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Objectives: Investigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice.
Design: Pragmatic, cluster randomised controlled trial with general practice as unit of randomisation.
Setting: 72 general practices in Hesse, Germany.
Participants: 505 randomly sampled, cognitively intact patients (≥60 years, ≥3 chronic conditions under pharmacological treatment, ≥5 long-term drug prescriptions with systemic effects); 465 patients and 71 practices completed the study.
Interventions: Intervention group (IG): The healthcare assistant conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision support system, the general practitioner optimised medication, discussed it with patients and adjusted it accordingly. The control group (CG) continued with usual care.
Outcome measures: The primary outcome was a modified Medication Appropriateness Index (MAI, excluding item 10 on cost-effectiveness), assessed in blinded medication reviews and calculated as the difference between baseline and after 6 months; secondary outcomes after 6 and 9 months’ follow-up: quality of life, functioning, medication adherence, and so on.
Results: At baseline, a high proportion of patients had appropriate to mildly inappropriate prescriptions (MAI 0–5 points: n=350 patients). Randomisation revealed balanced groups (IG: 36 practices/252 patients; CG: 36/253). Intervention had no significant effect on primary outcome: mean MAI sum scores decreased by 0.3 points in IG and 0.8 points in CG, resulting in a non-significant adjusted mean difference of 0.7 (95% CI −0.2 to 1.6) points in favour of CG. Secondary outcomes showed non-significant changes (quality of life slightly improved in IG but continued to decline in CG) or remained stable (functioning, medication adherence).
Conclusions: The intervention had no significant effects. Many patients already received appropriate prescriptions and enjoyed good quality of life and functional status. We can therefore conclude that in our study, there was not enough scope for improvement.
Trial registration number: ISRCTN99526053. NCT01171339; Results.
The behavioral sciences, including most of psychology, seek to explain and predict behavior with the help of theories and models that involve concepts (e.g., attitudes) that are subsequently translated into measures. Currently, some subdisciplines such as social psychology focus almost exclusively on measures that demand reflection or even introspection when administered to persons. We argue that such a focus hinders progress in explaining behavior. One major reason is that such an exclusive focus on reflections results in common method bias, which then produces spurious relations, or in other words, low discriminant validity. Without the valid measurement of theoretical concepts, theoretical assumptions cannot be tested, and hence, theory development will be hampered. We argue that the use of a greater variety of methods would reduce these problems and would in turn foster theory building. Using a representative sample of N = 472 participants (age: M = 51.0, SD = 17.7; 54% female), we compared the validity of a classical introspective attitude measure (i.e., the New Ecological Paradigm) with that of an alternative attitude measure (i.e., the General Ecological Behavior scale). The latter measure, which was based on self-reported behavior, showed substantially better validity that we argue could aid theory development.
The physical housing environment is important to facilitate activities of daily living (ADL) for older people. A hindering environment may lead to ADL dependence and thus increase the need for home services, which is individually restricting and a growing societal burden. This study presents simulations of policy changes with regard to housing accessibility that estimates the potential impact specifically on instrumental activities of daily living (I-ADL), usage of home services, and related costs. The models integrate empirical data to test the hypothesis that a policy providing funding to remove the five most severe environmental barriers in the homes of older people who are at risk of developing dependence in I-ADL, can maintain independence and reduce the need for home services. In addition to official statistics from state agencies in Sweden and Germany, we utilized published results from the ENABLE-AGE and other scientific studies to generate the simulations. The simulations predicted that new policies that remove potentially hindering housing features would improve I-ADL performance among older people and reduce the need for home services. Our findings suggest that a policy change can contribute to positive effects with regard to I-ADL independence among older people and to a reduction of societal burden.
Establishing local coherence relations is central to text comprehension. Positive-causal coherence relations link a cause and its consequence, whereas negative-causal coherence relations add a contrastive meaning (negation) to the causal link. According to the cumulative cognitive complexity approach, negative-causal coherence relations are cognitively more complex than positive-causal ones. Therefore, they require greater cognitive effort during text comprehension and are acquired later in language development. The present cross-sectional study tested these predictions for German primary school children from Grades 1 to 4 and adults in reading and listening comprehension. Accuracy data in a semantic verification task support the predictions of the cumulative cognitive complexity approach. Negative-causal coherence relations are cognitively more demanding than positive-causal ones. Moreover, our findings indicate that children's comprehension of negative-causal coherence relations continues to develop throughout the course of primary school. Findings are discussed with respect to the generalizability of the cumulative cognitive complexity approach to German.
