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This study aims to assess the ability of the Abdus Salam International Centre for Theoretical Physics (ICTP) Regional Climate Model version 4.7.1 to reproduce historical monthly mean temperatures and precipitation in different physical geographical conditions of Georgia. RegCM4.7.1 simulation has been done at 12 km resolution over the territory of Georgia from 1985 to 2014, with the hourly ERA5 high-resolution atmospheric reanalysis of the global climate data of the European Centre for Medium-Range Weather Forecasts (ECMWF) as boundary conditions. Standard deviation is used to evaluate the model's performance against Georgia's meteorological station data. This metric helps quantify the agreement between model outputs and observed data. Conducting historical runs and validating the model against observed data contributes to understanding how regional climate models perform in regions with diverse geographical features and is crucial for ensuring the reliability of future climate projections. A group of weather stations with the best data modeling results in all months of the year when the difference between the actual and model data does not exceed the standard deviation value is Kutaisi, Gori, Sagarejo, Tbilisi, and Tsalka for air temperature and Akhalkalaki, Akhaltsikhe, Dedoplistskaro, Gori, Sagarejo, Tbilisi, Telavi, and Tianeti for precipitation. The modeling results are generally satisfactory, indicating that the model can be used effectively for future climate projections in Georgia. These findings provide valuable insights for policymakers, stakeholders, and researchers working on climate change adaptation in Georgia. [ABSTRACT FROM AUTHOR]

Agriculture is the traditional and leading field of economy of Tetritskaro Municipality, but it faces the challenge of changing climate. The study examines the perceptions of climate change among male and female farmers in Tetritskaro, including their primary sources of information, chosen adaptation measures, and their respective needs. Climate change data that are available in Tetritskaro focused on characteristic extreme weather events coupled with face-to-face interviews from 254 farmers (male - 53%, female - 47%) was analyzed. The study revealed that men and women have more or less similar perceptions of climate change issues. Male farmers primarily rely on conversations with fellow farmers for information on climate, seasonal prediction, and weather forecasts, while female farmers depend on indigenous knowledge of the local environment. Male and female farmers have adapted to the changes in climate similarly by applying some measures, while the exchange of information between fellow farmers, use of various hail protection products, and crop diversification techniques are more frequent among male farmers. Farmers expressed the need for low-interest loans to purchase agricultural products and equipment and restore/create windbreak zones. Most of the male farmers indicate the need for the introduction of new technologies, while female farmers are more in need of training in agricultural activities. The reliance on the experience of other farmers can be seen as a form of social learning and knowledge sharing. Understanding and respecting these local communication channels and sources of knowledge is important for designing effective extension programs and information campaigns. Addressing the traditional men-women roles and cultural and social norms is critical to increasing the adaptation opportunities of female farmers. The study highlights the necessity of developing climate change adaptation policies and interventions in Tetritskaro. The obtained results can be used in other agricultural regions with the same problems. [ABSTRACT FROM AUTHOR]

Introduction: Germany and the European Union have experienced successive waves of refugees since 2014, resulting in over 1.6 million arrivals, including families with young children. These vulnerable populations often face xenophobia, discrimination, substandard living conditions and limited healthcare access, contributing to a high prevalence of mental health problems (MHP). Our primary goal is to proactively address MHP in refugee parents and prevent its potential impact on their children through effective early interventions. Using a low-threshold, primary care-based approach, we aim to enhance parenting skills and address parental psychopathology, creating a supportive environment for parents and children., Methods and Analysis: In this randomised controlled trial, 188 refugee parents of 6-year-old children or younger who meet the clinical cut-off on the MHP scale will participate. They are randomly assigned to either the experimental psychotherapeutic intervention, delivered by general practitioners (10-week Improve intervention), or treatment as usual, in a ratio of 1:1. The randomisation will be masked only for outcome assessors. Improve includes face-to-face sessions with general practitioners, an interactive online parenting programme (Triple P Online) and regular protocol-based telephone calls by psychologists. Primary outcomes will assess the intervention's effects on parental and child MHP and parenting skills, with secondary outcomes including psychosocial and physical health indicators. Outcomes will be assessed at pre, post and at 3-month and 6-month follow-ups. The study is scheduled to run from February 2019 to July 2025., Ethics and Dissemination: The project Improve-MH (application number 602) was approved by the local ethics committee of Ruhr-University of Bochum and is being conducted in accordance with the Declaration of Helsinki. The study is also conducted in full accordance with the German Data Protection Act, and the Good Clinical Practice guideline (GCP) and is sensitive to specific ethical considerations. Results will be disseminated at scientific conferences, published in peer-reviewed journals and provided to consumers of healthcare., Trial Registration Number: The trial was prospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS-ID: DRKS00019072) on 16 March 2020., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: With the beginning of the Covid-19 vaccinations in primary care, a new and work-intensive responsibility arose for medical assistants (MA). In addition to their existing duties and the challenges posed by Covid-19, they had to organize, plan, and in some cases carry out the vaccinations and follow up on the documentation., Methods: A total of 21 semi-structured interviews were conducted with MA between April and September 2021. Particularly considering the timing of the interview, questions were asked about the daily work routine and the associated vaccine organization. The interviews were then analyzed using MAXQDA software based on Kuckartz's qualitative content analysis., Results: The MA criticized a lack of organization and transparency in the planning and implementation of vaccinations. Each vaccination had to be pre- and post-processed, resulting in an immense bureaucratic effort. Additional work and stress were the results. Also, MA had to deal with difficult patients., Conclusion: The experience of MA must be taken into consideration in the future to create guidance for dealing with an increased demand for vaccinations. The guidelines for the future must ensure that MA are relieved and supported by a meaningful organization during such events., Competing Interests: Kathrin Schlößler ist angestellte Ärztin in einer Hausarztpraxis aus deren Praxis MFA für diese Studie befragt wurden. Als angestellte Hausärztin war sie auch als Studienärztin ein einer Studie nach dem Arzneimittelgeset (sponsor Lilly) tätig. Sie bezog ihr reguläres Gehalt als angestelte Ärztin und erhielt keine Vergütung oder Aufwandsentschädigung durch den Sponsor.Im März 2022 erhielt Anastasia Suslow mit einem Vortrag zu der hier vorgestellten Studie einen Forschungspreis in Höhe von 1250 Euro durch die Initiative Deutscher Forschungspraxennetze – DESAM-ForNet., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

