[Conception and Preliminary Evaluation of a Rehabilitation-Attending Counseling Service for Caregivers of Stroke Patients]. / Konzeption und erste Evaluation eines rehabilitationsbegleitenden Beratungsangebots für Angehörige von Schlaganfallpatienten.

This paper presents the pilot project "The Caregivers' Guide", which is financed by the German Federal Ministry of Education and Research (BMBF). The project's concept is outreach-oriented and personal, giving constant support to relatives of stroke patients throughout rehabilitation. Its effects were reviewed in an accompanying study. A combination of qualitative and quantitative methods was chosen to gather data on the experiences and assessments of the caregivers, as well as changes during the counselling process. 62 caregivers completed questionnaires before and after the intervention. Additionally, 30 qualitative interviews were carried out. Positive effects could be observed in accordance with the project goals, especially regarding provision of appropriate information, burden reduction and strengthening clients' resources. The accompaniment by a fixed reference person was viewed as helpful, the combination of professional knowledge and emotional support was deemed most essential. The concept "The Caregivers' Guide" is suitable as an impetus of innovation regarding the development of counseling structures for family caregivers.

[Stress and Burnout Risk in Nursery School Teachers: Results from a Survey]. / Stressbelastungen und Burnout-Risiko bei Erzieherinnen in Kindertagesstätten: Ergebnisse einer Fragebogenstudie.

This article presents results from a study of 834 nursery school teachers in Germany, investigating working conditions, stress, and stress-related health problems. In order to evaluate the extent of mental and psychosomatic troubles, as well as the risk of burnout, we used the standardised questionnaire "Burnout Screening Scales" (BOSS I). Data analysis yielded a high percentage of nursery school teachers who reported a remarkably high stress level; nearly 20% can be considered as a high-risk group for burnout. Poor staff conditions in many nurseries turned out to be the crucial stress source, along with large groups, insufficient teacher-child ratio, time pressure and multitasking. In the concluding discussion of the study results, we consider possible measures to reduce stress and to improve working conditions for nursery school teachers.

[On prevalence of parenthood in schizophrenia patients]. / Zur Prävalenz von Elternschaft bei schizophrenen Patienten.

A clinical sample of n=370 patients suffering from schizophrenia/schizo-affective disorder (ICD-10 diagnosis F20/25) was investigated as to the prevalence of parenthood along with socio-demographic and clinical aspects. Data analysis yielded that 26.5% of the patients were parents, with women having three times more often children than men. Among those patients who had children, 41% were living together with them in the same household. The results point out that parental roles should be much more considered when treating mentally ill patients with children. This is a vital interest for the parents affected as well as for their children. Furthermore, a working cooperation between adult psychiatry and the youth help system needs to be established.

[Life satisfaction and subjective importance of life domains in schizophrenia patients: the role of partnership and parenthood]. / Lebenszufriedenheit und subjektive Relevanz von Lebensbereichen bei schizophren Erkrankten.

OBJECTIVE: The aim is to analyze determinants of subjective quality of life in schizophrenia patients. METHODS: Life satisfaction and subjective importance of life domains were assessed in 107 patients (FLZ (M)) and compared with the general population (n = 2974). RESULTS: Schizophrenia patients experience lower levels of life satisfaction as well as less meaningfulness in all life domains. According to the range-of-affect hypothesis, patients with low importance ratings judged their life satisfaction more homogenously. While the presence of a partnership increases life satisfaction, parenthood has only indirect influences on satisfaction. CONCLUSION: Psychiatrists should not only explore life satisfaction, but also the importance of different life domains and the patient's family relations. Supporting beneficial family relations can increase the quality of life in schizophrenia patients.

[Gender- and age-specific aspects of assistance need in caregivers of stroke patients: results from a qualitative panel study]. / Geschlechts- und altersspezifische Aspekte des Hilfebedarfs bei Angehörigen von Schlaganfallpatienten - Ergebnisse einer qualitativen Längsschnittstudie.

AIM: The present study aimed at investigating the need for professional assistance in carers of stroke patients who do not require a therapeutic group intervention; and furthermore, how this need for assistance is changing in the course of rehabilitation. METHOD: Ten highly burdened spouses of stroke survivors were interviewed twice in the framework of a qualitative panel study. In-depth interviews concerning subjective burden and assistance requirements were carried out and analyzed using Grounded Theory coding procedures. RESULTS: The evaluation of the interview data showed that the relatives' needs for assistance change in the course of rehabilitation, and feature gender- and age-specific differences. Assistance needs persist in the medium and long term, with qualitative diversifications: During the in-patient rehabilitation period, carers request mainly illness-related information, whereas emotional assistance is rarely desired. This is different during the out-patient rehabilitation period: While the desire for further information decreases, the need for emotional assistance (e. g.disburdening counselling) increasingly comes to the fore. Women much more often desire professional assistance than men. DISCUSSION: When designing and offering professional assistance for caregivers of stroke patients, gender- and age-specific aspects should be taken into account, as well as the medium- and long-term changes in assistance need.

