Search Results (59)

There is scant literature on migrants with an entrepreneurial background and who return to their country of origin. Using a transnational theoretical approach, we seek to contribute to research in this field by analysing the return strategies and expectations of Colombian migrant entrepreneurs participating in the Programme Migration and Diaspora (PMD). This programme is implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH (German Society for International Cooperation, Eschborn, Germany) on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ, Berlin, Germany). To this end, a mixed-methods study was conducted. Likert scale questionnaires and semi-structured interviews were applied to twenty-seven entrepreneurs participating in the programme, analysing quantitative and qualitative variables. Migrants seek to contribute to Colombia’s development through entrepreneurship, looking for various commercial connections for which security and planning conditions are necessary. They see entrepreneurship as sustenance, which in most cases results in transnational links between Germany and Colombia. For that to happen, contacts and acquired experiences are fundamental, as well as tangible and intangible resources, amongst which the information and support for entrepreneurship granted by GIZ stand out. Generally, it is essential to continue strengthening differentiated and comprehensive support strategies for all types of migrant entrepreneurs in destination countries. Full article

Background and Objectives: Sleep disorders are highly prevalent in society and require focused attention within healthcare systems. While patient history, reported complaints, and subjective sleep questionnaires can provide initial insights into potential sleep issues, polysomnography (PSG) remains the gold standard for diagnosing various sleep disorders. However, long waiting times for PSG appointments in many healthcare facilities pose challenges for timely diagnosis and treatment. This study aimed to evaluate the diagnostic value of subjective measures, including patient-reported parameters, in comparison to the objective findings of PSG. Materials and Methods: In this study, we retrospectively analysed the data from 562 patients who underwent clinical evaluation and PSG testing at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2018 and 2024. We report the diagnostic accuracy of different sleep questionnaires to detect various sleep disorders in our population. Results: We report the corresponding sensitivity and specificity values: the Epworth Sleepiness Scale (ESS)—73.2% and 44.1% for detecting severe obstructive sleep apnoea and 87.1% and 76.8% for detecting hypersomnia; the Insomnia Severity Index (ISI)—77.2% and 63.3% for detecting insomnia; the Berlin Questionnaire (BQ)—67.8% and 68.8% for detecting obstructive sleep apnoea; the Ullanlina Narcolepsy Scale (UNS)—84.4% and 58.9% for detecting hypersomnia; the Innsbruck REM Sleep Behaviour Disorder Inventory (RBD-I)—93.3% and 52.5% for detecting RBD; the REM Sleep Behaviour Disorder Single-Question Screen (RBD1Q)—73.3% and 81.0% for detecting RBD; and the Paris Arousal Disorder Severity Scale (PADSS)—57.5% and 90.5% for detecting parasomnia. Conclusions: When comparing our findings with the previous literature, we found that the screening tools generally demonstrated a slightly poorer performance in our population. However, our results suggest that certain individual questions from the comprehensive questionnaires may provide comparable diagnostic values, while reducing the patient burden. We propose a targeted screening approach that integrates fundamental clinical parameters, key screening questions, and selected validated questionnaires, enabling primary care and outpatient clinicians to more efficiently identify patients who may require referral for specialised sleep evaluation and treatment. Full article

Background: Aging is a well-established independent risk factor for both cognitive impairment and sleep disorders, including obstructive sleep apnea (OSA), a modifiable yet underrecognized condition. OSA has been implicated in biological mechanisms contributing to Alzheimer’s disease, including amyloid-β accumulation, tau phosphorylation, and neuroinflammation. This underscores the need to optimize OSA diagnosis in individuals with an increased risk of dementia. Methods: This cross-sectional observational study enrolled adults aged 60–85 years with a CAIDE dementia risk score ≥6. Subjective sleep was evaluated using validated questionnaires (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Oviedo Sleep Questionnaire), while objective sleep data were obtained through a single-night peripheral arterial tonometry (PAT)-based wearable device, complemented by a 7-day sleep diary. Participants also completed the STOP-BANG and Berlin questionnaires, with clinically relevant findings communicated to participants. Results: Among 322 participants (48.8% women; mean age 71.4 ± 6.4 years), moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15) was identified in 48.49%, despite the absence of prior diagnoses. Subjective screening tools frequently underestimated OSA severity compared to objective assessments. While no significant sex-based differences were noted, higher AHI values correlated strongly with increased body mass index and elevated dementia risk scores. Conclusions: A marked discrepancy between subjective and objective sleep measurements complicates the accurate diagnosis and management of most sleep disorders, including OSA. Sleep disorders remain significantly underdiagnosed in individuals at increased risk for dementia. Integrating wearable technologies and structured tools such as sleep diaries into routine assessments can enhance diagnostic precision, enabling timely interventions for these modifiable risk factors of dementia. Full article

