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1.
Eur J Gen Pract ; 27(1): 119-129, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34132623

RESUMO

BACKGROUND: The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication - including prescription and over-the-counter (OTC) drugs - of elderly patients in primary care is still insufficient. OBJECTIVES: This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort. METHODS: MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation. RESULTS: Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322-0.430; female: ρ = 0.301, CI 0.624-0.340). CONCLUSION: The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.


Assuntos
Multimorbidade , Medicamentos sem Prescrição , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Prescrições , Atenção Primária à Saúde , Estudos Prospectivos
2.
J Comorb ; 9: 2235042X19883560, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-35174099

RESUMO

BACKGROUND: Multimorbidity in elderly patients is a major challenge for physicians, because of a high prevalence of and associations with many adverse outcomes. However, the mechanisms of progressing multimorbidity are not well-understood. The aim of our study was to determine if the progression of multimorbidity is influenced by health behaviour and social support and to analyse if the patients' socio-economic status had an effect on these prognostic factors. METHODS: The study was designed as prospective cohort study based on interviews of 158 GPs and 3189 patients randomly selected from GP records (response rate: 46.2%). Patients were aged 65-85 years at recruitment and observed in four waves of data collection (dropout rate: 41.5%). Statistical analyses of the 'hot deck' imputed data included multilevel mixed-effects linear regression allowing for random effects at the study centre and GP practice within study centre level. RESULTS: Regarding cardiovascular and metabolic diseases, multimorbidity progressed more rapidly in patients who reported less physical activity (ß = -0.28; 95% confidence interval = -0.35 to -0.20), had more tobacco-related pack years (0.15; 0.07-0.22) and consumed less alcohol (-0.21; -0.31 to -0.12) at baseline. Multimorbidity related to psychiatric and pain-related disorders progressed more rapidly if the patients had less perceived social support (-0.31; -0.55 to -0.07) and reported less physical activity (-0.08; -0.15 to -0.02) at baseline. Education and income only slightly modified the effects of these variables. CONCLUSION: Depending on the multimorbidity cluster, different strategies should be used for slowing down the progression of multimorbidity. Changing lifestyle and increasing social support are beneficial for the entire group of elderly multimorbid patients - regardless of their socio-economic status. REGISTRATION: ISRCTN89818205.

3.
Ophthalmologe ; 116(7): 647-655, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30349941

RESUMO

BACKGROUND: Physicians are highly vulnerable to work-related stress; however, little is known about the workload of ophthalmologists. MATERIAL AND METHODS: In March 2017 a cross-sectional and paper-based survey of all practice-based ophthalmologists in the federal state of Thuringia was conducted. Additionally, data from 2016 and 2009 using physician fee schedule datasets provided by the Thuringian Association of Statutory Health Insurance Physicians were analyzed. RESULTS: The response rate was 27% (n = 42 ophthalmologists) of which 95% (n = 40) exceeded the effort-reward cut-off value (>1) indicating a high level of work stress. The overall number of treatment cases did not show a statistically significant difference between 2016 and 2009 (n = 118 ophthalmologists, p = 0.412). In contrast, the number of treatment cases of patients with type 2 diabetes mellitus and essential (primary) hypertension was statistically significantly higher in 2016 compared to 2009 (n = 118 ophthalmologists, p < 0.05). CONCLUSION: Almost all respondents reported a high level of work stress and this was reflected in the number of treatment cases of patients with type 2 diabetes mellitus and essential hypertension, which was statistically significantly higher in 2016 than in 2009. The results suggest that working conditions should be adapted to meet the needs of chronically ill patients and reduce physicians' workload at the same time.


Assuntos
Diabetes Mellitus Tipo 2 , Estresse Ocupacional , Oftalmologistas , Estudos Transversais , Humanos , Prática Privada , Inquéritos e Questionários , Carga de Trabalho
4.
J Clin Epidemiol ; 105: 112-124, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30253216

RESUMO

OBJECTIVES: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. STUDY DESIGN AND SETTING: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-based medicines used to treat these disorders. Based on this list, a score (medCDS) was developed to predict mortality using data of a large longitudinal cohort of older outpatients (training sample; MultiCare Cohort Study). By assessing receiver-operating characteristics (ROC) curves, the performance of medCDS was then confirmed in independent cohorts (ESTHER, KORA-Age) of community-dwelling older patients and compared with already existing medication-based scores and a score using selected anatomical-therapeutic-chemical (ATC) codes. RESULTS: The final medCDS score had an ROC area under the curve (AUC) of 0.73 (95% CI 0.70-0.76). In the validation cohorts, its ROC AUCs were 0.79 (0.76-0.82, KORA-Age) and 0.74 (0.71-0.78, ESTHER), which were superior to already existing medication-based scores (RxRisk, CDS) and scores based on pharmacological ATC code subgroups (ATC3) or age and sex alone (Age&Sex). CONCLUSIONS: A new medCDS, which is based on actual treatment standards, predicts mortality of older outpatients significantly better than already existing scores.


