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There has been an increase in discussion concerning the integration of sexuality education and the prevention of sexual violence. Furthermore, this is a concern at the level of different pedagogical professions in Germany, since sexuality education and sexual violence prevention have developed as largely separate fields. Both sexuality educators and sexual violence professionals work with a broad target group to prevent sexual violence, including children, young people, as well as parents and professionals working in social work or education. They collaborate at times, but they also engage in debates about their respective pedagogical approaches. Based on group discussions with 12 teams specializing in the two fields, this article analyzes how their tacitly shared knowledge (collective orientation) underpins their different pedagogical strategies. This should be considered to improve their long-term inter-professional cooperation.
Der vorliegende Beitrag befasst sich vor dem Hintergrund der aktuellen Diskussion über einen Fachkräftemangel in der Pflege mit der Zuverlässigkeit der Abbildung der Pflegeberufe in amtlichen Statistiken und methodischen Problemen bisheriger Vorausberechnungen. Daten zur Zahl der Beschäftigten in Pflegeberufen bieten mehrere amtliche Statistiken. Ein Vergleich dieser Statistiken zeigt jedoch zum Teil erhebliche Unterschiede in den Datenangaben sowohl für einzelne Pflegeberufe als auch für die Gesamtzahl des Pflegepersonals. Auf Grundlage einer Analyse der jeweiligen Methodiken kommt der Beitrag zu dem Schluss, dass eine Zusammenführung der Daten der Krankenhausstatistik, der Statistik der Vorsorge- und Rehabilitationseinrichtungen und der Pflegestatistik differenziertere und auch zuverlässigere Daten bietet als die Arbeitsmarktstatistik oder Gesundheitspersonalrechnung.
For people with physical disabilities, it is often desirable to regain control over their personal environment and communication tools. This paper introduces a novel Human-Machine Interface (HMI) using one-shot learning for individualized control signals without extensive training or specialized hardware. Our work suggests a modular system that utilizes common, easily accessible devices like webcams to interpret user-defined gestures and commands through a single demonstration. As a feasibility study on healthy volunteers, we investigate the control of a computer mouse by head movements only. We demonstrate the technical details of the HMI and discuss its potential applications in enhancing the autonomy and interaction capabilities of users with disabilities. By combining usercentric design principles with the advancements in one-shot learning, we aim to forge a more inclusive, accessible path forward in the development of assistive technologies.
Background: Falls are a common problem experienced by people living with HIV yet predictive models specific to this population remain underdeveloped. We aimed to identify, assess and stratify the predictive strength of various physiological, behavioral, and HIV-specific factors associated with falls among people living with HIV and inform a predictive model for fall prevention.
Methods: Systematic review and meta-analysis were conducted to explore predictors of falls in people living with HIV. Data was sourced, screened, extracted, and analyzed by two independent reviewers from eight databases up to January 2nd, 2024, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Evidence quality and bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Mixed Method Appraisal Tool (MMAT), respectively. Pooled odds ratios (OR) with 95% confidence intervals (CI) were computed using random-effects models to establish associations between predictors and falls risk. We applied established criteria (Bradford Hill’s criteria, Rothman’s and Nweke’s viewpoints) to stratify risk factors and create a weighted predictive algorithm.
Results: This review included 12 studies on falls/balance dysfunction in 117,638 participants (54,513 people living with HIV), with varying ages (45–50 years), sample sizes (32 − 26,373), study durations (6 months to 15 years), disease stages (CD4 + counts 347.2 cells/mm³ to ≥ 500 cells/µL) and fall definitions (self-reported histories to real-time reporting). Some predictors of falls in people living with HIV including depression, cannabis use, cognitive impairment/neurocognitive adverse effects (NCAE), hypertension, and stavudine—showed perfect risk responsiveness (Ri = 1), indicating their strong association with falls. Notably, cannabis use demonstrated the highest risk weight (Rw = 3.0, p < 0.05, 95%CI:1.51–5.82), followed by NCAE (Rw = 2.3, p < 0.05, 95%CI:1.66–3.21) and frailty with a broad confidence interval (Rw = 2.2, p < 0.05, 95%CI:0.73–14.40). Other significant predictors included hypertension (Rw = 1.8, p < 0.05, 95%CI:1.33–2.33), depression (Rw = 1.6, p < 0.05, 95%CI:1.22–2.18), stavudine use (Rw = 1.5, p < 0.05, 95%CI: 0.95–2.25), neuropathy (Rw = 1.3, p < 0.05, 95%CI:1.26–2.11), and polypharmacy (Rw = 1.2, p < 0.05, 95%CI:1.16–1.96). The fall risk threshold score was 12.8, representing the 76th percentile of the specific and sufficient risk weight.
