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The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.


Wiedebusch S.,University of Applied Health Sciences at Bochum-Hordel | Petermann F.,University of Bremen
Kindheit und Entwicklung | Year: 2011

Early promotion of social-emotional skills as a preventive intervention in order to support this key development area shows short- and long-term effects on positive social behavior, learning motivation, and academic success, as well as physical and mental health of children. In this paper, structured programs for different target and age groups, i. e., caregivers of toddlers, preschoolers, and elementary school children are presented. Opportunities and limits of early promotion are highlighted. Thus, children at risk particularly benefit from an early promotion of social-emotional competence. Finally, recommendations for the use of developmental screenings and programs in (early) educational institutions are pronounced on the basis of evaluation results. A three-tiered model, which allows an individual and need-based support planning, is introduced. © Hogrefe Verlag, Göttingen 2011.


Gethin G.,National University of Ireland | Grocott P.,King's College London | Probst S.,University of Applied Health Sciences at Bochum-Hordel | Clarke E.,Royal College of Surgeons in Ireland
International Journal of Nursing Studies | Year: 2014

Aim: To determine from a multi-disciplinary and international perspective current practice in the management of wound odour. Background: Malodour is cited by patients and carers as one of the most distressing and socially isolating aspects of their wounds. The absence of a standardised approach to assessment and management underscores the need to collect baseline data to support guideline development. Design: On-line survey. Methods: A study specific questionnaire in English, Spanish, Italian and German was emailed to wound care organisations worldwide, palliative and oncology nursing organisations, and known contacts with a special interest in wound management, for distribution to members between December 2011 and February 2012. Results: 1444 people from 36 countries responded. 12% assess odour with descriptive words being the most frequent form of assessment. Charcoal and silver based dressings were the most frequently used odour management agents, yet, only 48.4% and 23% respectively reported these as being very effective. Antimicrobial agents were cited as most effective but were not the most frequently used. 8% use aromatherapy oils direct to the wound, and 74% combine a range of dressings to try and manage odour. Odour, pain and exudate management were the greatest wound management challenges facing patients and clinicians. 46.7% of respondents encounter patients with MFW on a monthly basis and 89% agreed there is a need to develop guidelines in this area. Conclusion: A 'trial and error' approach to odour management exists with low overall satisfaction with current practice. There is a need for research and education on means to assess odour and odour management options. © 2013 Elsevier Ltd.


Vossel S.,Jülich Research Center | Weiss P.H.,Jülich Research Center | Weiss P.H.,University of Cologne | Eschenbeck P.,Jülich Research Center | And 3 more authors.
Cortex | Year: 2013

Introduction: Right-hemispheric stroke can give rise to manifold neuropsychological deficits, in particular, impairments of spatial perception which are often accompanied by reduced self-awareness of these deficits (anosognosia). To date, the specific contribution of these deficits to a patient's difficulties in daily life activities remains to be elucidated. Methods: In 55 patients with right-hemispheric stroke we investigated the predictive value of different neglect-related symptoms, visual extinction and anosognosia for the performance of standardized activities of daily living (ADL). The additional impact of lesion location was examined using voxel-based lesion-symptom mapping. Results: Step-wise linear regression revealed that anosognosia for visuospatial deficits was the most important predictor for performance in standardized ADL. In addition, motor-intentional and perceptual-attentional neglect, extinction and cancellation task performance significantly predicted ADL performance. Lesions comprising the right frontal and cingulate cortex and adjacent white matter explained additional variance in the performance of standardized ADL, in that damage to these areas was related to lower performance than predicted by the regression model only. Conclusion: Our data show a decisive role of anosognosia for visuospatial deficits for impaired ADL and therefore outcome/disability after stroke. The findings further demonstrate that the severity of neglect and extinction also predicts ADL performance. Our results thus strongly suggest that right-hemispheric stroke patients should not only be routinely assessed for neglect and extinction but also for anosognosia to initiate appropriate rehabilitative treatment. The observation that right frontal lesions explain additional variance in ADL most likely reflects that dysfunction of the supervisory system also significantly impacts upon rehabilitation. © 2012 Elsevier Ltd.


Posenau A.,University of Applied Health Sciences at Bochum-Hordel | Peters T.,Ruhr University Bochum
GMS Zeitschrift fur Medizinische Ausbildung | Year: 2016

Aim: Interprofessional education (IPE) istakingon increasing importance in our complex healthcare system and receiving ever greater attention in the teaching of health science. The majority of concepts and methods employed in this area are based on normative ideas about interprofessional cooperation and only seldom based on empirical research. This paper is an initial attempt to augment this deductive approach with an inductive perspective for the purpose of subsequently providing empirical support for IPE teaching methods. Method: Drawingon the qualitative approach to linguistic conversation analysis, language-based professional markers are identified on the basis of recorded classroom simulations with nursing and midwifery students; it is assumed that these markers are significant in relevant interprofessional communication processes and, as a result, influence actual collaboration between the health professions. These markers are classified and commented on, and their importance to teaching and practical implementation in interprofessional interaction is emphasized. Results: Students routinely use various professional markers in simulations. However, these occur much less frequently than initially expected, except when marking difference in relation to physicians. At the same time, all the interactions are shaped by pronounced self-presentation among the students, and this comprises a large aspect of the interactions observed here. Profession-specific communication and differentiation processes also appear to be slow in estab ishing themselves in terms of students delegatingtasks or voicing expectations. In addition, the role of “student” has a function that should not be underestimated in these interactions. Conclusion: Professional markers are an essential component of interprofessional communication and are based on numerous, observable linguistic phenomena, of which only a few are presented here. This empirical approach has not yet appeared in the discourse surrounding IPE; however, it is, in the authors’opinion, not only necessary to compare interprofessional interactions with lived reality, but also to be in a position to operationalize interprofessional practice and ultimately assign it to competency areas. For this reason, further empirical observations and analyses are needed to tighten the still unclear definition of interprofessional communication and to develop empirically founded, measurable criteria for teachingand testing. © 2016 Posenau et al.