Assuntos
Doença Crônica , Vida Independente/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Doença Crônica/epidemiologia , Doença Crônica/terapia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Mortalidade , Multimorbidade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Projetos de Pesquisa
5.
Z Gastroenterol ; 56(12): 1499-1506, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30466134

RESUMO

BACKGROUND: Colorectal cancer is one leading cause of cancer-related morbidity and mortality. Its prognosis depends largely on tumour stage at diagnosis. Migration status was associated with late stage at diagnosis in some studies, yet results are inconsistent. METHODS: The cross-sectional study "The Diagnostics of Colorectal Carcinoma in Migrants and Non-Migrants in Germany" (KoMigra) investigated the association between migration background and tumour stage of colorectal cancer at diagnosis in a large German urban area. Patient variables were collected via a survey translated into nine languages. Data on tumour stage were extracted from medical records. RESULTS: 437 patients could be recruited for analysis. Explorative logistic regression yielded no significant difference for tumour stage "I" versus "II-IV" according to the tumour classification "Union Internationale Contre le Cancer" (UICC) between migrants and non-migrants. Although the odds of a higher tumour stage were consistently higher in migrants than non-migrants, the effect estimates had wide confidence intervals. In descriptive analyses, migrants reported symptoms more often and for longer time than non-migrants. This was especially true for patients with poor proficiency of German. CONCLUSIONS: Migration background was not significantly associated with advanced tumour stage at diagnosis. However, the effect of poor language proficiency should be explored further.


Assuntos
Neoplasias Colorretais , Diagnóstico Tardio , Migrantes , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Alemanha , Humanos , Estadiamento de Neoplasias
6.
Eur J Gen Pract ; 23(1): 11-19, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27841043

RESUMO

BACKGROUND: Cancer screening participation rates in Germany differ depending on patients' gender. International studies have found that patient-physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women. OBJECTIVES: We aimed to ascertain whether gender concordance influences general practitioners' (GPs') rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany. METHODS: For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios. RESULTS: Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis. CONCLUSION: Patient-physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings. [Box: see text].


Assuntos
Clínicos Gerais/estatística & dados numéricos , Programas de Rastreamento/métodos , Neoplasias/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Detecção Precoce de Câncer/métodos , Feminino , Alemanha , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
7.
Pediatr Blood Cancer ; 64(5)2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27804208

RESUMO

BACKGROUND: Primary brain tumors are common in childhood, but the etiology is largely unclear. As studies on birth weight as a risk factor for the occurrence of histologically specified tumors have been inconclusive, we decided to update a 2008 meta-analysis on the subject. METHODS: A search strategy was performed in Medline and EMBASE for the period 2007-2016. We included six new studies and performed further subgroup analyses for medulloblastoma and primitive neuroectodermal tumors (PNETs). Dichotomous analyses were performed for low (2,500 g) and high birth weight (4,000 g cutoff point). RESULTS: Our results confirmed that high birth weight increases the risk of astrocytoma (odds ratio [OR] = 1.60, 95% confidence interval [CI]: 1.23-2.09) and medulloblastoma/PNET. However, subgroup analysis revealed an increased risk of medulloblastoma (OR = 1.31, 95% CI: 1.08-1.58) but not of PNET (OR = 1.16, 95% CI: 0.92-1.46). Low birth weight was associated with an increased risk of medulloblastoma/PNET. Subgroup analysis for medulloblastoma and PNET revealed increased risk but CIs included zero. Neither low nor high birth weight was associated with the risk of ependymoma. CONCLUSIONS: While an association between high birth weight and astrocytoma was confirmed, more studies are needed to investigate medulloblastoma and PNET risk in children with high and low birth weight.