Conclusion: Our meta-analysis identifies predictors of falls in people living with HIV, emphasizing physiological, behavioral, and HIV-specific factors. Integrating these into clinical practice could mitigate falls-related sequelae. We propose a novel approach to falls risk prediction using a novel clinical index, resulting in a HIV-specific falls risk assessment tool.
Background: Cachexia accounts for about 20% of all cancer‐related deaths and indicates poor prognosis. The impact of Fusobacterium nucleatum (Fn), a microbial risk factor for colorectal cancer (CRC), on the development of cachexia in CRC has not been established.
Methods: We evaluated the association between Fn abundance in pre‐surgical stool samples and onset of cachexia at 6 months post‐surgery in n = 87 patients with stages I–III CRC in the ColoCare Study.
Results: High fecal Fn abundance compared to negative/low fecal Fn abundance was associated with 4‐fold increased risk of cachexia onset at 6 months post‐surgery (OR = 4.82, 95% CI = 1.15, 20.10, p = 0.03).
Conclusion: Our findings suggest that high fecal Fn abundance was associated with an increased risk of cachexia at 6 months post‐surgery in CRC patients. This is the first study to link Fn abundance with cachexia in CRC patients, offering novel insights into biological mechanisms and potential management of cancer cachexia. Due to the small sample size, our results should be interpreted with caution. Future studies with larger sample sizes are needed to validate these findings.
The development of methods for the meta‐analysis of diagnostic test accuracy (DTA) studies is still an active area of research. While methods for the standard case where each study reports a single pair of sensitivity and specificity are nearly routinely applied nowadays, methods to meta‐analyze receiver operating characteristic (ROC) curves are not widely used. This situation is more complex, as each primary DTA study may report on several pairs of sensitivity and specificity, each corresponding to a different threshold. In a case study published earlier, we applied a number of methods for meta‐analyzing DTA studies with multiple thresholds to a real‐world data example (Zapf et al., Biometrical Journal. 2021; 63(4): 699–711). To date, no simulation study exists that systematically compares different approaches with respect to their performance in various scenarios when the truth is known. In this article, we aim to fill this gap and present the results of a simulation study that compares three frequentist approaches for the meta‐analysis of ROC curves. We performed a systematic simulation study, motivated by an example from medical research. In the simulations, all three approaches worked partially well. The approach by Hoyer and colleagues was slightly superior in most scenarios and is recommended in practice.
Introduction: The integration of Patient-Reported Experience Measures (PREM) alongside traditional clinical outcomes is crucial for improving quality of care. Although PREMs are frequently measured in inpatient treatment settings, they are rarely employed in digitally supported care processes or longitudinal assessment of care pathways.
Methods: To gain an overview of PREMs used to cover patients’ experiences with digitally supported care processes in heart failure (HF), a scoping review was conducted in Medline.
Results: Out of 538 publications, 29 were identified that focus on PREMs in digitally supported care processes across 9 unspecific and 14 disease-specific groups, with 5 manuscripts focusing on HF. PREMs were mostly assessed using self-developed, study-specific questionnaires lacking standardization and validity. In total, 9 PREM dimensions and 25 sub-dimensions were identified. This included care delivery, privacy, physician-patient relationship, involvement, administration, information, knowledge, technology, and experiences in general.
Conclusion: The findings suggest that the relevance of different dimensions assessed depends largely on the type of care rather than the underlying chronic disease.
Alterations within the tryptophan–kynurenine metabolic pathway have been linked to the etiology of colorectal cancer (CRC), but the relevance of this pathway for prognostic outcomes in CRC patients needs further elucidation. Therefore, we investigated associations between circulating concentrations of tryptophan–kynurenine pathway metabolites and all‐cause mortality among CRC patients. This study utilizes data from 2102 stage I–III CRC patients participating in six prospective cohorts involved in the international FOCUS Consortium. Preoperative circulating concentrations of tryptophan, kynurenine, kynurenic acid (KA), 3‐hydroxykynurenine (HK), xanthurenic acid (XA), 3‐hydroxyanthranilic acid (HAA), anthranilic acid (AA), picolinic acid (PA), and quinolinic acid (QA) were measured by liquid chromatography–tandem mass spectrometry. Using Cox proportional hazards regression, we examined associations of above‐mentioned metabolites with all‐cause mortality, adjusted for potential confounders. During a median follow‐up of 3.2 years (interquartile range: 2.2–4.9), 290 patients (13.8%) deceased. Higher blood concentrations of tryptophan, XA, and PA were associated with a lower risk of all‐cause mortality (per doubling in concentrations: tryptophan: HR = 0.56; 95%CI:0.41,0.76, XA: HR = 0.74; 95%CI:0.64,0.85, PA: HR = 0.76; 95%CI:0.64,0.92), while higher concentrations of HK and QA were associated with an increased risk of death (per doubling in concentrations: HK: HR = 1.80; 95%CI:1.47,2.21, QA: HR = 1.31; 95%CI:1.05,1.63). A higher kynurenine‐to‐tryptophan ratio, a marker of cell‐mediated immune activation, was associated with an increased risk of death (per doubling: HR = 2.07; 95%CI:1.52,2.83). In conclusion, tryptophan–kynurenine pathway metabolites may be prognostic markers of survival in CRC patients.
