Türkische Übersetzung und erste psychometrische Überprüfung der deutschsprachigen FAMOS (Fragebogen zur Analyse Motivationaler Schemata) und INK (Inkongruenzfragebogen)

Theoretischer Hintergrund: Standardisierte psychologische Messinstrumente in der Psychotherapie für Personen mit Migrationshintergrund fehlen weitgehend. Fragestellungen: Die türkischsprachigen Übersetzungen des Fragebogens zur Analyse Motivationaler Schemata (FAMOS) und des Inkongruenzfragebogens (INK) wurden in die türkische Sprache übersetzt und psychometrisch überprüft. Methode: Insgesamt füllten 73 türkischsprachige Patienten und 230 gesunde türkischsprachige Personen mit Migrationshintergrund in der Schweiz FAMOS und INK aus. Ergebnisse: Die Skalen von FAMOS und INK zeigen gute Reliabilität und Validität. Patienten weisen stärker ausgeprägte Vermeidungsziele und Inkongruenzwerte als gesunde Personen auf. Schlussfolgerungen: Die türkischen Versionen von FAMOS und INK eignen sich sowohl für die klinisch-psychologische Forschung als auch für die Praxis.

The Active Subjects of Welfare Reform: a Street-Level Comparison of Employment Services in Australia and Denmark

This paper explores the similarities and differences between Denmark and Australia in adopting welfare reform activation measures in the field of employment services. In Australia and Denmark the discourse of welfare reform centres the 'activation' of citizens through 'mutual obligation' type requirements. Through various forms of case management, unemployed individuals are encouraged to act upon themselves in creating the right set of ethical dispositions congruent with 'active citizenship'. At the same time any resistance to heightened conditionality on the part of the unemployed person is dealt with through a range of coercive and disciplinary techniques. A comparative case study between these two countries allows us to consider how similar ideas, discourse and principles are shaping policy implementation in countries that have very different welfare state trajectories and institutional arrangements for the delivery of social welfare generally and employment services specifically. And in research terms, a comparison between a Nordic welfare state and an Anglo-Saxon welfare state provides an opportunity to critically examine the utility of 'welfare regime' type analyses and the neo-liberal convergence thesis in comparative welfare research. On the basis of empirical analysis, the article concludes that a single focus on abstract typologies or political ideologies is not very helpful in getting the measure of welfare reform (or any other major policy development for that matter). At the 'street-level' of policy practice there is considerably more ambiguity, incoherence and contradiction than is suggested by linear accounts of welfare reform.

Mobile competence network for community health workers in rural Myanmar: a supportive information system that facilitates the improvement of health services.

The goal of this project is the development of international cooperation for fostering solutions to provide better access to basic healthcare services.

Effect of B-type Natriuretic Peptides on Long-Term Outcomes After Transcatheter Aortic Valve Implantation.

B-type natriuretic peptide (BNP) levels are elevated in patients with aortic stenosis (AS) and decrease acutely after replacement of the stenotic valve. The long-term prognostic value of BNP after transcatheter aortic valve implantation (TAVI) and the relative prognostic utility of single versus serial peri-interventional measurements of BNP and N-terminal prohormone BNP (NT-pro-BNP) are unknown. This study sought to determine the impact of BNP levels on long-term outcomes after TAVI and to compare the utility of BNP versus NT-pro-BNP measured before and after intervention. We analyzed 340 patients with severe AS and baseline pre-TAVI assessment of BNP. In 219 patients, BNP and NT-pro-BNP were measured serially before and after intervention. Clinical outcomes over 2 years were recorded. Patients with high baseline BNP (higher tertile ≥591 pg/ml) had increased risk of all-cause mortality (adjusted hazard ratio 3.16, 95% confidence interval 1.84 to 5.42; p <0.001) and cardiovascular death at 2 years (adjusted hazard ratio 3.37, 95% confidence interval 1.78 to 6.39; p <0.001). Outcomes were most unfavorable in patients with persistently high BNP before and after intervention. Comparing the 2 biomarkers, NT-pro-BNP levels measured after TAVI showed the highest prognostic discrimination for 2-year mortality (area under the curve 0.75; p <0.01). Baseline-to-discharge reduction, but not baseline levels of BNP, was related to New York Heart Association functional improvement. In conclusion, high preintervention BNP independently predicts 2-year outcomes after TAVI, particularly when elevated levels persist after the intervention. BNP and NT-pro-BNP and their serial periprocedural changes provide complementary prognostic information for symptomatic improvement and survival.

