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Search Results: 1 - 10 of 151862 matches for " Claudia Küver "
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Strategies for Improving Participation in Diabetes Education. A Qualitative Study
Ingmar Sch?fer, Marc Pawels, Claudia Küver, Nadine Janis Pohontsch, Martin Scherer, Hendrik van den Bussche, Hanna Kaduszkiewicz
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095035
Abstract: Objective Diabetes mellitus is highly prevalent and can lead to serious complications and mortality. Patient education can help to avoid negative outcomes, but up to half of the patients do not participate. The aim of this study was to analyze patients' attitudes towards diabetes education in order to identify barriers to participation and develop strategies for better patient education. Methods We conducted a qualitative study. Seven GP practices were purposively selected based on socio-demographic data of city districts in Hamburg, Germany. Study participants were selected by their GPs in order to increase participation. Semi-structured face-to-face interviews were conducted with 14 patients. Interviews were audiotaped and transcribed verbatim. The sample size was determined by data saturation. Data were analysed by qualitative content analysis. Categories were determined deductively and inductively. Results The interviews yielded four types of barriers: 1) Statements and behaviour of the attending physician influence the patients' decisions about diabetes education. 2) Both, a good state of health related to diabetes and physical/psychosocial comorbidity can be reasons for non-participation. 3) Manifold motivational factors were discussed. They ranged from giving low priority to diabetes to avoidance of implications of diabetes education as being confronted with illness narratives of others. 4) Barriers also include aspects of the patients' knowledge and activity. Conclusions First, physicians should encourage patients to participate in diabetes education and argue that they can profit even if actual treatment and examination results are promising. Second, patients with other priorities, psychic comorbidity or functional limitations might profit more from continuous individualized education adapted to their specific situation instead of group education. Third, it might be justified that patients do not participate in diabetes education if they have slightly increased blood sugar values only and no risk for harmful consequences or if they already have sufficient knowledge on diabetes.
The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient's experiences
Ingmar Sch?fer, Claudia Küver, Benjamin Gedrose, Falk Hoffmann, Barbara Ru?-Thiel, Hans-Peter Brose, Hendrik van den Bussche, Hanna Kaduszkiewicz
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-55
Abstract: Cohort study with a baseline interview and a follow-up after 10.4 ± 0.64 months. Data on process and outcome measures were collected by telephone interviews with 444 patients enrolled and 494 patients not enrolled in the German DMP for type 2 diabetes. Data were analyzed by multivariate logistic regression analyses.DMP enrolment was significantly associated with a higher process quality of care. At baseline enrolled patients more often reported that they had attended a diabetes education course (OR = 3.4), have ≥ 4 contacts/year with the attending physician (OR = 3.3), have at least one annual foot examination (OR = 3.1) and one referral to an ophthalmologist (OR = 3.4) and possess a diabetes passport (OR = 2.4). Except for the annual referral to an ophthalmologist these parameters were also statistically significant at follow-up. In contrast, no differences between enrolled and not enrolled patients were found concerning outcome quality indicators, e.g. self-rated health, Glycated hemoglobin (GHb) and blood pressure. However, 16-36% of the DMP participants reported improvements of body weight and/or GHb and/or blood pressure values due to enrolment - unchanged within one year of follow-up.In the light of patient's experiences the DMP enhances the process quality of medical care for type 2 diabetes in Germany. The lack of significant differences in outcome quality between enrolled and not enrolled patients might be due to the short program duration. Our data suggest that the DMP for type 2 diabetes should not be withdrawn unless an evidently more promising approach is found.Health care improvement for patients with type 2 diabetes is an important target of health care policy in Germany. In summer 2003 a disease management program (DMP) for type 2 diabetes was introduced on a nationwide basis within the statutory health insurance, which covers 86% of the German population. Participation in the DMP is voluntary for physicians and patients and connected with financial
Selection effects may account for better outcomes of the German Disease Management Program for type 2 diabetes
Ingmar Sch?fer, Claudia Küver, Benjamin Gedrose, Eike-Christin von Leitner, András Treszl, Karl Wegscheider, Hendrik van den Bussche, Hanna Kaduszkiewicz
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-351
