[Outpatient care for mentally traumatized children and adolescents in Germany]. / Ambulante psychotherapeutische Versorgungssituation von traumatisierten Kindern und Jugendlichen in Deutschland.

Outpatient care for mentally traumatized children and adolescents in Germany Abstract. Objective: In Germany, information on outpatient care for mentally traumatized children and adolescents are not available. Therefore, the study tried to investigate outpatient care in this patient-group by licensed medical and psychological psychotherapists. Method: Altogether, 206 outpatient psychotherapists with qualification for trauma therapy and license to treat children and adolescents were asked to participate by completing an anonymous standardized questionnaire. Results: The response rate was 44 %. Only 20 out of 92 participants stated that they gained sufficient knowledge regarding mental trauma treatment during their training. Besides, the study revealed that not all traumatized children and adolescents have prompt access to treatment, due to the lack of therapeutic capacities by the psychotherapists. Conclusion: The results point to the problem of not sufficient education on mental trauma in children and adolescents during the training of psychotherapists. Moreover, an increase of the capacities for treatment became obvious. Psychotherapeutic care of traumatized children and adolescents can be difficult in some regions in Germany. Consequently, training and post-graduate education of psychotherapists as well as the planning of outpatient infrastructure should be changed.

Awareness of HIV Transmission Risks and Determinants of Sexual Behaviour: Descriptive and Multivariate Analyses among German Nursing Students.

BACKGROUND AND AIM: Nursing students play a crucial role in sexual health education. Evidence suggests, however, that nursing students had several gaps in their knowledge of HIV transmission. This study investigates how nursing students in Germany assess the potential risks of spreading HIV in defined situations and which factors influence the self-expressed sexual behaviour patterns of these students. METHODS: A standardized anonymous questionnaire was administered to a sample (N=617) of nursing students in 2008 and 2013. The survey was conducted during lessons, resulting in a response rate of 100%. RESULTS: For 17.4% of the students, assistance with personal hygiene was associated with higher HIV transmission risk. Also, changing dirty linen (17.6%) and physical examination (14.1%) were also noted similarly risky. The average age of first sexual intercourse was 15.5 years and the number of lifetime sexual partners was 4.3. The higher the average number of lifetime sexual partners, the higher the likelihood to use condoms only sometimes or never (OR 1.11). Forty students reported an unintended pregnancy. The likelihood to be unintentionally pregnant was six times higher among students aged 25 years or older (OR 6.16). CONCLUSIONS: The results clearly show that students overestimated HIV transmission risks in most of the situations encountered during health services provided by nurses, but overall sexual health behaviour indicated rather less risky behaviour. Nonetheless, the relatively high rate of unintended pregnancies is quite concerning. The findings underline the need for stronger integration of HIV and sexual education in the curricula of nursing schools in Germany.

Vaccination coverage among students from a German health care college.

Health care students are at risk of acquiring and transmitting vaccine-preventable diseases. The purpose of this study was to assess their vaccination status and the influence of determining factors on their vaccination status. Unsatisfactory vaccination rates (43.8%-94.1%) and significant effects regarding age, sex, and socioeconomic status were found; therefore, there is an increased need for education and motivation for vaccinations in student training.

Patient satisfaction and willingness to return to the provider among women undergoing gynecological surgery.

PURPOSE: To identify factors associated with 'patient satisfaction' and 'willingness to return to the provider' in gynecology and to assess similarities as well as differences between the two concepts. METHODS: Study data were obtained from 968 randomly selected gynecology patients discharged from 22 hospitals who responded to a mailed survey. The validated instrument consisted of 37 items and assessed medical and service aspects of care, patient and visit characteristics. The dependent variables consisted of ratings of willingness to return to the provider and overall satisfaction. Bivariate and multivariate techniques were used to reveal relationships between indicators and both dependent variables. RESULTS: The multivariate analyses identified individualized medical care, kindness of medical practitioners, treatment outcome and organization of discharge as the most consistent predictors of the patients' likelihood to return and overall satisfaction. Differences between both concepts pertained to the significance of service variables (cleanliness and quality of food) for patient satisfaction and visit-related characteristics (length of stay and occurrence of complications) for willingness to return. CONCLUSIONS: Study findings suggest that patient satisfaction and willingness to return to the provider do not reflect the same concepts. Although service aspects such as quality of food influence satisfaction ratings, they do not increase the likelihood that patients choose the same hospital in case of another treatment. Communication between patients and medical practitioners is highly important. Revealed predictors of both concepts are alterable by healthcare professionals and should be focused on to enhance patient satisfaction and to increase the probability patients return to their provider.

