Henna Riemenschneider

Enhancing the Effectiveness of Diabetes Self-Management Education: The Diabetes Literacy Project

Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes. Although national programs exist, there is no EU-wide strategy for diabetes self-management education, and patients with limited literacy face barriers to effective self-management. The Diabetes Literacy project, initiated with the support of the European Commission, aims to fill this gap. The project investigates the effectiveness of diabetes self-management education, targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States, as part of a comprehensive EU-wide diabetes strategy. National diabetes strategies in the EU, US, Taiwan, and Israel are compared, and diabetes self-management programs inventorized. The costs of the diabetes care pathway are assessed on a per person basis at national level. A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support, and the moderating role of health literacy, organization of the health services, and implementation fidelity of education programs are considered. Web-based materials are developed and evaluated by randomized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy. The 3-year project started in December 2012. Several literature reviews have been produced and protocol development and research design are in the final stages. Primary and secondary data collection and analysis take place in 2014. The results will inform policy decisions on improving the prevention, treatment, and care for persons with diabetes across literacy levels.

Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels!

Over the past decades, we have observed an increase of prevalence of diabetes in many countries along with significant differences in prevalence trends between countries worldwide (1). In Europe and other Western countries, the prevalence rate reaches a plateau or has slowed down on the level of ∼8–10%. In Asia, a continuous rise in prevalence has been monitored, similar to that in Africa, and an explosion of diabetes prevalence can be observed in the Arabic region. Surprisingly, in each of the countries, there is a significant number of people who do not develop diabetes during their lives despite living unhealthy lifestyles in similar environments—in Europe, an estimated 10% of the population (2). These people might be the secret answer to successful individual diabetes prevention, but we still do not understand the detailed mechanisms of why some people develop diabetes—and why others do not. What we can do is observe individual lifestyle and environment as determinants for the development or prevention of diabetes and the respective risk factors including genetic susceptibility. The interplay between these determinants, influencing the probability of the individual staying healthy or how a person learns or chooses a healthy lifestyle, will define success in diabetes prevention (3). Innovative actions are needed to slow down the progression of type 2 diabetes. The purpose of this article is to offer innovative policy and environmental strategic activities designed to enable sustainable diabetes prevention with scalability on national level. ### Why Do We Need Environmental and Policy Changes in Diabetes Prevention? Diabetes prevention is a success story, but it generates new challenges. Throughout the past 15 years, a number of randomized controlled trials have sought to test various interventions to prevent diabetes (4). The results are overwhelmingly positive on an individual level, with a significant relative diabetes risk reduction attributed to lifestyle and pharmacological intervention (5 …

Current vaccination status regarding measles among university students in Dresden, Germany.

Germany aimed to eliminate measles by 2015, but vaccination coverage is still insufficient, especially in respect to adolescents and young adults. A cross-sectional survey with 711 students studying a range of subjects showed a high acceptance regarding vaccination. Actual self-reported vaccination rates were lower; only 65.5% of medical students and 25.3%-39.4% of other student groups reported complete vaccination against measles. Of the students, 12.6%-45% did not know their vaccination status. Vaccination acceptance did not correlate with vaccination behavior: accessible vaccination opportunities at universities should be offered.

Comparative analysis of diabetes self-management education programs in the European Union Member States

Diabetes self-management education (DSME) is generally considered as an integral part of diabetes care. The availability of different types of self-management in the European Union Member States (EUMS) remains uncertain. The aim of this study is to perform a comparative analysis of existing DSME programs (DSMEP) implemented in EUMS. Unpublished data regarding DSME in the EUMS was assessed with Diabetes Literacy Survey using wiki tool (WT) targeting patients and different stakeholders. An additional literature review (LR) was performed in PubMed to identify published studies regarding DSMEP in the EUMS from 2004 to 2014. A total of 102 DSMEP implemented in EUMS were reported in the WT and 154 programs were identified from the LR. Comparative analysis of the data indicated that a majority of programs are aimed at adults and only a minority at children and elderly. Only a small percentage of the programs utilize information technology for teaching and learning, and only one out of five programs pay attention to depression. The identified DSMEP aimed primarily to empower patients through increasing knowledge and changing attitudes and beliefs towards diabetes. This study provides an overview of the present state-of-the-art on diabetes self-management education programs in the 28 EUMS. To increase participation, existing DSMEP should be made more accessible to the patients as well as tailored to specific patient groups.

Facharztpräferenzen von Medizinstudierenden im Kontrast zum Bedarf an Allgemeinmedizinern in Sachsen

Aim of the study: Especially in the rural areas of Germany, there are not enough general practitioners (GPs) for primary care. Preferred medical specialties of medical students can help get an estimate of the number of future GPs. This study compares this estimate to the current need for GPs in Saxony. Methods: 587 medical students at the second, sixth and tenth semester were invited to take part in an anonymous cross-sectional study regarding their specialty preferences at the Technical University Dresden. Based on the data of the medical requirements for Saxony, 4 model calculations were generated for comparison of the estimated numbers of future GPs and the current need for GPs. Results: The most commonly preferred medical specialties were surgery (19.1%), internal medicine (12.9%), pediatrics (11.6%) and general practice (9.9%). A significant increase in specialist preference for GP was observed from the sixth (4.9%) to the tenth semester (14.0%). The model calculations show that approximately 29% to 111% of the open positions for GPs could be filled by the potential new GPs from Dresden. Conclusion: Currently, medical students planning to become GPs cannot meet the corresponding need for GPs. Future studies should include the points of view of students, continuing education assistants, GPs and patients.