Assuntos
Astrocitoma/epidemiologia , Peso ao Nascer/fisiologia , Neoplasias Encefálicas/epidemiologia , Ependimoma/epidemiologia , Meduloblastoma/epidemiologia , Tumores Neuroectodérmicos Primitivos/epidemiologia , Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Criança , Pré-Escolar , Ependimoma/patologia , Humanos , Meduloblastoma/patologia , Tumores Neuroectodérmicos Primitivos/patologia
8.
BMC Cancer ; 15: 605, 2015 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-26314581

RESUMO

BACKGROUND: Although the risk of developing colorectal cancer (CRC) is 2-4 times higher in case of a positive family history, risk-adapted screening programs for family members related to CRC- patients do not exist in the German health care system. CRC screening recommendations for persons under 55 years of age that have a family predisposition have been published in several guidelines. The primary aim of this study is to determine the frequency of positive family history of CRC (1st degree relatives with CRC) among 40-54 year old persons in a general practitioner (GP) setting in Germany. Secondary aims are to detect the frequency of occurrence of colorectal neoplasms (CRC and advanced adenomas) in 1st degree relatives of CRC patients and to identify the variables (e.g. demographic, genetic, epigenetic and proteomic characteristics) that are associated with it. This study also explores whether evidence-based information contributes to informed decisions and how screening participation correlates with anxiety and (anticipated) regret. METHODS/DESIGN: Prior to the beginning of the study, the GP team (GP and one health care assistant) in around 50 practices will be trained, and about 8,750 persons that are registered with them will be asked to complete the "Network against colorectal cancer" questionnaire. The 10% who are expected to have a positive family history will then be invited to give their informed consent to participate in the study. All individuals with positive family history will be provided with evidence-based information and prevention strategies. We plan to examine each participant's family history of CRC in detail and to collect information on further variables (e.g. demographics) associated with increased risk. Additional stool and blood samples will be collected from study-participants who decide to undergo a colonoscopy (n ~ 350) and then analyzed at the German Cancer Research Center (DKFZ) Heidelberg to see whether further relevant variables are associated with an increased risk of CRC. One screening list and four questionnaires will be used to collect the data, and a detailed statistical analysis plan will be provided before the database is closed (expected to be June 30, 2015). DISCUSSION: It is anticipated that when persons with a family history of colorectal cancer have been provided with professional advice by the practice team, there will be an increase in the availability of valid information on the frequency of affected individuals and an increase in the number of persons making informed decisions. We also expect to identify further variables that are associated with colorectal cancer. This study therefore has translational relevance from lab to practice. TRIAL REGISTRATION: German Clinical Trials Register DRKS00006277.


Assuntos
Adenoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Saúde da Família , Adenoma/sangue , Adulto , Colonoscopia , Neoplasias Colorretais/sangue , Estudos Transversais , Detecção Precoce de Câncer , Medicina Geral , Alemanha , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Sangue Oculto , Relações Médico-Paciente , Medicina Preventiva/métodos , Projetos de Pesquisa , Medição de Risco
9.
Fam Pract ; 32(5): 483-91, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26142418

RESUMO

BACKGROUND: GPs regard cancer guidelines as useful yet criticise their limited applicability to the primary care setting. OBJECTIVES: To determine the extent to which English-language breast, colorectal and prostate cancer guidelines contain recommendations that are relevant to GPs and to find out which of the GPs' roles in cancer care the recommendations refer to. METHODS: Evidence- and consent-based English-language breast, colorectal and prostate cancer guidelines were searched for in guideline databases and selected guideline providers' web pages, and checked against inclusion and exclusion criteria. Relevant recommendations were identified, extracted and examined. The involvement of GPs in guideline development as well as whether they were named as a target group was further investigated. RESULTS: Of the 65 identified guidelines, 35 were eligible and contained recommendations applicable to GPs. GPs were directly involved in the development of the majority of only breast cancer guidelines and were explicitly named as a target group in fewer than 50% of guidelines. The majority of recommendations dealt with patient-physician communication, with a focus on cancer therapy. Rarer procedural recommendations predominantly concentrated on follow-up/survivorship care. Less than one-third of all relevant recommendations concerned diagnosis. Only breast cancer guidelines provided a high number of recommendations on transitions between primary and secondary care. CONCLUSION: Greater consideration of GPs would increase their acceptance of guidelines, promote delivery of high-quality cancer care and clarify responsibilities between cancer care providers. The GP's role in cancer diagnosis is not appropriately reflected in cancer guideline recommendations.


