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In the design of long-term care systems, preferences can serve as an essential indication to better tailor services to the needs, wishes and expectations of its consumers. The aim of this systematic review was to summarize and synthesize available evidence on long-term care preferences that have been elicited by quantitative stated-preference methods. The databases PubMed and Web of Science were searched for the period 2000 to 2020 with an extensive set of search terms. Two independent researchers judged the eligibility of studies. The final number of included studies was 66, conducted in 19 different countries. Studies were systematized according to their content focus as well as the survey method used. Irrespective of the heterogeneity of studies with respect to research focus, study population, sample size and study design, some consistent findings emerged. When presented with a set of long-term care options, the majority of study participants preferred to “age in place” and make use of informal or home-based care. With increasing severity of physical and cognitive impairments, preferences shifted toward the exclusive use of formal care. Next to the severity of care needs, the influence on preferences of a range of other independent variables such as income, family status and education were tested; however, none showed consistent effects across all studies. The inclusion of choice-based elicitation techniques provides an impression of how studies operationalized long-term care and measured preferences. Future research should investigate how preferences might change over time and generations as well as people’s willingness and realistic capabilities of providing care.

Zusammenfassung Mithilfe eines präferenzbasierten Indexinstruments zur Messung der Pflegeheimqualität kann die gesundheitsökonomische Evaluation von Pflegeleistungen erleichtert und die Perspektive der Nutzer:innen stärker als bisher in die Bewertung einbezogen werden. Ein solches Instrument ist der in Australien entwickelte Consumer Choice Index - 6 Dimension (CCI-6D). Durch die Übertragung des Instruments auf das deutsche Pflegewesen sowie die Ermittlung von Gewichtungsfaktoren soll dessen Anwendung auch hierzulande ermöglicht werden.

Background To date, the establishment and development of palliative day-care clinics and day hospices in Germany have been completely unsystematic. Research is needed to gain insight into these services and to ensure their accessibility and quality. Accordingly, the ABPATITE research project aims at: (1) identifying the characteristics of palliative day-care clinics and day hospices in Germany, (2) determining demand and preferences for these services, and (3) proposing recommendations (with expert agreement) for the needs-based establishment and development of these services. Methods The research is a multi-perspective, prospective, observational study following a mixed-methods approach across three study phases. In phase 1a, qualitative expert interviews will be conducted to capture the facility-related characteristics of palliative day-care clinics and day hospices in Germany; the results will feed into a questionnaire sent to all such institutions identified nationwide. In phase 1b, a questionnaire will be sent to local statutory health insurance providers, to gain insight into their contracts and accounting and remuneration models. In phase 2a, a service preference survey will be conducted with patients and family caregivers. In phase 2b, semi-structured interviews with management staff will explore the factors that promote and hinder the provision of service. In phase 2c, the external perspective will be surveyed via focus groups with local actors involved in hospice and palliative care. In phase 3a, focus groups with representatives from relevant areas will be conducted to develop recommendations. Finally, in phase 3b, recommendations will be agreed upon through a Delphi survey. Discussion The empirically developed recommendations should enable the establishment and development of day hospices and palliative day-care clinics in Germany to be better managed, more oriented to actual demand, and more effectively integrated into wider health care services. Importantly, the findings are expected to optimize the overall development of hospice and palliative care services. Trial registration: The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00021446; date of registration: April 20, 2020). The study is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.

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Zusammenfassung Hintergrund Um den strukturellen und finanziellen Bedurfnissen der steigenden Zahl an Pflegebedurftigen gerecht zu werden, haben seit der Einfuhrung der Pflegeversicherung im Jahr 1995 diverse Reformen zur Weiterentwicklung des Pflegesystems beigetragen. Ziel dieser Studie ist es, eine Einschatzung der Reformansatze, Herausforderungen und Verbesserungsvorschlage aus Sicht von Pflegeberater*innen aufzuzeigen. Methode Grundlage der Analyse sind 14 semi-strukturierte, leitfadengestutzte Einzelinterviews mit Pflegeberater*innen. Die Interviews wurden wortlich transkribiert und nach der Methode der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse Bei den gesetzlichen Anderungen nahmen die befragten Pflegeberater*innen spurbare positive Auswirkungen in Bezug auf den Leistungsumfang wahr, jedoch mit dem Verweis begrenzter Umsetzungsmoglichkeiten aufgrund fehlender Pflegeinfrastruktur. Herausforderungen wurden insbesondere in den haufigen Gesetzesanderungen, unklaren Zustandigkeiten und landerspezifischen Regelungen gesehen. Diskussion und Schlussfolgerung Insgesamt zeigten die Interviews komplexe Abhangigkeiten im deutschen Pflegesystem auf und die Notwendigkeit eines offentlichen Diskurses zum Thema Eigenverantwortung, Gerechtigkeit und einer flachendeckenden Versorgung. Der Aufbau einer zentralen Informationsplattform wurde vorgeschlagen, um die Transparenz der Angebote auf kommunaler Ebene zu erhohen.

