Search

To compare opioid prescription rates between patients enrolled in coordinated ambulatory care and patients receiving usual care.In this retrospective cohort study, we analysed claims data for insured patients with non-specific/specific back pain or osteoarthritis of hip or knee from 2014 to 2017.The study was based on administrative data provided by the statutory health insurance fund 'Allgemeine Ortskrankenkasse', in the state of Baden-Wurttemberg, Germany.The intervention group consisted of patients enrolled in a coordinated ambulatory healthcare model; the control group included patients receiving usual care. Outcomes were overall strong and weak opioid prescriptions. Generalised linear regression models were used to analyse the effect of the intervention.Overall, 46 001 (non-specific 18 787/specific 27 214) patients with back pain and 19 366 patients with osteoarthritis belonged to the intervention group, and 7038 (2803/4235) and 963 patients to the control group, respectively. No significant difference in opioid prescriptions existed between the groups. However, the chance of being prescribed strong opioids was significantly lower in the intervention group (non-specific back pain: Odds Ratio (OR) 0.735, 95% Confidential Interval (CI) 0.563 to 0.960; specific back pain: OR 0.702, 95% CI 0.577 to 0.852; osteoarthritis: OR 0.644, 95% CI 0.464 to 0.892). The chance of being prescribed weak opioids was significantly higher in patients with specific back pain (OR 1.243, 95% CI 1.032 to 1.497) and osteoarthritis (OR 1.493, 95% CI 1.037 to 2.149) in the intervention group.Coordinated ambulatory healthcare appears to be associated with a lower prescription rate for strong opioids in patients with chronic musculoskeletal disorders.German Clinical Trials Register (DRKS00017548).

In 2014, the novel orthopedic care program was established by the AOK health insurance fund in southern Germany to improve ambulatory care for patients with musculoskeletal disorders. The program offers extended consultation times, structured collaboration between general practitioners and specialists, as well as a renewed focus on guideline-recommended therapies and patient empowerment. The aim of this study was to assess the impact of the program on health service utilization in patients with hip and knee osteoarthritis (OA).This retrospective cohort study, which is based on claims data, evaluated health service utilization in patients with hip and knee OA from 2014 to 2017. The intervention group comprised OA patients enrolled in collaborative ambulatory orthopedic care, and the control group received usual care. The outcomes were participation in exercise interventions, prescription of physical therapy, OA-related hospitalization, and endoprosthetic surgery rates. Generalized linear regression models were used to analyze the effect of the intervention.Claims data for 24,170 patients were analyzed. Data for the 23,042 patients in the intervention group were compared with data for the 1,128 patients in the control group. Participation in exercise interventions (Odds Ratio (OR): 1.781; 95% Confidence Interval (CI): 1.230-2.577; p = 0.0022), and overall prescriptions of physical therapy (Rate Ratio (RR): 1.126; 95% CI: 1.025-1.236; p = 0.0128) were significantly higher in the intervention group. The intervention group had a significantly lower risk of OA -related hospitalization (OR: 0.375; 95% CI: 0.290-0.485; p 0.0001). Endoprosthetic surgery of the knee was performed in 53.8% of hospitalized patients in the intervention group vs. 57.5% in the control group; 27.7% of hospitalized patients underwent endoprosthetic surgery of the hip in the intervention group versus 37.0% in the control group.In patients with hip and knee OA, collaborative ambulatory orthopedic care is associated with a lower risk of OA-related hospitalization, higher participation in exercise interventions, and more frequently prescribed physical therapy.

Traffic performance of leisure traffic has increased over the last years. Leisure traffic can be distinguished into common and uncommon leisure traffic. Common leisure traffic includes regular and routinised mobility whereas uncommon leisure traffic, for example, is represented by day trips or (short-time) vacations. The performance of uncommon leisure traffic is harmful to the environment due to its high share of motorised private transport (MPT) in the transport mode for the trip to the vacation destination as well as for the mobility during the vacation, is harmful to the environment. Thus, the inspection of uncommon leisure traffic is gaining importance to achieve environmental and climate change objectives. Therefore, traffic concepts targeting visitors become more important. The current empirical database for holiday traffic required for optimal adopted concepts has limitations. This article relates to uncommon leisure traffic. Essential characteristics of traffic behaviour of visitors, such as choice of transport mode for the trip to the vacation destination and the mobility during vacation, preferences for innovative tariffs and causes regarding choice of transport mode, are presented based on a survey conducted in 2013.

