Prevalence and Correlates of Dry Eye in a German Population Sample.

PURPOSE: In this cross-sectional survey, we assessed the prevalence of dry eye disease (DED) in a representative German population sample. In addition, we examined the associations between DED, health-related quality of life (HRQoL), and level of fatigue. Finally, we further validated the German version of the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and present norm data of the German population. METHODS: A random sample of German residents aged 16 years and older was recruited between October and December 2021. All participants completed the SPEED, Short Form 36, and Multidimensional Fatigue Inventory 20 questionnaires. RESULTS: Of the 2495 participants who completed the survey, 450 (21.6%; 95% confidence intervals 20.0-23.1) reported a SPEED total score of ≥4, indicating a positive screening for DED. DED was significantly more common in women and older age. Participants who screened positive for DED reported significantly higher levels of fatigue and lower values in all domains of HRQoL. A receiver operating characteristic curve of the SPEED was generated using an ophthalmologist's diagnosis. The area under the curve was estimated to be 0.886 (95% confidence intervals 0.858-0.913). A cutoff score ≥4 seemed to be appropriate as an indicator of DED. Cronbach's α was excellent (0.95). CONCLUSIONS: DED is common in the German population. We confirmed associations with sex, age, HRQoL, and fatigue level, indicating a high burden of DED. The German version of the SPEED is a valid instrument for the assessment of DED symptoms.

Psychometric properties, factor structure, and German population norms of the multidimensional fatigue inventory (MFI-20).

Objective: The Multidimensional Fatigue Inventory (MFI-20) is commonly used, but its factor structure remains unclear. The MFI-20 consists of five subscales (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). This study investigates the psychometric properties, including the factor structure, of a general German population sample and tests group hypotheses on gender and age. Another objective is to provide normative data by gender and age groups. Methods: Using data from a representative German sample (n=2,509), reliability and convergent validity measures, group hypothesis testing, and confirmatory/exploratory factor analyses were conducted. Results: The MFI-20 demonstrated satisfactory internal consistency and showed adequate convergent validity with the SF-36. All subscales of the MFI-20 were significantly correlated (0.71-0.85). Physical fatigue exhibited the highest (0.42) and mental fatigue had the lowest (0.19) correlation with age. Fatigue scores were significantly higher for women and significantly increased with age. A five-factor structure showed poor model fit; using an exploratory factor analysis, a two-factor structure emerged (a general factor and a mental/motivational factor). Conclusion: The MFI-20 is a reliable and valid instrument for measuring fatigue in the general population, but the five-factor structure is not supported. The subscale general fatigue or the MFI-20 total score might measure fatigue sufficiently. The provided norms can be used for further research and individual assessment.

Handling Missing Data in the Short Form-12 Health Survey (SF-12): Concordance of Real Patient Data and Data Estimated by Missing Data Imputation Procedures.

If information on single items in the Short Form-12 health survey (SF-12) is missing, the analysis of only complete cases causes a loss of statistical power and, in case of nonrandom missing data (MD), systematic bias. This study aimed at evaluating the concordance of real patient data and data estimated by different MD imputation procedures in the items of the SF-12 assessment. For this ends, MD were examined in a sample of 1,137 orthopedic patients. Additionally, MD were simulated (a) in the subsample of orthopedic patients exhibiting no MD (n = 810; 71%) as well as (b) in a sample of 6,970 respondents representing the German general population (95.8% participants with complete data) using logistic regression modelling. Simulated MD were replaced by mean values as well as regression-, expectation-maximization- (EM-), and multiple imputation estimates. Higher age and lower education were associated with enhanced probabilities of MD. In terms of accuracy in both data sets, the EM-procedure (ICC2,1 = .33-.72) outperformed alternative estimation approaches substantially (e.g., regression imputation: ICC2,1 = .18-.48). The EM-algorithm can be recommended to estimate MD in the items of the SF-12, because it reproduces the actual patient data most accurately.

[Validation of the Short-Form-Health-Survey-12 (SF-12 Version 2.0) assessing health-related quality of life in a normative German sample]. / Validierung der Messung gesundheitsbezogener Lebensqualität mittels des Short-Form-Health-Survey-12 (SF-12 Version 2.0) in einer deutschen Normstichprobe.