As the German population is continually aging and the majority of older adults still wish to ‘age in place’, the need for informal care provided by family and friends will correspondingly continue to increase. In addition, while the need for formal (professional) care services is also likely to increase, the supply already does not meet the demand in Germany today. The aim of our study is the elicitation of people’s willingness to provide informal care by means of a discrete choice experiment. The self-complete postal survey was disseminated to a random sample of the German general population in Lower Saxony. Data cleansing resulted in a final sample size of 280 participants. A conditional logit and a latent class model were estimated. All attributes were judged as highly relevant by the respondents. The results revealed that an increase in the care hours per day had the greatest negative impact overall on the willingness to provide informal care in our sample. The marginal willingness-to-accept for 1 h of informal care was €14.54 when having to provide informal care for 8 h in reference to 2 h per day. This value is considerably higher than the national minimum wage of €9.82. A three-class latent class model revealed preference heterogeneity. While a monetary compensation is often discussed to increase the willingness and availability of informal care in a country, our results show that this statement could not be generalized within our entire sample.

Contains fulltext : 252263.pdf (Publisher’s version ) (Open Access) 08 juli 2022

Bei den Diskussionen zu Klimawandel und Gesundheit stehen die negativen Folgen der globalen Erwarmung haufig im Vordergrund. Um die Menschen zum Klimaschutz zu motivieren, sollten jedoch auch die positiven Effekte von Klimaschutzmasnahmen auf die individuelle Gesundheit berucksichtigt werden. In diesem Beitrag wird anhand einer Literaturubersicht zunachst das Konzept der gesundheitlichen Co-Benefits von Klimaschutzmasnahmen vorgestellt (A). Im empirischen Teil folgt eine quantitative und qualitative Untersuchung der Verknupfung von Klimawandel und Gesundheit in EU-Rechtsakten (B). Zudem werden Ergebnisse von 18 Tiefeninterviews in deutschen Haushalten dahin gehend analysiert, wie gezielte Informationen zu gesundheitlichen Co-Benefits die Bereitschaft zur Anderung des Lebensstils beeinflussen (C). A: Direkte Co-Benefits von Klimaschutzmasnahmen sind individuell beeinflussbar und erlebbar. Sie betreffen vor allem die Lebensbereiche Ernahrung, Mobilitat und Wohnen. Indirekte Co-Benefits hangen von gesamtgesellschaftlichen Masnahmen z. B. zur Reduktion von Luftverschmutzung ab. B: Gesundheit wird in EU-Rechtsakten zum Klimawandel zwar genannt, die Co-Benefits werden aber nur in geringem Umfang angesprochen. C: In Haushalten werden zwar direkte gesundheitliche Co-Benefits in Lebensstilentscheidungen einbezogen. Da aber ein klimafreundlicher Lebensstil von vielen Faktoren abhangt, reichen Informationen allein nicht aus, um Verhaltensanderungen zu bewirken. Auf politischer Ebene mussen die Synergien zwischen Klima- und Gesundheitsschutz erkannt und in intersektorale politische Masnahmen umgesetzt werden. Im Sinne von Verhaltnispravention konnen Haushalte so bei der Umsetzung von klima- und gesundheitsfreundlichen Lebensstilen strukturell unterstutzt werden.

Background: Undocumented migrants, in particular pregnant women and their newborns, constitute a particularly vulnerable group of migrants. The aim of this study was to systematically review the academic literature on the use and outcomes of maternal and child healthcare by undocumented migrants in the European Union (EU) and European Free Trade Association (EFTA) countries. Methods: The databases, MEDLINE, Embase, CINAHL Plus, Global Health and Popline were searched for the period 2007 to 2017. Two independent reviewers judged the eligibility of studies. The final number of included studies was 33. Results: The results of quantitative, qualitative and mixed methods studies were analysed separately due to their differences in study design, sample size and quality. Overall, the quantitative studies found that undocumented women underutilised essential maternal and child healthcare services, and experienced worse health outcomes. Qualitative studies supported these results, indicating that undocumented migrants were hesitant to use services due to a lack of knowledge and fear of deportation. Studies included in the review covered 10 of 32 EU or EFTA countries, making a European comparison impossible. Conclusions: Despite major methodological differences between included studies, the results of this review indicate that the status of undocumented migrants exacerbates known health risks and hampers service use.

Since the implementation of long-term care insurance in 1995, various reforms have contributed to the development of the German nursing care system in order to meet the structural and financial needs of the growing number of people in need of care. The aim of this paper is to present an assessment of care consultants on past legislation, challenges encountered during their work and suggestions to improve the current care system.14 semi-structured, face-to-face interviews were conducted with care consultants. All interviews were transcribed verbatim and a qualitative content analysis was performed.Care consultants perceived tangible improvements with regard to the scope of benefits as a direct result of recent legislation changes. The use of these benefits, however, is limited due to an insufficient growth of care infrastructure. Particularly frequent legislation changes, unclear responsibilities and dissimilar regulations between federal states were seen as challenges.Complex dependencies within the German nursing care system were identified and the necessity for a public discourse on themes such as self-responsibility, equity and a comprehensive (nationwide) care supply was underlined. A central information platform was proposed in order to concretely improve information about services available locally.

