Profound Sexual Dysfunction Among Patients with Hidradenitis Suppurativa: A Cross-sectional Study.

INTRODUCTION: Sexual health, a critical aspect of overall well-being, is often compromised in individuals with chronic disorders. Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that mainly affects intertriginous areas, potentially impacting sexual health as a result of its specific symptoms and psychosocial burden. METHODS: This cross-sectional study utilized data from the EpiCAi project, focusing on 199 patients with HS. Participants completed digital questionnaires assessing sexual health via sex-specific instruments: the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men, alongside different psychosocial scales. The disease severity was assessed using the Hurley stage and the Lesion Identification Scheme for Acne Inversa (LISAI). RESULTS: The majority of the participants reported impaired sexual health, with significant clinical sexual dysfunctions noted in 71.8% of women (FSFI score < 26) and erectile dysfunction in 63.8% of men. Sexual dysfunction was associated with several factors, including age, and marital status. Psychosocial factors, notably depression and quality of life, showed strong correlations with sexual health outcomes. Notably, women over 40 and those treated with biologics reported more severe dysfunction, while among men, employment status significantly influenced sexual health. CONCLUSIONS: HS profoundly affects the sexual health of both male and female patients, with significant impacts on their quality of life and psychological well-being. The findings underscore the necessity for healthcare providers to address sexual health proactively in the management of HS, considering both physical symptoms and psychosocial impacts. This holistic approach is essential for improving patient outcomes and overall quality of life. TRIAL REGISTRATION: German Register for Clinical Trials, identifier DRKS00025315.

Real-world effectiveness and safety of the LAight-therapy in patients with hidradenitis suppurativa.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa (HS)/Acne inversa (Ai) is a chronic debilitating disease with limited therapy options. The device-based LAight therapy was approved in Europe in 2017. The aim of this study was to evaluate the effect of real-world care with at least one treatment with LAight therapy on disease activity and burden in 3,437 patients. PATIENTS AND METHODS: Patients were included in the analysis if they had a diagnosis of HS and received at least one treatment. The endpoints Hidradenitis Suppurativa Severity Score System (IHS4), pain on the numeric rating scale (pain-NRS) and Dermatology Life Quality Index (DLQI) were analyzed using a linear mixed model for repeated measures (MMRM) over 26 weeks of care with LAight therapy. Furthermore, responder rates were calculated for all endpoints, and the therapy's safety profile and patient satisfaction were thoroughly examined. RESULTS: A significant decrease in IHS4, pain-NRS, and DLQI was achieved during 26 weeks of care with LAight. The BMI at baseline had a significant negative effect on therapy response for pain-NRS and DLQI. CONCLUSIONS: This study confirms that LAight therapy leads to satisfactory disease control in all stages of severity and is a valuable addition to the therapeutic repertoire of HS.

Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. METHODS: We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project "Epidemiology and Care in Acne inversa (EpiCAi)." The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. RESULTS: Regardless of gender, HS has an enormous impact on patients' sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (ß = 0.25), the number of active lesions, the affected areas (ß = 0.14), and psychosocial aspects, including low quality of life (ß = 0.404), stigmatization (ß = 0.411), depression (ß = 0.413), and anxiety (ß = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. CONCLUSION: Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.

Drivers of disease severity and burden of hidradenitis suppurativa: a cross-sectional analysis on 553 German patients.

BACKGROUND: Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life-defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. METHOD: The cross-sectional study is based on the baseline data of 553 participants of the health care research project "EsmAiL," which was carried out as a multicenter randomized controlled trial. It included adult HS-patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. RESULTS: Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. CONCLUSIONS: HS is a severe and debilitating dermatosis. As a result of the well-established factors involved, HS requires a multi-causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi-professional care. To prevent disease progression, a structured treatment plan is needed.

A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effectiveness.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. METHODS: EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). RESULTS: Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. CONCLUSION: Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.

A structured, multimodal form of care reduces costs in the treatment of Hidradenitis suppurativa compared to standard care.

A centre-based ambulatory care concept for hidradenitis suppurativa improves disease activity, disease burden and patient satisfaction: results from the randomized controlled EsmAiL trial.