Validation of the Short-Form-Health-Survey-12 (SF-12 Version 2.0) assessing health-related quality of life in a normative German sample Objectives: Convergent and divergent validation of the Short-Form-Health-Survey-12 assessing HRQoL by analyzing its associations with depressiveness (PHQ-9), social support (OSS-3) and satisfaction with life (SWLS). Methods: A normative German sample (N = 2.524) was analyzed using correlation, regression as well as confirmatory factor analysis and structural equation modelling for ordinal data. Results: The SF-12-scale Mental Health is associated most strongly with the validation criteria (PHQ: r[scales/constructs] = -.73/-.88, OSS-3: r = .35/.55, SWLS: r = .47/.62). Mental Health (ß = .36) and Social Support (OSS-3; ß = .25) allow to explain a significant amount of variance of the SWLS (R2 = .28). On construct level Emotional Role Functioning (ß = .28) proved to be significant additionally. Conclusions: The SF-12 scales are associated with the validation criteria as expected. The SF- 12 proved to be suitable for modelling core components of HRQoL within a biopsychosocial framework aiming at predicting satisfaction with life.

[The need for psychosocial support and patients' desire for psychosocial support in female cancer patients - predictors and correlates]. / Betreuungsbedarf und subjektiver Unterstützungswunsch von Krebspatientinnen im Längsschnitt ­ Prädiktoren und Korrelate.

The need for psychosocial support and patients' desire for psychosocial support in female cancer patients - predictors and correlates Objectives: The aims of the present study were to determine the need for psychosocial support of cancer patients, the subjective request for support and to examine the relationship between the need for psychosocial counselling, psychological distress and quality of life. Methods: 112 patients (consecutive) answered questionnaires about mental stress (GAD-2 and PHQ-2), quality of life (SF-8) as well as the Hornheide Screening Instrument (HSI) during their hospital stay (T1), two weeks (T2) and three months after their discharge (T3). Results: The need for psychosocial support goes down from 65.2 % (T1) to 39.3 % (T3). The psychological distress was in a positive (GAD-2 - HSI T1: r = 0.44, p < 0.01; PHQ-2 - HSI T1: r = 0.54, p < 0.01), the quality of life in a negative relationship to the need for support (SF-8 PCS - HSI T1: r = -0.45, p < 0.01; SF-8 MCS - HSI T1: r = -0.56, p < 0.01). The match between the need for support and the subjective desire to be cared for by psychologists was low (conversation persons not needing support: T1: 17.1 %, T2: 3.8 %, T3: 5.5 %; conversation persons needing support: T1: 13.7 %, T2: 18.4 %, T3: 18.2 %). Conclusions: The divergence between the assessed need for support and the subjective desire for consultations leads to the conclusion that both methods, screening and asking for desire of counseling, should be adopted in combination to provide adequate psychooncological support.

Predicting presenteeism via effort-reward imbalance and dispositional optimism: Is it the interaction that matters? Results from The Saxony Longitudinal Study.

BACKGROUND: The importance of experienced work stress and individual traits as well as their interplay is analyzed with regard to dysfunctional coping behavior in case of sickness. OBJECTIVE: The aim of this study was to examine the predictive capability of effort-reward imbalance (ERI) including overcommitment, meaning the intrinsic propensity in terms of excessive work-related expenditure (OC), in consideration of dispositional optimism/pessimism on presenteeism. METHODS: A total of 353 men and women aged 38 from the 25th panel wave of The Saxony Longitudinal Study in 2011 were included in the analysis. Effort-reward imbalance (ERI) including overcommitment was assessed with the Effort-Reward Imbalance Questionnaire. Dispositional optimism and pessimism were quantified using the German version of the Life-Orientation-Test (LOT-R). Presenteeism was measured by single item two years later. RESULTS: Multiple regression analysis showed that the amount of the effort-reward imbalance experienced in 2011 had no statistically significant predictive potential with regard to presenteeism in 2013. After splitting the sample according to a validated effort-reward imbalance threshold, remarkable prediction of presenteeism for participants experiencing an ERI was accomplished by the moderating effect of dispositional pessimism on overcommitment (ß= 0.32; p <  0.001). CONCLUSIONS: Although ERI did not have the expected predictive capability relating to the entire sample, the detailed analysis of the moderating effect of pessimism on overcommitment and the resulting amount of explained variance for those participants experiencing an ERI is a noteworthy finding.

