[Evaluation and Utilization - Quality Management in a Paediatric University Outpatient Department]. / Evaluation und Inanspruchnahme - Qualitätssicherung in der pädiatrischen Ambulanz einer Universitätsklinik.

BACKGROUND: Based on an increasing number of outpatient treatments, an extensive demand planning is necessary to ensure the quality of medical care. University outpatient clinics are special parts of this sector and therefore it is necessary that a research demonstrates the nearly uninvestigated position of a paediatric outpatient clinic. PATIENTS: The research at the university hospital for children and adolescents in Leipzig started in 2009 to survey 2283 of in total 9391 patients and the physicians. METHODS: Sociodemographic data as well as economic and medical facts were determined by using questionnaires. In each case a questionnaire was answered by the children or their accompanying persons and a separate one was completed by the respective doctor. RESULTS: The results created a foundation, on the basis of patient volume per day and per daytime. Less than 20% of the children admitted to consult the clinic for their first time. The majority of patients visit them because of a letter of referral. Most of the patients (58%) were younger than 6 years old. Approximately 35% of patients did not come from the city region of Leipzig. CONCLUSION: The investigation evidenced the necessity of a day and night operating institution for children in the region of Leipzig as well as the high specialisation of the outpatient clinic. In need of further investigation is the cooperation between several physicians to find out if this lots of medical examination are necessary or if there took place overlapping.

[Chronic pain, pain disease, and satisfaction of patients with pain treatment in Germany. Results of a representative population survey]. / Chronische Schmerzen, Schmerzkrankheit und Zufriedenheit der Betroffenen mit der Schmerzbehandlung in Deutschland. Ergebnisse einer repräsentativen Bevölkerungsstichprobe.

BACKGROUND: There are only few data from representative samples of the general German population on the prevalence of a "pain disease" and on satisfaction with pain therapy of persons with chronic pain available. METHODS: A cross-sectional survey with people aged ≥ 14 years representative for the German population was conducted in 2013. Measures were obtained for presence of chronic pain (based on the definition of the International Association for the Study of Pain) and for "pain disease" by the presence of disabling pain in the Chronic Pain Grade Questionnaire and increased psychological distress in the Patient Health Questionnaire 4. In case of chronic pain reports, the satisfaction with current pain treatment and current treatment by a pain specialist were assessed. RESULTS: Responses were received from 2508 (57.5 %) of the 4360 people contacted. The prevalence of chronic pain was 26.9 % [95 % confidence interval (CI) 25.2-28.6 %]. A total of 7.4 % (95 % CI 5.0-9.9 %) met the criteria for chronic disabling nonmalignant pain, while 2.8 % (95 % CI 2.2-3.4 %) of participants met the criteria of a pain disease. In all, 31.9 % of persons with disabling pain reported current treatment by a pain specialist and 33.1 % of persons with disabling pain were (very) dissatisfied with current pain treatment. Treatment by a pain specialist was associated with higher health care use and lower treatment satisfaction. CONCLUSION: There is a need to improve the care of persons with chronic disabling pain. Whether pain specialist treatment is (cost) effective in chronic disabling pain needs to be examined by longitudinal studies.

[Prevalence of disabling abdominal pain and menstrual cramp. Results from a representative survey of the general German population]. / Prävalenz beeinträchtigender Bauchschmerzen und Menstruationsbeschwerden. Befragung einer repräsentativen deutschen Bevölkerungsstichprobe.

BACKGROUND: There are no data available on the prevalence of disabling abdominal pain and menstrual cramp in adults in Germany. METHODS: Abdominal pain and menstrual cramp, additional somatic symptoms and depressive symptoms were assessed by the Patient Health Questionnaires (PHQ) 15 and 9 in persons ≥ 14 years from a sample representative of the general German population. The association of disabling abdominal and menstrual cramp with demographic and clinical variables was tested by logistic regression analyses. RESULTS: A total of 2524 out of 4064 (62.1 %) contacted persons participated in the study. Of the participants 11.9 % reported suffering from slight abdominal pain and 0.9 % reported suffering from severe abdominal pain within the last 4 weeks. Female gender with an odds ratio (OR) of 2.23 (95 % confidence interval CI 1.67-2.98, p < 0.001), younger age (OR 0.97, 95 % CI 0.96-0.98, p < 0.001), physical symptom burden PHQ 15 (OR 1.33, 95 % CI 1.26-1.40, p < 0.0001) and depression PHQ 9 (OR 1.13, 95 % CI 1.08-1.77, p < 0.0001) were predictive for abdominal pain. Of the women aged 14-55 years 19.8 % reported to be slightly troubled by menstrual cramp and 3.9 % reported suffering from severe menstrual cramp within the last 4 weeks. Menstrual cramps were predicted by younger age (OR 0.96, 95 % CI 0.94-0.97, p < 0.001), somatic symptom burden PHQ 15 (OR 1.24, 1.12-1.36, p < 0.0001) and depression PHQ 9 (OR 1.08, 95 % CI 1.01-1.15, p < 0.0001). CONCLUSION: Persons in the general German population frequently reported slightly disabling abdominal pain and menstrual cramp; however, severely disabling abdominal pain and menstrual cramp were rarely reported. Abdominal pain and menstrual cramps were associated with additional somatic complaints and depression.

