Psychometric properties of the PROMIS Preference score (PROPr) in patients with rheumatological and psychosomatic conditions.

BACKGROUND: The PROMIS Preference score (PROPr) is a new generic preference-based health-related quality of life (HRQoL) score that can be used as a health state utility (HSU) score for quality-adjusted life years (QALYs) in cost-utility analyses (CUAs). It is the first HSU score based on item response theory (IRT) and has demonstrated favorable psychometric properties in first analyses. The PROPr combines the seven PROMIS domains: cognition, depression, fatigue, pain, physical function, sleep disturbance, and ability to participate in social roles and activities. It was developed based on preferences of the US general population. The aim of this study was to validate the PROPr in a German inpatient sample and to compare it to the EQ-5D. METHODS: We collected PROPr and EQ-5D-5L data from 141 patients undergoing inpatient treatment in the rheumatology and psychosomatic departments. We evaluated the criterion and convergent validity, and ceiling and floor effects of the PROPr and compared those characteristics to those of the EQ-5D. RESULTS: The mean PROPr (0.26, 95% CI: 0.23; 0.29) and the mean EQ-5D (0.44, 95% CI: 0.38; 0.51) scores differed significantly (d = 0.18, p < 0.001). Compared to the EQ-5D, the PROPr scores were less scattered across the measurement range which has resulted in smaller confidence intervals of the mean scores. The Pearson correlation coefficient between the two scores was r = 0.72 (p < 0.001). Both scores showed fair agreement with an Intraclass Correlation Coefficient (ICC) of 0.48 (p < 0.05). The PROPr and EQ-5D demonstrated similar discrimination power across sex, age, and conditions. While the PROPr showed a floor effect, the EQ-5D showed a ceiling effect. CONCLUSION: The PROPr measures HSU considerably lower than the EQ-5D as a result of different construction, anchors and measurement ranges. Because QALYs derived with the EQ-5D are widely considered state-of-the-art, application of the PROPr for QALY measurements would be problematic.

[Management of chronic pain using extended release tilidine : Quality of life and implication of comedication on tilidine metabolism]. / Management von chronischem Schmerz mit retardiertem Tilidin : Lebensqualität und Bedeutung der Komedikation für den Tilidinmetabolismus.

BACKGROUND AND OBJECTIVES: The synthetic opioid tilidine is often used in chronic pain treatment. However, the activation via metabolism in patients with concomitant medication and reduced liver or kidney function is not thoroughly investigated. We therefore studied pain treatment efficacy, health-related quality of live and the metabolism of tilidine in patients with chronic pain. METHODS AND MATERIALS: In all, 48 patients, who were on a stable dose of oral prolonged release tilidine for at least 7 days, were included in this observational multicenter study. Liver and kidney function were assessed in routine blood samples, concentrations of tilidine, nortilidine and bisnortilidine were determined using a validated LC/MS/MS method. Comedication was registered and patients experience with regard to quality of life, pain, gastrointestinal symptoms and adverse events was assessed in standardised questionnaires. RESULTS: On average a daily dose of 180 mg tilidine was taken. Dose normalized plasma concentrations of the active metabolite nortilidine ranged between 1.6 ng/ml and 76.5 ng/ml (mean 29.2 ± 25.1 ng/ml). Ratios between tilidine and nortilidine were on average 0.28 (median = 0.13, standard deviation = 0.67). Patients were on 1 to 14 different concomitant medications. About 66% of the patients had sufficient pain treatment. Almost no opioid-induced constipation was observed. Only few patients had decreased kidney or liver function which did not result in elevated nortilidine concentrations. CONCLUSION: Pain treatment using tilidine resulted in variable nortilidine concentrations which are obviously not strongly influenced by comedication or reduced liver or kidney function. Only a few side effects were observed with almost no opioid-induced constipation.

Mental health of patients from different cultures in Germany.

BACKGROUND: Empirical studies on migration and mental health of migrants are still rare. In Germany they are often characterised by low sample sizes and are limited to certain diseases and geographical areas (old federal states). The comparability of their results is limited. Nonetheless, the assessment of migrants' health is necessary for adequate medical and psychosocial care for this target group. AIM: To provide data on mental health of migrants from Poland and from Vietnam in Germany. METHODS: We have assessed a random sample of migrants from Poland (n=140) and from Vietnam (n=88) using the Giessen Subjective Complaints List - 24 (GSCL-24) and the Hospital Anxiety and Depression Scale (HADS). Additionally we asked migrants about their knowledge of health care institutions in case of psychosocial problems, their demands and the existing barriers to health care utilisation. RESULTS: Migrants from Poland and Vietnam have a higher general score of complaints of physical ill-health and higher anxiety and depression values than Germans. Psychosocial and medical institutions are visited less. CONCLUSION: Further analytical studies are needed to clarify health differences between these groups. Migrants are a heterogeneous group and only group-specific investigations will clarify associations between countries of origin, health status and use of health care institutions.

[Health and migration. Psychosocial determinants]. / Migration und Gesundheit. Psychosoziale Determinanten.