BACKGROUND: Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions that occurs in young women, in particular, and affects approximately 1% of the population. Outpatient care is often inadequate and usually cannot prevent progression. OBJECTIVES: To evaluate in the EsmAiL ('Evaluation eines strukturierten und leitlinienbasierten multmodalen Versorgungskonzepts für Menschen mit Akne inversa') trial whether an innovative care concept can decrease disease activity and burden, and improve patient satisfaction. METHODS: EsmAiL was conducted as a two-arm, multicentre, prospective, randomized controlled trial that included 553 adults with HS. Inclusion criteria were a minimum of three inflammatory lesions and at least a moderate impact of the disease on quality of life. The control group (CG) remained under standard care, while patients in the intervention group (IG) were treated according to a trial-specific, multimodal concept. The primary endpoint was the absolute change in International Hidradenitis Suppurativa Severity Score System (IHS4). RESULTS: In total, 274 patients were randomized to the IG and 279 to the CG. Altogether, 377 attended the final assessment after 12 months of intervention. Participants in the IG (n = 203) achieved a mean improvement in IHS4 of 9.3 points, while the average decrease in IHS4 in patients in the CG (n = 174) was 5.7 points (P = 0.003). Patients treated under the new care concept also reported a statistically significantly higher decrease in pain, Dermatology Life Quality Index and Hospital Anxiety and Depression Scale scores compared with those in the CG (P < 0.001). Patient satisfaction was also statistically significantly higher in the IG compared with the CG (P < 0.001). CONCLUSIONS: The establishment of standardized treatment algorithms in so-called 'acne inversa centres' in the ambulatory setting has a substantial, positive impact on the course of HS and significantly improves patient satisfaction.

Utilization of point-of-care tests among general practitioners, a cross-sectional study.

BACKGROUND: Point-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs). METHODS: A questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany. RESULTS: A total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful. DISCUSSION/CONCLUSION: The most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results. TRIAL REGISTRATION: In accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry.

Participation in structured diabetes self-management education programs and its associations with self-management behaviour - a nationwide population-based study.

OBJECTIVE: To evaluate the relationship between participation in structured diabetes self-management education programs (DSME) and self-management behaviour (SMB) in routine care. METHODS: The study included 864 ever- and 515 never-DSME participants from the population-based survey German Health Update (GEDA) 2014/2015. SMB and clinical care variables were: Following a diet plan, keeping a diabetes diary, holding a diabetes pass, self-monitoring of blood glucose (SMBG), foot self-examination (FSE), retinopathy screening, haemoglobin A1c (HbA1c) measurement and examination of the feet by clinicians (FEC). We conducted logistic regression analyses for association of DSME-participation with SMB, adjusting for various variables. RESULTS: DSME-participation was significantly associated with SMB including following a diet plan (OR 1.88 [95% CI 1.21-2.92]), keeping a diabetes journal (OR 3.83 [2.74-5.36]), holding a diabetes health passport (OR 6.11 [4.40-8.48]), SMBG (OR 2.96 [2.20-3.98]) and FSE (OR 2.64 [2.01-3.47]) as well as retinopathy screening (OR 3.30 [2.31-4.70]), HbA1c measurement (OR 2.58 [1.88-3.52]), and FEC (OR 3.68 [2.76-4.89]) after adjusting for confounders. CONCLUSION: DSME-participation is associated with higher frequencies of various SMB and clinical care variables in routine care. Never-DSME attenders are more likely not to receive retinopathy screening, FEC and HbA1c measurements as recommended. PRACTICE IMPLICATIONS: Clinicians should refer diabetes patients to a DSME and ensure a regular follow up for never-DSME attenders.

Pushing occupational rehabilitation - implementation of a therapy diary in the outpatient aftercare of psychosomatic rehabilitation may promote the occupational reintegration process: a survey of therapists and patients.

BACKGROUND: Treatment results achieved after fulfilling an inpatient psychosomatic rehabilitation are often not permanent. Additional participation in outpatient rehabilitation aftercare may reduce the risk of recurrent disorders and support a successful reentry to working life. A therapy diary should accompany the aftercare and bring about the self-reflection process of psychosomatic rehabilitates, which could reduce recurrent disease progressions and support the recovery process as a whole. The study focuses on the evaluation of the effectiveness and implementation potentialities of a therapy diary in outpatient rehabilitation aftercare. METHODS: In a qualitative study, seven therapists for outpatient rehabilitation aftercare in Central Germany and eleven outpatient psychosomatic rehabilitation patients were interrogated using partially standardized, guideline-based expert interviews. The data evaluation is based on the Qualitative Content Analysis according to Mayring. RESULTS: The results show that an accompanying use of a therapy diary during the outpatient rehabilitation aftercare enables an intense commitment through own thoughts and feelings. By writing down thoughts, emotions, dysfunctional behaviors in problematic situations, great successes are experienced. Through this initiated self-reflection process, the rehabilitant gains a better knowledge of one's behavior in dealing with oneself and the environment and thereby, whenever necessary, learns to create new ways of acting. CONCLUSIONS: The voluntary use of the therapy diary in the outpatient rehabilitation aftercare could assist the therapy process and henceforward the recovery of the rehabilitants, and also increase the prospect of successful occupational rehabilitation.

Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study.

OBJECTIVE: Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes. RESEARCH DESIGN AND METHODS: The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour. RESULTS: Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one's personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management. DISCUSSION: In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.

"Corona-Debriefing": concept and pilot testing of a 90-minute workshop for undergraduate-education and specialist-training in family medicine.

Background: The corona pandemic is changing the framework conditions for medical studies and continuing education as well as the work with patients and within teams. Systematic reflection and communication about experiences and ways of dealing with them forms the basis for successful learning in and out of the crisis. Therefore, we designed a 90-minute workshop "Corona-Debriefing" for students and physicians in specialist-training in family medicine (ÄiW) using three successive moderated interaction phases: Questionnaire survey via tele-dialogue voting (TED) with immediate presentation of results and discussion, moderated experience reports on the categories risk/assessment/support/coping and finally moderated group discussions in small groups to collect "best practice" examples of crisis management. Objective: We tested "Corona-Debriefing" as a pilot test with 48 participants (TN) in July 2020 (30 present, 14 online) in order to assess mental stress and risk perception of participants plus formative/brief summative evaluation of the workshop. Methods: The PHQ-4 with its subscales GAD-2 (anxiety) and PHQ-2 (depression) was used to assess mental stress; risk assessments were made by means of self-constructed 5-point Likert-scales for the dimensions person/society/health/economy. A formative evaluation was carried out by means of a questionnaire at the end of the event; the brief summative assessment was asked for by means of a school grading scale. Results: 37 complete TED questionnaires and 22 evaluations were obtained. TN showed a low personal risk assessment, but considerable fears about social and economic developments. Needs are seen mainly in improvements regarding organization, protective equipment and technical communication (e.g. official recommendations for action). The workshop was rated "good" or "very good" in 95% of the evaluations. Criticism was directed at the limited time available, the narrowing of topics by moderators and the desire for (even) more room for the exchange of personal experiences. Conclusion: The workshop "Corona-Debriefing" is a relatively easy way to use crisis experiences for learning processes. "Corona-Debriefing" can be used by changing the focus of moderation in various courses, years or fields of study, whereby the participants' own personal and clinical crisis experiences remain a prerequisite for a meaningful "debriefing".

Participation in structured diabetes mellitus self-management education program and association with lifestyle behavior: results from a population-based study.

OBJECTIVE: Whether participation in structured diabetes self-management education programs (DSME) for participants with diabetes mellitus is associated with a healthy lifestyle in routine care apart from randomized-controlled studies remains unclear and is this studies' research question. RESEARCH DESIGN AND METHODS: We identified 1300 persons with diabetes mellitus drawn from the cross-sectional population-based analysis German Health Update 2014/2015 (GEDA 2014/2015), which integrated the modules of the European Health Interview Survey (EHIS) wave 2. Of those, 816 were ever-DSME participants and 484 never-participants. We conducted multivariable weighted logistic regression analyses for lifestyle differences comparing ever-DSME and never-DSME participants. Lifestyle was defined by physical activity (PA), current smoking, fruit/vegetable consumption and body mass index (BMI). Age, sex, socioeconomic status, living together, limitation due to health problems for at least for 6 months, self-efficacy and attention to one's health were included as confounders in the regression models. RESULTS: Ever-DSME participants engaged significantly more often in cycling at least 1 day per week (OR 1.62, 95% CI: 1.15-2.30) and performed significantly more often aerobic endurance training of 150 min per week (including walking: OR 1.42, 95% CI: 1.03-1.94, without walking: OR 1.48, 95% CI: 1.08-2.03) compared with never-DSME participants. Ever-DSME participants were significantly more often ex-smoker compared with never-DSME participants (OR 1.39, 95% CI: 1.03-1.88). DSME attendance was not significantly associated with current smoking, BMI and fruit or vegetable consumption. CONCLUSION: DSME participation is associated with a moderately healthier lifestyle particularly for PA even in routine healthcare. Study results emphasize the importance of a broadly dissemination of DSME access for nationwide diabetes healthcare. Future studies should adjust for DSME participation when investigating lifestyle in persons with diabetes.

Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners.

BACKGROUND: Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the integration of this application of US into routine care and outpatient settings needs to be explored. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures. METHODS: Notification of the study, a self-designed questionnaire, and a reminder were mailed to 600 randomly selected GPs in Saxony and Saxony-Anhalt. RESULTS: The response rate was 47.7% (n = 286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Among GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US applied it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and more commonly used US for fracture diagnosis compared to non-users. CONCLUSION: The need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the safety, usefulness, and effectiveness of this still seldom used diagnostic approach for suspected fractures.

[Subjectively Experienced Workload during Continuing Education in General Medicine and Demands on a Competence Center: A Cross-Sectional Study from Saxony-Anhalt]. / Subjektiv erlebte Arbeitsbelastung in der Weiterbildung Allgemeinmedizin und Anforderungen an ein Kompetenzzentrum ­ eine Querschnittsstudie aus Sachsen-Anhalt.

AIM OF THE STUDY: The expectations of trainees in training at Centers of Excellence are still partly unclear. Recent studies demonstrated the negative impact of high workload and stress on young doctors' mental health, a problem since the start of their careers. From trainees' point of view, are there differences in subjective occupational stress between inpatient and outpatient care sectors? How does a high subjective workload of general medicine trainees affect the demands made on the Centers of Excellence? METHOD: Design: cross-sectional study from March to June 2017 in Saxony-Anhalt Sample: every general medicine trainee registered with the KOSTA (n=221) Questionnaire: self-developed; content: demands on a Center of Excellence, sociodemographic parameters, biography of qualification, evaluation of previous postgraduate training in inpatient and outpatient care sectors, questionnaire about effort-reward-imbalance (ERI). RESULTS: In total, 73 responses from the trainees were received (33.0%). Every single response was included in the analysis. Occupational stress was specified on an averaging index from 1 (lowest) to 4 (highest). Higher workload was reported in the inpatient care sector (inpatient: 2.8 vs. outpatient: 2.1, p<0.01). The subjective workload was significantly increased by the amount of overtime work (inpatient: η²=18.3%, p=0.02, outpatient: η²=28.3%, p<0.01). Persons with above-average occupational stress tended to express a higher need for complete planning of qualification (percentage difference d%=0.31), mentoring (d%=0.15) and informal exchange with colleagues (d%=0.19). Trainees' feeling of occupational stress was proved to be independent of personal and demographic characteristics. CONCLUSION: General practice trainees need more mentoring with higher levels of occupational stress. This has to be considered when individual consulting is offered.

What keeps medical students healthy and well? A systematic review of observational studies on protective factors for health and well-being during medical education.

BACKGROUND: Despite the growing evidence of a negative impact of medical school on students' health and well-being, little is known about protective factors for staying healthy and well during medical education. Therefore, a systematic review of peer-reviewed studies aiming to identify such predictors was conducted. METHODS: Medline, Embase, and PsychInfo were systematically searched by using preselected MeSH terms to identify English- and German-language peer-reviewed articles (observational studies) examining predictors for medical students' health and well-being, published between January 2001 and April 2018. Two authors independently selected abstracts reporting predictors for medical students' health and well-being. Further, two authors extracted information from the identified studies, needed for methodological quality assessment of the studies, as well as for comprehensive description of identified predictors. RESULTS: From 5013 hits in the database search, six observational studies met the inclusion criteria and were included in the final analysis. These studies were of heterogeneous design and quality. They featured a wide variety of health and well-being related outcomes and of its predictors. Lower levels of perceived stress, as well as lower levels of neuroticism were found to predict better health-related outcomes. CONCLUSIONS: Further research, by using harmonized tools for the assessment of outcomes, as well as predictors, is needed to determine what keeps students healthy and well during medical education. Identifying protective factors is an essential prerequisite for the design of evidence-based health-promoting interventions.

Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years.

Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project represented a significant predictor for the preferred choice of the area (OR 7.98; 95% CI [1.27-50.27], p=0.027). Students who assessed the commitment (r=0.504), support (r=0.526) and interaction management (r=0.529) of the mentors positively were more likely inclined to continue their participation in the KAM. Conclusion: The successful conveyance of care-relevant competences to students proved to be an important predictor in our project for the preference of the specialty general practice. This requires that the medical mentors are suitably trained and that the students are specifically prepared for practical experience.