Factors influencing sleep quality among nursing staff: Results of a cross sectional study

PURPOSE Given the intense physical and mental demands placed on nurses and other caregivers, getting sufficient sleep is essential to maintaining both individual health and professional performance. The goal of our study is to describe and analyze the self-reported sleep quality of nursing staff and identify which factors have an influence on it. METHODS The sample was comprised of 153 female nurses over the age of 20 years who completed written surveys regarding their health status and health behavior. Their responses were subjected to ANOVA analysis with post hoc follow-up tests and logit regression was used. RESULTS 33% of female nursing staff reported poor quality sleep. Lower quality of life, tachycardia and unequal distribution of work load were most strongly associated with poor sleep quality. CONCLUSION Our study indicates that reducing workplace stress is a good place to start in developing a proactive strategy. A comprehensive prevention strategy should include both behavioral and situational prevention elements. Future studies should focus on identifying causal factors and developing prevention strategies.

State of diabetes self-management education in the European Union Member States and non-EU countries. The Diabetes Literacy project.

Background Diabetes self-management education (DSME) is considered essential for improving the prevention and care of diabetes through empowering patients to increase agency in their own health and care processes. However, existing evidence regarding DSME in the EU Member States (EU MS) is insufficient to develop an EU-wide strategy. Objectives This study presents the state of DSME in the 28 EU MS and contrasts it with 3 non-EU countries with comparable Human Development Index score: Israel, Taiwan, and the USA (ITU). Because type 2 diabetes mellitus (T2DM) disproportionately affects minority and low-income groups, we paid particular attention to health literacy aspects of DSME for vulnerable populations. Methods Data from multiple stakeholders involved in diabetes care were collected from Feb 2014 to Jan 2015 using an online Diabetes Literacy Survey (DLS). Of the 379 respondents (249 from EU MS and 130 from ITU), most were people with diabetes (33% in the EU MS, 15% in ITU) and care providers (47% and 72%). These data were supplemented by an expert survey (ES) administered to 30 key informants. Results Access to DSME varies greatly in the EU MS: an average of 29% (range 21% to 50%) of respondents report DSME programs are tailored for people with limited literacy, educational attainment, and language skills versus 63% in ITU. More than half of adult T2DM patients and children/adolescents participate in DSME in EU MS; in ITU, participation of T1DM patients and older people is lower. Prioritization of DSME (6.1 ± 2.8 out of 10) and the level of satisfaction with the current state of DSME (5.0 ± 2.4 out of 10) in the EU MS were comparable with ITU. Conclusion Variation in availability and organization of DSME in the EU MS presents a clear rationale for developing an EU-wide diabetes strategy to improve treatment and care for people with diabetes.

Health related quality of life in male patients with osteoporosis: results of a cross sectional study

Introduction: Osteoporosis is one of the most common diseases affecting elderly persons. Male patients with osteoporosis have rarely been the focus of earlier studies. This study explores health related quality of life (HRQoL) indicators in a sample of German male patients with osteoporosis to determine potential avenues for clinical practice changes. Methods: This cross-sectional study describes two HRQoL indicators (EQ5D and QUALEFFO-41) in a sample of male patients being treated for osteoporosis. Questionnaires were sent to all male patients being treated at the Dresden University Hospital outpatient endocrine clinic. Of the 344 patients invited to participate in the study 155 (57.2%) were included. Results: Overall HRQoL EQ-5D-scores for male patients with osteoporosis were greater than those of comparable groups of the German population. Patients with ≥2 fractures had the highest level of impairment in HRQoL. Of all the dimensions of EQ-5D-scores, pain/discomfort was the most affected. Better HRQoL (median values <10.0/QUALEFFO-41 scores) were detected in the whole sample for jobs around the house, activities of daily living and mobility compared to other dimensions. The highest levels of impairment were observed in the QUALEFFO-41 domains of general health perception, mental function and pain. Conclusion: This analysis confirms the association between number of fractures and worse estimation of HRQoL in male patients. Because men are 3 times less likely to suffer from osteoporosis than women, the specific HRQoL characteristics of male patients with this disease can often be overlooked. Clinicians should consider mental health referral especially for osteoporotic male patients having experienced ≥2 fractures.

Impfstatus bei Pflegepersonal

Background: Health care workers can be multiplicators for infectious diseases due to their patient contacts. Vaccinations are not mandatory in Germany but there are recommendations for people at higher risk such as health care workers. There is no representative data regarding vaccination status of health care workers in Germany. Aim: We examined vaccination status among nurses regarding diphtheria, tetanus, pertussis, poliomyelitis, hepatitis A (HA) and hepatitis B (HB) as well as correlations between age, professional years, vaccination status and acceptance. Methods: An anonymous cross sectional survey concerning health burden and health behavior including vaccination was conducted among health care workers. Statistical analysis using SPSS included descriptive analysis, subgroup specific differences of distribution were tested by chi2-tests. Results: Regardless of age or professional years, 99 % of the nurses evaluated that vaccinations are at least “partly necessary”. Sufficient vaccination status was reported more often concerning tetanus (82 %) and HB (70 %) but less often regarding diphtheria (52 %), poliomyelitis (49 %), HA (43 %) and pertussis (42 %). With respect to some vaccinations, proportion of nurses not knowing their vaccination status was higher than 20 %. Conclusions: Despite the high vaccination acceptance, vaccination status among participating nurses was not sufficient. Implementation of vaccination measures targeting health care workers should be strengthened to reach higher vaccination coverages to prevent vaccination preventable infectious diseases among health care workers and patients in hospitals.