Objectives: To assess the psychometric properties of the German self-reported version of the Kiddy-KINDL that measures Health Related Quality of Life (HRQoL) in 3 to 5 year old kindergarten children. Study design: The population of the study comprised baseline data of a longitudinal study whose main aim is to investigate self-reported health outcomes in young children (N = 317).Methods: Missing values, the distribution of data, internal consistency (Cronbach's alpha and Guttman's lambda), and reliability (split half and two weeks test-retest) were analysed. To assess discriminant validity, mean differences were tested splitting the sample regarding socio-emotional competences (VBV 3-6), age and gender. Structural validity was investigated with Confirmatory Factor Analysis (CFA).Results: Mean HRQoL was 69.79 (SD 16.84). Overall missing values were 8.1%, overall Cronbach's alpha was 0.75 and overall Guttman's lambda was 0.77; for the whole scale Spearman-Brown test for split half reliability resulted in 0.80 and ICC for test-retest in 0.83. Discriminant validity investigation differentiated groups with high and low socio-emotional competence and those children who were 4.5 years or older, compared to the younger ones. Differences between boys and girls were also found. CFA suggested two main dimensions: physical and socio-emotional.Conclusion: This preliminary validation of the Kiddy-KINDL in very young children shows satisfactory psychometric properties. However, results of the Cronbach's alpha, Guttman's lambda and the CFA depicted problems, mainly in the psychological dimension. Due to these we recommend to use the Kiddy-KINDL as an instrument with only two dimensions. Further studies in general population samples are needed. (C) 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Der nicht-alltagliche Freizeitverkehr ist ein bislang wenig betrachteter Teil des gesamten Verkehrsbereichs. Dabei ist zu beachten, dass der nicht-alltagliche Freizeitverkehr auf Grund des hohen Anteils des motorisierten Individualverkehrs (MIV) bei der An- und Abreise sowie bei der Fortbewegung am Urlaubsort selbst bislang nicht umweltvertraglich abgewickelt wird. Mit steigendem Verkehrsaufkommen durch (Kurz-)Urlauber und Tagesgaste wachst dessen Bedeutung jedoch hinsichtlich der Erreichung von Umwelt- und Klimaschutzzielen.

Auditory extinction and spatio-temporal order judgment (STOJ) were assessed in patients with acquired brain damage by systematically manipulating onset times in bilateral stimulation under free-field conditions. We tested the hypothesis that extinction will be reduced by increasing stimulus onset asynchrony. Two groups of patients with right-hemisphere (RH, n=17) or left-hemisphere (LH, n=17) damage were investigated in comparison to a healthy control group (n=12). The patients were recruited based on previously diagnosed impairments: auditory discrimination deficits with (RH(E)/LH(E)) or without extinction (RH(0)/LH(0)) due to cortical and/or subcortical temporo-parietally centred lesions. Stimuli were presented bilaterally in the acoustic free-field, with an onset asynchrony of ± 30 to ± 150 ms, or unilaterally, from speakers located ± 60°. Low frequency (LF) and high frequency (HF) stimuli were used to address spatial auditory processing in the horizontal plane based on the two main cues of interaural time and interaural intensity differences, respectively. The subjects' task was to indicate whether they perceived one (left or right) or two stimuli (left and right), and in the case of two make an STOJ (left or right first). Temporal asynchrony significantly reduced extinction in those patients that previously exhibited extinction for bilateral-simultaneous stimulation (RH(E)/LH(E)). In addition, their error rates in STOJ were higher than the controls'. A number of patients with no previous signs of extinction in bilateral-simultaneous stimulation (RH(0)/LH(0)) also showed impaired STOJ: in RH(0) patients this was specific to ipsilesional-leading stimuli, whilst in LH(0) patients no side-specific effect was observed. The data support the notion of differential roles for the two hemispheres in spatio-temporal auditory perception and are discussed with respect to prevalent models of extinction and its possible long-term reduction.

International audience; A comprehensive review of the state-of-the-art of the separation of various organically-bound metals and metalloids for speciation analysis is presented. Recent developments in chromatographic (gas, liquid and supercritical fluid), electrophoretic (free-flow and gel) and fractionation techniques are discussed, followed by a survey of pertinent applications to speciation analysis for organometals and metalloids. The required sample characteristics for a given separation technique are specified and appropriate derivatization procedures are characterized. Methods applicable to the speciation of organic species of a particular element in various matrices are critically evaluated. © 1995 Springer-Verlag.

International audience; A method is presented for the selective determination of the volatile selenium species dimethylselenide and dimethyldiselenide, using a commercially available purge-and-trap injection system coupled to capillary gas chromatography-microwave induced plasma-atomic emission spectrometry. The efficiency of the purging step was evaluated and the parameters affecting the purge and trap processes were optimized. The method was applied to the determination of volatile selenium compounds in lake water. Relative detection limits of 2ng/l for dimethylselenide and dimethyldiselenide, corresponding to an absolute detection limit of 10 pg, were achieved. © 1995 Springer-Verlag.

International audience; Interferences in trace and ultratrace speciation analysis of organotin and organolead compounds in various samples by gas chromatography coupled with atomic absorption spectrometry (AAS) and/or microwave induced plasma atomic emission spectrometry (MIP AES) are investigated. Particular attention is given to the effects of matrix co-extractives and reagents impurities introduced during sample preparation. Their influence on the detection limits is discussed in terms of baseline noise level, blank value, formation of artefacts and signal suppression. Loss of column resolution during the analysis of some matrices is observed. © 1994 Springer-Verlag.

International audience; Two simple sample preparation methods for the speciation analysis of triphenyltin and butyltin compounds in marine biotissues, using tetramethylammonium hydroxide (TMAH) solubilization and enzymic hydrolysis, have been developed and compared with conventional acid digestion. Derivatization was carried out in situ using sodium tetraethylborate (NaBEt4) without prior separation of the analytes from the tissue matrix. Separation and detection was performed using capillary gas chromatography (GC) coupled to microwave‐induced plasma atomic emission spectrometry (MIP AE) allowing detection limits of 2 ng g−1 (as tin) to be reached. The accuracy of the presented methods was demonstrated by the analysis of a fish reference material (NIES No. 11). the necessity for sample clean‐up is discussed and examples of the analysis of mussel tissue are shown. Copyright © 1994 John Wiley & Sons, Ltd.