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1.
BMC Health Serv Res ; 22(1): 1002, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35932066

RESUMO

BACKGROUND: Human papilloma virus (HPV) causes multiple anogenital diseases including cervical cancer and is the most common sexually transmitted infection. Healthcare resource utilization (HRU) associated with HPV-related anogenital diseases includes diagnostic and disease specific treatment regimens. A recent study showed disease burden of young women aged 23-25 years, who were the first populations eligible to receive HPV vaccination after its introduction in Germany. Cost for the German statutory health insurance (SHI) due to HPV­related anogenital diseases in this population are unknown. This study aimed at assessing HRU and costs related to HPV-associated anogenital diseases for the Germany SHI. METHODS: We used a retrospective, matched cohort design to leverage the prior identified cohort of 23-25-year-old women born between 1989-1992 diagnosed with HPV-related anogenital disease from the Institute for Applied Health Research Berlin (InGef) Research Database. German SHI claims data from 2012-2017 were analyzed. The prior identified cases were matched (direct, without replacement) to women without anogenital diseases (1:10 ratio). HRU and costs for inpatient care, outpatient care, and pharmaceutical during a 3-year observation period were determined for both cases and controls and increments between the groups were assessed. RESULTS: 2,972 women diagnosed with anogenital diseases (cases) who were matched to 29,720 women without anogenital diseases (controls). Cases had more outpatient visits (52.4 visits vs. 39.2 visits) and more cases (45.2% vs. 31.7%) were hospitalized at least once in the 3­year observation period. Most common outpatient procedures performed in cases were conization of the cervix uteri (4.4% cases; n < 5 controls), followed by other excision and destruction of diseased tissue of the cervix uteri (3.1% in cases; 0.0% in controls). Median difference in total healthcare costs of €684 (mean difference: €1,089, 95%CI: €752-1,426) suggest that HPV-related anogenital diseases were responsible for approximately €3.2 Million more healthcare costs for the identified cases in the four birth cohorts within the 3­year observation period in the InGef Research Database. Costs were mainly driven by outpatient care (41.6% of total costs). CONCLUSION: In Germany, HPV-related anogenital diseases among young women are associated with considerable HRU and financial expenditures, mostly driven by outpatient care.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Adulto , Atenção à Saúde , Feminino , Alemanha/epidemiologia , Custos de Cuidados de Saúde , Humanos , Seguro Saúde , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/terapia , Estudos Retrospectivos , Adulto Jovem
2.
Anaesthesiologie ; 71(6): 485-492, 2022 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-35925145

RESUMO

Acute coronary syndrome is the most common reason for the deployment of emergency medical services in Germany. Approximately 20-25% of all medical emergencies result from the indications for the suspicion of acute coronary syndrome. A substantial proportion of the total mortality rate is observed in the preclinical phase. Consequently, targeted diagnostics and treatment are of particular importance in this early phase. This article provides recommendations for the approach to patients with acute coronary syndrome in the prehospital phase and in the emergency department.


Assuntos
Síndrome Coronariana Aguda , Serviços Médicos de Emergência , Infarto do Miocárdio , Síndrome Coronariana Aguda/diagnóstico , Serviço Hospitalar de Emergência , Alemanha , Humanos , Infarto do Miocárdio/tratamento farmacológico
3.
Anaesthesiologie ; 71(8): 579-585, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35925199

RESUMO

The quality of postoperative pain therapy in Germany shows a heterogeneous treatment practice and large differences in quality between individual institutions, The patient representatives in the Federal Joint Committee (G-BA) have therefore decisively campaigned for many years that instruments of non-legislative standards are employed in order to noticeably improve the quality of perioperative pain therapy for patients in Germany. As a result of these efforts, in October 2020 a binding specification for internal quality management was included in the quality management guidelines (QM-RL) by the G­BA. This describes in concrete terms the structural and procedural requirements for an internal quality management of acute pain for all institutions in which operations and comparable potentially painful interventions are carried out. This article describes the content of this regulation and the resulting consequences for the institutions, the medical and administrative management and especially the role of anesthesia.