[Prevalence of chronic pain in Germany. A representative survey of the general population]. / Prävalenz chronischer Schmerzen in Deutschland. Befragung einer repräsentativen Bevölkerungsstichprobe.

BACKGROUND: There are no up to date data from representative samples of the general German population on the prevalence of debilitating pain and of pain diseases available. METHODS: A cross-sectional survey of a representative sample of the German general population including persons ≥ 14 years of age was conducted in 2012 based on face-to-face interviews using standardized questionnaires. Chronic pain was assessed by the widespread pain index (WPI), disability by the subscales physical functioning and role function of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) and psychological distress by the patient health questionnaire (PHQ-4). Chronic pain with associated physical and social impairments was defined by at least one pain site over 3 months in the WPI and at least one response of a moderate or severe impairment in both subscales of the EORTC 30 QLQ-C30. Chronic pain with associated physical, mental and social impairment (pain disease) required in addition a probable depressive and/or anxiety disorder in the PHQ-4. RESULTS: A total of 2,515 out of 4,480 (56.1 %) of contacted persons finished the study of which 32.9 % reported chronic pain, 5.4 % reported chronic pain with associated physical and social impairments and 2.3 % associated physical, mental and social impairments. No participants with local pain (only one pain site) but 24.0 % of participants with widespread pain (6-19 pain sites) met the criteria of a pain disease. CONCLUSIONS: The reports of chronic pain in epidemiological studies do not necessarily imply a suffering (physical, psychological and social impairment) from pain.

[Prevalence and predictors of urogenital pain in men. Results from a survey of a representative German population sample]. / Prävalenz und Prädiktoren urogenitaler Schmerzen des Manns. Ergebnisse einer repräsentativen deutschen Bevölkerungsstichprobe.

BACKGROUND: In Germany no data are available on the prevalence and predictors of urogenital pain in men from representative population samples. MATERIALS AND METHODS: Persons older than 14 years of age from a representative sample of the German population were examined by standardized questionnaires within a cross-sectional survey. Urogenital pain was assessed by the German version of the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), depression by the patient health questionnaire PHQ-9 and health-related quality of life by the short form health survey SF-36. RESULTS: A total of 2,043 persons (66.5%s) took part in the study and 960 men with a mean age of 47.2 years were analyzed. The 1-week prevalence of urogenital pain was 9.6% whereby 2.4% met the criteria of mild and 1.9% the criteria of severe prostatitis-like symptoms. The total pain score of the NIH-CPSI was predicted by old age, high income and high depression scores. Men with mild and severe prostatitis-like symptoms reported higher depression and lower health-related quality of life than men without prostatitis-like symptoms CONCLUSIONS: Prostatitis-like symptoms are associated with depression and reduced health-related quality of life in the general population.

[Prevalence and predictors of pain in several body regions. Results of a representative German population survey]. / Prävalenz und Prädiktoren von Schmerzen in mehreren Körperregionen. Ergebnisse einer repräsentativen deutschen Bevölkerungsstichprobe.

