Translation and Psychometric Testing of the Hägerbäumer Presenteeism Scale in English.

PURPOSE: Interest in presenteeism has increased in research. Presenteeism is a behaviour of going to work despite illness. It has been predominantly measured using single items, which introduce limitations to validity. To overcome these limitations, Hägerbäumer developed a German multi-item presenteeism scale. METHODS: The aim of the study was to provide an English translation and psychometric testing of the scale. This was conducted in two phases with native English-speaking employed adults. Phase 1 includes translation and cognitive debriefing, phase 2 testing construct validity and internal consistency reliability. RESULTS: Cognitive debriefing with 10 employees revealed no problems with understanding or answering the translated items. In total, 487 employed adults participated in the study, of which data from 287 were included in the analysis. For structural validity, the goodness-of-fit indicators all reached their thresholds (TLI = 0.98, CFI = 0.99, RMSEA = 0.07, SRMR = 0.02). The scale does not show differences between sexes and age groups but between sectors (F6,70.95 = 5.53, p < 0.001). The internal consistency reliability was satisfactory with α = 0.89 (CI 95%, 0.87-0.91). CONCLUSION: The translated multidimensional scale for measuring presenteeism at the behavioural level demonstrated good psychometric properties in an initial validation. Further psychometric testing is required before using this scale in cross-national comparison in research and international companies.

[Dermatological video consultations for German prisons : Experiences from teledermatological consultations 2020 to 2022]. / Dermatologische Videosprechstunden für deutsche Justizvollzugsanstalten : Erfahrungen aus teledermatologischen Konsilen 2020 bis 2022.

BACKGROUND: With increasing shortage of medical personnel also in the medical care in German correctional facilities, telemedicine has been used since 2016, initially in projects and then for regular medical care. Since 2019, there is the possibility of dermatological expertise in regular video consultations. OBJECTIVE: The benefits of an interdisciplinary online consultation with video and store and forward technology for dermatological issues are highlighted in terms of efficiency and feasibility. MATERIAL AND METHODS: A descriptive analysis of 450 dermatological video consultations for German correctional facilities from February 2020 to July 2022 was carried out with respect to procedures, indications and demand. RESULTS: Requests were made via a standardised form with optional photographs, which were sent via a secure cloud to the dermatology department in store and forward mode. The majority of cases could be presented live in a regular weekly video consultation and only single cases required an acute presentation within 24 h. The spectrum of skin diseases was comparable to cases presenting to a dermatology outpatient clinic. The interdisciplinary consultation management together with colleagues from general medicine enabled the transfer of the cases to the medical personnel at the correctional facility on site for follow-up and further medical procedures. Treatment could be started in all cases without delay. CONCLUSION: Teledermatology represents an important contribution to medical care in German correctional facilities and the interdisciplinary cooperation saves time and resources in the presentation and treatment of skin diseases.

[Patient Participation in Development of Quality Indicators using the Example of National Disease Management Guidelines for Chronic Heart Failure - A Qualitative Analysis of Collective Perspectives]. / Patientenbeteiligung bei der Entwicklung von Qualitätsindikatoren am Beispiel der Nationalen VersorgungsLeitlinie Chronische Herzinsuffizienz - Eine qualitative Analyse kollektiver Sichtweisen.

PURPOSE: In this qualitative study it was investigated by group discussions with patients suffering from chronic heart failure, how relevant the existing quality indicators of the National Disease Management Guidelines for Chronic Heart Failure are being estimated. METHODS: 6 group discussions were performed. The sample was formed from 4 mixed-gender groups, a male group and a female group. Participants were recruited from local heart sports groups. For the interpretation a method similar to the grounded theory was used. RESULTS: The main conclusion is that in principle quality indicators are accepted. However, many of these indicators neglect the everyday aspects of patients' life. Participants show a disposition of "yes - but" regarding the quality indicators. This phenomenon could be theoretically grasped using the concept of order of knowledge. While participants keep referring to an order of everyday knowledge, quality indicators make recourse to a medical order of knowledge. Both orders of knowledge may compete with each other. CONCLUSIONS: The professional knowledge order of medicine needs to open up to a patients' knowledge order. Patient representatives in health care bodies need to be trained to develop a reflexive point of view to different knowledge orders enabling them to represent patients' everyday knowledge more confidently. Otherwise there is danger of conformation to the professional knowledge order of medicine only for reasons of being recognised as equal partners.

[Promotion of next generation primary care physicians: initiatives in the university training of medical students]. / Förderung des allgemeinmedizinischen Nachwuchses : Initiativen in der universitären Ausbildung von Medizinstudierenden.

