Attachment styles and healthcare utilization: exploring the role of the patient-doctor relationship.

BACKGROUND: With the purpose of improving healthcare, past research has examined the link between healthcare utilization and attachment. It is suggested that an individual's attachment style influences both the quality of their patient-physician relationship and healthcare utilization patterns. Nevertheless, most studies concentrate on the individual aspect, overlooking the dyadic dimension; specifically, the investigation of how insecure attachment relates to health behavior within patient-physician relationships. This gap leaves the role of the patient-doctor relationship in this process unclear. Therefore, to elucidate this complex interplay, we hypothesized that the correlation between attachment and healthcare utilization is mediated by the quality of the patient-physician-relationship. METHOD: Participant selection was based on electoral districts, a random-route procedure, and the Kish selection grid. The participants were visited by a trained interviewer who collected psychometric and sociodemographic information. Participants answered the Experiences in Close Relationships-Revised questionnaire (ECR-RD8) and the Patient-Doctor Relationship Questionnaire (PDRQ-9). Additionally, participants were asked about their healthcare utilization. The final sample consisted of N = 2.275 participants. RESULTS: In average the participants reported consulting their primary health care practitioner M(SD) = 4.44 (4.76) times in the past 12 months. Generally, the participants rated the quality of the relationship with their primary health care practitioner close to "totally appropriate" (M = 4.12 ± .69). The degree of insecure attachment manifested towards the lower extremity of the scale. The total effect of the mediation analyses was significant. Regardless, the indirect effect indicated a trend result with minimal effect sizes. CONCLUSION: The findings of the current study bridged the gap between attachment styles and healthcare utilization. Nonetheless, our results suggested insufficient support for the mediating role of the primary care physician in the relationship between attachment style and healthcare utilization. Considering the characteristics of the sample, this outcome may not apply in a clinical context. However, further research is needed to shed light in the revealed trends and indicate implications.

[The 2-Scale Model of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to Assess Vision-Related Quality of Life]. / Das 2-Skalen-Modell des National Eye Institute Visual Function Questionnaire (NEI-VFQ) zur Erfassung der sehbezogenen Lebensqualität.

Aim This study addresses the examination of the factorial validity of the National Eye Institute Visual Function Questionnaire 39 (NEI-VFQ 39) and the neuro-ophthalmological supplement in a German sample. Method Eighty-one patients with visual field defects affecting at least one eye answered the NEI-VFQ 39 and the supplement. Theoretical factor structures reported in the manuals were examined in confirmatory factor analysis. Because of a misfit, items retained after item analysis were subjected to exploratory factor analysis. Results The originally postulated factor structures could not be replicated. Many items revealed floor effects. The 21 remaining items could be assigned to two factors - "visual functioning" and "socio-emotional impairment". Conclusion The weakness of the theoretical factors can be avoided by using the 2-scale model.

[The short version of the Brief Symptom Inventory (BSI -18): preliminary psychometric properties of the German translation]. / Die Kurzform des Brief Symptom Inventory (BSI -18): erste Befunde zu den psychometrischen Kennwerten der deutschen Version.

The short version of the Brief Symptom Inventory (BSI-18) is an easily applicable, reliable and valid self-report measure in wide international use. It assesses the syndroms of somatisation, depression and anxiety by means of 6 items each. For the psychometric evaluation of the German translation, undergraduate students, non-clinical subjects and psychosomatic outpatients were administered the BSI-18. Across these populations, all scales showed satisfactory to good internal consistencies (Cronbachs alpha ranged between 0.63 and 0.93). The item-total correlation as item discrimination index was sufficiently high, patricularly in the patient sample (rit ≥ 0.40). The correlations of the BSI-18 with measures of similar dimensions were moderate to high indicating a good convergent validity. Criterion-related validity was established in so far that patients scored significantly higher in all BSI-18 scales than did the non-clinical samples. With some exceptions, the German translation of the BSI-18 has similarly good psychometric qualities as the American original.

