Factors associated with self-assessed increase in tobacco consumption among over-indebted individuals in Germany: a cross-sectional study.

BACKGROUND: Over-indebtedness is an increasing phenomenon in industrialised nations causing individual hardship and societal problems. Nonetheless, few studies have explored smoking among over-indebted individuals. METHODS: A cross-sectional survey (n=949) on retrospectively assessed changes in tobacco consumption was carried out in 2006 and 2007 among clients of 84 officially approved debt and insolvency counselling centres in Germany (response rate 39.7%). Logistic regressions were performed to explore factors associated with reports of increased smoking after onset of over-indebtedness. RESULTS: 63% of all respondents stated daily or occasional tobacco consumption. Almost one fifth reported an increase in smoking after becoming over-indebted. Females were less likely to report increased smoking than men (aOR 0.66, 95% CI 0.44-0.99) whereas respondents who had been over-indebted for more than 10 years were more likely to report increased smoking than those who had been over-indebted for less than five years (aOR 1.66; 95%-CI 1.00-2.76). The odds of increased smoking were also elevated among those who reported that their families and friends had withdrawn from them as a consequence of their over-indebtedness (aOR 1.82; 95%-CI 1.06-3.14). CONCLUSIONS: The study identifies over-indebted individuals and particularly over-indebted men as a high-risk group of smokers. Low levels of social embeddedness/support were associated with a further increase in smoking after becoming over-indebted. Given recent increases of over-indebtedness, the findings highlight the need to develop appropriate public health policies.

Thinking about giving up clinical practice? A gender-stratified approach to understanding junior doctors' choices.

PURPOSE: This study examined the association between workplace factors and thinking about leaving clinical care by junior doctors (i.e., doctors in postgraduate training) in Germany, and used a gender-stratified approach to address the so-called feminization of medicine. METHOD: In this cross-sectional questionnaire study, 1,494 German junior doctors working in patient care in Bavaria in 2006-2007 were sent a questionnaire about considering leaving patient care (outcome variable). Logistic regression analyses were used to calculate the predictive influence of workplace factors on the outcome variable (adjusted odds ratio [aOR], 95% confidence interval [95% CI]). RESULTS: Of the 637 responding junior doctors, altogether 52% (men 49.3%, women 54.2%) had thought about leaving clinical practice. Support of colleagues and superiors (men aOR 2.70, 95% CI 1.20-6.04; women aOR 3.46, 95% CI 1.67-7.17), performance feedback (women aOR 1.88, 95% CI 1.23-3.14), the availability of postgraduate training possibilities (men aOR 4.74, 95% CI 1.53-14.69), overtime (women aOR 1.82, 95% CI 1.02-3.25), weekend duty (men aOR: 3.58, 95% CI 1.86-6.88), and the medical specialty were found to be significant predictors for thinking about leaving clinical practice for both men and women. CONCLUSIONS: Workplace factors predict the wish for leaving clinical care for junior doctors. Male and female junior doctors seem to have different priorities in the workplace, which should be addressed in order to retain them in patient care.

Well prepared for work? Junior doctors' self-assessment after medical education.

BACKGROUND: Apart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety. METHODS: A cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness. RESULTS: All in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model. CONCLUSIONS: Many junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates.

Prevalence of diagnosis and direct treatment costs of back disorders in 644,773 children and youths in Germany.

BACKGROUND: Many authors have reported about the high prevalence rates of self-reported back pain in children. Nevertheless, little is known about the diagnosis of back disorders--regardless of whether the diagnosis is associated with back pain or not. Therefore, the aim of this study was to analyse the prevalence rates and costs of diagnosis of back disorders in childhood and youth. METHODS: We conducted a secondary data analysis of a large, population based German data set (2,300,980 insurants of statutory health insurance funds) which allowed for identification of prevalence rates of diagnoses of back disorders in children (age group 0-14 years) and youths (age group 15-24 years) using three digit ICD-10 codes for dorsopathies (M40-M54: kyphosis and lordosis; scoliosis; spinal osteochondrosis; other deforming dorsopathies; ankylosing spondylitis; other inflammatory spondylopathies; spondylosis; other spondylopathies; spondylopathies in diseases classified elsewhere; cervical disc disorders; other intervertebral disc disorders; other dorsopathies, not elsewhere classified; dorsalgia). Direct treatment costs were calculated based on the real incurred costs for cases with a singular diagnosis of a back disorder. Wherever possible, the results of the random sample were extrapolated to all insurants of statutory health insurance funds (i. e., about 90% of the German population). RESULTS: We found prevalence rates for the diagnosis of back disorders to range between 0.01 - 12.5%. "Scoliosis" (M41) and "dorsalgia" (M54) were the most frequent diagnoses in both age groups. Based on these results, it was calculated that in 2002 alone, approximately 1.4 million children/youths in Germany were diagnosed with "dorsalgia" (M54), and that the direct costs for back disorders in childhood and youth accounted for at least 100 million Euros. CONCLUSIONS: Instead of focusing on the individual, and self-reported disorder or disability, this analysis allowed for the detailed evaluation of medical experts' opinion on back disorders in childhood and youth and for a more objective or public health oriented insight in the topic of diagnosis of back pain and other back disorders. However, due to the methodological limitations by using ICD-10 coding, standardized random validity checks of population based data sets should be mandatory.

Over-indebtedness and its association with the prevalence of back pain.

BACKGROUND: Over-indebtedness is an increasing phenomenon worldwide. Massive financial strain, as found in over-indebted persons, might influence the occurrence of back pain. In this explorative study we examined the prevalence of back pain in over-indebted persons in Germany for the first time ever and compared it to the prevalence of back pain in the German general population. METHODS: A cross sectional study comprising 949 participants (52.6% women) was conducted to collect data on the point prevalence of back pain in an over-indebted collective. A representative sample of the German general population (N = 8318, 53.4% women) was used as non-indebted reference group. RESULTS: The point prevalence of back pain was 80% in the over-indebted collective, compared to 20% in the general population. The influence of socioeconomic factors on the prevalence of back pain differed partially between the general population and the over-indebted collective. Being over-indebted was identified as an independent effect modifier and was associated with an eleven times increased probability to suffer from back pain (aOR: 10.92, 95%CI: 8.96 - 13.46). CONCLUSION: Until now, only little is known about the effects of intense financial strain like over-indebtedness on health. Our study suggests that over-indebted persons represent a risk group for back pain and that it might be sensible to take financial strain into account when taking a medical history on back pain. Over-indebtedness and private bankruptcy is of increasing importance in industrialized countries, therefore more research on the subject seems to be necessary.