[Psychometric evaluation of the German version of the Health Regulatory Focus Scale]. / Psychometrische Überprüfung der deutschen Version der Health Regulatory Focus Scale.

Psychometric evaluation of the German version of the Health Regulatory Focus Scale Objectives: This study examines the psychometric properties of the German version of the Health Regulatory Focus Scale (HRFS), which measures health-related promotion- and prevention-based motivation. METHODS: The study is based on data from the 28th (N = 332) and 29th survey wave (N = 253) of the Saxony Longitudinal Study. It examines item characteristics, factorial, convergent and prognostic validity as well as the influence of sociodemographic variables. RESULTS: The psychometric properties of the German version are excellent, after removal of Item 5. A two-factor structure as well as good validity were confirmed. CONCLUSION: The shortened German version of the HRFS is well suited to capturing the health related regulatory focus of this test and makes it useful in the area of health promotion and prevention.

[Towards a Rehabilitation- and Participation-Oriented Psychotherapy]. / Perspektiven einer Teilhabeorientierten Psychotherapie in Anlehnung an Empfehlungen der Deutschen Gesellschaft für Rehabilitationswissenschaften (DGRW).

Mental disorders (such as recurrent mood disorders, personality disorders, or psychotic disorders) come along with enduring impairment in daily life activities. Therefore psychotherapeutic actions in inpatient or outpatient settings require a life-span and participation-oriented treatment perspective. Participation-oriented treatment aims at social and vocational integration in general life despite enduringly recurring or resting symptoms. According to the model of health problems offered by the International Classification of Functioning, Disability and Health, ICF (WHO, 2001), disability can be defined as context-dependent activity impairment due to illness. Disability is not the person̓s illness itself, but depends on the interaction of health status and contextual conditions. This context-dependent impairment shall be overcome with the help of treatment. In psychotherapy, the perspective of participation over the life-span has always been of great importance. However, it has until now hardly been mentioned explicitly.For practical handling of the ICF philosophy, its bio-psycho-social model of health problem-description is useful. Psychotherapists should gain knowledge on medical, vocational, and social rehabilitation treatment aims, institutions and the health care system. Psychotherapists may serve, similar to family physicians, as a case manager of illness processes. They do not only aim reducing mental illness symptoms, but focus on life-span management of the mental disorder. The aim is mainly to improve patients̓ daily life participation.

[Use of the ICF in medical rehabilitation in Germany: claims and reality]. / Nutzung der ICF in der medizinischen Rehabilitation in Deutschland: Anspruch und Wirklichkeit.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) is being used in the medical rehabilitation practice in different ways. The World Health Organization (WHO) and many other stakeholders have formulated claims and expectations for its use. OBJECTIVES: A comparative presentation of the claims of various stakeholders for the use of the ICF with examples in current practice. MATERIALS AND METHODS: Database searches (PubMed, REHADAT, and Google Scholar) were conducted for studies concerning claims and the current use of the ICF in practice. RESULTS: There are different requirements regarding the use of the ICF. While lawmakers and social insurance agencies remain very cautious and vague, other stakeholders (research institutions, organizations, stakeholders, service providers) formulate higher expectations and call for greater use of the ICF. In practice, the ICF is used in the form of a bio-psycho-social model, a common language and many different adaptations. CONCLUSIONS: The different requirements for the use of ICF demonstrate the motivations and interests of the stakeholders. Signals must now be sent both by politics and by social insurance agencies that go far beyond non-binding declarations. Furthermore it is necessary to systematize and evaluate the many use adaptations that are primarily being used by service providers. Research is needed on the concrete use of ICF-based instruments and its intended and unintended effects.