[A comparison of multimodal programmes of patient education in the rehabilitation of chronic low back pain]. / Multimodale Interventionsprogramme in der Rehabilitation von Patienten mit chronischen Rückenschmerzen--Ein Vergleich.

There is growing evidence for the effectiveness of multimodal intervention concepts for chronic low back pain in the international literature, and accordingly several German rehabilitation programmes for the treatment of chronic low back pain patients have been developed. Focus of this paper is to describe and compare frequently used German multimodal intervention programmes for in- and outpatient rehabilitation of patients with chronic low back pain. Programmes were chosen by searching the most relevant online resources as well as the online pages of Deutsche Rentenversicherung and Zentrum Patientenschulung during September 2008. Keywords guiding the search were: Patientenschulung, Rückenschmerzen, Manual, psychologische multimodale Interventionskonzepte, Rehabilitationsprogramm, psychology, intervention, low back pain, manual and therapy. By this means, six manually supported multimodal rehabilitation programmes for the in- and outpatient therapy of patients with chronic back pain could be identified: Göttinger Rücken-Intensiv-Programm (GRIP), the psychological programme for chronic head- and low back pain, the Münchner Rücken-Intensiv-Programm (MRIP), Back to Balance, Arbeiten und Leben--Back to Balance (ALEBABA) und Rückenfit: Lebenslust statt Krankheitsfrust. These programmes are depicted and compared with regard to their potentials and limitations in supporting the rehabilitation process of patients with chronic low back pain. While comparing the programmes, a number of similarities between them can be detected, as well as pronounced differences, e. g., regarding settings and complexity. In most programmes, lack of appropriate evaluation studies and lack of aftercare turn out to be critical aspects.

[Impairments of vision- and health-related quality of life in stroke patients with homonymous visual field defects depend on severity of visual function loss]. / Beeinträchtigung der seh- und gesundheitsbezogenen Lebensqualität bei Schlaganfallpatienten mit homonymen Gesichtsfelddefekten in Abhängigkeit von der Schwere des visuellen Funktionsverlustes.

BACKGROUND AND PURPOSE: Little is known about whether and to what extent health- and vision-related quality of life in stroke patients with visual field defects is influenced by the severity of visual function loss and which quality of life is achieved compared to healthy control persons. PATIENTS/MATERIALS AND METHODS: Results of the National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ) and the Medical Outcome Study Short-Form 36 Health Survey (SF-36) of 177 first stroke patients with visual field defects were compared with scores of age- and sex-matched healthy reference persons. The influence of visual field loss, perimetric data, reduced visual acuity and demographic variables on NEI-VFQ and SF-36 scores were estimated by analyses of variance. RESULTS: First stroke patients showed worse results in 11/12 NEI-VFQ and in 6/8 SF-36 subscales when compared to healthy controls. The factor "intact central visual field" influenced 9/12 NEI-VFQ subscales (F-range 3.16 - 14.11; all p < 0.05), but only one SF-36 scale (F = 3.15; p < 0.05). Patients with larger intact visual fields, shorter reaction times in the visual field test and better visual acuity reached higher NEI-VFQ and SF-36 scores. Male patients reported worse scores for SF-36 subscale General Health Perceptions than female patients (F = 8.61; p = 0.004), but no differences in vision-related quality of life due to the factor gender could be detected. CONCLUSIONS: Patients with visual field defects showed considerable reductions in vision- and health-related quality of life compared to healthy control persons. These were mainly influenced by variables of visual functioning such as size of intact visual field, reaction times or visual acuity. The size of the intact central visual field influenced vision-related quality of life rather than health-related quality of life.

[Psychological factors related to gastric banding. Results of a follow-up study]. / Psychische Faktoren bei Magenbandimplantation. Ergebnisse einer Follow-up-Untersuchung.