The article provides an overview of the contemporary literature on the social and psychological factors which are associated with migration. Derived from the operationalisation of "migration" and an examination of the methodological peculiarities of migration research, a (transactional) stress model of migration is proposed incorporating potentially stress-eliciting influences of migration including occupational pressures, social isolation and/or family-related problems and their impact on psychological and physical health. There are inconsistencies in the findings regarding psychological health, which can in part be explained through the phenomena of the "healthy migrant effect", duration of stay in the host culture or the culture-specificity. Moreover, a discussion is provided of the extent that disorders associated with differentially stressed migrants will be manifested in the health care system. Finally, concluding remarks are offered together with a short discussion of the implication of these findings for future research and social and health policy decision-making.

[Sexual disorders in the aging male]. / Sexualstörungen des alternden Mannes.

Sexual dysfunction in the aging male has only recently found widespread attention. As apposed to enduring conceptions of "asexual" elderly, recent representative surveys show that the majority of men maintain sexual wishes and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing morbidity. Sexual dysfunctions in aging result from physical, psychological, partner-related changes and lifestyles. These should be considered in the diagnosis and treatment of sexual dysfunctions in the aging male.

[Complaints and health care system utilisation of ethnic German migrants from the former Soviet Union to Germany and their families]. / Beschwerden und Inanspruchnahme des Gesundheitswesens von Spätaussiedlern bei Einreise nach Deutschland.

OBJECTIVES: The aim of the study is the description of subjective morbidity, health care system utilisation and complaints of ethnic German migrants from the former Soviet Union at the beginning of migration. At present no data are available concerning aspects of health behaviour among this largest immigrant population in Germany. METHODS: 300 ethnic German migrants and their families (mean age 37.2 and 51% female) were interrogated shortly after migration to Germany. They answered questions about prevalence of diseases, health care system utilization, actual health status and completed the Giessen Subjective Complaints List (GSCL-24). German standards exist for all questionnaires. RESULTS: 237 ethnic German migrants report to have suffered from at least one disease during the course of the last year. They see the gynaecologist and dentist as often as the German population, pay fewer visits to practitioners and specialists but seek more medical advice from the medical lay system. The majority of subjects are satisfied with their health. Migrants describe their health status as lower than the German population compared to which they also report more complaints (Overall distress in GSCL-24 : 17.2 for migrants and 14.0 for Germans) and different complaints (headaches, fatigue). CONCLUSIONS: The different medical care system and differences in the treatment of patients could account for the less frequent use of medical services by ethnic German migrants. Actual stressors like language differences and acculturation problems are discussed as possible reasons for the increased rate of complaints among ethnic German migrants. Although they suffer from more complaints the German migrants do not seem to modify their help-seeking behaviour.

[Men and health--new epidemiological data from Germany in a summary]. / Männer und Gesundheit--neue epidemiologische Daten aus Deutschland im Uberblick.

OBJECTIVES: In epidemiological investigations men are often considered and used as the healthy control group. This article aims to provide a detailed overview about health in men. METHODS: Analyses of the indices of health (life expectancy; mortality; state of health) and health-related behaviour (drinking, smoking, and eating behaviour; use of the health system' services) were performed, using data of the German Health Board (1999) and of an health survey in commission of the state (1998) plus data from our own representative investigations of 1994 and 1996. RESULTS: Men, in comparison to women, have a shorter life expectancy as well as a higher mortality rate when suffering from cardiac infarction, lung cancer, traffic accidents, or suicide. In consideration of health-related behaviour, men do smoke and drink more and more frequently than females. In addition, men call on the services of the health system to a lesser extent and deny psychological influences to their health. Effects of age and differences between East and West Germany were obtained. CONCLUSIONS: The presented data can only be explained by a combination of biological, psychological, and sociological perspectives. According to these results, investigations of health-related data should focus more on the difference between men, on the gender-related role of men in different contexts and on the investigation of the sub-group of healthy men.

Dendritic organization of neurons of the superior colliculus in animals with different visual capability.

The aim of the study was to compare several morphological characteristics of neurons in the superficial layers of the superior colliculus in diurnal and nocturnal mammals with different visual specialization. Thus, we investigated the rat (Rattus norvegicus), a nocturnal animal; the tree shrew (Tupaia glis), a diurnal animal, and the Mongolian rodents, Microtus brandti (nocturnal) and Alticola barakshin (diurnal). The investigation was focused on the study of the organization and extent of dendrites of Golgi-impregnated projection neurons, which were divided in two classes: narrow-field and wide-field cells. We determined that the ratios between the volumes of dendritic fields of the investigated neuronal types and the total volume of the superior colliculus differed to a great extent between the different species. The tree shrew had the largest superior colliculus and the smallest wide-field neurons, while the rat had the largest wide-field neurons. As for the Mongolian rodents, we provided the first description of superior colliculus neurons. The day-active animal Alticola barakshin was found to have a 50% larger volume of the superior colliculus than that of the night-active animal Microtus brandti, and the size of the dendritic field of both wide-field neurons and narrow-field neurons was smaller than that of Microtus brandti. Electron microscopic investigation of wide-field neurons performed in the rat revealed only a few symmetric synaptic contacts on the arborizations of distal and terminal dendrites and numerous asymmetric synapses on the dendritic stem. Our findings support the hypothesis that whereas the narrow-field neurons are relay neurons in the retino-tecto-thalamic pathway of the visual system, the wide-field neurons may play additional roles in the retino-tecto-reticulo-spinal system.