You can easily judge the character of a man by how he treats those who can do nothing for him.” ― Johann Wolfgang von Goethe
Germany: Bundesrepublik Deutschland) is the largest country in Central Europe. Germany is a federation of 16 states, roughly corresponding to regions with their own distinct and unique cultures. Germany is one of the most influential European nations culturally, and one of the world’s main economic powers. Known around the world for its precision engineering and high-tech products, it is equally admired by visitors for its old-world charm and “Gemütlichkeit” (coziness). If you have perceptions of Germany as simply homogeneous, it will surprise you with its many historical regions and local diversity.
Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance (Gesetzliche Krankenversicherung) officially called “sickness funds” (Krankenkassen) and private health insurance (Private Krankenversicherung), colloquially also called “(private) sickness funds”. According to the Euro health consumer index, which placed it in 7th position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it. https://en.wikipedia.org/wiki/Main_Page
Preterm Birth Rate I Germany is 9.2% (rank 106)
U.S. preterm births rise for second year in a row
By Ashley Welch CBS News November 1, 2017, 2:45 PM
After nearly a decade of decline, the U.S. rate of preterm birth — the largest contributor to infant death in the country — increased again in 2016 for the second year in a row, according to a new report from the March of Dimes. More than 380,000 babies are born prematurely each year, putting them at greater risk of death before their first birthday. They’re also more likely to suffer lifelong disabilities and chronic health conditions including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays. In addition to the health toll, the National Academy of Medicine reports that preterm birth accounts for more than $26 billion each year in avoidable medical and societal costs. The “March of Dimes Premature Birth Report Card” cites data from the National Center for Health Statistics (NCHS) that found the U.S. preterm birth rate went up from 9.6 percent of births in 2015 to 9.8 percent in 2016. Some communities were hit even harder than others. “The 2017 March of Dimes Report Card demonstrates that moms and babies in this country face a higher risk of preterm birth based on race and zip code,” Stacey D. Stewart, president of the March of Dimes, said in a statement. “We see that preterm birth rates worsened in 43 states plus the District of Columbia and Puerto Rico, and among all racial/ethnic groups. This is an unacceptable trend that requires immediate attention.” The findings revealed startling racial disparities: Across the nation, African-American women are 49 percent more likely to deliver their babies preterm compared to white women, while American Indian/Alaska Native women are 18 percent more likely to deliver prematurely compared to white women. The report provides rates and grades for states and counties within all 50 states, the District of Columbia and Puerto Rico:
- 4 states — Vermont, New Hampshire, Washington, and Oregon — received “A” grades for preterm birthrates of 8.1 percent or less.
- 13 states received a “B” grade for preterm birthrates between 8.2 and 9.2 percent.
- 18 states got a “C” grade for preterm birthrates between 9.3 and 10.3 percent.
- 11 states and the District of Columbia received a “D” grade for preterm birthrates between 10.4 and 11.4 percent.
- 4 states, including West Virginia, Alabama, Louisiana, and Mississippi, as well as Puerto Rico, got an “F” for preterm birth rates of 11.5 or greater.
UGANDA PREMATURE BABIES; 9PM- 19/09/2017
In Uganda’s rural environment something as simple as a foot length card saves lives. Thank you to Community Health Care Workers, local medical and scientific specialists and cooperative family members who collaborate with expertise and resources to reduce childhood mortality and increase Community wellness. See our May 20, 2016 blog for additional information regarding the progressive and resourced-based work of Dr. Getrude Namazzi and Associates.
2017 NEONATAL & PEDIATRIC AWARD Winner- UNC Carolina Air Care Pediatric/Neonatal Transport Team
PREEMIE FAMILY PARTNERS
Science Daily – Children’s National Health System – September 15, 2017
- 45 percent of parents experience depression, anxiety and stress when newborns leave NICU
- Parents who were the most anxious also were the most depressed; older parents were less stressed
Almost half of parents whose children were admitted to Children’s National Health System’s neonatal intensive care unit (NICU) experienced postpartum depressive symptoms, anxiety and stress when their newborns were discharged from the hospital. And parents who were the most anxious also were the most depressed, according to research presented during the 2017 American Academy of Pediatrics (AAP) national conference.
The Centers for Disease Control and Prevention has found that one in 10 infants born in the United States each year is born preterm, or before 37 weeks’ gestation. Because fetuses undergo dramatic growth in the final weeks of pregnancy, readying them for life outside of the womb, tiny preemies often need help in the NICU with such essentials as breathing, eating and regulating their body temperature. Some very sick newborns die.