BACKGROUND: There are no data available from representative samples of the general German population on predictors of widespread pain (WP) and fibromyalgia syndrome (FMS). METHODS: A cross-sectional survey of a representative sample of the German general population with persons over 14 years old was conducted based on face-to-face contact using standardised questionnaires. The number of pain sites and the presence of WP and FMS were assessed by the regional pain scale (RPS), somatic symptom intensity was measured by the Patient Health Questionnaire (PHQ-15), depressed mood by PHQ 9 and health-related quality of life (HRQOL) by the Short Form Health Survey (SF-12). RESULTS: Out of 4064 persons contacted, 2524 (62.1%) completed the study. The prevalence of CWP was 8.6% and of FMS 3.8%. The sex ratio for WP and FMS was 1:1. The variance of the number of pain sites was explained by older age, low social class index, high somatic symptom intensity, low depressed mood in 52.4% (p<0.001). Older age (OR 2.0, 95% CI 1.71; 2.36; <0.001), low social class index (OR 0.64; 95% CI 0.46; 0.91; p=0.01) and potential somatoform syndrome (OR 3.0; 95% CI 1.27; 7.15; p<0.001) predicted WP with a probability 94.4%. Older age (OR 1.39, 95% CI 1.19; 1.62, p <0.001), low social class index (OR 0.61, 95% CI .40, 0.93; p=0.02) and potential somatoform syndrome (OR 19.42; 95% CI 10.31; 36.61; p<0.001) predicted FMS with a probability 97.7%. CONCLUSION: WP and FMS are components of a complex of high somatic symptom intensity, low social class index and older age.

[Acute ethanol intoxication among children and adolescents. A retrospective analysis of 173 patients admitted to a university children hospital]. / Alkoholintoxikation bei Kindern und Jugendlichen. Eine retrospektive Analyse von 173 an einer Universitätskinderklinik betreuten Patienten.

BACKGROUND: In the last time the alcohol consumption among children and adolescents is a big theme in all kind of media. The ethanol consumption among children and adolescents has risen during the last years, but also new hazardous drinking patterns like "binge-drinking" are increasing. These drinking episodes are responsible for many hospital presentations of children and adolescents with acute ethanol intoxication. PATIENTS AND METHODS: This study is a retrospective analysis of 173 patients admitted to the university children hospital of Leipzig due to acute ethanol intoxication during the period 1998-2004. Investigated parameters were: socio-demographic factors, clinical presentation and management as well as quantity and type of alcohol. RESULTS: During the years 1998-2004 the rate of alcohol intoxicated patients in this study increased, from 1998-2003 at about 171.4%. Totally 173 patients with an average age of 14.5 years were admitted to the university children hospital. There were significantly more boys than girls. The mean blood alcohol concentration of these patients was 1.77%. Some of the patients had severe symptoms. 62 were unconscious, 2 were in coma and at least 3 patients had to be ventilated. A difference between socioeconomic groups could be observed by comparing the different school types. 44.8% of the patients went to the middle school. Furthermore 17 patients of this study had mental disorders or psychosocial problems and were therefore in psychological or psychiatric treatment. CONCLUSIONS: In this study a significant influence of social classes or psychosocial problems on alcohol consumption such as binge-drinking leading to acute ethanol intoxication could not be found. Alarming is the increasing number of ethanol intoxicated patients, the young age, the high measured blood ethanol concentrations and the severe symptoms of these patients. This is the reason why early and intensive prevention strategies are required.

[Health-related quality of life of siblings of children with type 1 diabetes mellitus]. / Gesundheitsbezogene Lebensqualität von Geschwistern an Diabetes mellitus Typ 1 erkrankter Kinder und Jugendlicher.

BACKGROUND INFORMATION: A chronic illness in childhood or adolescents constitutes a drastic event for the whole family, especially for the healthy siblings. This could impair their quality of life. PATIENTS AND METHODS: We designed a case-control-study in three centres (Leipzig, Giessen and Augsburg) with questionaires sent to 72 diabetic children, 71 of their siblings and 63 children of neighbourhood (controls) aged between 8 and 16 years. KINDL-Questionnaire was used for the study of the health-related quality of life of children and adolescents, supplemented by other appropriate items. RESULTS: The results indicate a positive health related quality of life of the healthy siblings of families with a child who has type 1 diabetes. Differences in the quality of life depend on factors such as age and gender of the children and relate to specific items of sibling relationship (e. g. "worried about sibling", "looked after sibling"). Generally, there was a great similarity with regard to the quality of life of healthy brothers and sisters from affected families compared with children of families without a child suffering from chronic illness. CONCLUSIONS: The results indicate that the health related quality of life of healthy siblings of children with diabetes only differs insignificantly from brothers and sisters of "healthy" families.

[Alumni of medical sciences and their life satisfaction]. / Lebenszufriedenheit von AbsolventInnen der Medizin--Eine empirische Untersuchung zum Vergleich der Lebenszufriedenheit von AbsolventInnen mit Gleichaltrigen sowie zur Aufklärung des Faktors Lebenszufriedenheit.

