Pflegeschulungen für Angehörige mit Migrationshintergrund und Kompetenzbildungen für professionell Pflegende

Background

The proportion of people in need of care with a migration background and therefore the demand for qualified nursing staff will increase. So far, however, considerations and concepts aiming to improve the care situation (including cultural sensitivity) for people in need of care with a migration background are lacking.

Objective

The following questions are addressed on the basis of care training for relatives with migration background and competence development for health care professionals: What content should the care training/competence development take into account? What are the limits regarding planning and implementation, and what are the suggestions for improvements?

Materials and methods

The development of care training and competence development was based on a needs and resources assessment (in the form of a systematic literature review, an expert workshop, semistructured interviews with relatives with migration background who are providing nursing care). A training manual that has been published includes research results and findings and is applicable to other target groups and settings.

Results and discussion

A transcultural training manual was developed and tested for use in outpatient care. It consists of two parts: training for relatives providing nursing care and competency training for health care specialists. It enables the planning, preparation, and implementation of training courses and includes theoretical background knowledge, practical exercises, and didactic advice. When using the manual, however, the target group should be planned at an early stage and individual needs and resources of course participants should be taken into account.

     

Der Stellenwert von Muttermilch für die gesunde Entwicklung Frühgeborener – aktuelle Übersicht und praktische Aspekte

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - In den letzten Jahren konnte der immense Vorteil der Muttermilchernährung für Frühgeborene belegt werden: in Bezug...     

Efflux-mediated resistance to florfenicol and/or chloramphenicol in Bordetella bronchiseptica: identification of a novel chloramphenicol exporter

OBJECTIVES: Twenty florfenicol- and/or chloramphenicol-resistant Bordetella bronchiseptica isolates of porcine and feline origin were investigated for the presence of floR and cml genes and their location on plasmids. METHODS: The B. bronchiseptica isolates were investigated for their susceptibility to antimicrobial agents by broth micro- or macrodilution and for their plasmid content. Hybridization experiments and PCR assays were conducted to identify resistance genes. Transformation and conjugation studies were performed to show their transferability. Representatives of both types of genes including their flanking regions were sequenced. Moreover, inhibitor studies with the efflux pump inhibitor Phe-Arg-beta-naphthylamide (PAbetaN) were performed. RESULTS: The gene floR was found in the chromosomal DNA of 9 of the 18 florfenicol/chloramphenicol-resistant isolates. Sequence analysis revealed that the deduced FloR protein sequence differed by a single amino acid exchange from FloR of Vibrio cholerae. A chloramphenicol-resistant, but florfenicol-susceptible isolate carried a novel plasmid-borne cml gene, designated cmlB1. The CmlB1 protein revealed only 73.8-76.5% identity to known CmlA proteins. The gene cmlB1 was not part of a gene cassette. The results of inhibitor studies with PAbetaN suggested that a so-far unidentified efflux system might play a role in phenicol resistance of the remaining florfenicol- and/or chloramphenicol-resistant isolates. CONCLUSIONS: This is to the best of our knowledge the first report of a floR gene in B. bronchiseptica isolates. The identification of the first member of a new subclass of cml genes, cmlB1 from B. bronchiseptica, extends our knowledge on specific chloramphenicol exporters.     

More habitual physical activity is linked to the use of specific,more adaptive cognitive reappraisal strategies in dealing with stressful events

Physical activity may improve stress resilience and well‐being. However, specific links to individuals' coping abilities with stressful events are sparse. This study tested whether individuals reporting more physical activity in daily life showed a higher capacity for cognitive reappraisal in dealing with potential stressors. Ninety‐eight participants reported their regular physical activity in the Freiburger Questionnaire on Physical Activity and completed a maximum performance test of their inventiveness in generating reappraisals for situations depicting real‐life stressors. The latter provides scores for overall cognitive reappraisal capacity (quantity of ideas) and preference for specific cognitive reappraisal strategies (quality of ideas; positive reinterpretation; problem‐oriented, de‐emphasizing reappraisals). Additionally, participants' anxious and depressive dispositions and general creative abilities were assessed. Results showed no association between time spent on physical activities per week and total quantity of generated reappraisal ideas. However, a higher degree of physical activity was specifically linked to a greater relative preference for the reappraisal strategy of positive reinterpretation. Opposite associations emerged for the strategy of de‐emphasizing reappraisals. The findings support the notion of more adaptive cognitive reappraisal use in more physically active individuals and may advance research on interrelationships between physical activity and cognitive and affective functions implicated in stress management.     

