Low-threshold Services Research Articles

Voluntary work: an appropriate approach to improve the practical response and care of older victims of domestic violence?

Up until now, in the Federal Republic of Germany, little attention has been paid to domestic violence experienced in the partnerships of senior citizens, both in the public eye, in terms of state action, as well as in specialised psychosocial services. The elderly women and men in question form a heterogeneous group, who have until now, found it difficult to access existing intervention and support systems, or are barely accommodated by them. Current research findings and action programmes pinpoint the need for low-threshold support services. The research project has been examining the question of whether volunteer guides in the senior/health/integration area can reach this target group more effectively, and make it easier for those affected to access the help system in a low-threshold aid setting. Based on insights gleaned from 17 qualitative expert interviews and three focus group discussions with volunteer guides and in cooperation with three local partners, training has been developed that should provide the guides with knowledge of domestic violence and information about the support system. While the guides are showing great interest in tackling the problem, the assessments of the professionals range from approval, scepticism and reservations to rejection.

Pertussis vaccination status and vaccine acceptance among medical students: multicenter study in Germany and Hungary

BackgroundMedical students are at risk of contracting and transmitting infectious diseases such as pertussis. Complete vaccination status is important to protect own, patient and public health. Knowing own vaccination status is elementary for following current vaccination recommendations, including boosters. We aimed to assess pertussis vaccination status and vaccination acceptance among medical students of different nationalities.MethodsA cross-sectional multicenter health survey at German and Hungarian universities enclosed international medical students in the 1st, 3rd and 5th year of study. Self-reported data from 2655 students regarding pertussis vaccination status were analyzed. Subgroup analysis enclosed data of German (n = 1217), Hungarian (n = 960) and other nationality (n = 478) students (“other”).ResultsMore Hungarians reported basic immunization (39.0% vs 15.8% Germans vs 24.3% others, p ≤ 0.05). Booster vaccination was reported more by Germans (60.5% vs 43.6% Hungarians vs 36.0% others, p ≤ 0.05). Germans were more likely to report being unvaccinated (3.7% vs 0.9% Hungarians, p ≤ 0.05). More medical students of other nationalities were unaware of their pertussis vaccination status (37.4% vs 20.0% Germans/ 16.5% Hungarians, p ≤ 0.05). 75.2% (n = 1931) rated pertussis vaccinations as absolutely necessary (86.2% Hungarians vs 69.8% Germans/ 66.1% others, p ≤ 0.05).ConclusionsPositive attitudes towards vaccinations were reported but a large group reported insufficient vaccination status and being not aware of their status, especially among international students. Hungarians possibly have a better vaccination status than reported, based on mandatory vaccinations in childhood. The low awareness of vaccination status has implications for future booster vaccinations. All students should be informed about current recommendations and receive vaccination offers in frames of low-threshold medical services.

Challenges, relationship and outcomes in low-threshold drug services

PurposeThis paper reports on the findings of an action research study that sought to explore the development and provision of community-based low-threshold services within a socially disadvantaged area. In the context of debates, in regard to both the nature and efficacy of low-threshold drugs services and increasingly neo-liberal policy approaches to drug service provision that prioritise outcomes and drug treatment interventions, the purpose of this paper is to report on practitioners’ understandings of challenges, relationship building and outcomes within community-based low-threshold service provision in Dublin, Ireland.Design/methodology/approachAn action research method of co-operative inquiry groups was utilised, with nine practitioners from one community-based drug agency participating in a series of four sessions over a three-month period.FindingsThree key themes emerged in relation to building and sustaining client–practitioner relationships: the mechanisms by which the practitioners engaged with their clients and sought to develop relationships; how safe spaces were created and maintained in order to address client needs; and practitioners’ understanding of challenges and outcomes in low-threshold intervention work.Originality/valueDrawing on a co-operative inquiry method, this paper concludes that practitioner attention to relational distance evidenced in community-based low-threshold service provision, may provide an alternative to episodic, outcome driven drug treatment and intervention.