OBJECTIVES AND METHODS: Medical doctors are especially burdened with psychological and social aspects of their occupation. These circumstances may lead to low life satisfaction and substance abusing behaviour and burn out symptoms are probable. In this paper we investigate, if alumni of medical sciences show lower life satisfaction compared to their peers. If so, we want to know, which factors influence this result. This survey is based on n = 671 alumni of medicine in seven German universities. RESULTS: The life satisfaction of alumni differs significantly from the peer sample. Outstanding are the highly significant and powerful differences to the scale "leisure". It was evident by an iterative regression that the variables "extreme input at work", "instrumentality/masculinity", "effort-reward imbalance", "expressivity/femininity" as well as "career self-efficacy-expectation", clarify 43 % of the variance in the group of alumni working by the time of enquiry. CONCLUSIONS: The results point out, that already alumni of medical science are in the "circle of burn-out". Their life satisfaction is more affected, if the workload is perceived high and the perceived benefits are low. Individual as well as external aspects influence life satisfaction and can be a starting-point for prevention.

[The emotional sensitivity of elderly people--validation of the Profile of Mood States for people over 60 years]. / Die emotionale Befindlichkeit älterer Menschen -- Normierung des Profile of Mood States für über 60-Jährige.

The German short version of the "Profile of Mood States (POMS)" with 35 items (seven-point response scale; rating related to the past 24 hours) was psychometrically tested in a sample of elderly people of 60 years of age and older (n=690; 57% female). The internal structure of the POMS with four factors (dejection, fatigue, displeasure, vigour) could largely be replicated, even though the first three factors are intercorrelated. Reliability of the scales appears to be very good. The convergent validity of the POMS scales could be proved by correlations with the Beck Depression Inventory and the SF-36. Specific norms are presented for four age groups, men and women and elderly living in Eastern and Western Germany. So it seems appropriate to use the German short version of the POMS as a valid and economic instrument for gerontological studies.

Knowledge and attitudes towards preimplantation genetic diagnosis in Germany.

BACKGROUND: Preimplantation genetic diagnosis (PGD) is a technique which is often related to emotional debates because of its ethical and social implications. Worldwide there are different forms of legislation; Germany constitutes an interesting case because of the historical background concerning eugenics and dealing with handicapped persons at the time of national socialism. PGD is currently not legal but there are still polarized positions and legalization remains an issue. Studies about the attitudes of the general population towards PGD are rare. METHODS: Data were collected in a representative survey carried out in November 2003. Subjects were 2110 persons in Germany aged 18-50 years. RESULTS AND CONCLUSIONS: Respondents had little knowledge about PGD. There were incorrect assumptions about the diagnostic possibilities and a lack of basic genetic knowledge. A tendency towards a general acceptance of PGD for medical indications was found. Non-medical indications such as sex selection were generally not accepted. It could be observed that respondents who already had a notion about PGD overestimated the diagnostic possibilities and would eventually use PGD in the future more than respondents who had never heard about PGD before.

[In-house questioning on patient satisfaction in a maximum resource clinic--report from practice]. / Inhousebefragung zur Patientenzufriedenheit in einem Klinikum der Maximalversorgung -- Ein Praxisbericht.

Since 1999, the statutory obligation of all German hospitals to establish an internal quality management system has resulted in an increase of patient surveys on inpatient care. Information on the subjective satisfaction of the patients is of particular interest because improvements may be realised. In the present paper, the objectives, the methodology and the choice of a tested survey instrument, the interpretation of the results and the practical problems in implementing a survey on patient satisfaction at the Leipzig University Hospital (a public institution comprising 1,464 beds in 2001) will be reported. This is intended to facilitate comparable projects in the future and to enable hospitals with fewer resources to organize and use such surveys. Altogether, 1,718 questionnaires (Hamburg questionnaires on patient stay in hospital, HFK) from 43 wards could be evaluated. The high satisfaction determined (mean values of the scores for 10 test parameters are between 1.72 and 2.02 on a 5-point scale) corresponds to the general tendency of patients to make socially desirable responses. Covert dissatisfaction was therefore analysed comparing the relative frequencies of complete and limited satisfaction at item level. Sociodemographic patient characteristics such as age and stay in hospital were of no substantial relevance. One important aim of the Leipzig survey project was to give detailed feedback within brief time periods. The project focussed on a differentiated and early monitoring of responses. If requested, an oral presentation of the results was made to each structural unit. This presentation included the spontaneous responses of the patient, which enhanced the acceptance of the investigation by the medical staff.