BMI, physical inactivity, cigarette and alcohol consumption in female nursing students: a 5-year comparison.

BACKGROUND: Nursing staff are often involved in counseling patients with regard to health behavior. Although care promoting healthy lifestyle choices is included in the curriculum of nursing students in Germany, several studies of nursing students have reported a high prevalence of unhealthy behavior. This paper focuses on the behavior of female nursing students with regard to body mass index (BMI), physical activity, and cigarette and alcohol consumption. It describes trends through the comparison of results from 2008 and 2013. METHODS: Data was collected in two waves at a regional medical training college. First, 301 nursing students were asked to fill out a 12 page questionnaire on health behavior in 2008. The questioning was repeated in 2013 with 316 participating nursing students using the previous questionnaire. RESULTS: 259 female nursing students completed the questionnaire in 2013. 31.6% of them were either overweight or obese, 28.5% exercised less than once a week, 42.9% smoked between 10 and 20 cigarettes a day and 72.6% drank alcohol, wherefrom 19.7% consumed alcohol in risky quantities. In comparison to the data of 266 female nursing students from 2008, there were significant differences in the BMI and alcohol consumption: The percentage of overweight and obese students and the percentage of alcohol consumers at risk increased significantly. CONCLUSIONS: Health behavior of female nursing students is often inadequate especially in regard to weight and cigarette and alcohol consumption. Strategies are required to promote healthy lifestyle choices.

[Vaccinations among students in health care professions]. / Impfstatus von Auszubildenden in Gesundheitsfachberufen.

Incomplete vaccinations among students in health care professions lead to an increased risk for infections. Until now, only few studies related to this issue do exist. Therefore vaccinations and awareness regarding the importance of vaccinations among students in health care professions should be investigated. All 433 students of a regional college for health care professionals were asked to complete a standardized and anonymous questionnaire. Altogether 301 nursing students and 131 students of the other health care professions participated. About 66.1 percent of nursing students and 50.4 percent of students of other health care professions rated vaccination as "absolutely necessary". Different percentages of completed vaccinations were reported for tetanus (79.1 percent versus 64.4 percent), hepatitis B (78.7 percent versus 77.5 percent) and hepatitis A (74.1 percent versus 68.5 percent). 6.3 percent versus 15.4 percent did not know if they were vaccinated against tetanus, hepatitis B (5.3 percent versus 7.7 percent) and hepatitis A (5.6 percent versus 9.2 percent). While approximately half of the students reported "primary vaccination and booster" against mumps (59.5 percent versus 53.5 percent), measles (58.8 percent versus 54.6 percent) and rubella (58.3 percent versus 55.4 percent), this was reported less for pertussis (43.8 percent versus 39.8 percent) and varicella (32.4 percent versus 25.2 percent). The results indicate inadequate vaccination status in the investigated students. In addition, a gap between the awareness of the importance of vaccinations and personal preventive behavior became obvious. Therefore, education of these future health professionals still requires issues related to vaccinations.

Quality of life and life circumstances in German myasthenia gravis patients.

BACKGROUND: Myasthenia gravis (MG) is a chronic neuromuscular disease. Advances in medical therapy have continuously increased the life expectancy of MG patients, without definitively curing the disease. To analyze life circumstances and quality of life (QoL), a large German MG cohort was investigated. METHODS AND SAMPLE: In cooperation with the German Myasthenia Association, 2,150 patients with confirmed MG were asked to respond to a mailed questionnaire. The standardized questions related to demographic data, impairments, therapeutic course, use of complementary therapies, illness-related costs, and quality of life (SF-36). In total, 1,518 patients participated, yielding a response rate of 70.6%. The average age was 56.7 years, and the proportion of females 58.6%. RESULTS: Despite receiving recommended therapy, many patients still suffered from MG-related impairments. In particular, mobility and mental well-being were reduced; moreover, quality of life was markedly reduced. Stepwise linear regression analysis revealed illness stability, impairments, mental conditions, comorbid diseases, and employment to be determinants of QoL. CONCLUSION: Results indicate that despite prolonged life expectancy among MG patients, health-related quality of life is low. This outcome resulted mainly from impaired mobility and depression. Physical and mental well-being might be improved by additional therapy options. Additionally, health care resources could be used more efficiently in these patients.

Disability status and quality of life in multiple sclerosis: non-linearity of the Expanded Disability Status Scale (EDSS).