Abstract: Case control study comparing DMP patients with usual-care patients at baseline and follow up; mean follow-up period of 36 ± 14 months. We used chart review data from 51 GP surgeries. Participants were 586 DMP and 250 usual-care patients with type 2 diabetes randomly selected by chart registry. Data were analysed by multivariate logistic and linear regression analyses. Significance levels were p ≤ 0.05.There was a better chance for enrolment if patients a) had a lower risk status for diabetes complications, i.e. non-smoking (odds ratio of 1.97, 95% confidence interval of 1.11 to 3.48) and lower systolic blood pressure (1.79 for 120 mmHg vs. 160 mmHg, 1.15 to 2.81); b) had higher activity rates, i.e. were practicing blood glucose self-monitoring (1.67, 1.03 to 2.76) and had been prescribed a diabetes patient education before enrolment (2.32, 1.29 to 4.19) c) were treated with oral medication (2.17, 1.35 to 3.49) and d) had a higher GP-rated motivation for diabetes education (4.55 for high motivation vs. low motivation, 2.21 to 9.36).At baseline, future DMP patients had a lower risk for diabetes complications, were treated more intensively and were more active and motivated in managing their disease than usual-care patients. This finding a) points to the problem that the German DMP may not reach the higher risk patients and b) selection bias may impair the assessment of differences in outcome quality between enrolled and usual-care patients. Suggestions for dealing with this bias in evaluation studies are being made.Sufficient evaluation is a precondition for deciding whether the implementation of any new health care policy was successful. Policy makers depend on this scientific evidence, but their decisions sometimes restrain researchers from generating evidence in a valid way. This is the case with the nationwide disease management program (DMP) for type 2 diabetes, which was introduced in Germany in 2003.The DMP was started in a rush with no preceding randomized con
Los nuevos saberes para la inserción laboral: formación para el trabajo con jóvenes vulnerables en Argentina
Jacinto, Claudia;Millenaar, Verónica;
Revista mexicana de investigación educativa , 2012,
Abstract: in a context of transformations in the socio-employment world, this article examines change with respect to the knowledge of work that is involved in young people's initial employment transitions. the article is based on a qualitative study of two vocational training centers in argentina. the question is aimed at determining the existence of a common core of required knowledge for obtaining work in the formal as well as informal spheres of employment. the results show the ways the two vocational training centers support young people in developing skills to manage their own strategies. both centers express, during the teaching process, a common core of knowledge that is implicit in transition processes. yet on educating young people with different profiles, for different segments of the labor market, the vocational training centers' objectives and estimations of required knowledge also differ.
Ultima Década , 2009,
Abstract: Los problemas de empleo y de desafiliación de los jóvenes se han tornado en un verdadero desafío para las políticas públicas y acciones de la sociedad civil. Desde hace tiempo, se implementan programas y estrategias diversas que, en gran medida, comparten un diagnóstico inespecífico sobre el trasfondo de los problemas en el mercado de trabajo y los llamados "déficits" de formación. Estos enfoques resultan limitados frente a la compleja trama de dimensiones estructurales, institucionales, familiares, individuales y subjetivas que colocan a los jóvenes, en particular a los más pobres, en situación de desventaja. El presente artículo se plantea discutir en particular uno de estos aspectos: el nivel institucional; para reflexionar sobre las formas en que las instituciones intentan intervenir en la transición juvenil, frente a los procesos de individualización y de debilitamiento institucional. De este modo, se han seleccionado dos casos de organizaciones en Argentina que se proponen generar un fuerte impacto sobre las subjetividades de los jóvenes, a través de abordajes que toman en cuenta las "constelaciones de desventajas" juveniles, de un modo amplio. Este análisis de dos instituciones que dan lugar preferencial a los abordajes subjetivos, abre la reflexón acerca de las posibilidades institucionales de proveer nuevos soportes colectivos y contribuir a la individualización de los sujetos y al desarrollo de sus propias estrategias.
Pertenencia cultural y corporativa en el curso de biografías transnacionales: un estudio de caso de un inmigrante de Sierra Leona en Alemania Kulturelle und gemeinschaftliche Zugeh rigkeit im Verlauf transnationaler Biografien: Fallstudie eines sierra-leonischen Immigranten in Deutschland Cultural and Corporate Belonging in the Course of Transnational Biographies: A Case Study of a Sierra Leonean Immigrant in Germany
Jan Küver
Forum : Qualitative Social Research , 2009,
Abstract: Cómo emerge la afiliación cultural y corporativa en las biografías transnacionales? Cómo se desarrolla bajo la influencia de estructuras de poder nacionales y globales? Estas cuestiones se abordan en este estudio, que combina enfoques epistemológicos relacionados con el interjuego de factores sociales e individuales en la formación de la identidad con un análisis estructural de las relaciones de poder históricas en la forma de racismo y colonialismo. Empíricamente, este artículo identifica como los inmigrantes tratan con los desafíos de la integración en la sociedad anfitriona e incorporan esas experiencias a su construcción biográfica personal. El trabajo se concentra en inmigrantes africanos, particularmente de Sierra Leona, en Alemania. Las conclusiones se elaboran desde un análisis reconstructivo de narraciones biográficas seleccionadas, las cuales fueron analizadas en detalle desde diferentes perspectivas. URN: urn:nbn:de:0114-fqs0903234 Die zentrale Fragestellung dieser Studie ist, wie sich gesellschaftliche und kulturelle Zugeh rigkeit in transnationalen Lebensl ufen herausbilden und wie sie sich unter dem Einfluss von globalen und nationalen Machtstrukturen entwickeln. Zur Beantwortung dieser Fragen werden