ABSTRACT
Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.
Subject(s)
International Classification of Functioning, Disability and Health/classification , International Classification of Functioning, Disability and Health/standards , Patient-Centered Care/standards , Practice Guidelines as Topic , Precision Medicine/standards , Rehabilitation/standards , Social Medicine/standards , Germany , Humans , InternationalityABSTRACT
PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.
Subject(s)
International Classification of Diseases/classification , Patient-Centered Care , Precision Medicine , Terminology as Topic , Germany , HumansABSTRACT
Common health problems are increasing due to the combination of decreased physical activity demands in everyday life and demographic changes; thus, the importance of exercise therapy is increasing. The incidence and prevalence of today's predominant chronic diseases are directly related to physical activity. However, daily clinical routine does not stay abreast with these changes. The education of physicians, and thus their scope of action, is dominated by biomedical therapy concepts, predominantly drug therapy concepts. Differential and consolidated findings of modern exercise and sport science are astonishingly rare in the counselling and treatment portfolio of medical care. The present disease management program for persons with diabetes mellitus type 2 is a good example. Referring to this background, the authors address the new approach of "ICF-oriented exercise programs and biopsychosocial status." They present resource-related interventional strategies and health care concepts for chronic health disorders like the metabolic syndrome or diabetes mellitus type 2. The relevance and use of active health promotion and care - due to lifestyle- and age-related health problems of the population - will increase in importance and be more commonly recommended.
Subject(s)
Diabetes Mellitus, Type 2/rehabilitation , Exercise Therapy/methods , Health Promotion/organization & administration , International Classification of Diseases/organization & administration , Patient Education as Topic/methods , Resource Allocation/organization & administration , Chronic Disease , Germany , Humans , PsychologyABSTRACT
PURPOSE: To assess how the speed of injection of local anesthetic solutions affected pain of injection, bulbar akinesia and analgesia with retrobulbar anesthesia (RBA). METHODS: 70 patients undergoing RBA for cataract surgery were enrolled in a prospective masked trial. They were allocated randomly to receive 5 ml anesthetic solution injected either within 20 seconds (group A) or within 60 seconds (group B). Additionally, akinesia of the orbicularis muscle was created according to O'Brien's technique. The pain of injection was registered on an ordinal analogue scale immediately before and after RBA. The following data were collected before and 20 minutes after retrobulbar injection: eye motility (Kestenbaum test), and corneal sensitivity (0: no sensitivity; 1: sensitivity remaining). Data were also collected on age, sex, and bulbar length, and any side effects of the intervention. RESULTS: Injection pain did not differ in the two groups. After RBA horizontal and vertical eye motility was slightly lower in group A than group B. Persistent motility was found in 18 patients in group A and 16 in group B. Median horizontal and vertical motility was 0 mm in both groups. Four patients in group A and five in group B had corneal sensitivity persisting after RBA. CONCLUSIONS: This comparison of different injection velocities brought to light no significant differences regarding bulbar analgesia and akinesia after RBA.