Entre as diversas perspectivas de pesquisa em educação, a Hermenêutica Objetiva se destaca hoje, na Alemanha, como uma das mais difundidas e reconhecidas abordagens da pesquisa sociológica qualitativa. O estágio de pós-doutorado realizado na Faculdade de Ciências da Educação - Instituto de Formação de Professores de Nível Secundário - da Universidade Johann Wolfgang Goethe em Frankfurt am Main foi uma das ações decorrentes do intercâmbio acadêmico firmado entre dois grupos de pesquisa, o "Teoria Crítica e Educação" (UFSCar - Brasil) e o "Reconstrução Pedagógica do Ensinar" (Universidade de Frankfurt - Alemanha). A partir dos conceitos que fundamentam o processo pedagógico (educação, instrução e formação), e da formulação de uma teoria pedagógica com base empírica, operada com o referencial teórico epistemológico da Hermenêutica Objetiva, o artigo aborda a situação atual da formação política nas escolas públicas alemãs. Como resultados, três aspectos gerais se destacam: 1) As análises sobre a metodologia da Hermenêutica Objetiva apontam a pertinência desse tipo de investigação na Educação, se o propósito for evidenciar os aspectos imanentes do processo pedagógico; 2) As reformas recentes na política educacional alemã indicam o processo de instrumentalização do ensino e o empobrecimento da formação em termos sociopolíticos; 3) A reconstrução empírica das aulas de política no ensino público alemão evidencia a superficialidade do conhecimento, o autoritarismo pedagógico, as práticas pedagógicas pseudo-democráticas; além da instrumentalização e judicialização da política, como temática de ensino.
A booming middle class, new attractive study destinations and a resulting shift in student mobility trends have recently established a new dynamic in international higher education. To stay competitive, countries apply marketing strategies to promote and "sell" their higher education to international students-cum-customers. With the growing use of the Internet to research study destinations, the role of online channels in higher education promotion is becoming increasingly important. The current study investigates the case of Malaysian higher education branding in cyberspace. By applying content analysis to the two major higher education online platforms, this study identifies the core brand values of Malaysian higher education and evaluates their coherence. The research findings demonstrate that both platforms combine nation and higher education branding efforts to create a harmonised image of the national higher education system. Additionally, several suggestions are made concerning the optimisation of the architecture and information presentation of the websites to enhance their attractiveness for users. Finally, the necessity of further investigation into higher education branding for the successful implementation of internationalisation policies in Malaysia is emphasised.
Background: The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved.
Methods: Two focus groups, with independent facilitators, were conducted with six researche rs who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis.
Results: Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention;
(2) personal characteristics of trial participants; (3) practical issues; (4) researchers’ engagement with participants; (5)
training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants’ friends and family, and post-natal return to smoking.
Conclusions: Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers’ friends and family, as well as for avoiding post-natal return to smoking.
O presente artigo discute as atuais transformações nos sistemas educacionais em todo o mundo. Tendo como foco a União Europeia (UE) e a Organização para a Cooperação e o Desenvolvimento Econômico (OCDE) como atores de políticas, seu argumento é que tais transformações implicam uma tripla "economização" da política educacional, que pode ser constatada em todos os níveis da área educacional. A importância cada vez maior dessas organizações nas questões educacionais configura uma transição para uma "constelação pós-nacional" também na área educacional, na medida em que a soberania educacional nacional está, no mínimo, passando por reajustes. No entanto, a "economização" das políticas educacionais não se limita a aproximar a educação das necessidades da economia e a transformar seus serviços em mercadorias comercializáveis. Ela também afeta o nível operacional da educação. Uma lógica de produção está sendo implementada na descrição realizada pelas próprias instituições do sistema educacional, que deixaram de ser estabelecimentos burocraticamente administrados para ser concebidos como uma atividade comercial gerencialmente controlada, uma atividade na qual uma ação empresarial se faz necessária. Esse novo tipo de administração faz surgir o problema da legitimação democrática das decisões políticas que, em termos ideais, combina três elementos: o democrático, o "expertocrático" e o ético-profissional. O artigo discute as consequências de uma mudança no equilíbrio desses três elementos no caso da Alemanha.
The empirical research investigates the orientation and learning processes of adolescents concerning global issues in different educational settings. How do adolescents create their knowledge about the world? What worldviews and ideas do adolescents have about global perspectives? How do they deal with the complexity of world society? The qualitative-empirical research focuses on the comparative analysis of learning processes in different educational settings, such as school lessons in different subjects, school-based extra-curricular activities and non-formal youth work outside school. The main topic of the paper is a case study of a group of female students who run World Shop as student company. The objective is to describe a specific learning culture at a gymnasium, a German grammar school, and the learning processes which occur within a certain learning arrangement. In this context, the student company is important both as an extra-curricular project and because issues which occur in its work setting are integrated into different school lessons. The integration of Global Education in school culture results from the presence of the student company in everyday life at school and the combination of informal learning processes within the peer milieu and formal systematic instruction in school lessons. The research reveals the great potential for the desired acquisition of competencies and knowledge. This in turn demonstrates the extent that student learning is encouraged by a particular school and learning culture.