[Validation of Personal Factors in Breast Cancer Rehabilitation - A National Delphi Survey]. / Validierung von Personbezogenen Faktoren im Bereich der onkologischen Brustkrebsrehabilitation ­ eine Delphi-Befragung auf nationaler Ebene.

Objective: In the International Classification of Functioning, Disability and Health (ICF), data on environmental and personal factors, the so-called facilitators or barriers, can be gathered. The World Health Organization (WHO) has not classified personal factors. This is justified with the cultural differences among countries. The German society for social medicine and prevention (DGSMP) has performed pioneering work and has provided a classification draft. The aim of this study is to validate this draft in the context of oncological rehabilitation of breast cancer patients in Germany. Design: 21 experts from 8 rehabilitation centers and 2 breast cancer support groups in Germany were interviewed about personal factors in a 2-round survey using the Delphi technique. The expert group included doctors, nurses, therapists, psychologists with experience in rehabilitation of breast cancer patients and breast cancer patients. The responses of the first round were linked to the DGSMP draft. The degree of fit was calculated by means of the kappa statistic. In the second round, the focus was on the agreement of the personal factors determined in the first round. Results: The experts identified 244 factors out of which 203 (83.2%) were linked to the DGSMP draft. There are 77 categories in the DGSMP draft; 43 of them were included by the experts in the first round and 34 were not mentioned (kappa coefficient 0.776; 95% bootstrapped confidence interval 0.712-0.817). In the second round, 34 of the 43 named DGSMP categories achieved an agreement of at least 75% among the experts. Conclusions: The draft of the DGSMP working group is a comprehensive collection of facilitators and barriers in breast cancer rehabilitation and should be integrated reasonably in rehabilitation. More research on personal facilitators and barriers has to be carried out to show their concrete influence on functioning ability of breast cancer patients.

[ICF assessment in the field of psychiatric rehabilitation--a rationale for a stand-alone rehabilitation assessment]. / ICF-Assessment in der psychiatrischen Rehabilitation--Begründung einer eigenständigen Rehabilitationsdiagnostik.

PURPOSE: Assessment in the field of rehabilitation tries to establish the impairment of the functional health on basis of an existent ICD disease. Regarding the same disease there can be very different states of functional health. Within the interdisciplinary rehabilitation field the ICF is supposed to be an appropriate format to function as a common assessment tool. METHODOLOGY: A rehabilitation center had gathered data (n=77) with an ICF core set for psychiatric rehabilitation that was analyzed with quantitative methods (secondary data analysis). The logic of data evaluation was as follows: are there autonomous types (factor analysis) of impairment concerning the ICF concepts and is there a systematically intervention allocation according to these types (comparison of means)? For this purpose the quantita-tive assessed ICF item selection was compared to the ICD-10 diagnosis schizophrenia, affective disorder or personality disorder as well as with the quantified interventions as listed from the annuity insurance. RESULTS: The core set shows discriminant construct validity concerning ICD-10 diagnoses. Factor analysis identified 3 types of impairment of functional health independent of ICD-10 diseases: cognitive, psychomotoric and emotional type. The allocation of therapeutic interventions happens not yet systematically according to the impairment type. CONCLUSIONS: An autonomous rehabilitation assessment beyond the ICD-10 diagnosis is scientifically verified. Furthermore research is necessary which interventions are indicated for the several ICF impairment types what should lead to an increased efficiency.

[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation]. / Bedeutung der personbezogenen Faktoren der ICF für die Nutzung in der praktischen Sozialmedizin und Rehabilitation.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

[Personal factors of the ICF]. / Personbezogene Faktoren der ICF.

PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.

[Modeling employee stress in psychiatric rehabilitation--effects of personal and organizational factors]. / Ein Stressmodell für Mitarbeiter in der psychiatrischen Rehabilitation--Effekte von Person- und Organisationsmerkmalen.

Increasing stress-associated health problems in Germany often are attributed to problems on the job, in particular to rising work demands. The study includes several stress predictors from other results and from literature in one predictive model for the field of work of "psychiatric rehabilitation".A cross-sectional design was used to measure personal and organizational variables with quantitative standard questionnaires as self-ratings from n=243 pedagogically active employees from various professions. Overall stress and job stress were measured with different instruments.The sample showed above-average overall stress scores along with below-average job stress scores. The multivariate predictive model for explaining the heightened stress shows pathogenetic and salutogenetic main effects for organizational variables such as "gratification crisis" and personal variables such as "occupational self-efficacy expectations" as well as an interaction of both types of variables. There are relevant gender-specific results concerning empathy and differences between professions concerning the extent of occupational self-efficacy.The results are a matter of particular interest for the practice of workplace health promotion as well as for social work schools, the main group in our sample being social workers.

[Family treatment in schizophrenic adolescents - correlation between symptom state and relationship quality]. / Angehörigenarbeit mit Eltern schizophren Erkrankter - Zusammenhang zwischen Symptombelastung und Beziehungsqualität.