erkenntnistheoretische Ans tze zum Zusammenspiel von gesellschaftlichen Zuschreibungen und individuellen Identit tskonstruktionen mit Strukturanalysen gesellschaftlicher Machtverh ltnisse in Form von Rassismus und Kolonialismus verbunden. Die Arbeit zeigt auf, wie Migrant/innen die Probleme und Herausforderungen der Integration in verschiedenen Gesellschaften und sozio-kulturellen Bezugssystemen l sen und in ihre biografischen Selbstkonstruktionen einflie en lassen. Dabei konzentriert sie sich auf afrikanische, speziell sierra-leonische Migrant/innen in Deutschland. URN: urn:nbn:de:0114-fqs0903234 How does cultural and corporate affiliation emerge in transnational biographies? How does it develop under the influence of global and national power structures? These questions are addressed in this study that combines epistemological approaches dealing with the interplay of social and individual factors in identity formation with a structural analysis of historical power relations in form of racism and colonialism. Empirically this paper identifies how immigrants deal with challenges of integration into the host society and incorporate these experiences into their biographical self-construction. It concentrates on African and particularly Sierra Leonean immigrants in Germany. The findings are generated from a reconstructive analysis of selected b
A gyógyítás szolgálatában a Barcaságtól Frankóniáig. Paul Francisci orvosi k nyvtárának jegyzéke a 18. század elejér l Service for the healingfrom Barca till Franc. The list of. Paul Francisci’s medical library at the 18 beginning of the century
Verók Attila, Dr.
Kaleidoscope History , 2012,
Identificación de indicadores de conservación para la reserva nacional de Junín, Perú
Claudia Caro,Zulema Quinteros,Verónika Mendoza
Ecología Aplicada , 2007,
Abstract: La Reserva Nacional de Junín (RN Junín), considerada como Humedal de Importancia Internacional, especialmente como Hábitat de Aves Acuáticas (Sitio RAMSAR), viene atravesando por una serie de problemas que están causando malestar entre los habitantes de la zona. Teniendo en cuenta este aspecto y en respuesta a las necesidades de información que ayuden a los tomadores de decisiones a cumplir con los objetivos de creación de la Reserva, se identificó un juego de 24 indicadores para monitorear los procesos de conservación que se lleven a cabo en este lugar. Los indicadores fueron elegidos tomando en cuenta las metas y objetivos socialmente determinados y las características que presenta el ecosistema, con la finalidad de evaluar el estado, presión, impacto y respuesta de las actividades humanas sobre los recursos y servicios más importantes de esta área Natural Protegida. A través de este trabajo se pretende dar a conocer una metodología que permita un efectivo acercamiento de la sociedad a los procesos de monitoreo, en el marco del manejo adaptativo de ecosistemas, resaltando los valores sociales sin dejar de lado el rigor científico de los parámetros ambientales
Claudia Verónica Carranza-Vera
Ra Ximhai , 2011,
Abstract: A summer day at six in the morning, appeared in the sky Dola a lot of birds, so many and so different that people flabbergasted. Moreover after a time the birds are organized and start a bloody battle, similar to that which would arise between two human armies. In conclusion, only a few birds fly off, and the battlefield is strewn with bodies of birds of different species, some of them with great features. Excess bodies causes diseases among the inhabitants of Dola, who can not keep up to collect them. The bottom line is to be seen in this war a divine warning to both Burgundian County sinners to humanity.
Cortical Plasticity as a Mechanism for Storing Bayesian Priors in Sensory Perception
Hania Kver,Shaowen Bao
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0010497
Abstract: Human perception of ambiguous sensory signals is biased by prior experiences. It is not known how such prior information is encoded, retrieved and combined with sensory information by neurons. Previous authors have suggested dynamic encoding mechanisms for prior information, whereby top-down modulation of firing patterns on a trial-by-trial basis creates short-term representations of priors. Although such a mechanism may well account for perceptual bias arising in the short-term, it does not account for the often irreversible and robust changes in perception that result from long-term, developmental experience. Based on the finding that more frequently experienced stimuli gain greater representations in sensory cortices during development, we reasoned that prior information could be stored in the size of cortical sensory representations. For the case of auditory perception, we use a computational model to show that prior information about sound frequency distributions may be stored in the size of primary auditory cortex frequency representations, read-out by elevated baseline activity in all neurons and combined with sensory-evoked activity to generate a percept that conforms to Bayesian integration theory. Our results suggest an alternative neural mechanism for experience-induced long-term perceptual bias in the context of auditory perception. They make the testable prediction that the extent of such perceptual prior bias is modulated by both the degree of cortical reorganization and the magnitude of spontaneous activity in primary auditory cortex. Given that cortical over-representation of frequently experienced stimuli, as well as perceptual bias towards such stimuli is a common phenomenon across sensory modalities, our model may generalize to sensory perception, rather than being specific to auditory perception.
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