Youngsters’ Perspectives on Continuity in Their Contacts with Youth-Care Services

AbstractContinuity is seen as an important aim for the quality of youth-care services. However, views on continuity are predominantly guided by experts, without much attention to user perspectives. This paper focuses on youngsters’ experienced continuity in relation to youth-care services. Twenty-five youngsters, who were in residential care or reached by low-threshold youth services, were interviewed about their experiences in and out of care. In thematically exploring the biographical narratives for important experiences of continuity, three major themes emerged: (i) the need for footholds in moments of existential chaos, (ii) the importance of timing of interventions to match the youngsters’ perspectives and (iii) the importance of the youngsters’ impact on their own care pathways. This study shows the need for support that is imbedded in a relational network within the context of youngsters in vulnerable situations. Rethinking youth services towards a better connection with these contexts is essential. Furthermore, the amount of control youngsters experience in their care interventions seems to be beneficial to the experience of continuity. It is argued that continuity should be seen as a process, in order to leave more space for negotiation and flexibility throughout the youngsters’ experiences in youth-care services.

Drug consumption rooms (DCRs) as a setting to address hepatitis C \u2013 findings from an international online survey

BackgroundPrevalence of Hepatitis C Virus (HCV) among people who inject drugs (PWID) is high. Risky injecting behaviours have been found to decrease in drug consumption rooms (DCRs) and supervised injecting facilities (SIFs), yet HCV prevention and treatment in these settings have not been extensively explored.MethodsTo determine the range and scope of HCV prevention and treatment options in these services, we assessed DCR/SIF operational features, their clients’ characteristics and the HCV-related services they provide. A comprehensive online survey was sent to the managers of the 91 DCRs/SIFs that were operating globally as of September 2016. A descriptive cross-country analysis of the main DCR/SIF characteristics was conducted and bivariate logistic models were used to assess factors associated with enhanced HCV service provision.ResultsForty-nine valid responses were retrieved from DCRs/SIFs in all countries where they were established at the time of the survey (Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland). Internationally, the operational capacities of DCRs/SIFs varied in terms of funding, location, size and staffing, but their clients all shared common features of vulnerability and marginalisation. Estimated HCV prevalence rates were around 60%. Among a range of health and social services and referrals to other programs, most DCRs/SIFs provided HCV testing onsite (65%) and/or offered liver monitoring or disease management (54%). HCV treatment onsite was offered or was planned to be offered by 21% of DCRs/SIFs. HCV testing onsite was associated with provision of other services addressing blood-borne diseases and HCV treatment was linked to the provision of OST. HCV disease management was associated with employing a nurse at a DCR/SIF and HCV treatment was associated with employing a medical doctor.ConclusionsDCRs/SIFs offer easy-to-access HCV-related services for PWID. The availability of onsite medical professionals and provision of support and education to non-medical staff are key to enhanced provision of HCV-related services in DCRs/SIFs. Funding and support for HCV treatment at the community level, via low-threshold services such as DCRs/SIFs, are worthy of action.

HIV rapid testing in community and outreach sites: results of a nationwide demonstration project in Italy

BackgroundGlobally the access to HIV testing has greatly increased over the past 30 years. Nonetheless, a high proportion of people living with HIV remains undiagnosed, even in resource rich countries. To increase the proportion of people aware of their HIV serostatus and their access to medical care, several strategies have been proposed including HIV rapid test programs offered outside health facilities. The aim of this project was to evaluate the feasibility and efficacy of the HIV rapid testing offered in community and outreach settings in Italy.MethodsWe conducted a national demonstration project on HIV rapid tests offered in community and outreach settings, including nongovernmental organization (NGO) facilities, primary care services for migrants and low-threshold services or mobile units for drug users (DU services). HIV rapid test on oral fluid (OraQuick®; Orasure Technologies) was anonymously offered to eligible people who presented themselves at the selected sites. Those with reactive results were referred to a specialized outpatient unit for confirmatory testing and medical care.ResultsOver a period of six months a total of 2949 tests were performed and 45.2% of individuals tested had not been previously tested. Overall 0.9% (27/2949) of tested people had a preliminary positive test. In NGO facilities the positivity rate was 1%. All subjects who performed their confirmatory test were confirmed as positive. In services for migrants the positivity rate was 0.5 and 80% were referred to care (with 1 false positive test). In DU services we observed the highest positivity rate (1.4%) but the lowest linkage to care (67%), with 1 false positive test.ConclusionOur project showed that the offering of an HIV rapid testing program in community and outreach settings in Italy is feasible and that it may reach people who have never been tested before, while having a significant yield in terms of new HIV diagnoses as well.

Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities

PurposeMothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis.Design/methodology/approachThis is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps.FindingsEngagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed.Originality/valueEngagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.

Mental health problems as one of the factors in the development and persistence of homelessness

The study aims to identify the presence of psychiatric disorders (and the different types) among the homeless, while also seeking a correlation between homelessness and mental health problems. The study was conducted as qualitative research at a low-threshold day treatment center in Trenčín between January 1 and October 1, 2017. The research sample consisted of twelve users of low-threshold social services, and through these participants we examined and identified not only the extent of psychiatric disorders present in them, but also the current state of treatment and the interest of the participants in addressing existing mental health problems alongside their relationship to their social environment. The results of the study demonstrated the connection between homelessness and mental health problems, as well as the consequences of the failure to treat psychological problems due to how the homeless act and their behavior toward their social environment, limiting the ability to reintegrate them into society.

Willingness to receive intravenous buprenorphine treatment in opioid-dependent people refractory to oral opioid maintenance treatment: results from a community-based survey in France

BackgroundInjectable opioids are an interesting option for people who inject drugs (PWID) that do not respond to oral Opioid Maintenance Treatment (OMT). To date, intravenous (IV) buprenorphine - a safer drug than full-opioid agonists in terms of overdose risk - has never been tested in a clinical trial on opioid dependence. We designed a survey to better understand the profile of PWID eligible for IV buprenorphine, and their willingness to receive it.MethodsThis cross-sectional community-based national survey was conducted through face-to-face interviews (in low-threshold and addiction care services) and online questionnaires (on https://psychoactif.org and other websites). Among the 557 participants, we selected those who were eligible for IV buprenorphine treatment (history of oral OMT, regular opioid injection) (n = 371). We used regression models to study factors associated with willingness to receive IV buprenorphine treatment among those with data on willingness (n = 353). In those who were willing (n = 294), we subsequently studied their willingness to receive daily supervised IV buprenorphine treatment.ResultsAmong the selected 353 participants, 59% mainly injected buprenorphine, 15% heroin, 16% morphine sulfate and 10% other opioids. Eighty-three percent of the sample reported willingness to receive IV buprenorphine treatment. Factors associated with willingness were: more than 5 injection-related complications, regular buprenorphine injection, no lifetime overdose, and completion of the questionnaire online. Factors associated with unwillingness to receive daily supervised treatment were younger age (OR[IC95%]=1.04[1.01; 1.07]) and stable housing (OR[IC95%]=0.61[0.37;1.01]) while regular heroin injectors were more willing to receive daily supervision (OR[IC95%]=2.94 [1.42; 6.10]).ConclusionsPWID were very willing to receive intravenous buprenorphine as a treatment, especially those with multiple injection-related complications. In addition, our findings show that IV buprenorphine may be less acceptable to PWID who inject morphine sulfate. Young PWID and those with stable housing were unwilling to receive IV buprenorphine if daily supervision were required. This preliminary study provides useful information for the development of a clinical trial on IV buprenorphine treatment.