Background: Prenatal factors have been implicated in the likelihood of reporting sleep disorders in infants. The influence of prenatal and pregnancy-related factors on the incidence of brief resolved unexplained events (BRUEs) in infants has not been established. Objectives: This study aims to evaluate the prenatal and pregnancy-related factors that may contribute to the development of BRUEs in infants. Methods: A single-center, observational, and cross-sectional cohort study was conducted on mothers of children presenting to the Pediatric Clinic of the University of Insubria’s Center for the Study of Respiratory Sleep Disorders with BRUEs as infants. The mothers of typically developing children were enrolled as a control group consecutively at their respective outpatient clinics. All mothers were administered comprehensive questionnaires including demographics, past medical histories, and pregnancy-related issues (weight gain, Berlin sleep-disordered breathing score, and insomnia severity index), psychological symptoms, medical history, illnesses, and medications. Results: Infants with BRUEs were delivered at an earlier gestational age. Mothers of infants with BRUEs were more likely to snore during pregnancy and have lower extremity edema during the first trimester, uterine contractions and restless legs syndrome symptoms during the second trimester, and muscle aches and aspirin usage during the third trimester. The insomnia severity index composite score was not different between the control and BRUE groups. Mothers of infants with BRUEs were less likely to report leg cramps, pregnancy-related diarrhea, fatigue, and gastroesophageal reflux. Conclusions: Mothers of infants presenting with BRUEs had more symptoms during pregnancy of snoring and uterine contractions but not insomnia and were less likely to report leg cramps, pregnancy-related diarrhea, fatigue, and gastroesophageal reflux. The reporting of this study conforms with the STROBE statement. Full article

Background: Preterm birth is a major global health issue, associated with increased neonatal morbidity and mortality. Mothers of preterm infants face unique challenges, particularly with regard to lactation, due to the complexities of preterm neonatal care. Social support has been recognized as a factor in promoting successful breastfeeding, especially in vulnerable groups such as mothers of preterm infants. Objective: This study aimed to explore the psychosocial factors influencing breastfeeding in mothers following preterm birth, with a particular focus on the role of social support in early lactation success. Methods: A cross-sectional observational study was conducted between December 2022 and March 2023 at a tertiary referral hospital in Poland. The study included 130 women (71 mothers of preterm infants and 59 mothers of full-term infants) in the early postpartum period. Data were collected through a self-administered questionnaire and the Polish version of the Berlin Social Support Scales (BSSS). Lactation success was assessed based on the mother’s ability to initiate and maintain breastfeeding or expressed milk production. Statistical analyses included Mann–Whitney U tests, Pearson’s Chi-Square, and logistic regression to determine the association between social support and lactation outcomes. Results: The study revealed that mothers of preterm infants exhibited a greater need for social support compared with those who delivered at term. Social support, particularly perceived emotional and practical support, appeared to be significantly associated with successful early lactation. Women who received adequate social support were more likely to initiate breastfeeding early and maintain lactation. Conclusions: Psychosocial factors, particularly social support, play a critical role in the success of lactation among mothers of preterm infants. These findings underscore the need for comprehensive support systems for mothers of preterm infants to promote breastfeeding and improve neonatal health outcomes. Full article