[The bio-psycho-social model and the International Classification of Functioning, Disability and Health : Examples of using the model, its parts and the items]. / Das biopsychosoziale Modell und die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit : Beispiele für die Nutzung des Modells, der Teile und der Items.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) can be used in practice in a variety of ways. OBJECTIVES: The aim of this work is to illustrate some of the most important ways of using the ICF and some aspects of their theoretical concepts. MATERIALS AND METHODS: Database searches (PubMed, Rehadat, and Google Scholar) were conducted for studies concerning the use of the ICF in practice. RESULTS: For all aspects of the ICF, and many of the intended ways of using it, there are concrete developments and examples or indications for their implementation into practice in different contexts. In particular, the common language and the bio-psycho-social model is widely accepted and applied in practice. At the level of chapters, there are a few developments and examples of practical applications of the ICF. When using the ICF based on Items, however, diverse developments of different theoretical and methodological quality are available. CONCLUSION: The multitude of different adaptations of the ICF for practice illustrates the great effort to the implementation in practice. However, this also shows that no comprehensive solution to the satisfaction of concerned protagonists was found. Research is needed on the theoretical foundations of the ICF, capturing the current practice of using the ICF and in the creation of specific instructions for ways to use the ICF in practice.

Symptom change trajectories during inpatient psychotherapy in routine care and their associations with long-term outcomes.

This study examined symptom change trajectories during inpatient psychotherapy and the association of these changes with long-term outcomes. In an observational multicenter study, weekly measurements of symptom severity were performed during inpatient treatment and 6 months after discharge. The symptom severity was measured using the 18-item scale of the Hamburg Modules for the Assessment of Psychosocial Health. The sample included 576 inpatients (mean age: 43.9 years; 77.6% female; main diagnoses: depressive (57.2%), adjustment (15.8%), anxiety (7.4%), and eating disorders (7.2%); mean treatment duration: 42.0 days). With empirically and clinically informed growth mixture models four subgroups of symptom change were revealed: gradual response (71%), early response (9%), delayed response (5%), and nonresponse (11%). Particularly low educational level, non-employment and chronic disorders were associated with unfavorable symptom courses (non- and delayed response). Long-term outcomes differed systematically across subgroups (p<0.001; η(2)=0.165). The patients who responded early presented the highest rates of clinically significant improvement (43.9%) from admission to follow-up. Nearly all of these patients (92.7%) showed reliable improvement. Due to the high association of symptom change trajectories with long-term outcomes, results may contribute to interventions that are tailored to the needs of patients and may foster longer lasting therapeutic effectiveness.

[Predictors of treatment duration for inpatients with mental disorders--a systematic literature review]. / Pradiktoren der stationaren Behandlungsdauer von Patienten mit psychischen storungen--Eine systematische Literaturanalyse.

OBJECTIVES: In a systematic literature review we examined patient-related predictors of inpatient treatment duration for mental disorders. METHODS: The databases Medline, Embase, Psyndex, PsycINFO and EBMR were systematically reviewed for studies in the years 1990-2009 regarding treatment duration of inpatients with ICD-10 diagnoses F3-F6. Also, their methodological quality was evaluated. RESULTS: Twenty-one studies examining 28 predictors (sociodemographic, clinical) were included. Longer treatment durations were found for patients living alone and with higher levels of initial symptom severity, duration of mental disorder, number of previous treatments, work absenteeism, and comorbidity. Obsessive-compulsive, eating and personality disorders were treated longer than depressive, anxiety, somatoform, and adjustment disorders. Results for age, gender, education, and profession were inconsistent. CONCLUSIONS: The studies included heterogeneous analyses, treatments, and patients. Despite their sufficient methodical quality, these results are only tentative.

Intervention by phone calls raises domiciliary activity and exercise capacity in patients with severe COPD.