PURPOSE: Whilst childhood trauma (CT) is a known risk factor across the spectrum of psychosis expression, little is known about possible interplay with genetic liability. METHODS: The TwinssCan Study collected data in general population twins, focussing on expression of psychosis at the level of subthreshold psychotic experiences. A multilevel mixed-effects linear regression analysis was performed including 745 subjects to assess the interaction between genetic liability and CT. The Symptom Checklist-90 (SCL-90-R) score of the co-twin was used as an indirect measure of genetic liability to psychopathology, while the Childhood Trauma Questionnaire Short-Form (CTQ-SF) was used to assess CT in the domains of physical, emotional and sexual abuse, as well as physical and emotional neglect. The Community Assessment of Psychic Experience (CAPE) questionnaire was used to phenotypically characterize psychosis expression. RESULTS: In the model using the CAPE total score, the interaction between CT and genetic liability was close to statistical significance (χ2 = 5.6, df = 2, p = 0.06). Analyses of CAPE subscales revealed a significant interaction between CT and genetic liability (χ2 = 8.8, df = 2, p = 0.012) for the CAPE-negative symptoms subscale, but not for the other two subscales (i.e. positive and depressive). CONCLUSION: The results suggest that the impact of CT on subthreshold expression of psychosis, particularly in the negative subdomain, may be larger in the co-presence of significant genetic liability for psychopathology. ispartof: SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY vol:54 issue:9 pages:1045-1054 ispartof: location:Germany status: published

In discussions on climate change and health, negative impacts of climate change usually dominate the discussion. However to motivate households and policy makers to climate action, one should also point out the health opportunities of climate change mitigation measures.We draw on the current literature to present the concept of health co-benefits of climate change mitigation measures (A). In the empirical part of the paper we first use a quantitative and qualitative text analysis to look at the link of climate change and health in EU legislation from 1990-2015 (B). We then describe results from qualitative in-depth interviews with 18 German households, in which we investigate how knowledge of health co-benefits influences households in implementing climate action. The interviews were part of a bigger European mixed-methods study.A: From the household perspective, we define direct health co-benefits, which can be influenced and experienced by an individual, and indirect health co-benefits, which are dependent on societal action. B: Health is mentioned in EU climate change legislation. However, EU legislation only touches upon health co-benefits in general and doesn't mention direct health co-benefits at all. C: Households consider health co-benefits in their lifestyle decisions. Yet, as there are many determinants of lifestyle, information on health co-benefits alone does not seem to be sufficient to trigger climate friendly and healthy behavior.First, synergies between health and climate change mitigation need to be recognized on a political level. Then, effective intersectoral policies need to be implemented to support households on multiple levels in implementing healthy and climate-friendly lifestyles.

Background Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe. Methods The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007–2017. Results A total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services. Conclusions Although it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services. Electronic supplementary material The online version of this article (10.1186/s12913-018-2838-y) contains supplementary material, which is available to authorized users.

Background Neither environmental nor genetic factors are sufficient to predict the transdiagnostic expression of psychosis. Therefore, analysis of gene-environment interactions may be productive. Objective A meta-analysis was performed using papers investigating the interaction between cannabis use and catechol-O-methyl transferase (COMT) polymorphism Val158Met (COMTVal158Met). Data sources PubMed, Embase, PsychInfo. Study eligibility criteria All observational studies assessing the interaction between COMTVal158Met and cannabis with any psychosis or psychotic symptoms measure as an outcome. Study appraisal and synthesis methods A meta-analysis was performed using the Meta-analysis of Observational Studies in Epidemiology guidelines and forest plots were generated. Thirteen articles met the selection criteria: 7 clinical studies using a case-only design, 3 clinical studies with a dichotomous outcome, and 3 studies analysing a continuous outcome of psychotic symptoms below the threshold of psychotic disorder. The three study types were analysed separately. Validity of the included studies was assessed using "A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions". Results For case-only studies, a significant interaction was found between cannabis use and COMTVal158Met, with an OR of 1.45 (95% Confidence Interval = 1.05–2.00; Met/Met as the risk genotype). However, there was no evidence for interaction in either the studies including dichotomous outcomes (B = -0.51, 95% Confidence Interval -1.72, 0.70) or the studies including continuous outcomes (B = -0.04 95% Confidence Interval -0.16–0.08). Limitation A substantial part of the included studies used the case-only design, which has lower validity and tends to overestimate true effects. Conclusion The interaction term between cannabis use and COMTVal158Met was only statistically significant in the case-only studies, but not in studies using other clinical or non-clinical psychosis outcomes. Future additional high quality studies might change current perspectives, yet currently evidence for the interaction remains unconvincing.