BACKGROUND: Progression in disability as measured by increase in the Expanded Disability Status Scale (EDSS) is commonly used as outcome variable in clinical trials concerning multiple sclerosis (MS). In this study, we addressed the question, whether there is a linear relationship between disability status and health related quality of life (HRQOL) in MS. METHODS: 7305 MS patients were sent a questionnaire containing a German version of the "Multiple Sclerosis Quality of Life (MSQOL)-54" and an assessment of self-reported disability status analogous to the EDSS. 3157 patients participated in the study. Patients were allocated to three groups according to disability status. RESULTS: Regarding the physical health composite and the mental health composite as well as most MSQOL-54 subscales, the differences between EDSS 4.5-6.5 and EDSS > or = 7 were clearly smaller than the differences between EDSS < or = 4 and EDSS 4.5-6.5. CONCLUSION: These results indicate a non-linear relationship between disability status and HRQOL in MS. The EDSS does not seem to be interval scaled as is commonly assumed. Consequently, absolute increase in EDSS does not seem to be a suitable outcome variable in MS studies.

Consumption of alcohol, cigarettes and illegal substances among physicians and medical students in Brandenburg and Saxony (Germany).

BACKGROUND: Patients regard health care professionals as role models for leading a healthy lifestyle. Health care professionals' own behaviour and attitudes concerning healthy lifestyle have an influence in counselling patients. The aim of this study was to assess consumption of alcohol, cigarettes and illegal substances among physicians and medical students in two German states: Brandenburg and Saxony. METHODS: Socio-demographic data and individual risk behaviour was collected by an anonymous self-administered questionnaire. Physicians were approached via mail and students were recruited during tutorials or lectures. RESULTS: 41.6% of physicians and 60.9% of medical students responded to the questionnaire; more than 50% of the respondents in both groups were females. The majority of respondents consumed alcohol at least once per week; median daily alcohol consumption ranged from 3.88 g/d (female medical students) to 12.6 g/d (male physicians). A significantly higher percentage of men (p < 0.05) reported hazardous or harmful drinking compared to women. A quarter of all participating physicians and one third of all students indicated unhealthy alcohol-drinking behaviour. The majority of physicians (85.7%) and medical students (78.5%) were non-smokers. Both groups contained significantly more female non-smokers (p < 0.05). Use of illegal substances was considerably lower in physicians (5.1%) than medical students (33.0%). Male students indicated a significantly (p < 0.001) higher level of illegal drug-use compared to female students. CONCLUSION: More than one third of the medical students and health care professionals showed problematic alcohol-drinking behaviour. Although the proportion of non-smokers in the investigated sample was higher than in the general population, when compared to the general population, medical students between 18-24 reported higher consumption of illegal substances.These results indicate that methods for educating and promoting healthy lifestyle, particularly with respect to excessive alcohol consumption, tobacco use and abuse of illegal drugs should be considered.

Chronical illness and maternity: life conditions, quality of life and coping in women with multiple sclerosis.

AIM: Research on life circumstances, quality of life (QOL) and coping behavior in mothers with multiple sclerosis (MS). METHOD: Anonymous standardised questionnaire sent to 7,050 members of a section of the German MS Association (response rate 44.8%). Comparison of 482 mothers with MS (children aged < 18 years) with 607 childless women with MS. RESULTS: No statistically significant differences concerning age, MS course, complaints or number of exacerbations. Mothers with MS more frequently had a relationship, a higher monthly net income, were less employed, EDSS-score was lower and disease duration shorter. In QOL mothers with MS showed better social aspects even after multivariate adjustment for sociodemographic and disease-related variables. Influencing parameters on the social area of QOL were employment status, age, monthly household net income and disability. In their coping behavior mothers tended more to "religiosity/search for sense in life". CONCLUSION: There were several differences in sociodemographic data, QOL and coping behavior factors between mothers and childless women with MS. However, if motherhood itself has an influence on QOL and coping can not be derived from our data but there are some hints that motherhood seems to be no potential problem for living with the disease. Further research upon this topic is needed.

Ratings of contracting infectious diseases and of the risk of sexual HIV transmission by health care students from Germany, Lithuania, and Namibia.

In Germany, Lithuania, and Namibia different types of the HIV epidemic are present. HIV testing of health care students and their ratings of the risk of sexually acquired HIV infections and factors influencing the risk of contracting infectious diseases were analyzed. 182 German medical and dental students, 176 Lithuanian medical students, and 135 Namibian student nurses participated by completing anonymous questionnaires. The Namibian student nurses rated sexual HIV transmission risks higher than the Lithuanian and German medical students did. In general, the Lithuanian medical students rated risks of HIV transmission lowest, compared to the students in the other two samples. Risk behavior and environmental factors were most emphasized by the three student samples as having an influence on the risk of contracting infectious diseases. Thus, national prevalence of HIV influences ratings of sexual HIV transmission risks, while rating of factors influencing the risk of contracting infectious diseases are similar.