Blattner B.,University of Applied Health Sciences at Bochum-Hordel
Public Health Forum | Year: 2012

Since its foundation, one aim of the teaching commission of the German association of public health is to ensure that all study programmes in Public Health offered in Germany are of comparable level and meet international standards. The criteria for comparison have changed in course of the Bologna process: Instead of the course content, the competencies that graduates have acquired when they enter the labour market are now relevant.


Brzank P.,University of Applied Health Sciences at Bochum-Hordel | Blattner B.,University of Applied Health Sciences at Bochum-Hordel
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2010

Domestic violence and partner violence against women is a serious problem in many countries, including Germany. This type of violence has far-reaching social, economic, and health consequences for victims. The health sector can play a decisive role within intervention and prevention, if healthcare providers discover at an early stage that violence is the cause for injuries and disorders. Screenings can identify victims of domestic and partner violence. In several other countries, recommendations or agreements about screening for domestic and partner violence in the health sector are already in place. In Germany, however, the discussion about this kind of screening is just beginning. This article introduces the debate by referring to a Health Technology Assessment from the UK and giving an overview. The present findings also justify screening for partner violence against women in Germany. However, further research on the screening instruments used with women as well as other victims, such as men or elderly, is recommended. © Springer-Verlag 2010.


Gress S.,University of Applied Health Sciences at Bochum-Hordel
Public Health Forum | Year: 2015

From a health economics perspective, managed competition is important in improving the health of the population. However, the success of managed competition has been limited so far. Moreover, health insurers have few incentives to provide long-term effective prevention and health promotion. Instead, they prefer to provide services which are effective as a marketing tool in the short term. © 2015 by De Gruyter.


Bilda K.,University of Applied Health Sciences at Bochum-Hordel
Aphasiology | Year: 2011

Background: Chronic aphasia is a lifelong handicap that often leads to social isolation, loss of autonomy, and restricted social activities. Hence it is essential to develop cost-effective therapeutic approaches that enable people with aphasia to practise language skills in reallife contexts. Over the last several years there has been a shift from impairment-oriented language therapy to functional approaches that train language skills in more realistic contexts. Studies performed in the cognitive neurosciences have produced evidence that massed practice and forced use are essential for achieving sustained learning success in patients with aphasia. Conversational script training is based on the theory that massed practice of a whole task is likely to result in automatic and effortless language output that may facilitate participation in everyday life activities. To enhance automatisation of script use cue-based massed drilling is required. Computers are an ideal and cost-effective medium for the implementation of this massed practice and drill. Several studies have documented the positive effects of computer treatment for people grappling with the effects of long-lasting aphasia. Aims: The study involved the development of a video-based script training programme. The objective was to show the positive effects and usefulness of the programme. Methods & Procedures: The study is a case series consisting of a pre-test, 10 days of computer-based therapy with 3 hours of daily training, and two follow-up evaluations at 4 weeks and 6 months respectively. The material included 50 conversational scripts that were presented in video scenes filmed at original locations. The baseline and posttreatment scripts were audio taped, transcribed, and compared with the target scripts on the point scale of the subtest "classification of sentences" of the Aachener Aphasia Test (AAT). Additionally, language skills were tested with the AAT and various questionnaires were filled out together with the participants and their partners to evaluate the effects of the training in the patients' everyday lives. Five participants with chronic aphasia took part in the study. All were German speakers aged 45 and upwards. They exhibited a variety of types and degrees of severity of aphasia. Word-finding difficulties accounted for a significant part of their aphasia. Outcomes & Results: The quality and quantity of production of script-related words improved in every patient. Three positive themes were identified from the questionnaires and interviews: increased verbal communication skills, improvement in communication skills evident in various everyday situations, and increased confidence. Conclusions: Video-based script training was found to be an effective treatment for chronic aphasia. © 2010 Psychology Press.


Luomajoki H.,University of Applied Health Sciences at Bochum-Hordel | Saner J.,University of Applied Health Sciences at Bochum-Hordel
Manuelle Medizin | Year: 2012

Low back pain (LBP) is in most cases non-specific, meaning that there is no clear medical cause for the problem. Subgrouping of these patients has been declared as one of main research areas of LBP. One possible subgroup of LBP is movement control dysfunction which means that patients cannot actively control movements of the lower back. A test battery consisting of six movement control tests was created to examine this dysfunction and was found to be reliable. The test battery can discriminate between patients with LBP and healthy controls. It was also shown that patients with movement control deficits have a distorted body image which can be measured with two-point discrimination tests. In a case series study (n = 38) patients with movement control dysfunction could be extensively improved in their disability, pain and function. However, as there was no control group in the study no causal conclusions can be drawn. © 2012 Springer-Verlag Berlin Heidelberg.

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