Background & Aims: Human studies examining associations between circulating levels of insulin-like growth factor 1 (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3) and colorectal cancer risk have reported inconsistent results. We conducted complementary serologic and Mendelian randomization (MR) analyses to determine whether alterations in circulating levels of IGF1 or IGFBP3 are associated with colorectal cancer development.
Methods: Serum levels of IGF1 were measured in blood samples collected from 397,380 participants from the UK Biobank, from 2006 through 2010. Incident cancer cases and cancer cases recorded first in death certificates were identified through linkage to national cancer and death registries. Complete follow-up was available through March 31, 2016. For the MR analyses, we identified genetic variants associated with circulating levels of IGF1 and IGFBP3. The association of these genetic variants with colorectal cancer was examined with 2-sample MR methods using genome-wide association study consortia data (52,865 cases with colorectal cancer and 46,287 individuals without [controls])
Results: After a median follow-up period of 7.1 years, 2665 cases of colorectal cancer were recorded. In a multivariable-adjusted model, circulating level of IGF1 associated with colorectal cancer risk (hazard ratio per 1 standard deviation increment of IGF1, 1.11; 95% confidence interval [CI] 1.05–1.17). Similar associations were found by sex, follow-up time, and tumor subsite. In the MR analyses, a 1 standard deviation increment in IGF1 level, predicted based on genetic factors, was associated with a higher risk of colorectal cancer risk (odds ratio 1.08; 95% CI 1.03–1.12; P = 3.3 × 10–4). Level of IGFBP3, predicted based on genetic factors, was associated with colorectal cancer risk (odds ratio per 1 standard deviation increment, 1.12; 95% CI 1.06–1.18; P = 4.2 × 10–5). Colorectal cancer risk was associated with only 1 variant in the IGFBP3 gene region (rs11977526), which also associated with anthropometric traits and circulating level of IGF2.
Conclusions: In an analysis of blood samples from almost 400,000 participants in the UK Biobank, we found an association between circulating level of IGF1 and colorectal cancer. Using genetic data from 52,865 cases with colorectal cancer and 46,287 controls, a higher level of IGF1, determined by genetic factors, was associated with colorectal cancer. Further studies are needed to determine how this signaling pathway might contribute to colorectal carcinogenesis.
Background: Consumption of fibre, fruits and vegetables have been linked with lower colorectal cancer (CRC) risk. A genome-wide gene-environment (G × E) analysis was performed to test whether genetic variants modify these associations.
Methods: A pooled sample of 45 studies including up to 69,734 participants (cases: 29,896; controls: 39,838) of European ancestry were included. To identify G × E interactions, we used the traditional 1–degree-of-freedom (DF) G × E test and to improve power a 2-step procedure and a 3DF joint test that investigates the association between a genetic variant and dietary exposure, CRC risk and G × E interaction simultaneously.
Findings: The 3-DF joint test revealed two significant loci with p-value <5 × 10−8. Rs4730274 close to the SLC26A3 gene showed an association with fibre (p-value: 2.4 × 10−3) and G × fibre interaction with CRC (OR per quartile of fibre increase = 0.87, 0.80, and 0.75 for CC, TC, and TT genotype, respectively; G × E p-value: 1.8 × 10−7). Rs1620977 in the NEGR1 gene showed an association with fruit intake (p-value: 1.0 × 10−8) and G × fruit interaction with CRC (OR per quartile of fruit increase = 0.75, 0.65, and 0.56 for AA, AG, and GG genotype, respectively; G × E -p-value: 0.029).
Interpretation: We identified 2 loci associated with fibre and fruit intake that also modify the association of these dietary factors with CRC risk. Potential mechanisms include chronic inflammatory intestinal disorders, and gut function. However, further studies are needed for mechanistic validation and replication of findings.
