Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared.Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition.Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.

Age- and sex-specific pediatric LMS-Percentiles for Laboratory Parameters enabled by Data mining

Background:Various laboratory parameters routinely measured in pediatric practice covariate with sex and age. Conventional reference intervals are not suitable to account for this variation. Here we demonstrate construction of continuous LMS percentile curves from routine laboratory data. This allows adequate adjustment for both sex- and age-dependent covariation in childhood.Material and Methods:Anonymized routine blood test results requested by primary health care physicians were collected, outliers excluded and LMS-models generated in R.Results:Percentiles for several biomarkers derived from a regional population were established in the 'LMS' framework and provided here for comparison with etablished reference ranges, discussion and, potentially, clinical use.Conclusion: The reference framework 'LMS' is well-known from pediatric growth charts and can also be used in laboratory medicine.

Ten years from propagule to mature plant of Butia purpurascens Glassman (Arecaceae): an endemic and endangered palm of the Brazilian Cerrado

With occurrence mainly in the southwest Goiás, Butia purpurascens has fruits and leaves widely extracted by the regional population. Coexists with exotic grasses, frequent burnings and cattle’s grazing and trampling. Young individuals are rarely seen. We aim to provide information about propagules, seedling formation and the monitoring of saplings of B. purpurascens until adults in reproductive phase. Fruits were selected, measured and benefited after harvest. Of 6,000 fruits collected 3,112 were discarded for being perforated by Conotrachelus weevils. The experiment divided 2,600 fruits into 13 treatments, distributed in ripe and immature fruits, with and without pulp. In addition, we adopt mechanical and chemical break dormancy mechanisms, different storage periods and seeding depths. After sixteen months of monitoring, the formation of eleven seedlings was obtained without distinction of any treatment. Seedlings and saplings developed slowly, taking two years to emit the first metaphyll. Over time, ten individuals died, most from fungal attack. After ten years, the only surviving palm generated two inflorescences, which produced fruit. The inefficient seedling production and the slow development of saplings, combined with the impact of the extractivism and the high rate of predation of the pyrenes, suggest the low recruitment rate of the species observed, in natural conditions. This type of data is one of the important tools for creating guidelines for the species conservation. Therefore, we suggest considering the reclassification of B. purpurascens as a Critically Endangered species in the Official List of Threatened Brazilian Species of Extinction.

Comparison of Anthropometric Indicators That Assess Nutritional Status From Infancy to Old Age and Proposal of Percentiles for a Regional Sample of Chile

Objectives: Anthropometric variables are used to evaluate health, dietary status, disease risks, and changes in body composition. The purpose of this study was to compare weight, height, and Body Mass Index (BMI) with American references from the National Center for Health Statistics (NCHS-2012), using BMI and Tri-Ponderal Mass Index (TMI) to propose percentiles for evaluating nutritional status of children, adolescents, and adults, ages 5–80 years old.Methods: A descriptive cross-sectional study was conducted in 15,436 (8,070 males and 7,366 females) children, youths and adults in the Maule region (Chile). The age range ranged from 5.0 to ~80 years of age. Weight and height were assessed. Body mass index BMI and tri-ponderal mass index (TMI) were calculated. The LMS method was used to generate percentiles.Results: The results illustrated that children were heavier and had more BMI during childhood compared to the NCHS references. During adolescence, reference values were greater until approximately ages 70–79. For height, children were relatively similar to those of the NCHS references, but during adolescence, differences became evident. Adolescence until approximately age 80, the population showed lower values for height. Percentiles were calculated using BMI and TMI by age range and sex. Differences occurred between the American NCHS references and the population with regard to the anthropometric variables of weight, height, and in BMI.Conclusion: Discrepancies with the American NCHS reference were verified in the anthropometric variables of weight, height and BMI. Reference percentiles of BMI and TMI were developed for the evaluation of the nutritional status of the regional population of Maule (Chile). Its use is suggested in clinical and epidemiological contexts.

Midblock: Reimagining the role of the underutilized suburban midblock section

<p>Our society’s inclination towards larger homes upon individually owned land titles has produced vast suburban sprawl, attributing a great deal of societal division and infrastructural strain. A feature exacerbating the situation in Papamoa’s suburban development is the inadvertent creation of midblock sections, primarily due to a lack of development foresight. Due to the rapid conversion of certain rural plots’ land-use from orchards to residential development and the stagnation of others, a mismatch of land sizes, shapes and orientations were left to be developed upon. These underutilised spaces often remain as untenanted interstitial spaces despite a dramatic regional population growth, a record low national home ownership and growing demand for housing from the Auckland market. This thesis examines the complexities of the midblock and the difficult New Zealand social and historical contexts that disrupt their development. It investigates how architects can use these conditions, as well as the spatial contexts of their locale, to inform design principles that can be used to integrate midblock designs into the suburban grain. Design within this research, thus, seeks to test these strategies as well as the development potential of these sites through investigating the efficacy of various alternative programmes. Furthermore, this research explores the potential of small scale public participatory consultation with local residents as a catalyst for architectural processes and design evaluation in analysing the appropriateness of midblock development strategies. It argues that participatory design consultation is a substantial tool for architects in both aligning development with local communities and critically analysing the effectiveness of design within the context of the midblock.</p>