BACKGROUND: Patients with severe COPD suffer from impairments of exercise capacity which affects daily activity. Conversely, activity might exert effects on the functional state. We studied whether a short-term intervention by regular phone calls caused an increase in activity at home and whether this resulted in a gain in exercise capacity. METHODS: Over a 2-week period (P1) normal daily activity was assessed in 21 patients with stable severe COPD (GOLD III/IV). After this, the individual setting was explored in a short home visit. The subsequent 2-week period (P2) involved phone calls every other day to raise home-based activity (target: 3x15 min daily at 75% of maximum dyspnea). During the study, patients wore an actograph plus pedometer and kept a diary. Before P1 and after P2, 6-min walking distance (6MWD), lung function, the Borg score and quality of life (SF-36, SGRQ) were determined. RESULTS: Compared to P1, actograph counts (p<0.05) were higher in P2. There was also an increase in 6MWD (p<0.05) and quality of life scores (SF-36, p<0.05) between initial and final visit, whereby improvements in 6MWD correlated with changes in activity (p<0.01). Conversely, four patients who experienced an exacerbation in P2 showed no increase in activity or 6MWD. CONCLUSIONS: In patients with stable severe COPD, it was possible to increase activity by regular phone calls without performing previous rehabilitation. Increased activity resulted in increased exercise capacity and quality of life within 2 weeks, underlining the effectiveness of continued motivational support in patients with severe COPD.

Pain regulation and health-related quality of life after thoracolumbar fractures of the spine.

Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such injuries. The aim of this study was to evaluate medium-term QoL and further to identify factors that influence the clinical outcome in patients with fractures of the thoracolumbar spine. Data of 906 patients who were treated during a 10-year period in our institution were evaluated retrospectively. Only patients with single-level traumatic injuries aged between 18 and 65 years without neurological deficits, concomitant injuries of other locations and internal comorbidities were included into the investigation (n = 204). Three different treatment groups (i.e. non-operative, dorsal and dorsoventral stabilisation) were compared to healthy controls as well as different pain populations. The QoL was assessed using established questionnaires (SF-36, HFAQ, VAS-Spinescore, PRQ, and PTSD). Sixty-five percent of the included patients (n = 133) were studied at an average follow-up of 5.3 +/- 1.7 years after injury. All treatment groups revealed an identical gender and age distribution. More severe and unstable injuries were found in the surgical groups associated with higher treatment costs and a longer inability to work. Compared to healthy controls, QoL was compromised to the same extent in all groups. Furthermore, all patients treated in this study did significantly better than low back pain individuals with regard to QoL and pain regulation parameters. In our study, patients with thoracolumbar spine fractures showed a reduced QoL compared to healthy controls. Thus, patients do not seem to regain their former QoL. However, the level of discomfort was comparably low in all groups, even in patients with more severe injuries requiring extensive surgery. Overall, outcome and QoL after traumatic fractures of the thoracolumbar spine rather seem to be determined by the severity of injury than by pain regulation or other psychosocial factors which is likely the case in low back pain disorders.

The assessment of mood at workplace - psychometric analyses of the revised Profile of Mood States (POMS) questionnaire.

With the Profile of Mood States (POMS), a German version of an international instrument for the assessment of mood is available. The paper introduces a new short version containing 24 items and four scales. In a study about indoor climate in 4596 office workers only a few missing values were noted. Psychometric analyses showed very good characteristics of the four scales regarding their internal consistency (Cronbach's alpha) and scale fit. High floor effects indicated a limited exhaustion of the scale range. Age and gender effects of the scale scores concerned the scales "vigour" and "fatigue". Furthermore, the scales of the POMS discriminated between groups with different self-reported disease incidences. A less beneficial characteristic of the POMS could be noted in terms of a high correlation of the scales "numbness" and "fatigue". With the tested version of the POMS, a short instrument with good psychometric properties has been presented which can be assessed in healthy as well as in health-impaired persons.

Quality of life in obsessive-compulsive disorder before and after treatment.