Assuntos
Neoplasias da Mama/terapia , Neoplasias Colorretais/terapia , Medicina de Família e Comunidade , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/terapia , Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Comunicação , Continuidade da Assistência ao Paciente , Feminino , Humanos , Idioma , Masculino , Relações Médico-Paciente , Neoplasias da Próstata/diagnóstico
10.
Forsch Komplementmed ; 22(1): 36-41, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25824403

RESUMO

BACKGROUND: The aim of this study was to investigate how general practitioners react when their cancer patients show interest in complementary medicine, and how their reaction is related to their knowledge in the field. METHODS: We conducted semi-structured interviews with 10 German general practitioners. Interviewees came from 5 different federal states and varied in terms of urban/rural setting, single/joint practice, additional certifications, gender and length of professional experience. Interviews were electronically recorded, transcribed and then analysed using qualitative content analysis according to Mayring. RESULTS: General practitioners feel largely responsible for providing information on complementary medicine to their cancer patients. However, uncertainty and a lack of knowledge concerning CAM lead mainly to reactive responses to patients' needs, and the general practitioners base their recommendations on personal experiences and attitudes. They wish to support their cancer patients and thus, in order to keep their patients' hopes up and maintain a trusting relationship, sometimes support complementary medicine, regardless of their own convictions. CONCLUSION: Although general practitioners see themselves as an important source of information on complementary medicine for their cancer patients, they also speak of their uncertainties and lack of knowledge. General practitioners would profit from training in complementary medicine enabling them to discuss this topic with their cancer patients in a proactive, open and honest manner.


Assuntos
Terapias Complementares/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/terapia , Relações Médico-Paciente , Atitude do Pessoal de Saúde , Terapias Complementares/educação , Terapias Complementares/normas , Feminino , Clínicos Gerais/educação , Humanos , Entrevistas como Assunto , Masculino
11.
BMC Health Serv Res ; 14: 336, 2014 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-25098231

RESUMO

BACKGROUND: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. METHODS: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). RESULTS: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. CONCLUSIONS: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors. TRIAL REGISTRATION: Current Controlled Trials ISRCTN89818205.


Assuntos
Doença Crônica/terapia , Acessibilidade aos Serviços de Saúde , Modelos Organizacionais , Atenção Primária à Saúde/organização & administração , Comorbidade , Estudos Transversais , Medicina Baseada em Evidências , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Qualidade da Assistência à Saúde , Qualidade de Vida , Autoeficácia , Apoio Social , Inquéritos e Questionários
12.
BMC Fam Pract ; 15: 62, 2014 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-24708815

RESUMO

BACKGROUND: It is not well established how psychosocial factors like social support and depression affect health-related quality of life in multimorbid and elderly patients. We investigated whether depressive mood mediates the influence of social support on health-related quality of life. METHODS: Cross-sectional data of 3,189 multimorbid patients from the baseline assessment of the German MultiCare cohort study were used. Mediation was tested using the approach described by Baron and Kenny based on multiple linear regression, and controlling for socioeconomic variables and burden of multimorbidity. RESULTS: Mediation analyses confirmed that depressive mood mediates the influence of social support on health-related quality of life (Sobel's p < 0.001). Multiple linear regression showed that the influence of depressive mood (ß = -0.341, p < 0.01) on health-related quality of life is greater than the influence of multimorbidity (ß = -0.234, p < 0.01). CONCLUSION: Social support influences health-related quality of life, but this association is strongly mediated by depressive mood. Depression should be taken into consideration in research on multimorbidity, and clinicians should be aware of its importance when caring for multimorbid patients. TRIAL REGISTRATION: ISRCTN89818205.


Assuntos
Doença Crônica/psicologia , Transtorno Depressivo/psicologia , Indicadores Básicos de Saúde , Qualidade de Vida , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Estudos de Coortes , Comorbidade , Estudos Transversais , Transtorno Depressivo/diagnóstico , Feminino , Medicina Geral , Avaliação Geriátrica , Alemanha , Serviços de Saúde para Idosos , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Morbidade , Fatores Socioeconômicos , Inquéritos e Questionários
13.
BMC Cancer ; 14: 123, 2014 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-24559172

