[Reporting of work-related mental health]. / Zur Organisationsdiagnose psychischen Befindens in der Arbeitswelt.

Along with the structural changes of the economy, the psychological well-being of employees becomes increasingly important for their performance. The reporting of mental well-being at the organizational level is an essential precondition for occupational health interventions. This article deals with the mental health of employees from ten different companies. These data show that almost 1 in 5 employees rate their mental well-being as poor. Most notably, women with lower status in the services sector are affected. Those who are temporarily in a bad mood are often affected by strong physical complaints and tend to assess the quality of their work as rather poor. Moreover, the data from 3,349 employees show that the extent of social capital of an organization highly correlates with the mental well-being of their employees. Our results show that work-related stress factors and (psychological) illnesses can be detected and prevented more often if the influence of social parameters on mental well-being are taken into consideration.

[Evaluation of outpatient rehabilitation: goals, conceptual framework and study design of a health and pension insurance joint research project]. / Die wissenschaftliche Begleitung im Rahmen der Empfehlungsvereinbarung von Kranken- und Rentenversicherung zur ambulanten Rehabilitation: Zielsetzungen, Rahmenbedingungen und Untersuchungsansatz.

In Germany the statutory health and pension insurance schemes are the main providers of medical rehabilitation, the majority of rehabilitation measures being given in an inpatient setting. Over the last few years, the health and pension insurance schemes have strengthened the extension of outpatient rehabilitation, and have funded a comprehensive evaluation study in this context. In this evaluation study outpatient rehabilitation in centres with different conceptual backgrounds is compared with inpatient rehabilitation in rehab clinics, indications considered being cardiology and orthopaedics. Overall, 14 rehab centres and more than 2000 patients were included in the project. The patients were interviewed and medically examined before and after the measure. A follow-up was done after six and twelve months. In addition to the rehabilitants themselves, the rehab centre physicians as well as the office-practice physicians were interviewed about the outcome of the rehab measure. One year after rehabilitation, data were collected from the relevant health and pension insurance funds concerning the benefits the patients had received. Due to the study's non-experimental design, validity of the results is confined to rehabilitants participating on an outpatient basis and who had been found medically suited for this type of rehabilitation, were capable of travelling to the rehab centre on their own within less than 45 minutes and had voluntarily opted for the outpatient setting. The findings of the study show that outpatient rehabilitants' motivation and expectations differ from those found in inpatient rehabilitation. The health economics analysis performed is restricted to the costs involved in the rehabilitation measure as such as well as the health-related benefits provided to the rehabilitants in the twelve-month study period. The issue of whether increasing outpatient rehab measures will lead to decreasing costs in the rehab system as a whole had not been considered in the framework of this project.

[Evaluation of health policy intervention on the community level--the "Neighborhood Coordination of Health and Social Care" Model Project in North Rhine-Westphalia]. / Evaluation einer gesundheitspolitischen Intervention auf kommunaler Ebene--Das Modellprojekt "Ortsnahe Koordinierung der gesundheitlichen und sozialen Versorgung" in Nordrhein-Westfalen.

Between October 1995 and December 1998 the pilot project 'Local Coordination of Health and Social Care' was conducted in 28 communities of the state of North Rhine-Westphalia. The project has been evaluated by two university research teams. The aim of the project was basically to establish new structures of health planning and coordination at the community level, in order to improve health reporting and health care as well as health promotion. To realize this aim round tables, working groups and project-offices were implemented in the communities. The evaluation was focused on the following question: What were the conditions (structures) and processes that influenced the project outcomes? Qualitative and quantitative methods were applied (interviews, standardised self-administered questionnaires, analyses of documents) to this end. Evaluation of structures showed that most communities succeeded in integrating relevant health policy actors into the newly created round tables and working groups. Working climate and achievements were evaluated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for programmes, and about 40% of these programmes were implemented during the project. The probability of programme implementation was particularly high if the programme was based on reliable local data and if execution was effected only on the community level. The possibly beneficial effects on health care and welfare produced by the new programmes could not be assessed within the short project period. The paper concludes with a brief discussion of practical consequences for future health policy at community level.