BACKGROUND: Obesity is a widespread illness in Western industrialized countries, causing a high financial burden for the health systems. Several studies could demonstrate the positive effects of bariatric surgery on psychological and psychosocial parameters. PATIENTS AND METHODS: Twenty patients with morbid obesity (BMI > or =40 kg/m(2)) answered two questionnaires, the SCL-90-R, assessing psychological distress, and the IIP-D, measuring interpersonal problems, before and 6 months after gastric banding. Six months after surgery an additional questionnaire measuring subjective feelings was administered, too. RESULTS: Seventy-five percent of the patients were dissatisfied with therapy and outcome. They reported a lack of psychological support as well as new surgery-related physical and psychological symptoms. CONCLUSION: This study pointed out the necessity for psychotherapeutic help after surgery to manage already existing or new psychological needs due to gastric banding.

[Quality of life - methodology and clinical practice aspects with a focus on ocular medicine]. / Lebensqualität - methodologische und klinisch-praktische Aspekte mit einem Fokus auf die Augenheilkunde.

Due to the demographic development in western industrialised countries, the proportion of visually impaired persons is likely to increase in the future. Currently there is a shift in scientific recognition from relative neglect of psychopathological distress in the visually impaired to better notice of disease-related subjective impairments that are detectable with specific questionnaire measures. Visual acuity primarily determines the subjective rating of visual functioning independent from the eye disease. Ophthalmic patients who show only mild symptoms from a medical point of view normally suffer considerably diminished vision-related quality of life with respect to physical, functional, mental, and social aspects. Treatment effects have been shown using vision-related quality-of-life measures for different ophthalmic diseases, particularly cataract surgery. Assessment of vision-related quality of life provides a meaningful complement to objective data.

[Visual field defects after cerebral lesions from the patient's perspective: health- and vision-related quality of life assessed by SF-36 and NEI-VFQ]. / Zerebral bedingte Gesichtsfelddefekte aus Patientensicht : Gesundheitsbezogene und sehspezifische Lebensqualität unter Verwendung des SF-36 und des NEI-VFQ.

BACKGROUND: In patients with visual field defects, measurement of health-related quality of life (hQoL) and vision-related quality of life (vQoL) is an important adjunct to clinical measures such as perimetry. The purpose of this study was to describe hQoL and vQoL of patients with visual field defects after cerebral lesions such as infarction, traumatic brain injury, and tumor. METHODS: The National Eye Institute -- Visual Function Questionnaire (NEI-VFQ) for vQoL and the SF-36 Health Survey for hQoL were administered to 24 patients about 2 years after occurrence of the visual field defect. Visual fields were measured by standard perimetry and a near-threshold campimetric method. Visual acuity was measured by the Landolt-Ring-Test. RESULTS: The NEI-VFQ scores -- but not SF-36 scores -- were not only lower than those of a disease-free group but also lower than those of patients with visual impairments not caused by cerebral damage. Rank correlations between the size of the visual field defect and NEI-VFQ subscales were significantly high or modest. With SF-36 scores these correlations were generally low and moderate at best. CONCLUSION: The NEI-VFQ is a valuable measure of self-reported visual impairment in patients with visual field defects after cerebral lesions. The measurement of unspecific hQoL is not sufficient to reflect the problems of patients with visual field defects.

Switching from cyclosporine to tacrolimus leads to improved disease-specific quality of life in patients after kidney transplantation.