Innovative co-design of integrated services designed to improve access to health care

An introduction: (comprising background and problem statement) Homeless people suffer higher mortality and morbidity rates than the general population at the same time their access to and indeed use of health services is less than the housed population.Description of policy context and objective: Ireland is currently experiencing an increase in homelessness. There is a shortage of suitable housing and this together with unaffordable rents in the private sector is pushing people out of their homes. There is an urgent need to:- focus services on homeless people and families in emergency accommodation;- accelerate the provision of social housing;- deliver more housing;- use vacant homes; and- improve the rental sector.These issues are addressed in Rebuilding Ireland: Action Plan for Housing and Homelessness (2016-2021). The HSE support the provision of specific health aspects of the plan.The HSE, together with the Local Authorities, has joint responsibility to provide a coordinated and integrated response to delivering homeless services to this growing group.The HSE Homeless Services oversee and manage a range of services and supports. These are provided through outreach specialist services, and specialised teams and individuals. They are contracted through the voluntary sector, to deliver services on behalf of the HSE to service users from diverse groups.Targeted population: Homeless population and others that the mainstream services don’t reach.Highlights: (innovation, Impact and outcomes) This innovative model of service policy planning and practice sees operations as an integrated system brought together by a common aim ; to provide access to services to vulnerable populations that mainstream services do not reach. The model operates within the policy and structural framework of the HSE’s National Drugs Rehabilitation Framework for health care provision. Within this framework Safetynet Primary Care (a medical charity) provides three levels of care i) Open access drop- in clinics for homeless people and others ineligible for mainstream services or unable to attend them. Typically these sites are appended to NGO non-medical low threshold services with high service user engagement (needle exchange, drop in food hall etc) ii) In-Reach Primary Care teams – at this level service provision takes medical care to the emergency hostels following best practice for health care for this cohort iii) An outreach service operates via mobile health unit targets the most vulnerable of the target group ie those without accommodation (rough sleepers) . Each level of service is provided by a mix of statutory non statutory and private organisations with Safetynet coordinating patient care via a web based patient management system ensuring that wherever patients are seen their medical records are available to the medical professional treating them.The integrated model however extends beyond the Primarycare domain to secondary care where a Social Inclusion team has been established in one of the cities Acute hospital. Co-ordination of patient care at the interface between primary and secondary care is managed through Multi disciplinary team working accross the two domains. An Innovative Partnership for Health Equity exists between researchers policy makers and planers and education has meant action research has been implemented to determine the homeless population’s health needs and service utilisation. This research has enabled policy , programme design to be finely attuned to need. This research has shown the increased development of services overtime of access to health care and access to key working and case management for the homeless population in DublinComments on transferability: This approach is adaptable to other urban centres in Ireland and Internationally. It also demonstrate that this level of interagency working is possible and can extend to other marginalised groups with complex needs suffering from inequalities such as refugees, travellers and migrants.Conclusions: (comprising key findings, discussion and lessons learned) The layered Safetynet system of provision for people falling through the service gaps for hard to reach groups is enhanced by Partnerships that demand reform in order to ensure health equity is reality rather than rhetoric .

Low mood in a sample of 5\u201312 year-old child psychiatric patients: a cross-sectional study

BackgroundNot much is known about low mood and its associates in child psychiatric patients. In this study, we examined the prevalence of low mood, how it associates with disruptive behaviour, and affects clinician-rated global functioning in child psychiatric outpatients.MethodsThe study population consisted of 862 5–12 year-old child psychiatric patients. The study sample was a subsample of all 1251 patients attending a child psychiatric outpatient clinic at Helsinki University Hospital in 2013–2015 formed by excluding 4 year-old and 13 year-old patients and those with missing or incomplete data. The parent-rated Strengths and Difficulties Questionnaire, collected as part of the routine clinical baseline measure, was used as a measure of psychiatric symptoms. The diagnoses were set according to ICD-10 by the clinician in charge after an initial evaluation period. The Children’s Global Assessment Scale (CGAS) score set by clinicians provided the measure of the patients’ global functioning. All information for the study was collected from hospital registers. Associations between emotional symptoms and conduct problems/hyperactivity scores were examined using ordinal regression in univariate and multivariate models, controlling for age and sex. The independent samples T test was used to compare the CGAS values of patient groups with low/normal mood.ResultsIn our sample, 512 children (59.4%) showed low mood. In multivariate ordinal regression analysis, low mood associated with conduct problems (OR 1.93, 95% CI 1.39–2.67), but no association was found between low mood and hyperactivity. Low mood was prevalent among children with oppositional defiant disorder or conduct disorder (51.8%). The global functioning score CGAS was lower among children with parent-reported low mood (52.21) than among children with normal mood (54.62, p < 0.001). The same was true in the subgroup of patients with no depression diagnosis (54.85 vs. 52.82, p = 0.001).ConclusionsLow mood is prevalent in child psychiatric outpatients regardless of depression diagnosis and it has a negative effect on global functioning. Low mood and behavioural problems are often associated. It is important to pay attention to low mood in all child psychiatric patients. We recommend prevention measures and low-threshold services for children with low mood.