Background: We have previously demonstrated that high-risk obstructive sleep apnea (HR-OSA), based on a modified Berlin Questionnaire (mBQ), is linked to worse clinical outcomes. Chest computed tomography (CT) imaging with the implementation of an artificial intelligence (AI) analysis program has been a valuable tool for the speedy assessment of huge numbers of patients during the COVID-19 epidemic. In the current study, we addressed how the severity of AI-guided, CT-based total opacity ratio (TOR) scores are associated with high-risk OSA and short-term outcomes in the same cohort. Methods: The ratio of the volume of high opacity areas to that of the total lung volume constituted the TOR. We arbitrarily applied thresholds of <5 (no or mild TOR), ≥5 and <15 (moderate TOR), and ≥15 (severe TOR). Results: In total, 221 patients were included. HR-OSA was observed among 11.0% of the no or mild TOR group, 22.2% of the moderate TOR group, and 38.7% of the severe TOR group (p < 0.001). In a logistic regression analysis, HR-OSA was associated with a severe TOR with an adjusted odds ratio of 3.06 (95% confidence interval [CI] 1.27–7.44; p = 0.01). A moderate TOR predicted clinical worsening with an adjusted hazard ratio (HR) of 1.93 (95% CI 1.00–3.72; p = 0.05) and a severe TOR predicted worsening with an HR of 3.06 (95% CI 1.56–5.99; p = 0.001). Conclusions: Our results offer additional radiological proof of the relationship between HR-OSA and worse outcomes in patients with COVID-19 pneumonia. A TOR may also potentially indicate the individuals that are at higher risk of HR-OSA, enabling early intervention and management strategies. The clinical significance of TOR thresholds needs further evaluation in larger samples. Full article

The Berlin questionnaire (BQ), with its ten questions, stands out as one of the simplest and most widely implemented non-invasive screening tools for detecting individuals at a high risk of Obstructive Sleep Apnea (OSA), a still underdiagnosed syndrome characterized by the partial or complete obstruction of the upper airways during sleep. The main aim of this study was to enhance the diagnostic accuracy of the BQ through Machine Learning (ML) techniques. A ML classifier (hereafter, ML-10) was trained using the ten questions of the standard BQ. Another ML model (ML-2) was trained using a simplified variant of the BQ, BQ-2, which comprises only two questions out of the total ten. A 10-fold cross validation scheme was employed. Ground truth was provided by the Apnea–Hypopnea Index (AHI) measured by Home Sleep Apnea Testing. The model performance was determined by comparing ML-10 and ML-2 with the standard BQ in the Receiver Operating Characteristic (ROC) space and using metrics such as the Area Under the Curve (AUC), sensitivity, specificity, and accuracy. Both ML-10 and ML-2 demonstrated superior performance in predicting the risk of OSA compared to the standard BQ and were also capable of classifying OSA with two different AHI thresholds (AHI ≥ 15, AHI ≥ 30) that are typically used in clinical practice. This study underscores the importance of integrating ML techniques for early OSA detection, suggesting a direction for future research to improve diagnostic processes and patient outcomes in sleep medicine with minimal effort. Full article

Introduction: Obstructive sleep apnea (OSA) is associated with an increased risk of hypertension, coronary artery disease, heart failure (HF), and atrial fibrillation (AF). Materials and methods: A total of 179 patients aged 34–81 years were included in the study. The median age was 63 years (interquartile range: 56–69 years). Of these patients, 105 (58.7%) were men, and 74 (41.3%) were women; there were cases of paroxysmal (n = 99), persistent (n = 64), and permanent AF (n = 16). All patients underwent investigations including respiratory sleep monitoring, echocardiography, and 24 h Holter electrocardiography monitoring. Statistical analyses were performed using IBM SPSS Statistics 26.0. Results: OSA was detected in 131 (73.2%) patients. In patients with OSA, paroxysmal AF was commonest (n = 65), followed by persistent AF (n = 51) and permanent AF (n = 15). The patients with sleep apnea had increased body mass index (33.6 kg/m2; p = 0.02), waist circumference (114 cm; p < 0.001), and neck circumference (42 cm; p < 0.001) values. HF (OR 2.9; 95% CI: 1.4–5.9; p = 0.004) and type 2 diabetes (OR 3.6; 95% CI: 1.5–8.3; p = 0.001) were more common in patients with AF and OSA. The STOP-BANG scale (AUC = 0.706 ± 0.044; 95% CI: 0.619–0.792; p < 0.001) and the Berlin questionnaire (AUC = 0.699 ± 0.044; 95% CI: 0.614–0.785) had a higher predictive ability for identifying sleep apnea. Conclusions: Patients with AF demonstrate a high prevalence of OSA and an increased association with cardiovascular comorbidities. The STOP-BANG scale and the Berlin questionnaire can be used to screen for OSA in patients with AF. Full article