Because their infants’ lives hang in the balance, NICU parents are at particular risk for poor emotional function, including mood disorders, anxiety and distress. Children’s National Neonatologist Lamia Soghier, M.D., and the study team tried to determine factors closely associated with poor emotional function in order to identify at-risk parents most in need of mental health support.
The study team enrolled 300 parents and infants in a randomized controlled clinical trial that explored the impact of providing peer-to-peer support to parents after their newborns are discharged from the NICU. The researchers relied on a 10-item tool to assess depressive symptoms and a 46-question tool to describe the degree of parental stress. They used regression and partial correlation to characterize the relationship between depressive symptoms, stress, gender and educational status with such factors as the infant’s gestational age at birth, birth weight and length of stay.
Some 58 percent of the infants in the study were male; 58 percent weighed less than 2,500 grams at birth; and the average length of stay for 54 percent of infants was less than two weeks. Eighty-nine percent of parents who completed the surveys were mothers; 44 percent were African American; and 45 percent reported having attained at least a college degree. Forty-three percent were first-time parents.
About 45 percent of NICU parents had elevated Center for Epidemiological Studies Depression Scale (CES-D) scores.
“The baby’s gender, gestational age at birth and length of NICU stay were associated with the parents having more pronounced depressive symptoms,” Dr. Soghier says. “Paradoxically, parents whose newborns were close to full-term at delivery had 6.6-fold increased odds of having elevated CES-D scores compared with parents of preemies born prior to 28 weeks’ gestation. Stress levels were higher in mothers compared with fathers, but older parents had lower levels of stress than younger parents.”
Dr. Soghier says the results presented at AAP are an interim analysis. The longer-term PCORI-funded study continues and explores the impact of providing peer support for parents after NICU discharge.
AAP News and Journals Pediatrics Accepted June 5, 2017 August 2017
Very Preterm Birth and Parents’ Quality of Life 27 Years Later
Dieter Wolke, Nicole Baumann, Barbara Busch, Peter Bartmann
BACKGROUND AND OBJECTIVES: Parents of preterm children experience increased distress early in their children’s lives. Whether the quality of life of parents of preterm children is comparable to that of parents of term children by the time their offspring reach adulthood is unknown. What precursors in their offspring’s childhood predict parental quality of life?
METHODS: A prospective whole-population study in Germany followed very preterm (VP) (<32 weeks gestation) or very low birth weight (VLBW) (<1500 g) (N = 250) and term-born individuals (N = 230) and their parents (VP or VLBW: N = 219; term: N = 227) from birth to adulthood. Parental quality of life was evaluated with the World Health Organization Quality of Life assessment and the Satisfaction with Life questionnaire when their offspring were adults (mean age 27.3 years, 95% confidence interval [CI]: 27.2 to 27.3). Childhood standard assessments of VP or VLBW and term offspring included neurosensory disability, academic achievement, mental health, and parent-child and peer relationships.
RESULTS: Overall quality of life of parents of VP or VLBW adults was found to be comparable to parents of term individuals (P > .05). Parental quality of life was not predicted by their children being born VP or VLBW, experiencing disability, academic achievement, or the parent-child relationship in childhood but by their offspring’s mental health (B = 0.15, 95% CI: 0.08 to 0.22) and peer relationships (B = 0.09, 95% CI: 0.02 to 0.16) in childhood.
CONCLUSIONS: As a testament to resilience, parents of VP or VLBW adults had quality of life comparable to parents of term adults. Support and interventions to improve mental health and peer relationships in all children are likely to improve parents’ quality of life.
- Copyright © 2017 by the American Academy of Pediatrics
HEALTH CARE PARTNERS
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Physicians’ occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals
Abstract – Published online 2016 Jun 15- PMCID: PMC491661
Objectives-This study aimed to analyze and compare differences in occupational stress, depressive symptoms, work ability and working environment among residents working in various medical specialties.
Results-Results show that up to 17% of the physicians reported high levels of occupational distress and 9% reported high levels of depressive symptoms. 11% of the hospital physicians scored low in work ability. Significant differences between medical specialties were demonstrated for occupational distress, depressive symptoms, work ability, job demands and job resources. Surgeons showed consistently the highest levels of perceived distress but also the highest levels of work ability and lowest scores for depression. Depressive symptoms were rated with the highest levels by anesthesiologists. Significant associations between physicians’ working conditions, occupational distress and mental health-related aspects are illustrated.