Assuntos
Dor Aguda , Manejo da Dor , Dor Aguda/diagnóstico , Alemanha , Hospitais , Humanos , Medição da Dor
4.
Urologie ; 61(8): 823-828, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35925292

RESUMO

The affiliated physician is one of the oldest types of self-employed physicians who work between outpatients and inpatient sectors. The number of physicians affiliated with hospitals in Germany has been decreasing steadily in recent decades. The reasons for this decline are diverse and include political and financial problems that need to be resolved. The new political changes aimed at the expansion of out-patient services in the sense of the AOP Catalog 115 b SGB V can be a new opportunity for affiliated physicians and the departments that they are affiliated with.


Assuntos
Médicos , Alemanha , Hospitais , Humanos , Pacientes Internados
5.
Urologie ; 61(8): 829-838, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35925293

RESUMO

BACKGROUND: Over the past 30 years, outpatient surgery has developed into an indispensable pillar of patient care in Germany, without its full potential coming to light. QUESTION: What are the reasons for the stagnation of further development of outpatient surgery and its suboptimal status quo? MATERIALS AND METHODS: Presentation and comparison of outpatient surgery numbers from clinics and practices, and a critical analysis of their development. RESULTS: After reaching a maximum number of outpatient operations in practices and clinics in 2015, there has been a location-independent decrease and stagnation due to underfunding of outpatient surgical structures and a shortage of resources. CONCLUSION: Outpatient surgery represents a patient-friendly and cost-effective alternative to inpatient interventions, provided that that medical and social indications rule out an increased risk. The expansion of outpatient surgery has so far provided relieve to the cost-intensive hospital sector and-in view of the shortage of nurses and physicians-will do so to an even greater extent as soon as politicians and payers commit to remuneration that is performance-related and actually covers the costs. Furthermore, the future of the healthcare system also depends on the future of outpatient surgery, which is to be assessed as positive.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Custos Hospitalares , Análise Custo-Benefício , Alemanha , Humanos , Pacientes Ambulatoriais
6.
Ophthalmologie ; 119(6): 582-590, 2022 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-35925367

RESUMO

BACKGROUND: The German Ophthalmological Society (DOG) regularly records the scientific activities of ophthalmological research institutions in Germany. OBJECTIVE: With this publication the DOG wants to make the performance of scientific ophthalmology in Germany transparent and increase the options for future research cooperation with facilities of research institutions. METHODS: Systematic survey of German research centers in ophthalmology. RESULTS: The current research map records the data from 41 German research centers for the reporting period 2018-2020. Compared to previous editions of the research map, there has been a significant increase in scientific activity. The number of studies reported rose to 496. The number of government funded research projects (n = 121) and projects funded by foundations (n = 108) also increased. Furthermore, the number of scientific publications has almost doubled: while 1919 were published in the period from 2012 to 2014 and 2305 in the period from 2015 to 2017, there were 4215 in the current reporting period. The map also reports on a continuous increase in the number of young scientists in ophthalmology. CONCLUSION: The research map demonstrates the performance of German scientific ophthalmology. At the same time, the need for research in ophthalmology remains high because many diseases that affect the eyes are not yet or not yet completely curable.


Assuntos
Oftalmologia , Médicos , Previsões , Alemanha , Humanos , Sociedades Médicas
7.
PLoS One ; 17(8): e0271345, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925933

RESUMO

With the EU Green Deal initiatives, European members seek to launch the first climate neutral continent by 2050. This paper assesses the stochastic convergence of per capita energy consumption series for an illustrative sample of 15 EU countries with memberships prior to the 2004 enlargement, using data spanning the 1970-2018 period. Results from the confidence interval subsampling (asymmetric and equal-tailed) highlight that 11 out of the 15 EU series exhibit a long-run memory behaviour, while a diverging pattern was observed for the UK, Germany, Portugal, and Italy. Finally, per capita energy use series persist but fail to reveal one of the above dynamics for Ireland and Spain. Also, findings from the non-parametric Bayesian application (ANOVA/linear Dependent Dirichlet Process (DDP) mixture model) show how economic growth operates as a converging energy consumption-enabler over the long-run, from which the EU membership cannot be excluded. In particular, we highlight how the nature of energy-GDP hypotheses vary with the stochastic properties of energy use (converging behaviour with temporary shocks, converging pattern with permanent shocks, and diverging dynamic). Finally, our conclusions overcome the well-established development stage argument as we claim that countries with similar energy convergence patterns may need to adopt similar energy policies.