In Germany, there are 1.8 million people currently living with dementia, and the trend is rising. In particular, the health system at the transition from hospital to outpatient care is facing major challenges given the high increase in a difficult patient clientele. Legal efforts have been undertaken (sect. 39a of the Fifth Social Code Book [SGB V]) to close the care gaps in the discharge and transfer process. This article aims to provide an overview of the documentation process of the discharge and transfer management for people with cognitive impairments in everyday clinical practice according to SGB V sect. 39 para. 1a after the Discharge Management Act came into force. Furthermore, the manuscript answers the research question "How is the statutory discharge management of people with cognitive impairments (MmkB) aged 65 and over documented" and highlights further characteristics of the discharge documentation for MmkB starting with the transition from the inpatient setting to other care settings. In order to answer the research question(s), a qualitative content analysis of all discharge documents available at the time of discharge was carried out as part of the intervention study on cross-sector care management to support cognitively impaired people during and after a hospital stay [intersec-CM], which was funded by the Federal Ministry of Education and Research. The results of the analysis show that, despite legal efforts, there are currently no standardized, unified processes of discharge management for people with cognitive impairments that can be traced in writing. However, departments with a large proportion of vulnerable patient groups were able to offer valuable insights: for example, their discharge documents included a short social history. Further evidence-based research and development in the domain of discharge management for people with cognitive impairments remains essential., (Copyright © 2024. Published by Elsevier GmbH.)

Introduction: In palliative home care frictional loss at the interface between primary palliative care (PPC) and specialised palliative home care (SPHC) is repeatedly pointed out. PPC and SPHC appear to be insufficiently interlinked. The model implemented in Westphalia-Lippe differs from others in Germany: it relies on close cooperation between general practitioners (GPs) and palliative consultancy services (PCS), an early start of the palliative care process and comprehensive/widespread collaboration. We hypothesize that the framework conditions applying in Westphalia-Lippe have positive effects on the uptake of palliative care activities by GPs. The objective of this study therefore is to compare GPs' attitudes and their willingness to provide palliative care between GPs in Westphalia-Lippe and GPs in other federal states/Associations of Statutory Health Insurance Physicians (ASHIPs) in order to empirically test our hypothesis., Methods: Secondary evaluation of a nationwide paper-based survey from 2018 for national data acquisition of GPs' palliative care activities at the interface of SPHC. Answers of the participating GPs from Westphalia-Lippe (n=119) are contrasted with the answers of the GPs from seven other federal states (n=1,025)., Results: GPs from Westphalia-Lippe have a consistently higher self-perception of being responsible for palliative care of their patients, more often take responsibility for palliative care activities and feel more confident in carrying them out. GPs from Westphalia-Lippe are more likely to know other palliative care facilities/actors and they find them to be more likely available for GPs. They rate the quality of the overall palliative infrastructure higher. For GPs from Westphalia-Lippe the involvement of PCS/SPHC providers is less important than for GPs from other regional ASHIPs. If they are involved in the palliative treatment of a patient, GPs from Westphalia-Lippe feel more frequently involved in the course of treatment., Discussion: Our study indicates that the special framework conditions for palliative care provided by GPs in Westphalia-Lippe have positive effects on their uptake of palliative care activities. An essential factor could be the PPC- and SPHC-integrated approach to palliative care in Westphalia-Lippe., Conclusion: Westphalia-Lippe may provide orientation for other regions regarding the involvement of GPs at the interface to specialized palliative care. Whether the type of palliative home care in Westphalia-Lippe also produces advantages in terms of quality and costs of care compared to the rest of Germany is something that needs to be investigated in the future., (Copyright © 2023. Published by Elsevier GmbH.)

Background: As older people are at increased risk of severe and fatal courses of SARS-CoV‑2 infection, they receive special attention, which, however, often refers one-sidedly to their need for protection. What is needed is a discussion that considers the subjective reality and resources as well as risks., Objective: The study focused on the perspectives of older people. The aim was to shed light on their subjective experience of the corona pandemic. The questions were how they experienced the pandemic, the risks, consequences and protective measures, to what extent these affected their everyday life and how they dealt with it., Material and Methods: A total of 12 guideline-based telephone interviews were conducted in May and June 2020 with 9 women and 3 men between 77 and 91 years of age, who lived in their own homes, had impaired health and needed help and care. The data were evaluated by structuring content analysis., Results: The respondents were generally concerned about the corona pandemic but considered their own risk to be low. They saw themselves as hardly affected by the immediate consequences of the crisis or severely restricted in their everyday lives. They experienced insecurity in social life and fear of loneliness was central. Overall, they considered the protective measures to be appropriate but criticized early cancelling, family contact restrictions and dealing with the dying., Conclusion: A moderate degree of direct personal involvement, acceptance and adaptability characterized the experience and handling of the corona pandemic. Resources and skills in dealing with the crisis become visible.