The economic burden of kidney graft failure in the United States

Despite improvements in outcomes for kidney transplant recipients in the past decade, graft failure continues to impose substantial burden on patients. However, the population‐wide economic burden of graft failure has not been quantified. This study aims to fill that gap by comparing outcomes from a simulation model of kidney transplant patients in which patients are at risk for graft failure with an alternative simulation in which the risk of graft failure is assumed to be zero. Transitions through the model were estimated using Scientific Registry of Transplant Recipients data from 1987 to 2017. We estimated lifetime costs, overall survival, and quality‐adjusted life‐years (QALYs) for both scenarios and calculated the difference between them to obtain the burden of graft failure. We find that for the average patient, graft failure will impose additional medical costs of $78 079 (95% confidence interval [CI] $41 074, $112 409) and a loss of 1.66 QALYs (95% CI 1.15, 2.18). Given 17 644 kidney transplants in 2017, the total incremental lifetime medical costs associated with graft failure is $1.38B (95% CI $725M, $1.98B) and the total QALY loss is 29 289 (95% CI 20 291, 38 464). Efforts to reduce the incidence of graft failure or to mitigate its impact are urgently needed.     

TMPRSS2-ERG Fusions Are Strongly Linked to Young Patient Age in Low-grade Prostate Cancer

Based on next-generation sequencing of early-onset prostate cancer (PCa), we earlier demonstrated that PCa in young patients is prone to rearrangements involving androgen-regulated genes—such as transmembrane protease, serine 2 (TMPRSS2)–v-ets avian erythroblastosis virus E26 oncogene homolog (ERG) fusion—and provided data suggesting that this situation might be caused by increased androgen signaling in younger men. In the same study, an accumulation of chromosomal deletions was found in cancers of elderly patients. To determine how age-dependent molecular features relate to cancer phenotype, an existing data set of 11 152 PCas was expanded by additional fluorescence in situ hybridization analyses of phosphatase and tensin homolog (PTEN), 6q15 and 5q21. The results demonstrate that the decrease in TMPRSS2–ERG fusions with increasing patient age is limited to low-grade cancers (Gleason ≤3 + 4) and that the significant increase in the deletion frequency with age was strictly limited to ERG-negative cancers for 6q15 and 5q21 but to ERG-positive cancers for PTEN. These data suggest that the accumulation of non–androgen-linked genomic alterations with advanced patient age may require an appropriate microenvironment, such as a positive or negative ERG status. The strong link of ERG activation to young patient age and low-grade cancers may help to explain a slight predominance of low-grade cancers in young patients.     

IgE alone stimulates mast cell adhesion to fibronectin via pathways similar to those used by IgE + antigen but distinct from those used by Steel factor

We recently demonstrated that immunoglobulin E (IgE), in the absence of cross-linking agents, activates signaling pathways in healthy murine bone marrow-derived mast cells (BMMCs) and that this activation enhances BMMC survival, at least in part, via secretion of autocrine-acting cytokines. We report herein that IgE alone also triggers the adhesion of both BMMCs and connective tissue mast cells (CTMCs) to the connective tissue component, fibronectin (FN). This adhesion occurs to the same extent as that triggered by optimal levels of Steel factor (SF) or IgE + antigen (IgE + Ag) and is mediated by an increased avidity of the integrin very late antigen 5 (VLA-5). Moreover, this IgE-induced adhesion, which is prolonged compared with that elicited by SF or IgE + Ag, requires phosphatidylinositol 3-kinase (PI3K), phospholipase C gamma (PLCgamma), and extracellular calcium but not extracellular-regulated kinase (Erk) or p38. Interestingly, we found, using the calcium channel blocker, 2-APB (2-aminoethoxydiphenyl borate) and Lyn-/- BMMCs that both IgE- and IgE + Ag-induced adhesion to FN require extracellular calcium entry, whereas SF does not. Furthermore, our data suggest that FN acts synergistically with IgE to prolong intracellular phosphorylation events and to enhance IgE-induced inflammatory cytokine production and BMMC survival.