Conclusions-Study results demonstrated significant differences in specific job stressors, demands and resources. Relevant relations between work factors and physicians’ health and work ability are discussed. These findings should be reinvestigated in further studies, especially with a longitudinal study design. This work suggests that to ensure physicians’ health, hospital management should plan and implement suitable mental health promotion strategies. In addition, operational efficiency through resource planning optimization and work process improvements should be focused by hospital management.
Full Site: http://bmjopen.bmj.com/content/6/6/e011369
Frontiers in Immunology
Preterm Birth Affects the Risk of Developing Immune-Mediated Diseases – 09 October 2017
Prematurity affects approximately 10% of all children, resulting in drastically altered antigen exposure due to premature confrontation with microbes, nutritional antigens, and other environmental factors. During the last trimester of pregnancy, the fetal immune system adapts to tolerate maternal and self-antigens, while also preparing for postnatal immune defense by acquiring passive immunity from the mother. Since the perinatal period is regarded as the most important “window of opportunity” for imprinting metabolism and immunity, preterm birth may have long-term consequences for the development of immune-mediated diseases. Intriguingly, preterm neonates appear to develop bronchial asthma more frequently, but atopic dermatitis less frequently in comparison to term neonates. The longitudinal study of preterm neonates could offer important insights into the process of imprinting for immune-mediated diseases. On the one hand, preterm birth may interrupt influences of the intrauterine environment on the fetus that increase or decrease the risk of later immune disease (e.g., maternal antibodies and placenta-derived factors), whereas on the other hand, it may lead to the premature exposure to protective or harmful extrauterine factors such as microbiota and nutritional antigen. Solving this puzzle may help unravel new preventive and therapeutic approaches for immune diseases.
Conclusion and Future Directions-Due to care under highly controlled conditions, preterm neonates are a distinct group of patients that can be used as a model to discern (epi-) genetic factors from environmental changes and from maturation-dependent changes in the immune system. Short-term and long-term influences of preterm birth can be measured by comparison to term born children. The influence of preterm birth on the developing immune system is poorly understood but may imprint the risk for immune-mediated diseases later in life (84). Future research should systematically address immunological pathways in the fetus (prenatal), in the preterm neonate and in the mature-born neonate to discern changes that were caused by maturational programs from those that were triggered by premature exposure to the extrauterine environment. The clinical outcome in relation to immune diseases should be assessed, furthering our understanding of the perinatal influences that have a long-term effect on the inflammatory response.
It remains unclear why preterm neonates have a reduced risk of atopic dermatitis and atopy defined as elevated serum IgE, specific IgE, and skin prick test (27). However the increased risk of asthma in preterm neonates is most likely not mediated by an atopic pathophysiology.
The following questions should be addressed in future studies:
- (1) Which factors are responsible for the epidemiological differences between asthma and atopic dermatitis in preterm children? In addition to thorough clinical phenotyping and lung function testing, it is essential to include objective analyses for sensitization such as serum IgE, specific IgE, and a skin prick test.
- (2) How are the various asthma and atopic dermatitis phenotypes distributed in preterm children?
- (3) Is the incidence of autoimmune disease altered in individuals that were born prematurely?
- (4) What effect do the microbiome, epigenetics, and other mechanisms have in imprinting the immune system of preterm neonates?
These studies could provide important insights into the mechanisms of immunological imprinting and potential therapeutic interventions to lower the risk of immune-mediated diseases not just in preterm neonates but in the wider population.
KAT CHAT –
Why We Matter – The Wisdom of Warriors– Kat Campos & Kathy Papac
Serving on a Neonatal Advisory Board exposed me (Kat) to the neonatal community on a deeper level. Members of the board included neonatologists, nurses, respiratory therapists, occupational and physical therapists, and preterm parents. I was a volunteer at the time representing Preterm Birth Survivors/NICU Grads. I enjoyed learning and working with a diverse team on various projects for our NICU unit, exploring topics that ranged from parent PTSD support to innovative areas of research such as the usage of probiotics for neonates.
When I started out on the board I did experience some adversity regarding my qualifications to actively contribute as a board member. At the time I was young and eager to learn from the healthcare providers around me. However, being questioned and told I couldn’t possibly “remember” my experience as a neonate helped me recognize the need for the preemie survivor voice and value to be acknowledged. The denial of my worth in this situation propelled me deeper into the Neonatal Womb community that was my family.