The Problem with Utility: Towards a Non-Consequentialist / Utility Theory Synthesis

I develop the argument that our current decision-making framework, utility theory, when used by itself, is 1) descriptively incomplete, 2) theoretically flawed, and 2) ethically questionable. In response, I offer an exploratory framework that incorporates both consequentialist and non-consequentialist motivations. Adding a commitment function provides a synthesis which remedies the problems associated with the sole use of utility theory. Finally, I show how philosophers Immanuel Kant, W.D. Ross, and Martin Buber provide an ethical basis for the framework.

From Theory to Practice: Improving the Impact of Health Services Research.

BACKGROUND: While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. DISCUSSION: Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. SUMMARY: Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care.

Inc. qu. 676 - Postilla super Psalterium et Cantica canticorum

Vorbesitzer: Martin Ott ; Dominikanerkloster Frankfurt am Main

Identifying characteristics of mentally ill homeless individuals who are successfully linked to health and social services post-incarceration via the jail inreach project

Healthcare for the Homeless—Houston (HHH) received a research grant from The Medallion Foundation, Inc. in March 2006 to pilot The Jail Inreach Project, an intensive “inreach” initiative to assess the impact of providing continuity of mental and primary health care services for homeless individuals who suffer from mental illness and/or substance abuse being released from jail. This pilot project was initiated by HHH, in collaboration with the Harris County Sheriff’s Office and the Mental Health Mental Retardation Authority of Harris County (MHMRA). Those who are flagged as “frequent flyers” and who are diagnosed with a mental illness are referred to the Jail Inreach Project. In order to maximize the effectiveness of the discharge plan, case managers offer the option of meeting the client at the time of release and bring them to the HHH clinic located four blocks from the jail. Participation in both the program and the option for direct release to the care of a case manager are voluntary.^ The purpose of this study is to determine the outcomes of the Jail Inreach Project and addresses the following objectives: (1) to evaluate the characteristics of inmates that chose to be released from jail to the direct care of an HHH case manager versus those who opt for self release and (2) to determine the number and percent of inmates that are linked to services and relationship with type of release (direct versus indirect), (3) to determine if there is a relationship between outcomes and characteristics and (4) to determine what outcomes are a function of release, controlling for characteristics. Statistical analysis, including frequencies, cross tabulations, chi-square and logistical regression, found that those who opt for self release are six times less likely to be successfully linked to services and that gender is the most significant predictor of choosing self release. Men are far more likely to opt for self release than women engaged in this program. These findings help inform policy and program design and development that addresses the difference in service utilization and successful linkage to services post-incarceration. Successful linkage to services, thus continuity of and access to care, further impact the effects of the revolving door phenomenon of mentally ill homeless individuals cycling between the streets, jails and hospital emergency centers.^

Ethnographic and epidemiologic approaches for the programming of prenatal and birth services in Mesa los Hornos, Mexico

The investigator conducted an action-oriented investigation of pregnancy and birth among the women of Mesa los Hornos, an urban squatter slum in Mexico City. Three aims guided the project: (1) To obtain information for improving prenatal and maternity service utilization; (2) To examine the utility of rapid ethnographic and epidemiologic assessment methodologies; (3) To cultivate community involvement in health development.^ Viewing service utilization as a culturally-bound decision, the study included a qualitative phase to explore women's cognition of pregnancy and birth, their perceived needs during pregnancy, and their criteria of service acceptability. A probability-based community survey delineated parameters of service utilization and pregnancy health events, and probed reasons for decisions to use medical services, lay midwives, or other sources of prenatal and labor and delivery assistance. Qualitative survey of service providers at relevant clinics, hospitals, and practices contributed information on service availability and access, and on coordination among private, social security, and public assistance health service sectors. The ethnographic approach to exploring the rationale for use or non-use of services provided a necessary complement to conventional barrier-based assessment, to inform planning of culturally appropriate interventions.^ Information collection and interpretation was conducted under the aegis of an advisory committee of community residents and service agency representatives; the residents' committee formulated recommendations for action based on findings, and forwarded the mandate to governmental social and urban development offices. Recommendations were designed to inform and develop community participation in health care decision-making.^ Rapid research methods are powerful tools for achieving community-based empowerment toward investigation and resolution of local health problems. But while ethnography works well in synergy with quantitative assessment approaches to strengthen the validity and richness of short-term field work, the author strongly urges caution in application of Rapid Ethnographic Assessments. An ethnographic sensibility is essential to the research enterprise for the development of an active and cooperative community base, the design and use of quantitative instruments, the appropriate use of qualitative techniques, and the interpretation of culturally-oriented information. However, prescribed and standardized Rapid Ethnographic Assessment techniques are counter-productive if used as research short-cuts before locale- and subject-specific cultural understanding is achieved. ^