Assuntos
Desenvolvimento Econômico , Energia Renovável , Teorema de Bayes , Dióxido de Carbono/análise , Alemanha , Itália
8.
BMC Psychiatry ; 22(1): 524, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918711

RESUMO

BACKGROUND: Previous research has demonstrated the negative effects of study-related stressors on the mental health of medical students. It has been found that social resources such as social identity, dual identity and social support help buffer negative mental health outcomes. Notably, social status has been found to weaken the connection between stress and depressive symptoms. Based on these findings, the present study investigates how social resources (i.e., social identity, social support, dual identity and status) mitigate the impact of study-related stressors on the mental health of medical students who carry an inordinate stress burden. METHODS: The data collection was based on a questionnaire (online and paper-pencil) which was distributed to medical students in North Rhine-Westphalia, Germany. The sample (224 participants) consisted of 77.2% female and 22.8% male medical students (36.2% human medicine students (HMS) and 63.8% dental medicine students (DMS)). The questionnaire included graphical scales and standardized questionnaires. We investigated demographic data, study-related stressors (i.e. academic performance, clinical practice, faculty relations) and depressive symptoms as outcomes, and social identity, social support, dual identity and status as moderators. The analyses were performed using SPSS 25 for Windows. RESULTS: We found significant positive associations between study-related stressors and depressive symptoms. While dual identity as well as social support by fellow students emerged as buffers in these associations, the other social resources did not. As regards status, it was found to work as a buffer only in HMS, who typically enjoy a significantly higher status than dental medical students. CONCLUSION: It is only social resources such as support from fellow students and dual identity, but not other resource types, that can be effective buffers against depressive symptoms associated with study-related stressors. These findings can be used to promote students' identities in relation to both fellow students and the faculty, or the university as a whole, enabling students to better cope with stress and, thus, suffer less from depressive symptoms. Furthermore, the HMS, who ascribe a relatively high status to themselves, can use their status as a buffering factor in stressful situations, in which little can be done from the outside.


Assuntos
Estudantes de Medicina , Estudos Transversais , Depressão/psicologia , Feminino , Alemanha , Humanos , Masculino , Estresse Psicológico/psicologia , Estudantes de Medicina/psicologia
9.
PLoS One ; 17(8): e0268598, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921259

RESUMO

BACKGROUND: Previous research suggests that romantic relationships play a crucial role for perceived control. However, we know surprisingly little about changes in perceived control before and after the end of romantic relationships. METHODS: Based on data from the Socio-Economic Panel Study (SOEP), a nationally representative household panel study from Germany, we examined changes of perceived control in the years around separation from a partner (N = 1,235), divorce (N = 423), and the death of a partner (N = 437). RESULTS: Multilevel analyses revealed that external control beliefs were higher in but not beyond the first year after separation from a partner. Internal and total control beliefs increased gradually in the years after separation. Moreover, internal control beliefs were higher in and especially beyond the first year after the death of a partner compared to the years before. No evidence was found that perceived control already changed in the years before relationship losses or in the years around a divorce. CONCLUSION: Taken together, these findings point toward stress-related growth of perceived control after some relationship losses-especially separation and the death of a partner.


Assuntos
Divórcio , Personalidade , Alemanha , Humanos , Transtornos da Personalidade
10.
PLoS One ; 17(8): e0271406, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921352

RESUMO

OBJECTIVES: This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. METHODS: An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. RESULTS: Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. CONCLUSIONS: Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.


Assuntos
Transtorno do Espectro Autista , Odontopediatria , Adolescente , Transtorno do Espectro Autista/terapia , Criança , Odontólogos/psicologia , Feminino , Alemanha , Humanos , Masculino , Odontopediatria/educação , Inquéritos e Questionários
11.
PLoS One ; 17(8): e0272344, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921378