BACKGROUND: The assessment of Quality of Life (QoL) is an important tool for elucidating target symptoms that are particularly bothersome to patients. The present study was designed to explore predictors of decreased QoL in obsessive-compulsive disorder (OCD) patients and to explore which aspects of QoL are most affected in OCD. Furthermore, the study investigated changes in QoL after treatment and the association between QoL change scores with symptomatic outcome. In line with prior research, it was expected that low QoL in OCD patients would be most pronounced for the emotional and social aspects of the construct. METHODS: Seventy-nine OCD patients were initially recruited. Patients were assessed with the SF-36 both before and after treatment. Norm values were derived from the general population to characterize status of impairment. OCD patients were contrasted with published SF-36 scores from 2 OCD samples as well as a newly recruited psychiatric and healthy control sample. RESULTS: Correlations with QoL were most pronounced for depression severity and number of OCD symptoms. Apart from low social and emotional QoL in the majority of patients, a large subgroup also reported lower physical well-being. Decreased scores on this subscale were mainly associated with length of illness, depression, and number of compulsions. Overall, QoL was significantly improved in therapy responders relative to nonresponders. CONCLUSIONS: The results largely correspond to previous findings showing that OCD patients share severely compromised well-being. Somewhat unexpected from previous research, QoL deficits were not restricted to emotional and social aspects of QoL but extended to somatic domains. The present results suggest that clinicians should thoroughly explore for depression as well as physical impairments in OCD patients, which, when present, may be additionally targeted to achieve comprehensive treatment success.

[The version 2.0 of the SF-36 Health Survey: results of a population-representative study]. / Die Version 2.0 des SF-36 Health Survey--ergebnisse einer bevölkerungsrepräsentativen Studie.

OBJECTIVES: The SF-36 is an internationally approved instrument to assess subjective health. In its second version the SF-36 contains modifications to version 1.0 in several item formulations and response categories. The second version is translated in German but a psychometric analysis and standardisation are still lacking. METHODS: The SF-36, version 2.0, was administered in a representative German sample (n = 2043), analysed concerning its scale structure, reliability, dissemination characteristics and differences in traits of populations and compared to version 1.0 (German health survey). RESULTS: Version 2.0 shows high reliability in subscales and has a scale structure which is comparable to that of version 1.0. The scale values in the actual population-representative sample survey are rather distributed obliquely and effects of sex, age and residence (Eastern/Western Germany) have been found in regression analyses. CONCLUSION: The psychometric comparability of both versions is given but should interpreted with caution as regards content because of the different enquiry periods. Though the expected gain in psychometric quality and discrimination of version 2.0 to version 1.0 is evident, but does not justify a preference to version 2.0.

[Demands on the evaluation of complex healthcare programs--disease management in Germany]. / Ansprüche an die Evaluation komplexer Gesundheitsprogramme--Disease-Management-Programme in Deutschland.

Disease management programs (DMP) are a new method of healthcare in Germany. Their implementation is legally secured and binding. Besides the requirements of a comprehensive documentation and the obligation to provide guideline-oriented healthcare, the statutory health insurances are also obliged to carry out a DMP evaluation. For this evaluation, a scientific advisory council of the Federal Insurance Office has submitted specific relevant criteria. The present contribution considers these criteria and relates them to the evaluation standards of the Evaluation Research Society. Additionally, some specific conditions for the undertaking of DMP and their evaluation in Germany are taken into consideration. The article ends with a suggestion for a comprehensive and methodologically accurate discussion.

Unmet health care needs and impact on families with children with disabilities in Germany.

OBJECTIVES: We sought to determine the independent effect of unmet health needs on family burden, in addition to the effects of functional impairment and parental care load, in children and adolescents with disabilities. METHODS: We conducted a cross-sectional survey of 273 families with children with disabilities using ambulatory services at an academic children's hospital in Germany. We measured family burden using a translated version of the Impact on Family Scale (FABEL). Independent variables were unmet health needs in 4 areas (medical care, care coordination, health education, and psychosocial services), level of functional disability, and nursing care load at home. Control variables included the child's age and gender, maternal employment status, and parental educational attainment. RESULTS: Most children had complex health conditions such as brain injury, congenital malformations, metabolic disease, myopathies, and brain tumors. Nearly half of families (44.6%) received home nursing cash benefits, indicating high care load. Parents reported most unmet needs in the areas of psychosocial counseling (17.2%) and care coordination (8.1%). After controlling for sociodemographic factors, unmet health needs predicted family burden independently of type (mental retardation or mobility impairment) and number of disabilities and nursing care load. Although only a few parents reported lack of medical services, this factor also contributed significantly to family burden. Multivariate analysis with these variables explained 45% of the variance in impact on the family. CONCLUSIONS: Addressing unmet health needs may alleviate the impact of caring for a child with a disability. Further studies are needed to show more definitively that families can benefit from integrated services including psychosocial counseling.