[Definition and requirements of health]. / Was ist und bedingt Gesundheit.

Health is conceptualized as an ability to cope. Health is dependent on how well the personal and the social system are adapted to each other. The person-environment interaction itself is shaped by culture and social structure and their consequences for the living and working conditions.

[The challenge of the health sciences to nursing]. / Pflege vor der Herausforderung durch die Gesundheitswissenschaften.

Health science, a challenge to nurses! We live in an age of old people who are chronically ill and in need of nursing care. Modern medicine's reply to the panorama of sickness and demography is to renew attempts to conquer the somatic progression with technology and chemistry. Will nursing be sucked into these developments or will it tackle new duties, arising, for example, in health promotion and rehabilitation? There are also problems of reshaping the health-care systems. Nursing will have to be involved in this because of special professional experience and the developing nursing sciences. This contribution deals with the human face of medicine and nursing and touches on proposals for a patient-oriented redesign of the health-care system.

Function of human epididymal spermatozoa.

Human epididymal spermatozoa taken from caput, corpus, and cauda were investigated to determine their fertilizing capacity (22 epididymides from 11 patients who had undergone orchidectomy because of prostatic cancer). The following functions, which have been reported to correlate positively with the fertilization rate, were determined: motility and progressive motility, chromatin condensation (assessed by aniline blue staining), acrosin activity, and induction of acrosome reaction by low temperature. In addition, stimulation of motility by pentoxifylline and phosphatidylcholine was examined. The results showed that motility, progressive motility, normal chromatin condensation, and inducible acrosome reaction increased from the caput to the cauda epididymidis, whereas acrosin activity was normal in all sections. Stimulation of progressive motility, especially that of caput spermatozoa, could be achieved by both pentoxifylline and phosphatidylcholine, the latter being definitely superior. In conclusion, our study confirmed that human spermatozoa in physiological status undergo several steps of maturation during the epididymal transit. Stimulation of sperm motility by phosphatidylcholine may be helpful for patients in whom epididymal spermatozoa are used for assisted reproduction.

Disturbances of sperm flagella due to failure of epididymal maturation and their possible relationship to phospholipids.

A recent classification of alterations of midpiece and flagellum describes the phenomenon of abnormal staining behaviour of human sperm flagella during Papanicolaou and Shorr staining. In these techniques, human sperm tails normally stain red; however, if epididymal function is disturbed, the flagella appear bluish, while they are devoid of other recognizable defects. Such spermatozoa were shown to be immotile, the motility disturbance being referred to as epididymal dysfunction. To define the physiological substrates of this descriptive phenomenon, caput spermatozoa from 10 epididymides of five patients who had undergone orchiectomy because of prostatic cancer were investigated. These spermatozoa showed severe motility disturbances, and almost all their flagella stained atypically. Attempts to stimulate such spermatozoa by pentoxifylline achieved a slight improvement in motility. However, addition of seminal plasma from fertile donors resulted in a significant improvement in motility, accompanied by an increase in the number of normally stained flagella. Even better results were achieved by incubation with liposomes made from soybean lipids, mainly phosphatidylcholine. It is concluded that poor motility and atypical staining behaviour of human caput sperm tails can at least partly be related to a lack of phospholipids in the flagellar membrane. Substitution of phospholipids may be a therapeutic approach in procedures using caput spermatozoa, although in addition to the improvement of sperm motility, the enhancement of fertilizing capacity remains to be established.

Effecting institutional change.

