Predictors of course in obsessive-compulsive disorder: logistic regression versus Cox regression for recurrent events.

OBJECTIVE: Two methods for predicting remissions in obsessive-compulsive disorder (OCD) treatment are evaluated. Y-BOCS measurements of 88 patients with a primary OCD (DSM-III-R) diagnosis were performed over a 16-week treatment period, and during three follow-ups. METHOD: Remission at any measurement was defined as a Y-BOCS score lower than thirteen combined with a reduction of seven points when compared with baseline. Logistic regression models were compared with a Cox regression for recurrent events model. RESULTS: Logistic regression yielded different models at different evaluation times. The recurrent events model remained stable when fewer measurements were used. Higher baseline levels of neuroticism and more severe OCD symptoms were associated with a lower chance of remission, early age of onset and more depressive symptoms with a higher chance. CONCLUSION: Choice of outcome time affects logistic regression prediction models. Recurrent events analysis uses all information on remissions and relapses. Short- and long-term predictors for OCD remission show overlap.

[A differential view and validation of the life-satisfaction construct: an analysis of proven procedures and recommendations for a methodologically based approach in measuring the dimensions of this construct]. / Eine differenzierende Betrachtung und Validierung des Konstruktes Lebenszufriedenheit: Analyse bewährter Verfahren und Vorschläge für ein methodisch fundiertes Vorgehen bei der Messung der Dimensionen dieses Konstruktes.

A combined factor analysis of 2 life satisfaction scales (Wiendieck: LSI, Lawton: PGC) and a somatic symptoms checklist (Lauter: Beschwerdeliste) resulted in 7 factors. Five of them replicate relatively reliable and valid dimensions, which have been described separately in several publications. The dimensions can be termed: (1) "Social Integration/Loneliness", (2) "Satisfaction with Life in Old Age", (3) "Subjective Somatic Symptoms", (4) "Tranquility/Insecurity, Concern", (5) "Retrospective Congruence". The consolidating element of this study is to compose proved dimensions into a broader multidimensional construct of life satisfaction. Aiming at standardisation in this field, we propose a relatively short and simply analysable questionnaire, measuring these dimensions. Besides this we give hints for experimental design and control of confounding effects.

[Validation of Guttman scales of vigor and readiness to make social contacts in the aged]. / Studien zur Validierung von Guttman-Skalen der Rüstigkeit und Kontaktbereitschaft bei Betagten.

Two Guttman-scales for the assessment of functional health and sociability of aged persons were examined in several different samples concerning their scalability, dimensionality, and validity. They proved well suited for a relatively broad use. Contrary to other measures of ADL-functioning, our functional health scale discriminates the upper levels of functional competence. In regard to expert-ratings as well as to measures of actual behavior, both scales proved to be valid. The functional health scale correlates significantly with the Barthel Index but shows a better sensibility for changes of functional competence during a half-year period.

[Facilities for the aged from an environment psychology viewpoint. An analysis of relationship between ratings of social climate and behavior of home residents]. / Alteneinrichtungen aus umweltpsychologischer Sicht. Eine Analyse der beziehungen zwischen Einschätzungen des sozialen Klimas und Verhalten von Heimbewohnern.

We present a concept for the quantification of "social climate" in institutions for the aged. To receive such evaluations from the aged, according to our experience, it is necessary to apply special techniques of exploration to reduce response sets of defense and facade. Comparing different institutions and analysing the correlations with behavioral data we can demonstrate the usefulness of these environmental variables. Differential results point to the fact that some characteristics of the aged have to be considered to interpret these variable of "social climate".

[Working conditions in 22 Hamburg homes for the aged from the viewpoint of the personnel]. / Das Betriebsklima in 22 Hamburger Alteneinrichtungen aus der Sicht des Personals.

A 23-item questionnaire measuring 4 relatively independent dimensions of working conditions and work atmosphere was developed on the basis of 252 respondents of the nursing staff in 22 institutions for the elderly, each comprising different levels of care. The factoranalytically derived and itemanalytically tested subscales measure the relation to management, colleagues and the aged inhabitants as well as working load. These institutional characteristics can be well illustrated in profiles and differentiate between single institutional different types of facilities and groups of them, belonging to different organisations. The validity of the different dimensions could be proven with regard to external criteria, both on facility level and on individual basis. According to our experience such profiles of working climate are well suited to stimulate problem discussions within the institutions and the exchange of experiences between the managers of different facilities.