BACKGROUND: Advances in transplantation medicine are linked to improved efficacy of immunosuppressive agents. At the same time, these agents endanger medical success by side effects that may impair survival and quality of life (QOL). This study examined whether conversion to tacrolimus-based immunosuppression due to cyclosporine-related side effects improved. QOL in patients after kidney transplantation. METHODS: In total 64 patients (29 men) with an average age of 51 years (SD+/-12) who had received a kidney allograft an average of 5.6 years (SD+/-4) before conversion participated. The reasons for conversion were cardiovascular/metabolic (n=26) or periodontal/dermatological side effects (n=38) of cyclosporine therapy. QOL was assessed before conversion and in average 7 months thereafter by a global (SF-36) and a disease-specific instrument (ESRD-SCL). RESULTS: Disease-specific QOL (ESRD-SCL, global index) improved significantly (P<.001, explanation of variance [EV]=16.6%) after conversion from cyclosporine to tacrolimus. In detail, cardiac and renal dysfunction (P<.01, EV=12.9%) as well as increased growth of gum and hair (P<.0001, EV=53.2%) were significantly reduced at end of the study. However, global QOL (SF-36) remained unchanged. CONCLUSION: Regardless of the indication (cardiovascular or cosmetic), switching to tacrolimus due to cyclosporine-related side effects improved disease-specific QOL within the short term.

Disease-specific quality of life in Turkish patients after successful kidney transplantation.

To investigate disease-specific quality of life (QOL) in Turkish patients after successful kidney transplantation, the End-Stage Renal Disease Symptom Checklist Transplantation Module (ESRD-SCL-TM), a multidimensional questionnaire measuring disease-specific QOL, was translated and administered to a sample of successfully transplanted patients. Intercultural differences between Turkish and German patients as well as the influence of demographic (age, gender) and clinical (duration of graft function, living versus cadaver transplantation) data in the Turkish patients were evaluated by multivariate analyses of variance, and correlative techniques. The 152 investigated Turkish patients, including 106 (69.7%) men and 46 (30.3%) women, had a mean age of 34.8 years (SD = 10.8, range, 14 to 67 years). Time since successful kidney transplantation varied between 1 and 297 months (mean = 19.2 months; SD = 36.9). One hundred twelve patients (73.7%) received a kidney from a living donor, and 40 (26.3%) from a cadaver. The Turkish patients suffered statistically significantly more from disease-specific distress than the German patients (19% explanation of variance). They reported higher distress regarding four of six subscales. Turkish women suffered statistically significantly more from "Limited Physical Capacity," and "Side-effects of Corticosteroids" (10% explanation of variance) than men. The demonstrated higher disease-specific distress in successfully transplanted Turkish patients compared to the German samples may be the result of intercultural differences in reporting psychological and disease-specific distress. On the other hand, the higher distress of women compared to men is well known. Both results pointed out the necessity of psychological support.

[Aspects of rehabilitation in HIV and AIDS]. / Aspekte der Rehabilitation bei HIV und AIDS.

Medical treatment of HIV infection has changed dramatically since 1997. The uncontrollable threat became a chronic disease. On the other hand, many HIV-infected people suffer from high psychological distress and multiple physical complaints. Interaction in HIV prevention could transform into psychological counseling. Counselors should initiate rehabilitation measures and occupational reintegration by utilizing all legal possibilities for handicapped people. Patients and physicians, psychologists and social workers as well as self-help groups should initiate successful reintegration into the workforce and daily life; this could positively influence compliance behavior.

Health-related quality of life in blepharospasm or hemifacial spasm.

OBJECTIVES: Health-related quality of life (HRQL) has become an important outcome criterion of medical interventions, but was hardly studied in patients with facial spasms. MATERIALS AND METHODS: Patients with blepharospasm or hemifacial spasm treated with botulinum toxin were included. A healthy control group sociodemografically matched to patients was established. Instruments applied included the SF-36 (global HRQL), the NEI-VFQ (disease-specific HRQL) and the Blepharospasm Rating/Disability Scale, the latter to patients only. RESULTS: Thirty-one patients with blepharospasm and 21 patients with hemifacial spasm took part. The Blepharospasm Rating/Disability Scale revealed minor functional limitations, but identified some symptoms to be improved. In both patient groups global (both SF-36 Component Summaries) and disease-specific (eight of 12 subscales) HRQL were significantly impaired compared with controls. CONCLUSION: HRQL should be integrated as core outcome criterion in treatment of patients with facial spasms. Assessment by a generic and a disease-specific instrument is recommended.