Are there any differences between different testing sites? A cross-sectional study of a Norwegian low-threshold HIV testing service for men who have sex with men

ObjectiveTo describe a Norwegian low-threshold HIV testing service targeting men who have sex with men (MSM).Design and settingAfter the HIV testing consultation, all users of the HIV testing service were...

GPs\u2019 and child and adolescent psychiatry specialists\u2019 experiences of joint consultations in the GP\u2019s office: a qualitative study

BackgroundThe study is an exploration of a joint consultation model, a collaboration between general practitioners (GPs) and specialists from child and adolescent mental health services (CAMHS) in Lillehammer, Norway.MethodsA qualitative study based on two focus group interviews, one with participating GPs and one with participating specialists from the local CAMHS. Participants were five GPs, with work experience varying from 6 months to 20 years (four of them specialists in general medicine) and two CAMHS specialists—a psychiatrist and a psychologist—both with more than 20 years of experience.ResultsThe focus group discussions revealed that both GPs and CAMHS specialists saw the joint consultations as a good teaching method for improving GPs’ skills in child and adolescent psychiatry. Both groups believed that this low-threshold service benefits the patients and that the joint consultation is especially suited to sort problems and determine the level of help required.ConclusionsThe GPs and CAMHS specialists shared the impression that the collaboration model is beneficial for both patients and health care providers. Close collaboration with primary health care is recommended in the guidelines for child and adolescent psychiatry outpatient clinics. We suggest that the joint consultation model could be a good way for GPs and CAMHS specialists to collaborate.

Drug residues in syringes and other injecting paraphernalia in Hungary.

The appearance and spread of new psychoactive substances (NPS) is a phenomenon seen throughout Europe since 2008. Synthetic cathinones, a group of NPS, have been self-reported as the drug injected by the vast majority of people who inject drugs (PWID) in Hungary. This study aims at updating our knowledge of what exactly are the compounds injected by PWID. This multi-site study analysed residues from used injecting drug paraphernalia collected from PWID via low-threshold services and from public places in Budapest, Debrecen, Miskolc, Szeged, Békéscsaba and Pécs between March 2015 and February 2016. The paper describes the results of the chemical analysis of 2985 analytical samples created out of the 22 005 objects collected in this period. Active agents and their occurrences (compound cases) were identified using GC-MS. The study detected 161 different compounds, mostly synthetic cathinones (29%), non-psychoactive compounds (14%), amines (12%), non-psychoactive medications (12%) and other substances (32%). Of the 12 762 compound cases, 50% were cathinones, 18% substitution medications, 9% non-controlled psychoactive substances and 24% other substances. Among compound cases, the most frequent cathinones were pentedrone (21%) and α-PHP (12%). Among substitution medications, most were methadone (93%), and non-controlled psychoactive substances were caffeine (74%) and nicotine (21%). Overall, the most prevalent substances were methadone (16%), pentedrone (10%) and caffeine (7%) with considerable variation detected among participating cities. Our results are consistent with previous self-reported data showing a high prevalence of synthetic cathinone injection among PWID in Hungary. We also detected a large-scale misuse of methadone by PWID.

