Quality of life in a high-risk group of elderly primary care patients: characteristics and potential for improvement.

PURPOSE: Quality of Life (QoL) is associated with a bandwidth of lifestyle factors that can be subdivided into fixed and potentially modifiable ones. We know too little about the role of potentially modifiable factors in comparison to fixed ones. This study examines four aspects of QoL and its associations with 15 factors in a sample of elderly primary care patients with a high risk of dementia. The main objectives are (a) to determine the role of the factors in this particular group and (b) to assess the proportion of fixed and potentially modifiable factors. METHOD: A high-risk group of 1030 primary care patients aged between 60 and 77 years (52.1% females) were enrolled in "AgeWell.de," a cluster-randomized, controlled trial. This paper refers to the baseline data. The multi-component intervention targets to decrease the risk of dementia by optimization of associated lifestyle factors. 8 fixed and 7 modifiable factors potentially influencing QoL served as predictors in multiple linear regressions. RESULTS: The highest proportion of explained variance was found in psychological health and age-specific QoL. In comparison to health-related QoL and physical health, the modifiable predictors played a major role (corr. R2: 0.35/0.33 vs. 0.18), suggesting that they hold a greater potential for improving QoL. CONCLUSION: Social engagement, body weight, instrumental activities of daily living, and self-efficacy beliefs appeared as lifestyle factors eligible to be addressed in an intervention program for improving QoL. TRIAL REGISTRATION: German Clinical Trials Register, reference number: DRKS00013555. Date of registration: 07.12.2017.

Does weight-related stigmatisation and discrimination depend on educational attainment and level of income? A systematic review.

OBJECTIVES: Obesity is considered a global health issue, because of its health-related consequences and also because of its impact on social status as a result of stigma. This study aims to review the quantitative state of research regarding socioeconomic characteristics' influence on weight-related stigmatisation and discrimination. Based on Bourdieu's Theory of Class and his concept of 'habitus', it is assumed that people with a higher level of education and income show stronger negative attitudes towards people with obesity. METHOD: A narrative systematic literature review was conducted in 2017 using PubMed, PsychINFO, Web of Science and the Cochrane Library. Seventeen studies that measured weight bias and either educational attainment or level of income were included in the analysis. RESULTS: The results of the studies included were inconsistent: six of these studies were found to support the hypothesis, whereas two of the studies contradicted it. The remaining seven studies did not show any significant correlation between weight bias and either education or income. CONCLUSION: In light of the inconsistent and heterogeneous results of the studies that report a significant association between weight bias and socioeconomic variables, the findings must be discussed concerning their cultural context, that is, cultural and governmental differences. Furthermore, educational attainment seems to be more likely to predict weight bias than income. The review revealed a lack of research when it came to examining the impact of socioeconomic capital on weight bias.

[General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?]. / Hausärztliche Bereitschaft zur Intervention bei zu hohem Alkoholkonsum: Eine Frage der Sicherheit im Umgang mit betroffenen Patienten?

Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.

[Screening and brief intervention in primary care: barriers against an early intervention for patients with alcohol misuse]. / Screening und Brief Intervention in der Hausarztpraxis: Barrieren gegen eine Frühintervention bei Patienten mit Alkoholmissbrauch.

STUDY GOAL: The effectiveness of screening and brief intervention (SBI) to reduce alcohol consumption has been shown by several studies in primary care. In spite of many attempts to establish SBI in routine care only a few patients are treated accordingly. Therefore in the study the General Practitioners' (GPs) assessment of barriers was investigated and tested for social desirability bias in order to determine barriers which are underestimated by GPs. METHOD: The questionnaire was sent to 700 GPs in Saxony-Anhalt. RESULTS: 178 questionnaires were analysed. Strong agreement could be found for barriers such as insufficient reimbursement and insufficient adherence of patients. GPs with low social desirability bias felt more awkward about asking patients about alcohol consumption and assessed SBI as less relevant for general practice. CONCLUSION: Primary care prevention of dependency should be advanced on the basis of a more elaborate knowledge of motivational effects of relevant barriers.

The role of control motivation in mortality salience effects on ingroup support and defense.

Terror management research has shown that mortality salience (MS) leads to increased support and defense of cultural ingroups and their norms (i.e., worldview defense, WD). The authors investigated whether these effects can be understood as efforts to restore a generalized sense of control by strengthening one's social ingroup. In Studies 1-3, the authors found that WD was only increased following pure death salience, compared with both dental pain salience and salience of self-determined death. As both the pure death and the self-determined death conditions increased accessibility of death-related thoughts (Study 4), these results do not emerge because only the pure death induction makes death salient. At the same time, Study 5 showed that implicitly measured control motivation was increased in the pure death salience condition but not under salience of both self-determined death and dental pain. Finally, in Study 6, the authors manipulated MS and control salience (CS) independently and found a main effect for CS but not for MS on WD. The results are discussed with regard to a group-based control restoration account of terror management findings.