RESUMO

BACKGROUND: In Germany, about 20% of the total population have a migration background. Differences exist between migrants and non-migrants in terms of health care access and utilisation. Colorectal cancer is the second most common malignant tumour in Germany, and incidence, staging and survival chances depend, amongst other things, on ethnicity and lifestyle. The current study investigates whether stage at diagnosis differs between migrants and non-migrants with colorectal cancer in an area of high migration and attempts to identify factors that can explain any differences. METHODS/DESIGN: Data on tumour and migration status will be collected for 1,200 consecutive patients that have received a new, histologically verified diagnosis of colorectal cancer in a high migration area in Germany in the previous three months. The recruitment process is expected to take 16 months and will include gastroenterological private practices and certified centres for intestinal diseases. Descriptive and analytical analysis will be performed: the distribution of variables for migrants versus non-migrants and participants versus non-participants will be analysed using appropriate χ2-, t-, F- or Wilcoxon tests. Multivariable, logistic regression models will be performed, with the dependent variable being the dichotomized stage of the tumour (UICC stage I versus more advanced than UICC stage I). Odds ratios and associated 95%-confidence intervals will be calculated. Furthermore, ordered logistic regression models will be estimated, with the exact stage of the tumour at diagnosis as the dependent variable. Predictors used in the ordered logistic regression will be patient characteristics that are specific to migrants as well as patient characteristics that are not. Interaction models will be estimated in order to investigate whether the effects of patient characteristics on stage of tumour at the time of the initial diagnosis is different in migrants, compared to non-migrants. DISCUSSION: An association of migration status or other socioeconomic variables with stage at diagnosis of colorectal cancer would be an important finding with respect to equal health care access among migrants. It would point to access barriers or different symptom appraisal and, in the long term, could contribute to the development of new health care concepts for migrants. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005056.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etnologia , Migrantes , Idoso , Estudos Transversais , Feminino , Alemanha/etnologia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Inquéritos e Questionários
14.
BMC Fam Pract ; 15: 1, 2014 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-24387712

RESUMO

BACKGROUND: With increasing life expectancy the number of people affected by multimorbidity rises. Knowledge of factors associated with health-related quality of life in multimorbid people is scarce. We aimed to identify the factors that are associated with self-rated health (SRH) in aged multimorbid primary care patients. METHODS: Cross-sectional study with 3,189 multimorbid primary care patients aged from 65 to 85 years recruited in 158 general practices in 8 study centers in Germany. Information about morbidity, risk factors, resources, functional status and socio-economic data were collected in face-to-face interviews. Factors associated with SRH were identified by multivariable regression analyses. RESULTS: Depression, somatization, pain, limitations of instrumental activities (iADL), age, distress and Body Mass Index (BMI) were inversely related with SRH. Higher levels of physical activity, income and self-efficacy expectation had a positive association with SRH. The only chronic diseases remaining in the final model were Parkinson's disease and neuropathies. The final model accounted for 35% variance of SRH. Separate analyses for men and women detected some similarities; however, gender specific variation existed for several factors. CONCLUSION: In multimorbid patients symptoms and consequences of diseases such as pain and activity limitations, as well as depression, seem to be far stronger associated with SRH than the diseases themselves. High income and self-efficacy expectation are independently associated with better SRH and high BMI and age with low SRH.


Assuntos
Autoavaliação Diagnóstica , Medicina Geral , Nível de Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Atenção Primária à Saúde , Fatores Sexuais
15.
Fam Pract ; 31(2): 209-14, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24465025

RESUMO

BACKGROUND: The multidisciplinary and sequential nature of cancer care makes continuity of care for patients difficult. Cancer patients have often known their general practitioners (GPs) for years and are often in constant contact with them. Objective(s). We examined German GPs' views on their involvement in the care of cancer patients. METHODS: We conducted semi-structured interviews with 30 German GPs. Purposeful sampling was applied to secure maximum heterogeneity. Interviews were recorded, transcribed and then analyzed using qualitative content analysis according to Mayring. RESULTS: GPs perceive a clear involvement in the latter phase of cancer care but a mainly sporadic role (as and when required) in earlier phases. They think that greater care contributions from GPs are generally beneficial to cancer patients, as their ability to take the patient's history, surroundings and co-morbidities into account enables them to provide more patient-centred care. GPs want to stay involved and to know how their cancer patients are progressing, and they complain about slow or non-existent information sharing between providers, as well as insufficient care coordination. They pro-actively try to overcome these obstacles through direct contact with patients and physicians, and by building networks of trusted care providers. CONCLUSIONS: Given their long-lasting and close relationships with cancer patients, GPs are in a position to accompany them throughout the whole process of cancer care. However, such general involvement is as yet uncommon. Shared care models may have the potential to take into account the complementary character of primary and specialist care.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais , Neoplasias/terapia , Papel do Médico , Continuidade da Assistência ao Paciente , Feminino , Alemanha , Humanos , Comunicação Interdisciplinar , Masculino , Cuidados Paliativos , Relações Médico-Paciente , Pesquisa Qualitativa
16.
PLoS One ; 8(6): e66742, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23826124