Background: Nasal airway obstruction (NAO) is characterised by high resistance in the nasal cavity with a collapsible and narrowed upper airway and is an integral part of OSA pathophysiology. The literature demonstrates that the identification of high-risk OSA in the young adult population leads to the prevention of later health consequences. A nasoorospirometer is a prototype device that measures nasal capacity during inspiration. The basis for measurement is a Wheatstone bridge and a thermal anemometer. The parameters are recorded via hot wire anemometry (HTA) with velocity measurements in the airflow field. Therefore, this pilot study aimed to test the feasibility of the device by examining a young adult sample. The secondary aim was to determine whether subjective NAO correlates with nasal capacity and whether NAO corresponds with anthropometric parameters and individual risk of OSA. Methods: A group of 31 participants (mean age 24.9 years) underwent a thorough laryngological examination. The nasoorospirometer was used to measure objective NAO (nasal capacity), the NOSE scale was used to gain subjective NAO evaluation, and the Berlin Questionnaire for the risk of OSA. Results: A correlation analysis confirmed no significant associations between the subjective and objective measures (p > 0.05). Higher BMI and neck circumference are associated with lower NAO and higher nasal patency in the population of young adults (r: 0.32–0.45; p < 0.05). The risk of OSA showed no statistically significant association (p > 0.05). Conclusions: We presented three methods of NAO assessment: subjective participant evaluation, objective nasoosopirometry, and objective laryngological assessment. However, the use of a nasoorospirometer with anthropometric measures in young adults needs to be verified in future studies. Full article

Fibromyalgia syndrome (FMS) is a common chronic pain disorder and often occurs as a concomitant disease in rheumatological diseases. Managing FMS takes a complex approach and often involves various non-pharmacological therapies. Fasting interventions have not been in the focus of research until recently, but preliminary data have shown effects on short- and medium-term pain as well as on physical and psychosomatic outcomes in different chronic pain disorders. This single-arm observational study investigated the effects of prolonged fasting (3–12 days, <600 kcal/d) embedded in a multimodal treatment setting on inpatients with FMS. Patients who were treated at the Department of Internal Medicine and Nature-Based Therapies of the Immanuel Hospital Berlin, Germany, between 02/2018 and 12/2020 answered questionnaires at hospital admission (V0) and discharge (V1), and then again three (V2), six (V3), and 12 (V4) months later. Selected routine blood and anthropometric parameters were also assessed during the inpatient stay. A total of 176 patients with FMS were included in the study. The Fibromyalgia Impact Questionnaire (FIQ) total score dropped by 13.7 ± 13.9 (p < 0.001) by V1, suggesting an improvement in subjective disease impact. Pain (NRS: reduction by 1.1 ± 2.5 in V1, p < 0.001) and quality of life (WHO-5: +4.9 ± 12.3 in V1, p < 0.001) improved, with a sustainable effect across follow-up visits. In contrast, mindfulness (MAAS: +0.3 ± 0.7 in V1, p < 0.001), anxiety (HADS-A: reduction by 2.9 ± 3.5 in V1, p < 0.0001), and depression (HADS-D: reduction by 2.7 ± 3.0 in V1, p < 0.0001) improved during inpatient treatment, without longer-lasting effects thereafter. During the study period, no serious adverse events were reported. The results suggest that patients with FMS can profit from a prolonged therapeutic fasting intervention integrated into a complex multimodal inpatient treatment in terms of quality of life, pain, and disease-specific functional parameters. ClinicalTrials.gov Identifier: NCT03785197. Full article

Background: The shifting reproductive age of women is reflected in European populations. Pregnancy in women older than 35 years is considered high-risk and can be an additional source of stress. The aim of this study was to assess the perceived stress of women experiencing late motherhood and the coping strategies used. Methods: The study was conducted in Poland by means of a diagnostic survey, using the COPE (Coping Orientation to Problems Experienced) Inventory, the Perceived Stress Scale (PSS), the Berlin Social Support Scales (BSSS), and a self-administered questionnaire. The study included 310 women who gave birth to their first child after the age of 35 and 313 respondents in a control group who gave birth before this age. Results: Based on the results, there were no statistically significant differences in feelings of stress among women who gave birth to their first child after the age of 35 (M = 18.33) compared to the control group (M = 18.14). However, statistically significant differences were observed regarding stress coping strategies. Conclusions: Women giving birth after the age of 35 were more likely to use strategies including active coping, planning, positive reformulation, acceptance, turning to religion, and seeking instrumental support. Full article

