Comorbidity in Primary Care – Causal or Casual? A Longitudinal Observational Study in Family Medicine

Background. Comorbidity is increasingly important in the medical literature, with ever-increasing impacts as populations age. Comorbidity has multiple and complex implications for the processes of diagnosis, treatment, prognosis, management and health care. The objective of this study is to measure casual versus causal comorbidity in primary care in three family practice populations.Methods. This is a longitudinal observational study using the Transition Project datasets. Transition Project family doctors in the Netherlands, Malta and Serbia recorded details of all patient contacts in an episode of care structure using electronic medical records and the International Classification of Primary Care, collecting data on all elements of the doctor-patient encounter, including diagnoses (1,178,178 in the Netherlands, 93,606 in Malta, 405,150 in Serbia), observing 158,370 patient years in the Netherlands, 43,577 in Malta, 72,673 in Serbia. Comorbidity was measured using the odds ratio of both conditions being incident or rest-prevalent in the same patient in one-year dataframes, as against not.Results. Comorbidity in family practice in the three population databases is expressed as odds ratios between the 41 joint most prevalent (joint top 20) episode titles in the three populations. Specific associations were explored in different age groups to observe the changes in odds ratios with increasing age as a surrogate for a temporal or biological gradient.Conclusion. After applying accepted criteria for testing the causality of associations, it is reasonable to conclude that most observed primary care comorbidity is casual. It would be incorrect to assume causal relationships between co-occurring diseases in family medicine, even if such a relationship might be plausible or consistent with current conceptualisations of the causation of disease. Most observed comorbidity in primary care is the result of increasing illness diversity.Trial registration.This study was performed on electronic patient record datasets made publicly available by the University of Amsterdam Department of General Practice, and did not involve any patient intervention.Funding. Self-funded.

Staff Capacity Building and Accountability in Transition Services

Transition services, particularly those that feature work-based learning experiences, often require designated staff to spend the majority of their time in the field. They also require that staff have the skills and supports to properly and effectively deliver these services. Training and monitoring these staff is critically important to ensure youth with disabilities experience strong employment outcomes. Maryland PROMISE was a statewide experimental, multicomponent, and community-based transition project that served 997 youth receiving Supplemental Security Income and their families. To ensure that staff effectively delivered services, Maryland PROMISE provided carefully designed professional development activities that included training, field-based coaching, and performance monitoring. This article reports on the Maryland PROMISE capacity building activities for project staff, provides data on the results of that process, and offers implications for the effective delivery of community-based transition services.

Case Study on Coaching Community College Faculty Member Experiences Transitioning to Online Education During COVID-19

This embedded case study focused on the experiences of coaches and community college faculty who participated in the coaching portion of an emergency remote transition project. The transition project was holistically designed to support community college faculty who had prepped for face-to-face courses and were shifting to remote teaching in a short period of time. Coaching services were one element of the project that also offered webinars, creation of short tutorial videos, and other support services. Qualitative and quantitative data were analyzed. Coaching was successful in helping community college faculty transition from teaching in-person courses to fully online courses quickly. Community college faculty showed determination, resilience, and remained dedicated to their students' successful completion of the semester despite the worldwide pandemic.

Neoliberalism and Welfare Chauvinism in Germany

Anti-immigration sentiments can take on a variety of forms, but a particularly prevalent version across Europe is welfare chauvinism. According to welfare chauvinism, the services of the welfare state should be provided only to natives and not to immigrants. Like many other European countries, German politics also features welfare chauvinism, and not only on the far right segment of the political spectrum. What drives welfare chauvinism? Most studies of welfare chauvinism try to assess whether economic or cultural factors matter most. In an attempt to bridge these perspectives, this article brings in neoliberalism. An examination of survey results from EBRD’s Life in Transition project suggests that neoliberal economic attitudes are a key determinant of welfare chauvinism. German respondents who have neoliberal economic views tend to see immigrants as a drain on the welfare state, while those who have economically leftist views tend to see immigrants as providing a positive contribution.