Studies I-III) as well as supplementary data that analyzed the implementation process at different stages. Guided by different theoretical frameworks, a combination of quantitative and qualitative research methods is used to comprehensively understand and cover the implementation process from different perspectives. Different Questionnaires (n=401; n=46) and administrative data were analyzed using descriptive statistics, while semi-structured interviews with the GeMuKi recruiting staff (n=6), multiprofessional healthcare providers (n=13) and pregnant women (n=12) as well as other text material like observation protocols (n=29) and internal project documents (n=99) were analyzed using qualitative content analysis. Results: Check-up visits in routine prenatal care proved to be a suitable setting for focusing on lifestyle topics. Pregnant women as well as healthcare providers expressed a need to address lifestyle topics. Intrinsic motivation and personal interest in the topics of nutrition, exercise, and overweight/obesity acted as facilitators for the implementation as they were crucial for the active participation of healthcare providers. A flexible distribution of tasks between gynecologists and medical assistants also facilitated the implementation. Lack of time due to many other tasks related to routine care was a key barrier to the implementation. Not all intervention components were implemented as intended. For instance, while the selection of counseling topics and the combination of joint goal-setting, feedback discussions, and push notifications were well received, other measures such as the conversational approach MI were inconsistently implemented by healthcare providers. The evaluation revealed information gaps regarding gestational weight gain and demonstrated much room for improvement in the inter-professional cooperation between gynecologists and midwives. Conclusion: The results provide valuable guidance as to how healthcare services in prenatal care might be reorganized, with the aim of reducing the future burden of chronic diseases for both mothers and children. For a successful translation into routine care, adaptations of specific intervention components as well as strategies to improve inter-professional cooperation should be discussed. In light of the increasing need for preventive action to reduce risks of lifestyle-related diseases, the opportunities and high accessibility offered by routine check-ups in community-based settings should not be missed

MHF1–2/CENP-S-X performs distinct roles in centromere metabolism and genetic recombination

Peer reviewedPublisher PD

The Explanation Matters: Enhancing AI Adoption in Human Resource Management

Artificial intelligence (AI) has ubiquitous applications in companies, permeating multiple business divisions like human resource management (HRM). Yet, in these high-stakes domains where transparency and interpretability of results are of utmost importance, the black-box characteristic of AI is even more of a threat to AI adoption. Hence, explainable AI (XAI), which is regular AI equipped with or complemented by techniques to explain it, comes in. We present a systematic literature review of n=62 XAI in HRM papers. Further, we conducted an experiment among a German sample (n=108) of HRM personnel regarding a turnover prediction task with or without (X)AI-support. We find that AI-support leads to better task performance, self-assessment accuracy and response characteristics toward the AI, and XAI, i.e., transparent models allow for more accurate self-assessment of one’s performance. Future studies could enhance our research by employing local explanation techniques on real-world data with a larger and international sample

Writing, Emotion, and Learning: the Influence of Researcher Identity and Experience on Analysis and Findings

This presentation explores the influence of researcher life experiences on data selection, data analysis, and writing up a study of lived experience with brain injury. Study methods—photoelicitation and narrative analysis methods—likely enhanced the study’s emotional impact on the researcher. Citing examples from brain injury survivor visual illness narratives, this presentation will illustrate insights into brain injury healing, researcher learning, and policy that emerged from this research

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers

Quantitative assessment of ventricular far field removal techniques for clinical unipolar electrograms

The incidence of atrial tachycardia steadily increases in industrial nations. During invasive electrophysiological studies, a cathetermeasureselectrograms within the atrium to assist detailed diagnosis and treatment planning. With unipolar and bipolar electrograms, two different acquisition modes are clinically available.Unipolar electrograms have several advantages over bipolarelectrograms. However, unipolar electrograms are more affected by noise and the ventricular far field. Therefore, only bipolar electrograms are typicallyused in clinical settings.A recently published ventricular far field removal technique models the ventricular far field by a set of dipoles and yieldedpromising results in a simulation study.However, the method lacks quantitative clinical validation.Therefore, we adapted thetechnique to clinical needsand applied it todatasetsoftwo patientsusing four different lengths of the removal window.Results were compared quantitatively by a tailored residual error measure.The used method resulted in a median reduction of the ventricular far field by approximately89% using a removal window of optimal length forbothpatients.The results showedthatthe dipole methodprovides an alternative to other VFF removal techniques in clinical practice because itcan reveal AA originally hidden by VFF without leading to a prolongation of the electrophysiological study

Mendelian breeding units <i>versus</i> standard sampling strategies: mitochondrial DNA variation in southwest Sardinia

We report a sampling strategy based on Mendelian Breeding Units (MBUs), representing an interbreeding group of individuals sharing a common gene pool. The identification of MBUs is crucial for case-control experimental design in association studies. The aim of this work was to evaluate the possible existence of bias in terms of genetic variability and haplogroup frequencies in the MBU sample, due to severe sample selection. In order to reach this goal, the MBU sampling strategy was compared to a standard selection of individuals according to their surname and place of birth. We analysed mitochondrial DNA variation (first hypervariable segment and coding region) in unrelated healthy subjects from two different areas of Sardinia: the area around the town of Cabras and the western Campidano area. No statistically significant differences were observed when the two sampling methods were compared, indicating that the stringent sample selection needed to establish a MBU does not alter original genetic variability and haplogroup distribution. Therefore, the MBU sampling strategy can be considered a useful tool in association studies of complex traits