The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder

The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder Self-harm and risk-taking behaviors are frequently occurring problems in adolescents' everyday life and commonly challenge the present child and adolescent health-care system. Those behaviors are typical features of borderline-personality disorder (BPD), a severe mental disorder that is associated with immense psychological strain, increased risk of mortality and poor psychosocial functioning. Despite controversy in the past, recent evidence shows that BPD is a valid and reliable diagnosis in adolescence. Consequently, specified and effective intervention programs for this age group are necessary. Instead, present health-care services for children and adolescents in Germany are usually characterized by long waiting periods for specialized outpatient treatments and unnecessary expanses of unnecessary long inpatient stays. Alternatively, and in order to prevent serious long-term consequences, new concepts - integrated in an ambulatory setting and close to patients' daily routines - should focus on early detection and treatment of adolescents at-risk presenting with borderline personality features. The specialist outpatient clinic AtR!Sk at the University Hospital Heidelberg ensures a low-threshold initial contact service, comprehensive and accurate diagnosis of BPD features, and rapidly "tailored" therapy for young people presenting with any types of risk-taking and self-harm behavior. AtR!Sk - as a pioneering approach in south Germany - provides evidence-based early detection and intervention for adolescent BPD.

The decentralization and integration of Norwegian psychiatric services and possible implications for coercive practices

Introduction : During the last 20 years, there has been a shift in Norway, with an increase in services provided at local district psychiatric units and in municipalities and a reduction in centralized hospital services [1]. Simultaneously, attention has been directed to the negative effects of use of coercion within the services [2]. While it has been pointed out that rates of coercion in Norway are relatively high, few have examined the implications of this organizational change for the use of coercion [3]. Methods : Drawing on data obtained from the Norwegian Patient Register, we analyzed all episodes of specialized psychiatric care given in the area of Vesteralen and Lofoten, North Norway, for the periods 2003-2006 and 2008-2012 (data from 2007 were unavailable). Patients subjected to involuntary admission and involuntary outpatient treatments were identified. Results : The number of patients being treated in the study area increased from 886 in 2003 to 1347 in 2012. The number of involuntarily admitted patients and patients in involuntary outpatient treatment fell from 110 in 2003 to 30 in 2012. Discussion, limitations and lessons learnt : Our data suggest that while the number of patients in treatment increased with more than 50% during the study period, the number of patients being coerced was reduced with more than 70%. Several factors (on which we lack data here) may be of importance to rates of involuntary admission and treatment, including patients’ diagnoses [4, 5] and staffs’ attitudes [5, 6]. However, the increased provision of decentralized psychiatric services is likely to be one important factor in the reduction of coercion [3]. Local and low-threshold psychiatric services increase access and give patients the opportunity to get help at an earlier stage, which may reduce the need for coercion [3, 5]. Further studies are needed to examine the importance of psychiatric services organization on rates of coercion. References : 1. Myklebust LH, Olstad R, Bjorbekkmo S, Eisemann M, Wynn R, Sorgaard K. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway. Int J Integr Care. 2011;11:e142. 2. Wynn R. Coercion in psychiatric care: clinical, legal, and ethical controversies. Int J Psychiatry Clin Pract. 2006;10(4):247-51. 3. Myklebust LH, Sorgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC Health Serv Res. 2014;14:64. 4. Myklebust LH, Sorgaard K, Rotvold K, Wynn R. Factors of importance to involuntary admission. Nord J Psychiatry. 2012 Jun;66(3):178-82. 5. Rotvold K, Wynn R. Involuntary psychiatric admission: The referring general practitioners' assessment of patients' dangerousness and need for psychiatric hospital treatment. Nord J Psychiatry. 2015;69(8):637-42. d 6. Wynn R, Kvalvik AM, Hynnekleiv T. Attitudes to coercion at two Norwegian psychiatric units. Nord J Psychiatry. 2011;65:133-7.

