Students or medical professionals: whose knowledge improved after social-medicine training? Results from a quasi-experimental evaluation study.

PURPOSE: Rehabilitation professionals are faced with judging and describing the social-medicine status of their patients. Rehabilitation professionals must know the core concepts of acute unfitness for work, psychological capacities, and long-term work capacity. Acquiring and applying this knowledge, requires training. The research question is if and to what extent medical professionals and students' knowledge changes after social medicine training. METHODS: This quasi-experimental study was carried out in the real-life context of social medicine training. Psychology students (n = 42), physicians/psychotherapists (i.e. state-licensed health professionals) (n = 44) and medical assistant professionals (n = 29) were trained. Their social medicine knowledge was measured before and after training by a 10-min expert-approved and content valid knowledge questionnaire. Three free-text questions had to be answered on the essential aspects of present and prognostic work ability and psychological capacities. Answers were rated for correctness by two experts. Paired t tests and variance analysis have been calculated for group comparisons. RESULTS: All groups improved their social medicine knowledge from the pre- to the post-test. The students started with the lowest level of knowledge in the pre-test. After training, 69% of the physicians/psychotherapists and 56.8% of the medical assistant professionals, but only 7% of the students, obtained maximum scores for naming psychological capacities. CONCLUSIONS: Social medicine knowledge increased after a training course consisting of eight lessons. The increase was greater for medical assistant professionals and physicians/psychotherapists than for students. Social medicine training must be adjusted to the trainee groups' knowledge levels.

Psychosocial interventions in Alzheimer's disease and amnestic mild cognitive impairment: evidence for gender bias in clinical trials.

BACKGROUND: Alzheimer's disease (AD) affects twice as many women as men. Gender differences in symptom profile, living conditions, coping style and response might affect the outcome of psychosocial interventions (PSIs). OBJECTIVES: Our aim was to review gender differences in the available high-quality phase III trials on PSI in AD and amnestic mild cognitive impairment (aMCI) by considering the gender ratio in the investigated samples. DESIGN: Randomized controlled trials published in 2000-2012 were stepwise analyzed by statistically testing the representativeness of the gender ratio and examining reported gender differences. RESULTS: Forty-five studies (62% of 73 studies) reported gender ratios for each subsample and were included. In these studies, females were underrepresented in the control groups. In the 14 studies (19%) reporting analyses of gender differences, women were underrepresented in both intervention and control groups. However, in the six studies (8%) reporting significant gender differences in outcome, gender distribution was in accordance with prevalence rates. CONCLUSION: Current evidence is insufficient for reliable conclusions on gender differences in PSI outcome in AD and aMCI, as 81% of the available clinical trials either not reported the gender ratio of their samples, or underrepresent females. Further research is needed addressing gender differences, and clinical trials should routinely control for gender bias.

Relationship between work-related attitudes, performance and capacities according to the ICF in patients with mental disorders.

BACKGROUND: The International Classification of Functioning Disability and Health (ICF) differentiates between functions, activities/capacities, contextual factors and participation. Dysfunctions can result in impaired capacities, which in turn can lead to problems with participation depending on the context. Motivational and volitional deficits are intervening factors. The question is to what degree work performance (i.e. participation), motivational factors, and the inability to perform activities (i.e. dysfunctions) interact. METHOD: Incapacities were measured in 213 patients (70% women) admitted to the Department of Behavioral Medicine using the Mini-ICF-Rating for Mental Disorders (Mini-ICF-APP), work performance was measured with the Endicott Work Productivity Scale (EWPS), and volitional and motivational problems in regard to work were assessed with the Arbeitsbezogenes Verhaltens- und Erlebensmuster (AVEM). Sick leave prior to admission and work-related problems were assessed in a special clinical interview. RESULTS: The mean global score of the Mini-ICF-APP across all patients was 0.84 +/- 0.56 (SD), corresponding to 'mild disability'. The highest disabilities in this patient population were found for 'flexibility' (item 3, 1.64 +/- 0.94); the lowest disabilities were found for 'self maintenance' (item 11, 0.19 +/- 0.44) and 'mobility' (item 12, 0.43 +/- 0.85). Partial correlations between the Mini-ICF-APP, AVEM and EWPS showed highly significant correlations between the Mini-ICF-APP and EWPS and no or weak correlations between the AVEM and the Mini-ICF-APP or EWPS. CONCLUSION: Work performance is primarily related to the inability to perform activities and incapacities, and only due to attitudes or volitional/motivational factors to a much lesser degree. Therefore, capacity and motivation can and must be separated.

The role of the "International Classification of Functioning, Disability and Health, ICF" in the description and classification of mental disorders.

Diagnoses according to ICD-10 or DSM are conclusions derived from diagnostic algorithms, based on symptoms, but also illness course, history and consequences of the illness state. But, there is only limited consensus about the definitions of the criteria which are the basis of diagnostic algorithms. In DSM there is only a small glossary of technical terms, while ICD does not provide any respective definitions at all. When the diagnostic criteria are unreliable or invalid, then also the diagnostic conclusions must be invalid, even when they are based on strict algorithms. Therefore, standardized definitions for diagnostic criteria are as important as standardized diagnostic algorithms. The ICF, published by WHO in 2001, defines in it's first chapter mental functions which are identical with descriptions of psychopathological terms, if there is a malfunctioning. As definitions of diagnostic criteria are missing in ICD or DSM, the ICF definitions for functions, and thus disorders of functions, are at present the only glossary of illness signs and symptoms. Therefore, the ICF can serve as the basis for diagnostic algorithms in ICD or DSM. Furthermore, illness definitions are, apart from symptoms, also based on illness consequences. These are also defined in ICF as capacities (or disorders of capacity) and participation. Disorders of functions, capacity and participation together can describe targets of treatment. In summary, ICD and ICF as members of the family of WHO classification systems can together provide a common language for the description of health, illness and treatment goals.