Midblock: Reimagining the role of the underutilized suburban midblock section

<p>Our society’s inclination towards larger homes upon individually owned land titles has produced vast suburban sprawl, attributing a great deal of societal division and infrastructural strain. A feature exacerbating the situation in Papamoa’s suburban development is the inadvertent creation of midblock sections, primarily due to a lack of development foresight. Due to the rapid conversion of certain rural plots’ land-use from orchards to residential development and the stagnation of others, a mismatch of land sizes, shapes and orientations were left to be developed upon. These underutilised spaces often remain as untenanted interstitial spaces despite a dramatic regional population growth, a record low national home ownership and growing demand for housing from the Auckland market. This thesis examines the complexities of the midblock and the difficult New Zealand social and historical contexts that disrupt their development. It investigates how architects can use these conditions, as well as the spatial contexts of their locale, to inform design principles that can be used to integrate midblock designs into the suburban grain. Design within this research, thus, seeks to test these strategies as well as the development potential of these sites through investigating the efficacy of various alternative programmes. Furthermore, this research explores the potential of small scale public participatory consultation with local residents as a catalyst for architectural processes and design evaluation in analysing the appropriateness of midblock development strategies. It argues that participatory design consultation is a substantial tool for architects in both aligning development with local communities and critically analysing the effectiveness of design within the context of the midblock.</p>

Pengaruh Tingkat Literasi Keuangan Terhadap minat Penggunaan Produk Finansial Teknologi Pada Mahasiswa FEBI UIN Sumatera Utara

In the BPS survey conducted in February-September 2020, Gen Z reached 75.49 million or 27.94 million out of a total population of 270.2 million, meanwhile, the number of millennials reached 69.9 million (25.87%). With the presence and dominance of the second generation groups who are relatively digitally literate among the regional population, Indonesia hopes to more easily understand these groups as the backbone of digitalization programs for various sectors in the next year. Digital literacy generation. This study aims to determine how big the level of financial literacy in FEBI UIN North Sumatra students and to determine whether or not there is an influence of literacy level on interest in using technology financial products. The research method used is a quantitative method. Data retrieval using a questionnaire distributed via google form with the respondents are students of Islamic Accounting, Management, Islamic Economics, Sharia Insurance and Sharia Banking study programs. Collecting data in this study using a questionnaire method with a Likert scale method and distributed to 100 respondents. In this study, the data analysis technique used was descriptive analysis and simple regression analysis using SPSS 15.0. The results of this study indicate that the literacy rate of FEBI UIN North Sumatra students is known to be 29.10%. It is classified into the Well literate category and there is a positive and significant influence between the level of financial literacy on the interest in using technology financial products

Health and life insurance-related problems in very long-term cancer survivors in Germany: a population-based study

Purpose Limited research suggests that cancer survivors have problems with insurance. Our study aimed to gain insight into the proportion of very long-term (14–24 years post-diagnosis) survivors of breast, colorectal, and prostate cancers who had problems with health (HI) and life (LI) insurance. Methods We used data from CAESAR (CAncEr Survivorship—A multi-Regional population-based study). Participants completed questions on change in insurance providers since cancer diagnosis, problems with requesting (additional) HI or LI, and how potential problems were resolved. We conducted logistic regression to determine factors associated with change in statutory HI. Results Of the 2714 respondents, 174 (6%) reported having changed HI providers. Most switched between different statutory HI providers (86%), 9% from statutory to private, and 5% from private to statutory. Respondents who changed statutory HI providers were more likely to be prostate cancer survivors (OR 2.79, 95% CI 1.01–7.68) while being ≥ 65 years at time of diagnosis (OR 0.58, 95% CI 0.35–0.96) and having ≥ 2 comorbid conditions (OR 0.61, 95% CI 0.40–0.92) were associated with reduced odds for change. Problems in changing HI were minimal and were resolved with additional contribution. Of the 310 respondents who tried to get LI, 25 respondents reported having difficulties, of whom the majority had their request rejected. Conclusion Most cancer survivors did not change their HI nor tried to buy LI after cancer diagnosis. Problems with changing statutory HI were generally resolved with additional contribution while the main problem encountered when buying LI was rejection of request.

The regional differences and influencing factors of tourism development on Hainan Island, China

Exploring the spatial pattern of tourism resources and tourism economy is vital to improve the utilization efficiency of tourism resources and promote sustainable tourism development. This research investigated the quantity and types of tourism resources and analyzed the spatial patterns of tourism resources on Hainan Island from the perspectives of spatial variation and spatial association. The spatial and temporal pattern of the number of tourists and tourism revenue during 2010–2019 were further analyzed. The influencing factors of tourism development were explored based on the geographic detector. The results showed that 10425 tourism resources exist on Hainan Island, and the type of buildings and facilities had the largest number of tourism resources. The geological landscape, astronomical phenomena and meteorological landscapes, buildings and facilities, ruins and remains, tourism commodities, and human activities showed significant spatial agglomeration. Domestic tourism was far more developed than inbound tourism in terms of the number of tourists and tourism revenue. However, the spatial difference of tourism resources and tourism economy was apparent on Hainan Island. Factor analysis showed that the quantity of hotels, the proportion of tertiary industry in the GDP, and the regional population were the most influential factors for the distribution of tourism resources, while the density of the road network, the quantity of hotels, the per capita GDP, the proportion of tertiary industry in GDP, the regional population, and the quantity of tourism resources showed obvious influences on the tourism economy of Hainan Island. Interactions of the factors mainly fell into three types: synergistic increases, single factor weakening, and nonlinear weakening. It is suggested that the local government should fully exploit diversity types of tourism resources on Hainan Island to attract more tourists and improve the tourism revenue; improving the inbound tourism, and to strengthen the construction of road network on Hainan Island.