RESUMO

BACKGROUND: Multimorbidity has a negative impact on health-related quality of life (HRQL). Previous studies included only a limited number of conditions. In this study, we analyse the impact of a large number of conditions on HRQL in multimorbid patients without preselecting particular diseases. We also explore the effects of these conditions on the specific dimensions of HRQL. MATERIALS AND METHODS: This analysis is based on a multicenter, prospective cohort study of 3189 multimorbid primary care patients aged 65 to 85. The impact of 45 conditions on HRQL was analysed. The severity of the conditions was rated. The EQ-5D, consisting of 5 dimensions and a visual-analogue-scale (EQ VAS), was employed. Data were analysed using multiple ordinary least squares and multiple logistic regressions. Multimorbidity measured by a weighted count score was significantly associated with lower overall HRQL (EQ VAS), b = -1.02 (SE: 0.06). Parkinson's disease had the most pronounced negative effect on overall HRQL (EQ VAS), b = -12.29 (SE: 2.18), followed by rheumatism, depression, and obesity. With regard to the individual EQ-5D dimensions, depression (OR = 1.39 to 3.3) and obesity (OR = 1.44 to 1.95) affected all five dimensions of the EQ-5D negatively except for the dimension anxiety/depression. Obesity had a positive effect on this dimension, OR = 0.78 (SE: 0.07). The dimensions "self-care", OR = 4.52 (SE: 1.37) and "usual activities", OR = 3.59 (SE: 1.0), were most strongly affected by Parkinson's disease. As a limitation our sample may only represent patients with at most moderate disease severity. CONCLUSIONS: The overall HRQL of multimorbid patients decreases with an increasing count and severity of conditions. Parkinson's disease, depression and obesity have the strongest impact on HRQL. Further studies should address the impact of disease combinations which require very large sample sizes as well as advanced statistical methods.


Assuntos
Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Depressão/fisiopatologia , Feminino , Humanos , Masculino , Obesidade/fisiopatologia , Doença de Parkinson/fisiopatologia , Estudos Prospectivos
17.
Support Care Cancer ; 21(12): 3293-300, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23887739

RESUMO

PURPOSE: General practitioners play an important role in palliative care for cancer patients. The intensity of care and its medical complexity make palliative care a demanding task for general practitioners. This study explored general practitioners' perceptions of their involvement in palliative cancer care and the constraints they confront. METHODS: We conducted semi-structured interviews with 13 German general practitioners. Recruitment occurred by means of purposeful sampling to secure maximum heterogeneity. The interviews were electronically recorded, transcribed, and then analyzed using qualitative content analysis according to Mayring. RESULTS: A number of themes were identified. General practitioners describe being intensely involved in the final phase of their patients' lives. When providing home-based end-of-life care to cancer patients, general practitioners become aware of the limitations in their medical skills and knowledge and their ability to provide round-the-clock care. They find it helpful and satisfying to collaborate with trusted care providers and seek to cooperate with specialized palliative care services for outpatients. CONCLUSIONS: The substantial involvement of general practitioners in end-of-life care for cancer patients pushes them to their limits because of the major time commitment required, and the need for special skills for which they have received no training. It will be a challenge to provide general practitioners with the structural and personal support they need to provide home-based palliative care for their cancer patients at end of life.