RESUMO

Promoting mental health addresses a global societal challenge. Nature connectedness, or relatedness to natural systems, is associated with increased well-being and mental health. Among urban populations, nature connectedness has been reported as lower. Nature connectedness in urban settings has been somewhat overlooked by researchers. This cross-sectional online study addressed this issue by identifying socio-demographic predictors of urban nature connectedness among 165 students, aged 20 to 40, from the Technical University of Munich. Analysis of the data from 153 female university students was conducted using ordinal regressions, (a) separately and (b) merged with their 12 male counterparts. A separate gender analysis for males could not be performed, due to sample size limitations. Although access to nature and a considerable nature dose in terms of frequency and duration of nature contact were noted, possibly achieved through the engagement in outdoor activities, urban nature connectedness was rather low. Results showed that urban nature connectedness was negatively predicted by living in a rural area and positively predicted by engagement in outdoor activities and increased hours per week spent in nature. This information can help researchers operationalize the construct of urban nature connectedness. Furthermore, it can aid the development of interventions aimed at promoting urban nature connectedness, by encouraging urban inhabitants to (repeatedly) get in contact with and spend time in provided high-quality urban nature (e.g., during outdoor activities). To draw conclusions about causality, further research is required to identify a clear cause-effect relationship between socio-demographic characteristics and urban nature connectedness. Based on a researched dose-response relationship, a(n) (inter)national recommendation for the duration of nature contact should be established to promote urban nature connectedness and, therewith, health in urban inhabitants. Future research should also investigate further potential individual influencing factors, as well as gender and within/between-country differences among urban inhabitants.


Assuntos
Estudantes , Estudos Transversais , Demografia , Feminino , Alemanha , Humanos , Masculino , Estudantes/psicologia , Universidades
12.
BMC Med Educ ; 22(1): 599, 2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-35922857

RESUMO

BACKGROUND: Microsurgery is a growing field which requires significant precision and skill. Eyesi Surgical, which is usually introduced during residency or fellowship, is an ophthalmologic microsurgery simulator which allows users to practice abstract microsurgical skills and more specialized skills. The purpose of this study was to assess the inclusion of microsurgical simulation training during medical school. METHODS: Seventy-nine German medical students in their 10th semester of education completed up to two days of training on the simulator during their ophthalmology clerkship. They received an objective numeric score based on simulator performance and completed pre and post training subjective questionnaires. RESULTS: There was no relationship found between students' Eyesi Surgical performance scores and their specialty interests (p = .8). The majority of students (73.4%) rated their microsurgical skills to be higher after simulator training than before training (p < 0.001). 92.4% of students found the Eyesi Surgical to be a useful component of the ophthalmology clerkship. Objective scores from Navigation Training Level 1 showed that students achieved better results in the criteria categories of Completing Objects and Tissue Treatment than in the categories of Instrument and Microscope Handling. The mean Total Score was 25.7 (± 17.5) out of a possible 100 points. CONCLUSION: The inclusion of surgical simulation in the ophthalmology clerkship led to increased confidence in the microsurgical skills of medical students. Offering surgical simulation training prior to residency can help to expose students to surgical fields, identify those that have particular talent and aptitude for surgery, and assist them in deciding which specialty to pursue.


Assuntos
Internato e Residência , Oftalmologia , Treinamento por Simulação , Estudantes de Medicina , Competência Clínica , Simulação por Computador , Alemanha , Humanos , Microcirurgia , Oftalmologia/educação , Estudos Prospectivos , Treinamento por Simulação/métodos
14.
BMC Psychiatry ; 22(1): 528, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-35927707

RESUMO

BACKGROUND: Many studies have previously compared the prevalence or sample means of distress and mental health problems from before to during the COVID-19 pandemic, while results on changes at the individual-level, and regarding multiple outcome measures are demanded. METHODS: This online study investigated individual changes in stress and mental health from before the COVID-19 pandemic to the first lockdown in adults from Southeastern Germany. This region was selected as it was where SARS-CoV-2 was first documented in Germany, and also due to the implementation of strict stay-at-home orders and social contact prohibitions. From April 10-27, 2020, we collected state measures and their clinical relevance for the subareas of perceived stress: worries, tension, joy, and demands. We also collected information regarding the following mental health problems: depression, anxiety, pathological worry, posttraumatic stress disorder (PTSD), and health anxiety; as well as retrospective measures of how participants felt they have changed in comparison to before the pandemic, ranging from worse to better. RESULTS: The analytical sample comprised 396 adult participants. On average, participants experienced increases in worries, tension, and lack of joy, and increases in mental health problems, but a decrease in demands. Perceived increases in symptoms of depression (26.0%) and PTSD (25.5%) were significantly more frequent than in symptoms of anxiety (particularly acute fear and panic) (5.6%), pathological worry (9.8%), and health anxiety (7.3%) (ps<.001). One per 10 participants (10.4%) reported an increase in depressive symptoms, and nearly two per 10 (18.4%) an increase in PTSD symptoms and additionally showed a clinically relevant symptom strain during lockdown. Interestingly, mainly non-specific PTSD symptoms associated with a general stress reaction were experienced to be increased. CONCLUSION: The findings suggest a dissociation of perceived changes in subareas of stress and mental health with a particular experience of increases in depressive and general stress symptoms and a decrease in external demands. This points to a need for a more differentiated view on the impact of the COVID-19 pandemic on stress and mental health, and for targeted interventions for mental health problems arising frequently during the pandemic.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Depressão/epidemiologia , Depressão/psicologia , Alemanha/epidemiologia , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia
15.
Front Public Health ; 10: 927658, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35910894