Background. The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. Methods: This cross-sectional descriptive–analytical study was conducted from March to August 2023 at the “Dr. Radivoj Simonović” General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales—for assessing social support—and the Connor–Davidson Resilience Scale—for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients’ sociodemographic and clinical characteristics and levels of social support. Results: The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support. Conclusion: This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other. Full article

Introduction: Athletes have demonstrated a significant increase in anxiety and stress connected to the COVID-19 pandemic. Drawing on the theory of salutogenesis, this study examined the relationship between the sense of coherence and social support and competitive elite-level athletes’ perception of the COVID-19 pandemic situation. Materials and Methods: The perceived secondary gains associated with the pandemic were analysed with a quasi-qualitative research methodology. The sample consisted of 204 competitive elite-level female football players aged 14–36 (M = 17.61, SD = 4.42) who completed the Sense of Coherence Questionnaire (SOC-29), the Berlin Social Support Scales (BSSS), and the researchers’ own questionnaire to assess the perception of the COVID-19 situation. Results: The results confirmed a relationship between a sense of coherence and coping better with the difficult situation caused by the coronavirus pandemic. No protective role of social support in the adaptive perception of the pandemic situation was identified. Conclusions: The data from the quasi-qualitative study testify to the use of the adversity of the pandemic to grow in many areas of female football players’ lives. The sense of coherence was a protective factor in mitigating the negative consequences of the COVID-19 pandemic situation. Full article

Preliminary clinical data suggest that pain reduction through fasting may be effective for different diagnoses. This uncontrolled observational clinical study examined the effects of prolonged modified fasting on pain and functional parameters in hip and knee osteoarthritis. Patients admitted to the inpatient department of Internal Medicine and Nature-based Therapies of the Immanuel Hospital Berlin between February 2018 and December 2020 answered questionnaires at the beginning and end of inpatient treatment, as well as at 3, 6, and 12 months after discharge. Additionally, selected blood and anthropometric parameters, as well as subjective pain ratings, were routinely assessed during the inpatient stay. Fasting was the only common intervention for all patients, being performed as part of a multimodal integrative treatment program, with a daily caloric intake of <600 kcal for 7.7 ± 1.7 days. N = 125 consecutive patients were included. The results revealed an amelioration of overall symptomatology (WOMAC Index score: −14.8 ± 13.31; p < 0.001; d = 0.78) and pain alleviation (NRS Pain: −2.7 ± 1.98, p < 0.001, d = 1.48). Pain medication was reduced, stopped, or replaced by herbal remedies in 36% of patients. Improvements were also observed in secondary outcome parameters, including increased quality of life (WHO-5: +4.5 ± 4.94, p < 0.001, d = 0.94), reduced anxiety (HADS-A: −2.1 ± 2.91, p < 0001, d = 0.55) and depression (HADS-D: −2.3 ± 3.01, p < 0.001, d = 0.65), and decreases in body weight (−3.6 kg ± 1.65, p < 0.001, d = 0.21) and blood pressure (systolic: −6.2 ± 15.93, p < 0.001, d = 0.43; diastolic: −3.7 ± 10.55, p < 0.001, d = 0.43). The results suggest that patients with osteoarthritis of the lower extremities may benefit from prolonged fasting as part of a multimodal integrative treatment to improve quality of life, pain, and disease-specific functional parameters. Confirmatory randomized controlled trials are warranted to further investigate these hypotheses. Full article

Since communication skills contribute significantly to professional success among veterinarians, there is a particular focus on developing communication classes in veterinary curricula. At Freie Universität Berlin, an e-learning course covering the basics of communication and a practical communication course based on role plays with and without simulation persons have been established. The outcome of these communication courses on the assessment of the relevance of several veterinary competencies and on the self-assessment of communication skills using the SE-12 questionnaire was investigated. For this purpose, students were surveyed before and after the e-learning course as well as before and after the practical course. Veterinarians were also surveyed on the relevance of veterinary competencies. The relevance of communicative competencies for professional success was rated significantly higher by the students after completing the practical course than by the other students and the veterinarians. Self-assessment of communication skills showed little increase after the e-learning course, but a significant increase after the practical course. Thus, an effective outcome of the communication classes was observed mainly after the practical course. However, the effect of the e-learning course cannot be ruled out since the students participating in the practical course have also completed the e-learning course beforehand. Full article