BACKGROUND: There is, and will be a serious shortage of young primary care physicians in Germany. Initiatives at medical faculties focusing on primary care may increase the recruitment of young primary care physicians. OBJECTIVES: The present report describes national and international university initiatives, as well as programs for the recruitment of primary care physicians, and reports on their evaluation. METHODS: We searched medical data bases, journals and the internet using corresponding key words in the sense of a pragmatic review article. We also contacted experts who were questioned on this topic. RESULTS: Initiatives for increasing the recruitment of young general practitioners were identified at nine medical faculties in Germany. The underlying hypothesis of the existing programs is that the decision to become a primary care physician depends on the time point, extent and quality of the training at medical school. The decisive limitation of existing programs is that they have been sparsely evaluated. The available results from evaluations consistently indicate quite large positive effects on the recruitment rates; however, the underlying study designs are highly prone to bias. CONCLUSION: The identified initiatives can be grouped into three different models: (1) postgraduate studies, (2) specialized curricula for selected students with high interest in primary care and (3) longitudinal integration of primary care teaching in the obligatory curriculum. Different aspects, such as selection of the curricular model, definition of content, reimbursement of personnel and material expenses as well as evaluation are relevant to the planning and implementation of such initiatives.

[Improvements in survival in patients with heart failure]. / Überlebensfortschritte bei Patienten mit Herzinsuffizienz.

The aim of this study is to describe improvements in survival of patients with heart failure. In addition, factors that may have contributed to these improvements are discussed. The extent of improvement in survival is substantial. This is presumably mainly due to a broad spectrum of new therapeutic options and the introduction of clinical guidelines, and the increasing level of awareness and adherence. For the near future, the increasing implementation of disease management programs and complex interventions has the potential to have a further positive influence on the survival of patients with heart failure.

[Pharmacotherapy in patients with ulcerative colitis]. / Medikamentöse Versorgung von Patienten mit Colitis ulcerosa.

BACKGROUND: Patients with ulcerative colitis experience various impairments. The pharmacological treatment of the disease comprises 5-aminosalicylic acid, corticosteroids as well as immunomodulatory and biological agents. Little self-reported data exist on the prescription of these drugs. METHODS: This cross-sectional study was conducted in 2005 as a postal survey in different regions of Germany [Kiel/Lübeck, Halle (Saale), Minden, Regensburg]. Patients with ulcerative colitis (UC) were recruited from specialised gastroenterological practices, university outpatient clinics, and the member registry of a prominent patient organisation (DCCV). Participants returned a questionnaire including established items and scales on physical and psychosocial well-being as well as the self-reported current medication. RESULTS: A total of 444 patients with ulcerative colitis returned the questionnaires. Most of the participants were female, had a high level of school education and were currently employed. Twenty-eight percent of the participants reported to receive corticosteroids and 71 % reported a current treatment with 5-aminosalicylic acid. Approximately one quarter of our study population reported a treatment with immunomodulatory agents. Analgesics were reported to be prescribed only in 15 % of the patients, primarily in patients with depressive symptoms. Patients recruited from specialised gastroenterological practices and university outpatient clinics were more likely to report the prescription of 5-aminosalicylic acid and immunomodulatory drugs than members of the patient organisation. Only 7 % of our patients received loperamide, however, probiotics (12 %) and complementary agents (36 %) seem to have an important role with regard to prevalence of intake. About 40 % of women but only 28 % of the men reported to use complementary agents. Persons with a duration of illness of less than 11 years (median split) were almost twice as likely to take corticosteroids than persons with a longer duration of ulcerative colitis. DISCUSSION: Our results suggest an estimation of prescription rates in ulcerative colitis. However, they raise new questions, for example, concerning a potential underuse of immunomodulatory agents in this patient population. With regard to the identified differences in prescription rates according to psychosocial characteristics further studies are needed to examine these relationships.

[Health-related quality of life in asthma patients from general practice]. / Gesundheitsbezogene Lebensqualität bei Asthmapatienten in der Hausarztpraxis.

OBJECTIVE: This study investigates health-related quality of life in asthma patients from general practices in comparison with a general population sample. It further examines the association between health-related quality of life, socio-demographic characteristics and smoking behaviour. PATIENTS AND METHODS: 838 asthma patients with a mean age of 47.8 +/- 16.3 years AND 66 % female participants from 83 general practices in the region of Göttingen and Freiburg/Germany completed the St. George's Respiratory Questionnaire (SGRQ), an instrument to assess health-related quality of life, and they completed questions on socio-demographic variables and smoking behaviour. SGRQ values were compared with estimates for the general population generated in Spain. The association between SGRQ and socio-demographic characteristics and smoking behaviour was analysed by multivariate linear regression models. RESULTS: The SGRQ total values for asthma patients were three times higher than in the general population sample corresponding to a higher level of restrictions in quality of life. Both in the general population sample and in asthma patients non-smokers had a better health-related quality of life than smokers, especially with respect to respiratory symptoms. In the multivariate analysis, socio-demographic characteristics and smoking behaviour were differently related to health-related quality of life. In smokers, the level of impairment by asthma symptoms was the higher the more they had smoked. Impairment in daily activities increased with increasing age and decreasing professional status. Increasing psycho-social restrictions were associated with higher age and lower educational level. CONCLUSION: Assessing health-related quality of life in its different dimensions enables the general practitioner to conclude on the individual impairment caused by the disease. This facilitates targeted therapeutic interventions. Results from this study underline once more that quality of life should be integrated as an additional clinical parameter in population-based analyses of health care use.