[Side effects of psychotherapeutic intervention for caregivers of stroke patients: do patients also benefit?]. / Nebeneffekte eines therapeutischen Gruppenprogramms für Ehepartner von Schlaganfallpatienten: Profitieren auch die Patienten?

AIM: The present study aimed at investigating whether stroke patients benefit from their spouses attending a psychotherapeutic group intervention, in terms of improved functioning level and quality of life. METHOD: Within the scope of a panel study with control group design, n = 124, stroke patients were interviewed using standardized questionnaires, regarding competences of daily life (PCRS) and quality of life (WHOQoL). In the intervention group, the patients' spouses attended a psychotherapeutic group intervention; the spouses of two control groups merely received illness-related information. Data was evaluated statistically by means of multiple regression analysis. RESULTS: No statistically significant effects of the caregiver intervention on the patients were found. However, patients of the intervention group tended to report improved quality of life in the course of the study period, whereas subjective quality of life worsened for patients of the control groups. In all groups, impairments of everyday-life competences increased. DISCUSSION: The results of this study suggest that psychotherapeutic group intervention for caregivers also has positive side effects on the patients. Further research is necessary in order to provide a better understanding of the mechanisms at work behind these positive side effects. Assistance concepts for spouses of stroke patients should utilize such intermediary effects more systematically.

[How do young physicians assess their medical studies in retrospect? Results of a medical graduates' survey in Germany]. / Wie bewerten angehende Arzte rückblickend ihr Medizinstudium? Ergebnisse einer Absolventenbefragung.

OBJECTIVE: German medical graduates were asked to assess their medical studies in retrospect after their final academic exam. The survey's findings should provide clues for improvements in medical teaching. METHOD: Between April 2002 and December 2002 n = 671 medical graduates from 7 Universities in Germany were interviewed. By means of a questionnaire the subjects were asked to specify their study motivation and occupational aims; furthermore they were required to give a retrospective assessment of their medical studies. FINDINGS: The main motive for the decision to study medicine and to be a doctor is the desire to work with people and to be helpful to them. Regarding their occupational aims, most graduates wish to be a medical specialist, especially an internist or a general practitioner. As to the medical teaching, the subjects of the clinical study period are considered much more relevant for the future professional practice than the subjects of the pre-clinical study period. Much criticism focuses on the lack of practice-related medical teaching. The study participants judge the imparting of both practical and psycho-social skills as extremely deficient. Only 37.9 % of the young physicians feel well or very well prepared to future clinical tasks after their final academic exam. DISCUSSION: The findings confirm that the medical curriculum should be reconsidered with greater emphasis on teaching more practical skills. Medical teaching should comprise training modules and methods that are more closely connected with clinical practice. In particular, basic skills training of doctor-patient relationship and problem-oriented classes should be implemented, integrating clinical and psychosocial aspects.

[Long-term life changes and stress sequelae for spouses of stroke patients]. / Langfristige Lebensveränderungen und Belastungsfolgen bei Ehepartnern von Schlaganfallpatienten.

OBJECTIVE: This study investigates the long-term effect of stroke on the quality of life and health of patients' spouses. METHOD: Twenty-six spouses of stroke patients were interviewed by means of standardized questionnaires and qualitative interviews. The study participants had been living with the consequences of stroke for 3 years on average when the interviews were carried out. RESULTS: A stroke is often followed by considerable changes in everyday life and by role shifts within the relationship. In particular, depressive and aggressive changes in the patient's behaviour are experienced as burdensome. In addition to impairments in quality of life, psychological and psychosomatic troubles can also from the burden experienced. Depressive symptoms are the main factor in these negative consequences: the more a patient is assessed as depressive, the more his/her spouse reports health problems and poor quality of life. DISCUSSION: Long-term changes in everyday life and partnership can bring about significant chronic burden for the spouses of stroke patients. Hence, offers of support and counseling are required not only in the acute and post-acute stages of stroke, but also after inpatient rehabilitation has ended.

[Does caring for a schizophrenic family member increase the risk of becoming ill? Psychological and psychosomatic troubles in caregivers of Schizophrenia patients]. / Ist die Betreuung eines schizophrenen Familienmitglieds mit einem Gesundheitsrisiko verbunden? Psychische und psychosomatische Beeinträchtigungen bei Angehörigen schizophrener Patienten.