RESUMO

Background: Area deprivation has been shown to be associated with various adverse health outcomes including communicable as well as non-communicable diseases. Our objective was to assess potential associations between area deprivation and COVID-19 standardized incidence and mortality ratios in Bavaria over a period of nearly 2 years. Bavaria is the federal state with the highest infection dynamics in Germany and demographically comparable to several other European countries. Methods: In this retrospective, observational ecological study, we estimated the strength of associations between area deprivation and standardized COVID-19 incidence and mortality ratios (SIR and SMR) in Bavaria, Germany. We used official SARS-CoV-2 reporting data aggregated in monthly periods between March 1, 2020 and December 31, 2021. Area deprivation was assessed using the quintiles of the 2015 version of the Bavarian Index of Multiple Deprivation (BIMD 2015) at district level, analyzing the overall index as well as its single domains. Results: Deprived districts showed higher SIR and SMR than less deprived districts. Aggregated over the whole period, the SIR increased by 1.04 (95% confidence interval (95% CI): 1.01 to 1.07, p = 0.002), and the SMR by 1.11 (95% CI: 1.07 to 1.16, p < 0.001) per BIMD quintile. This represents a maximum difference of 41% between districts in the most and least deprived quintiles in the SIR and 110% in the SMR. Looking at individual months revealed clear linear association between the BIMD quintiles and the SIR and SMR in the first, second and last quarter of 2021. In the summers of 2020 and 2021, infection activity was low. Conclusions: In more deprived areas in Bavaria, Germany, higher incidence and mortality ratios were observed during the COVID-19 pandemic with particularly strong associations during infection waves 3 and 4 in 2020/2021. Only high infection levels reveal the effect of risk factors and socioeconomic inequalities. There may be confounding between the highly deprived areas and border regions in the north and east of Bavaria, making the relationship between area deprivation and infection burden more complex. Vaccination appeared to balance incidence and mortality rates between the most and least deprived districts. Vaccination makes an important contribution to health equality.


Assuntos
COVID-19 , Teorema de Bayes , COVID-19/epidemiologia , Alemanha/epidemiologia , Humanos , Incidência , Pandemias , Áreas de Pobreza , Estudos Retrospectivos , SARS-CoV-2
16.
BMJ Open ; 12(8): e059100, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940827

RESUMO

OBJECTIVES: This study aimed to explore the association between patient activation and patients' experience of care among an elderly multimorbid population in Germany. DESIGN: Cross-sectional study. SETTING: Primary care practices in two German settings. PARTICIPANTS: 346 patients with 3 or more chronic conditions aged 65 years and over from 36 primary care practices. OUTCOME MEASURES: Patient activation was measured with the patient activation measure (PAM). To assess patient experiences with primary care, a set of questions concerning domains of primary care were included. Multilevel regression analyses were performed to examine which domains of care were associated with patient activation. RESULTS: Out of 1243 invited patients, a total of 346 took part in the study (participation rate 27.8 %). Mean PAM score was 76.1. Across all patients, 3.8% achieved PAM level 1, 7.5% level 2, 27.2% level 3% and 60.7% level 4. PAM scores suggest a highly activated patient group. In the regression analysis, three out ten domains of patients' experiences showed an association with patient activation. The domains 'being involved in decision as much as desired' (B=-8.56, p=0.012) and 'receiving a self-management plan' (B=6.51, p=0.051) were associated with higher patient activation scores. Patients with an up-to-date medication plan had lower patient activation scores (B=-12.01, p=0.041). CONCLUSION: Specific domains of primary care were found to be associated with patient activation. To enhance patient activation, primary care physicians may increase involvement of patients in decisions. Future research should examine the causality of these associations. TRIAL REGISTRATION NUMBER: DRKS00015718.