After serving for a 2-year term on the board, a transition in leadership and new Federal regulations were implemented into the rules and regulations for advisory board councils. I was informed that due to my status as a non-parent and non-professional care provider I would no longer qualify as a Board member. In addition, it was suggested that based on the assumption that because my experience in the NICU occurred as an infant I could not bring the same value as members working in the NICU or parents. On a deeper level both my mom and I knew that this assumption was incorrect. I realized that being told I was dismissed from serving as representative of NICU Grads I felt like I was being told the voice of the preemie survivor did not matter within the community that was built to make that voice possible. We were guided to create this blog in part to recognize and give voice to those who, like me, are preterm birth survivors.
Infant survival related to preterm birth is increasing, especially as it relates to the micro-preemie population. As we grow, thrive, experience life and face challenges, some of which will be related to being born preterm, our experiences and voices will be essential in charting our courses and the life experiences of the preterm birth brothers and sisters that follow. We are the Future of neonatal innovation. Ongoing and new research, methods of care, technologies, diagnostics and treatments will evolve from our experiences globally. Preterm birth survivors will be heard, we will participate, and we will demand recognition and quality healthcare. To the providers in our community I ask, please do not discourage or discount the ability for those of us that have been born early to connect to that journey. Do not disregard the fact that we are active participants in this Preterm Birth community. We too share stories, scars, and visceral memories of the trauma we have experienced. The Neonatal Womb community has the opportunity and responsibility to collaborate and support our Family as a whole. Each Partner in our community plays a critical role in the health and well-being of all of us. We ask that rather than shutting the door when we leave the NICU that the door of collaboration is left open. We need to continue to work together, to reach out to and support one another, so that doing better is not something placed into the future but is something tangible we can work towards today.
Early Life Stress May Have Greater Impact on Extreme Preemies’ Mental Health
A new Canadian study finds that childhood stress may pose an even greater mental health risk to adults who were extremely low birth weight preemies (2.2 pounds or less) than to those born at normal weight. In particular, decreased exposure to bullying and family problems during childhood and adolescence is linked to a lower risk of adult mental illness in extreme low birth weight preemies. Early mental health support for these children and their parents could also prove beneficial.
“In terms of major stresses in childhood and adolescence, preterm survivors appear to be impacted more than those born at normal birth weight,” said Ryan J. Van Lieshout, assistant professor of psychiatry and behavioural neurosciences at McMaster University and the Albert Einstein/Irving Zucker Chair in Neuroscience.
“If we can find meaningful interventions for extremely low birth weight survivors and their parents, we can improve the lives of preterm survivors and potentially prevent the development of depression and anxiety in adulthood.
The researchers used the McMaster Extremely Low Birth Weight (ELBW) Cohort, which involves a group of 179 extremely low birth weight survivors and 145 normal birth weight controls born between 1977 and 1982, which has 40 years’ worth of data.
The findings reveal that although these preemies were not necessarily exposed to a larger number of risk factors compared to their normal birth weight counterparts, these stressors appeared to have a greater impact on their mental health as adults.
Besides bullying by peers and a small circle of friends, researchers looked at a number of other risk factors, including maternal anxiety or depression and family dysfunction.
“We believe it may be helpful to monitor and provide support for the mental health of mothers of preemies, in particular, as for the purposes of this study, they were the primary caregiver,” said Van Lieshout.
“There can also be family strain associated with raising a preemie and all the related medical care, which can lead to difficulties. Support for the family in a variety of forms might also be beneficial.
The study builds on previous research showing that extremely low birth weight survivors have an increased risk of mental illness in adulthood.
“We are concerned that being born really small and being exposed to all the stresses associated with preterm birth can lead to an amplification of normal stresses that predispose people to develop depression and anxiety later in life,” said Van Lieshout.
The findings are published in The Journal of Child Psychology and Psychiatry.
Source: McMaster University
River Surfing in Munich, Germany
Check out Tropical Islands Resort is a tropical theme park located in the former Brand-Briesen Airfield in Halbe, municipality in the district of Dahme-Spreewald in Brandenburg, Germany, 50 kilometres from the southern boundary of Berlin. It is housed in a former airship hangar (known as the Aerium), the biggest free-standing hall in the world.