OBJECTIVE: The aim of this study was to investigate to what extent caregivers of schizophrenia patients suffer from psychiatric and psychosomatic symptoms themselves; furthermore, whether there are differences between parents and spouses. METHOD: 51 parents and 52 spouses of people with schizophrenia were interviewed regarding psychiatric and psychosomatic troubles using standardized questionnaires and diagnostic methods. RESULTS: A considerably increased prevalence of depressive disorders was found compared to the level in the general population. As well as mothers and wives, caregivers of patients with severe impairments of psycho-social functioning were particularly affected. The severity of the patient's disease and the caregiver's mental problems are significant predictors of psychosomatic complaints in parents and spouses. In addition, caregivers visit physicians more frequently, in particular family doctors, psychiatrists and psychotherapists. DISCUSSION: The results support the hypothesis that the burden carried by caregivers of severely affected schizophrenia patients increases their risk of becoming ill, which, as a consequence, leads to a greater use of medical resources. Specific offers of health care and advice on preventative measures appear to be necessary in order to preclude health impairments to caregivers as early as possible.

[Financial burden on spouses of patients suffering from schizophrenia, depression or anxiety disorder]. / Finanzielle Belastungen von Partnern psychisch Erkrankter.

The aim of this study was to compare financial burden of spouses, whose relative suffers from schizophrenia, depression or anxiety disorder. 151 spouses filled in the questionnaire about illness related expenses and financial loss. Additionally they estimate their subjective burden according to these experienced costs. Direct cash expenditures on behalf of the patients' illness were reported by 66 % spouses. In the sampling the amount of spent money did not differ statistically, however spouses of patients with anxiety disorder emphasised experiencing financial strain and described more often subjective economic disadvantages. Although most spouses of patients with psychiatric disorders experience illness related financial disadvantages, these costs were usually not considered as serious problem or as burdensome. Based on a subjective hierarchy of burdens financial problems can be regarded as less important for spouses of patients with mental illness. Thus, not only the material, but also the immaterial costs of care giving spouses should be taken into consideration when planning health policy decisions.

[Stress of family caregivers of psychiatric patients. Developmental trends, concepts and results of research]. / Belastungen von Angehörigen psychisch Kranker. Entwicklungslinien, Konzepte und Ergebnisse der Forschung.

OBJECTIVE: A review of the findings in the research literature on the effect of mental illness on other members of the patient's family is provided. This article critically examines the research to date with special reference to the conceptual and operational definitions of burden and methodological issues. RESULTS: The burdens of caring for a patient at home are considerable throughout different patient groups. Relatives' experience of burden is influenced by their cognitive appraisal of the situation and their psychosocial resources of coping with it. Research findings suggest that information and support provided by clinicians can alleviate caregiver burden, although it has been used too rarely in clinical routine. CONCLUSIONS: Finally, the review identifies advances made in this line of research in recent years and highlights areas that need further attention in future research work. Systematic research of families' responses to and management of mental illness should move beyond the more global concept of family and address the great diversity among families with mentally ill relatives. Furthermore, given the lack of consensus regarding the theoretical conceptualizing of the burden concept a new framework with reference to stressrelated research is suggested.

["The illness has totally changed our lives"--stress in partners of schizophrenic patients at the onset of illness]. / "Die Krankheit hat unser Leben total verändert"--Belastungen von Partnern schizophrener Patienten beim Beginn der Erkrankung.

OBJECTIVE AND METHOD: The aim of this study was to investigate how spouses of schizophrenic patients experience the onset of the disease. Based on the narrative analysis of 23 in-depth interviews, the article highlights different aspects of this stressful life event. RESULTS: The first episode of a schizophrenic disorder leads to severe distress in the spouse of the patient. Emotions of fear, despair and loss of control are especially pronounced if spouses feel that neither their information about the disease nor their supportive resources are sufficient. The illness is often viewed as an existential threat to marriage and family life. DISCUSSION: Supportive services for spouses of schizophrenic patients should be offered very closely to the onset of schizophrenia, because the situation is especially burdensome in this period. Interventions should meet the particular needs of spouses. In addition to information about the illness and coping strategies intervention programs should consider issues which are relevant for partnership and parenting roles.

Feasibility of a multi-state outcomes program for cardiopulmonary rehabilitation.

BACKGROUND: Outcomes validate program performance and patient benefits received from cardiac and pulmonary rehabilitation. However, outcomes have little meaning without test standardization and the ability to benchmark data with other programs. The purpose of this article is to demonstrate the feasibility for measuring standardized outcomes in a large number of rehabilitation programs. METHODS: The subjects included 928 cardiac patients and 222 pulmonary patients from 35 cardiac and 31 pulmonary rehabilitation programs. The SF-36 Health Survey, patient knowledge test, and 6-minute distance walk were administered before and after completion of the rehabilitation program. The patients completed rehabilitation according to the program guidelines at their respective site. RESULTS: Significant (P < 0.05) improvements were demonstrated for cardiac and pulmonary rehabilitation in each of the eight health concepts within the SF-36. In addition, patient knowledge and distance walked significantly (P < 0.05) improved for both cardiac and pulmonary rehabilitation. CONCLUSIONS: Although this study does not document the effectiveness of rehabilitation for patients, it does demonstrate that the collection and analysis of standardized outcomes among many cardiac and pulmonary rehabilitation sites is feasible.