Assuntos
Multimorbidade , Participação do Paciente , Idoso , Estudos Transversais , Alemanha/epidemiologia , Humanos , Atenção Primária à Saúde
17.
Int J Behav Nutr Phys Act ; 19(1): 102, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941614

RESUMO

BACKGROUND: Physical activity (PA) is a proven strategy to prevent chronic diseases and reduce falls. Furthermore, it improves or at least maintains performance of activities of daily living, and thus fosters an independent lifestyle in older adults. However, evidence on the association of PA with relevant subgroups, such as older adults with utilization of long-term care (LTC), is sparse. This knowledge would be essential for establishing effective, need-based strategies to minimize the burden on healthcare systems due to the increasing need for LTC in old age. METHODS: Data originate from the 2011/12 (t1) baseline assessment and 2016 (t2) follow-up of the population-based Cooperative Health Research in the Region of Augsburg (KORA-)Age study in southern Germany. In 4812 observations of individuals ≥65 years, the association between various types of PA (walking, exercise (i. e., subcategory of PA with the objective to improve or maintain one or more components of physical fitness), walking+exercise) and utilization of LTC (yes/no) was analyzed using generalized estimating equation logistic models. Corresponding models stratified by sex (females: 2499 observations; males: 2313 observations) examined sex-specific associations. Descriptive analyses assessed the proportion of individuals meeting the suggested minimum values in the German National Physical Activity Recommendations for older adults (GNPAR). RESULTS: All types of PA showed a statistically significant association with non-utilization of LTC in the entire cohort. "Walking+exercise" had the strongest association with non-utilization of LTC in the entire cohort (odds ratio (OR): 0.52, 95% confidence interval (CI): 0.39-0.70) and in males (OR: 0.41, CI: 0.26-0.65), whereas in females it was "exercise" (OR: 0.58; CI: 0.35-0.94). The proportion of individuals meeting the GNPAR was higher among those without utilization of LTC (32.7%) than among those with LTC (11.7%) and group differences were statistically significant (p ≤ 0.05). CONCLUSIONS: The GNPAR are rarely met by older adults. However, doing any type of PA is associated with non-utilization of LTC in community-dwelling older adults. Therefore, older adults should be encouraged to walk or exercise regularly. Furthermore, future PA programs should consider target-groups' particularities to reach individuals with the highest needs for support.


Assuntos
Vida Independente , Assistência de Longa Duração , Atividades Cotidianas , Idoso , Exercício Físico , Feminino , Alemanha , Humanos , Masculino
18.
BMC Psychiatry ; 22(1): 540, 2022 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-35948968

RESUMO

BACKGROUND: Covid-19 pandemic has been profoundly affecting people around the world. While contact restrictions, school closures and economic shutdown were effective to reduce infection rates, these measures go along with high stress for many individuals. Persons who have experienced adverse childhood experiences (ACEs) have an increased risk for mental health problems already under normal conditions. As ACEs can be associated with a higher vulnerability to stress we aimed to assess the role of ACEs on depressive symptoms during the Covid-19 pandemic. METHODS: In a cross-sectional online survey, 1399 participants above the age of 18 years were included during the first lockdown in Germany. Via two-way repeated measures ANOVA, differences in depressive symptoms before (retrospectively assessed) and during the pandemic were analyzed. Linear regression analyses were performed in order to identify predictors for increase of depressive symptoms. RESULTS: Compared to prior to the Covid-19 pandemic, depressive symptoms increased among all participants. Participants with ACEs and income loss reported about a stronger increase of depressive symptoms. Other predictors for increased depressive symptoms were young age and a lack of social support. CONCLUSIONS: Based on these results, ACEs are a significant predictor for an increase in depressive symptoms during the pandemic, indicating that personss with ACEs may be a risk group for mental health problems during the current and potential later pandemics. These findings underline the relevance of support for persons who have experienced ACEs and may help to provide more targeted support in possible scenarios due to the current or possible other pandemics. Besides, economic stability seems to be of prior importance for mental health.


Assuntos
Experiências Adversas da Infância , COVID-19 , Adolescente , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Alemanha/epidemiologia , Humanos , Pandemias , Estudos Retrospectivos
19.
Radiologie (Heidelb) ; 62(6): 535-548, 2022 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-35925065
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