The \u201cAachen fall prevention App\u201d \u2013 a Smartphone application app for the self-assessment of elderly patients at risk for ground level falls

BackgroundFall incidents are a major problem for patients and healthcare. The “Aachen Fall Prevention App” (AFPA) represents the first mobile Health (mHealth) application (app) empowering older patients (persons 50+ years) to self-assess and monitor their individual fall risk. Self-assessment is based on the “Aachen Fall Prevention Scale,” which consists of three steps. First, patients answer ten standardized yes–no questions (positive criterion ≥ 5 “Yes” responses). Second, a ten-second test of free standing without compensatory movement is performed (positive criterion: compensatory movement). Finally, during the third step, patients rate their subjective fall risk on a 10-point Likert scale, based on the results of steps one and two. The purpose of this app is (1) to offer a low-threshold service through which individuals can independently monitor their individual fall risk and (2) to collect data about how a patient-centered mHealth app for fall risk assessment is used in the field.ResultsThe results represent the first year of an ongoing field study. From December 2015 to December 2016, 197 persons downloaded the AFPA (iOS™ and Android™; free of charge). N = 111 of these persons voluntarily shared their data and thereby participated in the field study. Data from a final number of n = 79 persons were analyzed due to exclusion criteria (age, missing objective fall risk, missing self-assessment). The objective fall risk and the self-assessed subjective risk measured by the AFPA showed a significant positive relationship.ConclusionsThe “Aachen Fall Prevention App” (AFPA) is an mHealth app released for iOS and Android. This field study revealed the AFPA as a promising tool to raise older adults’ awareness of their individual fall risk by means of a low-threshold patient-driven fall risk assessment tool.

A pilot study of a low-threshold, low-intensity cognitive behavioral intervention for traumatized adolescents

This pilot study investigated whether traumatized adolescents ( N = 11) who received brief cognitive behavioral intervention, including self-help material, reported symptom relief. It also explored how the self-help material was used. A mixed methods, exploratory, one-group intervention design was used. The results indicated that the self-help material served as a flexible and useful therapeutic tool, one used to enhance coping in areas related to trauma, interpersonal relations, and school. Adolescents’ levels of post-traumatic stress symptoms decreased, and the results were sustained at the one-year follow-up period. The promising results provide a basis for studies with better methodological rigor to investigate effects of interventions that include the use of self-help material in low-threshold services for adolescents.»/><meta name=

Psychosocial Stress, Course of Pregnancy and Pregnancy Outcomes in the Context of the Provision of Sexual Services.

Introduction There has been very little medical research into pregnancies which occur in the context of prostitution, even though the associated health risks for mother and child, e.g. violence or maternal drug abuse, are well known. The aim of this study was to compile and summarize what is known (inter-)nationally about this topic and identify key points of support as part of a uniform standard of healthcare in pregnancy. Material and Methods A selective search of the literature was done in Pubmed and Livivo/Medpilot and in the databases NIH, Cochrane, DARE, NHSEED and HTA on the factors influencing preterm delivery. Results There are no systematic studies on pregnancy risks in the context of sexual services. But there is data available on specific risk factors, for example the increased risk of prematurity associated with sexual/physical violence (OR = 1.28-4.7). The Prostitute Protection Act provides only limited protection for affected women, and statutory maternity protection regulations also have little impact as they require a formal contract of employment which rarely exists even in the context of legal prostitution. Conclusion Approximately 400 000 women are currently working as prostitutes in the Federal Republic of Germany. The number of unreported cases is high. Nevertheless, there is little concrete data available on the probable health risks if these women become pregnant. The existing laws that should offer protection fall short of the mark. There is a need for more research into the future implementation of the Prostitute Protection Act which should focus on health counselling, health promotion and additional protective legislation. Low-threshold healthcare services offered in the context of prenatal care could be an opportunity to improve care.

Care Arrangements in Dementia Care Networks: Findings From the DemNet-D Study Baseline and 1-Year Follow-Up.

This study was conducted to describe care arrangements for persons with dementia (PwDs) who are living at home with the support of a dementia care network (DCN). Data on the utilization of formal and informal support were collected in face-to-face interviews at baseline and 1-year follow-up with PwDs and caregivers receiving support from 1 of 13 DCNs. Men with dementia were supported by twice as many informal caregivers as women (2 vs. 1, respectively, p < .001). Regional differences were found in home-care nursing services, social care groups, companion home services, and day care. The care situations were considered stable by most caregivers. DCNs appear to contribute to a high degree of perceived stability in care situations. Future research should investigate possible gender differences in informal support networks. DCNs should continue their efforts in making low-threshold services in rural areas available and accessible.