OBJECTIVE: Relationship quality in families with a schizophrenic adolescent is demonstrated by means of the concepts of ambivalence and Expressed Emotions. A concept for the work with families focusing on relationship quality as well as an empirical study analysing the correlation between symptom state and relationship quality are presented. METHODS: A questionnaire to register the family atmosphere (FEF) and the Brief Symptom Inventory (BSI) were administered to 43 schizophrenic patients. RESULTS: The sample replicated the parental relationship styles "criticism" and "emotional over-involvement". Both styles show different correlations with particular symptom areas: uncertainty in social relationships and somatic symptoms support the criticism relationship style and depression protects the adolescents from emotional over-involvement. CONCLUSIONS: The results are helpful with regard to parent counseling because they enable the parents to develop alternative relationship styles in time.

[How significant are customer surveys in the rehabilitation of patients with mental illness?]. / Wie aussagekräftig sind Kundenbefragungen in der medizinischen Rehabilitation von psychisch Kranken?

BACKGROUND: In Germany, customer surveys in the field of rehabilitation meanwhile are of high political relevance - particularly since the Deutsche Rentenversicherung (German Pension Insurance) has defined customer judgements as a significant outcome parameter. Both the theoretical conceptualization and the empirical data available suggest that customer satisfaction is a construct widely dependent on subjective factors, which has only little reference to the reality of treatment. In the Herzogsägmühle Rehabilitation Centre a detailed customer survey (rehabilitants with mental illness) was carried out for the first time in 2007 in the framework of internal quality management. METHODOLOGY: Data analysis was to yield new knowledge concerning the validity of subjective patient-related outcome parameters as well as relative to the content dimensioning regarding satisfaction and quality judgments in this specific sample. A Centre-specific questionnaire was constructed taking into account existing empirical data and theoretical considerations concerning the relevant content dimensions of customer satisfaction. Forty-six mostly male rehabilitants with an average age of 25 were interviewed. The majority of the interviewees had been diagnosed as having a schizophrenic or an affective disorder. The data obtained was submitted to a predominantly explorative data analysis, also testing various hypotheses. RESULTS: The results show that the rehabilitants' judgements are differentiated and that the expected positive bias was restricted to a few areas. Also it could be shown that treatment satisfaction and quality evaluations present different content dimensions. While satisfaction depends on the evaluation of treatment efficacy, the quality judgement is dependent on evaluation of the professional skills of the staff involved. CONCLUSION/CONSEQUENCES: In particular the quality judgments of the rehabilitants are important in both internal and external (by the cost carriers) quality management assurance. Both theoretical considerations and empirical findings on the subject of patient satisfaction suggest that surveys should be embedded in a comprehensive evaluation concept in the framework of effectiveness research. It is therefore projected to validate the patient judgements given at the Rehabilitation Centre on objective, treatment-related outcome parameters.

[Treatment prevalence in pathological gambling]. / Behandlungsprävalenz pathologischen Spielens.

Based on American studies lifetime prevalence of 'Pathological Gambling' (ICD-10, F 63.0) in Germany can be estimated at 0.5 %. That means about 400,000 gamblers requiring treatment. Epidemiological studies showed that only a little proportion is actually seeking treatment. Reliable knowledge about treatment prevalence does not exist for Germany. The study at hand using secondary data was performed to validate the estimation of the 'Deutsche Suchthilfestatistik' regarding inpatient and outpatient treatment prevalence in 'Pathological Gambling' with data from service providers (cost unit). The analysis proves the estimation of the German Addiction Statistics ('Deutsche Suchthilfestatistik') that the inpatient treatment prevalence has considerably risen. In spite of the consideration that treatment of pathological gambling is not limited to specialized hospitals there is still a considerable gap between estimated prevalence and treatment prevalence.

[A patient flow analysis within the Munich addiction treatment system--a pilot study]. / Patientenstromanalyse im Münchner Suchthilfesystem - eine Pilotstudie.

BACKGROUND: The highest efficiency in addiction treatment is attributed to a multistage programme consisting of several intervention types (e. g., counselling, withdrawal, therapy, community adjustment) in a specific order. AIM: The pilot study described focuses on the interactions between treatment modalities (i. e. on the process quality) within the addiction treatment system in Munich and the broader environs. METHOD: In eleven institutions out of the several intervention types 452 persons were anonymously queried. The interview was conducted by means of a questionnaire, which gathered information about the sequence of interventions. RESULTS: The results suggest that the treatment sequences (i. e. the patient flow) investigated are consistent with the intended cooperation within the multistage treatment programme. Furthermore, the results also indicate that more than a quarter of the participants came sought treatment/counselling of their own initiative. Particularly interesting is the observation that the participating institutions rarely checked where "their" patients pursue aftercare/treatment follow-up upon completion of the prescribed programme. Regarding the actual referrals during the four week investigation period, relatively low referrals among the participants in the drop-in center were observed. CRITICISM: It remains doubtful whether the selected institutions are really representative of the different intervention types, because the participating institutions within an intervention type operate from diverse conceptual backgrounds. Furthermore, the sample size obtained was both small and contained a diverse number of participants per institution type. Therefore, whether or not the results can be generalized is questionable. CONCLUSION: Based on these results the BAS supports the deployment and legal establishment of case managers in the coordination of a patient's global treatment process. It is believed that this step would result in a more purposeful and economical treatment within the multistage addiction treatment programme.

[Where are the 1.9 million patients dependent on legal drugs hiding?]. / Wo verstecken sich 1.9 Millionen Medikamentenabhängige?

Although the number of patients dependent on legal drugs is estimated to be as high as 1.9 million, very few are in clinical treatment. Research deficits in this area are evident.