Assuntos
Medicina Geral/métodos , Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Relações Médico-Paciente , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Pesquisa Qualitativa , Assistência Terminal
18.
J Clin Epidemiol ; 66(2): 209-17, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23257152

RESUMO

OBJECTIVE: We investigated the degree of comparability of the prevalence of chronic diseases and disease combinations in the elderly in two databases comparable with regard to diseases included, sex and age of the patients (65-85 years), and cutoff score for case definition. STUDY DESIGN AND SETTING: One study is based on chart-supported interviews with the primary care physicians within a cohort study of 3,189 multimorbid elderly patients. The second study analyzed claims data from ambulatory care delivered to the multimorbid members of one German Health Insurance (n = 70,031). Multimorbidity was defined by the presence of three or more chronic conditions from an identical list of 46 diseases. RESULTS: The difference of the median number of chronic conditions was 1 (mean 6.7 vs. 5.7). The prevalences of individual conditions were approximately one-third lower in the claims data, but the relative rank order corresponded well between the two databases. These relatively small prevalence differences cumulate when combinations of chronic conditions are investigated, for example, the prevalence differences between the two databases increased to nearly 100% for triadic combinations and nearly 170% for quartets. CONCLUSION: The study shows that conclusions regarding the prevalence of combinations of diseases should be drawn with caution when based on a single database.


Assuntos
Doença Crônica/epidemiologia , Comorbidade , Interpretação Estatística de Dados , Bases de Dados Factuais , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Medição de Risco , Sensibilidade e Especificidade
19.
BMC Health Serv Res ; 12: 89, 2012 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-22471952

RESUMO

BACKGROUND: Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern. METHODS: The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses. RESULTS: Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status. CONCLUSIONS: Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups. TRIAL REGISTRATION: ISRCTN89818205.


Assuntos
Doença Crônica/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Atenção Primária à Saúde , Classe Social , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade/tendências , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Medicina de Família e Comunidade , Feminino , Alemanha/epidemiologia , Humanos , Classificação Internacional de Doenças , Masculino , Prevalência , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários
20.
J Physiol ; 566(Pt 2): 355-68, 2005 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-15878938

RESUMO

Spinal lamina I projection neurones that transmit nociceptive information to the brain play a pivotal role in hyperalgesia in various animal models of inflammatory and neuropathic pain. Consistently, activity-dependent long-term potentiation can be induced at synapses between primary afferent C-fibres and lamina I projection neurones but not unidentified neurones in lamina I. The specific properties that enable projection neurones to undergo long-term potentiation and mediate hyperalgesia are not fully understood. Here, we have tested whether lamina I projection neurones differ from unidentified neurones in types or strength of primary afferent input and/or action potential-independent excitatory and inhibitory input. We used the whole-cell patch-clamp technique to record synaptic currents in projection and unidentified lamina I neurones in a transverse lumbar spinal cord slice preparation from rats between postnatal day 18 and 37. Lamina I neurones with a projection to the parabrachial area or the periaqueductal grey were identified by retrograde labelling with a fluorescent tracer. The relative contribution of NMDA receptors versus AMPA/kainate receptors to C-fibre-evoked excitatory postsynaptic currents of lamina I neurones significantly decreased with age between postnatal day 18 and 27, but was independent of the supraspinal projection of the neurones. We did not find a significant contribution of kainate receptors to C-fibre-evoked excitatory postsynaptic currents. Lamina I projection and unidentified neurones possessed functional GABAA and glycine receptors but received scarce action potential-independent spontaneous GABAergic and glycinergic inhibitory input as measured by miniature inhibitory postsynaptic currents. The miniature excitatory postsynaptic current frequencies were five times higher in projection than in unidentified neurones. The predominance of excitatory synaptic input to projection neurones, taken together with the previous finding that their membranes are more easily excitable than those of unidentified neurones, may facilitate the induction of synaptic long-term potentiation.


Assuntos
Neurônios/fisiologia , Medula Espinal/fisiologia , Sinapses/fisiologia , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Envelhecimento/fisiologia , Animais , Animais Recém-Nascidos , Plexo Braquial/efeitos dos fármacos , Plexo Braquial/fisiologia , Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Potenciais Pós-Sinápticos Excitadores/fisiologia , Técnicas In Vitro , Potenciais da Membrana/efeitos dos fármacos , Potenciais da Membrana/fisiologia , Fibras Nervosas Amielínicas/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Neurônios Aferentes/efeitos dos fármacos , Neurônios Aferentes/fisiologia , Técnicas de Patch-Clamp , Ratos , Ratos Sprague-Dawley , Receptores de AMPA/efeitos dos fármacos , Receptores de Glutamato/efeitos dos fármacos , Receptores de Ácido Caínico/efeitos dos fármacos , Receptores de N-Metil-D-Aspartato/efeitos dos fármacos , Medula Espinal/efeitos dos fármacos , Sinapses/efeitos dos fármacos
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