The paper deals with the need for institutional change and behaviour change in the medical care and social security system of the Federal Republic of Germany. The data reported are from the Oldenburg Longitudinal Study (OLS), in which a thousand males suffering from a first myocardial infarction have been surveyed with mailed questionnaires five times in five years. In this study, special emphasis has been given to the influence of social support from the spouse, the medical care system, and workmates on the coping process. Special emphasis has been given as well to institutional factors and organizational problems in the rehabilitation system of general practitioners, rehabilitation clinics and the social security system. The paper concludes that there is a clear need for comprehensive services and other measures that promote self-reliance and self-help activities among patients and their relatives. In the literature on heart disease, "health promotion" is mostly defined as behavioural change on the part of the individual--i.e. patients or members of what is conventionally called a "higher risk group". In this paper, however, I shall concentrate on another aspect which is no less important: the need for institutional change and behavioural change in the medical care and social security systems. This change, I argue, is needed in order to promote the health of patients who survived a first myocardial infarction.

[Long-term anxiety and depression following myocardial infarct]. / Langfristige angst und Depressivität nach Myokardinfarkt.

Data from the 5-year Oldenburg Longitudinal Study were used for investigating the causes of differences in psychological well-being in a national sample of 1000 cardiac patients. In a subsample of 400 married patients, for whom data from the spouse were available, exogenous influences, cognitive mediators, and two measures of psychological distress were linked up in models explaining/predicting the level of anxiety and depression. A major hypothesis was the salience of the illness-related cognitions of the patient as a determinant of long-term behavior and mood state. Early patient subjective health perceptions, the 'primary appraisal' of threat/harm/loss, were found to be the most important predictors of subsequent psychological well-being at the fourth wave of the study several years later. As an instrument for patient screening and psychosocial intervention, Type A's and other groups of subjects seemed to constitute high-risk patient groups.

[Social support and community health care]. / Soziale Unterstützung und gemeindenahe Versorgung.

Concepts of health have changed considerably over the last decades. Of particular interest is the relations between social support and health, between the social context of the individual, the social network of his family, friends, neighbours and workplace on one side, and health on the other side. The importance of social support is illustrated with data from the "Oldenburg Longitudinal Study (OLS)".

Marriage and the psychological consequences of a heart attack: a longitudinal study of adaptation to chronic illness after 3 years.

As part of a larger study on recovery from myocardial infarction in a national sample of male cardiac patients, data was collected on slightly under 400 men and their wives over a 5-year period. This longitudinal data set was used to investigate the role of patient health cognitions and marital factors on long-term psychological response to the illness. Negative appraisals of threat and loss due to cardiac impairment/disability were found to be the best predictor of anxiety and depression at 3-4 years after hospitalisation. Patient cognitions appeared to be a chief mediator of medically-defined illness. Supportive marital environments were defined by scales measuring intimate attachment and spouse conflict. The latter was found associated with negative health cognitions and elevated anxiety. High intimacy marriages appeared to provide adequate social support, and the level of intimacy between the spouses was inversely related to the level of depressed mood. These findings were suggestive of a buffering effect of the patient's social support system. Other predictors, including the type A pattern, 'vital exhaustion', and social class were investigated as components of a multifactorial model for clinical screening purposes.

Life-style and health: some remarks on different viewpoints.

Within the framework of the medical model of health and disease the factor 'life-style' plays a central role in the genesis of important disorders such as myocardial infarction or lung cancer. Two central issues, however, have been left unconsidered by most of the research done by medical epidemiologists: Disease, as a rule, has not one single but several causes; it is multifactorial in its etiology. This means that alongside 'life-style' there are other factors influencing pathogenesis. In this way we can explain, for example, the empirical finding that the classical risk factors only explain a minor amount of the morbidity and mortality due to coronary disease. A number of social and psychological factors influence those types of human behavior, which are known to have an adverse effect on health. The influence of age, sex, social status and parental and peer-group models have been empirically demonstrated. Social epidemiological research could contribute to a clarification and supplementation of the above-mentioned relationships leading to an improvement in our knowledge upon which to found preventive intervention. Social epidemiologists view health-adverse behavior as the consequence of social stress, that the individual attempts to cope with via smoking, drinking, etc. In the individual's social environment there exist numerous models, as well as informal pressures leading to such behavior. We should know more about the acute and chronic strains in the transition to adolescence and in later stages of the life-cycle.(ABSTRACT TRUNCATED AT 250 WORDS)