[Life experiences and differential aspects of the social relations of the aged in facilities for the aged. Empirical findings from 3 Hamburg facilities]. / Lebensvollzüge und differentielle Aspekte der Sozialbeziehungen Betagter in Alteneinrichtungen. Empirische Befunde aus drei Hamburger Institutionen.

In the beginning it is illustrated that there is a number of problems in the different fields of open care and work with institutionalized old people which could be better solved or reduced by an integrative approach. It is the goal of this report to make evident that there are wrong attitudes towards living in institutions which are - besides other barriers - hindering for the realization of such an integrative approach. After a view over the organization-structure and the supply offered by the institutions, the average-home-inhabitants are presented - from a cybernetical point of view - as "open systems" who take part in an exchange of "input" and "output" and who are able to realize more or less wide life experiences. There are significant differences between the institutions with regard to the conception and the organization-structure of the homes. The social contacts-distinguished between different patterns of contact, contact partners and inside/outside-orientation of the social contacts - are analysed and presented in their differential relations to the life satisfaction measures. The relative close correlation between different patterns of collective contacts and the measures of life satisfaction are especially interesting, because from these findings practical consequences for the organization of home-life and for the counseling of old people in the choice between the alternative offers of help can be deducted.

[Guttman scales for the comprehension of vigor and sociability in the elderly: comparative validation between self assessment and expert estimates of actual life accomplishments of inhabitants of old-age homes]. / Guttman-Skalen zur Erfassung der Rüstigkeit und Kontaktbereitschaft von Betagten: Vergleichende Validierung von Selbst- und Expertenbeurteilungen an faktischen Lebensvollzügen von Heimbewohnern.

In a previous article we described the development of two Guttman-scales for the self-assessment of functional health and sociability of old people. In this publication different aspects of scale-validity are examined. Together with corresponding expert-ratings and a measure of subjective health the two self-ratings are evaluated with regard to their relations to behavioral data. While the functional health scale reaches high coefficients of scalability and good validity, the sociability-scale still is in need of further improvement.

[Communication between inhabitants of homes for the aged. Intra- and extramural orientation and differential relationships to life satisfaction and self-experienced abilities to establish human contacts]. / Kontaktverhalten von Heimbewohnern. Binnen- und Aussenorientierung und differentielle Bezüge zu Lebenszufriedenheit und selbstwahrgenommener Kontaktfähigkeit.

To correct stereotyped images of global deficits concerning social life in homes for the aged, we present facts about different aspects of social life in three such homes in Hamburg and analyze the differential relations of these variables to life-satisfaction. By reconstructing the preceding day with the aged subjects, we were able to provide relatively precise behavioral measures of social contact. Per day in the average 3 to 5 hours of the up to 15 hours waking-time were spent with social contacts. These behavioral measures draw a quite differentiated picture of the institutions, which corresponds less to the image, usually ascribed to the specific housing categories, but seems to be more influenced by certain aspects of their social and physical environment. Interesting relations between social behavior and life-satisfaction show up in our population of aged people. While correlations between life-satisfaction and realized contacts with different kinds of partners (eg. friends, relatives, neighbors) are neglectible, the amount of group-contact--either selfinitiated or offered by the administration--shows consistent and rather close connections to different measures of life-satisfaction. If these results could be replicated in consecutive studies, they would imply important practical consequences.

[Assessing functional health and sociability of aged persons: the development and validation of two guttman-scales (author's transl)]. / Die Erfassung von Rüstigkeit und Kontaktbereitschaft bei Betagten: Entwicklung und Validierung zweier Guttman-Skalen.

Studies to develop and validate two Guttman-scales are reported, which aim at measuring level of functional health and inclination to engage in social contacts in aged persons. A first scale analysis, based on the answers of 150 old persons, resulted in two, 12-item scales, which according to Guttman's criterion were fully satisfying. In two consecutive studies Guttman-selfratings of two other samples of old people were validated against ratings of experts, who disposed of profound knowledge of the sampled persons (a physician of a nursing home, managers of homes for the aged). A second scale analysis was performed, too. The results, especially the very significant correlations between expert ratings and selfassessments, suggest a broader application of at least the functional health scale. It is proposed to use the scales, if one aims at increasing the fit between individual needs and amount of services provided, and as instruments to control for sample characteristics, if different care programs are evaluated.