The Symptom Check-List-90-R (SCL-90-R): a German validation study.

The Symptom Check-List-90-R (SCL-90-R) is a widely used psychological status symptom inventory. The properties of the German SCL-90-R version were studied in two clinical samples: psychosomatic outpatients and primary care patients. The data were compared with a German community sample. The internal consistency, measured by Cronbach's alpha coefficients, was found to be high, for the global scale and all original subscales. Mokken scale analysis indicated hierarchical structure for most of the subscales. Concurrent validity, evaluated by studying the relationship between the SCL-90-R subscales and the Inventory of Interpersonal Problems (IIP-C) and the General Health Questionnaire (GHQ-12) was also high. On the basis of receiver operating characteristic (ROC) analyses, it was found that the SCL-90-R was able to differentiate between subjects known to have a given psychological disorder and those who do not. Results of exploratory and confirmatory factor analysis failed to support the original nine factor model and two subsequent factor models. The strong interdependence of the original subscales and the strong first unrotated factor of the exploratory factor analyses raised concern regarding the multi-dimensionality of the SCL-90-R subscales. We concluded that the SCL-90-R is a useful tool for measuring psychological status, measuring change in outcome studies, or screening for mental disorders.

Assessing clinically significant change: application to the SCL-90-R.

A Symptom Checklist (SCL-90-R) is a potentially useful measure of psychological distress; it is frequently used in psychotherapy research and clinical practice. The purpose of this study was to illustrate the use of the SCL-90-R for determining statistically reliable change and clinical significance outlined by Jacobson and Truax in 1991. This paper describes the concepts of statistical and clinical significance of change. A proposal for obtaining and characterizing samples is made. Then a clinician's perspective is taken. Reliable change estimates and cut-off scores are chosen based on outcome data. Selected data from a single psychotherapeutic process and outcome study then were used to test the estimates of change and cut-off scores.

Quality of life in patients before and after kidney transplantation.

Abstract The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL. Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22). Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001). Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL. Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.

Quality of life in end-stage renal disease patients after successful kidney transplantation: development of the ESRD symptom checklist - transplantation module.

The End-Stage Renal Disease Symptom Checklist - Transplantation Module (ESRD-SCL((R))) was developed to assess the specific physical and psychological quality of life of renal transplant recipients, with a special focus on side effects of immune system suppression therapy. A list of potentially relevant items was administered to 458 transplant recipients. The symptoms present in >20% of patients were chosen, and factor analysis was used to create the final questionnaire which consists of 43 items in six dimensions: (1) limited physical capacity (10 items; internal consistency: Cronbach's alpha = 0.85); (2) limited cognitive capacity (8 items, alpha = 0.82); (3) cardiac and renal dysfunction (7 items, alpha = 0. 76); (4) side effects of corticosteroids (5 items, alpha = 0.77); (5) increased growth of gum and hair (5 items, alpha = 0.78), and (6) transplantation-associated psychological distress (8 items, alpha = 0.80). All questions are scored on a five-point Likert scale. Validity was demonstrated in correlation with corresponding SF-36 scales and in a stepwise hierarchical regression model predicting the subscales of the ESRD-SCL by sociodemographic and medical data. The ESRD-SCL was found to have adequate reliability, test-retest correlations in a subsample of 88 stable patients after 1 year, and construct validity.

[Introduction of the project "Westdeutsche Allgemeine Zeitung (WAZ) for visually impaired" (a talking electronic daily newspaper)]. / Vorstellung des Projektes "Westdeutsche Allgemeine Zeitung (WAZ) für Sehgeschädigte".

In order to complete the range of topical media, that is currently available for the visually impaired, a working group is developing and testing the "Westdeutsche Allgemeine Tageszeitung (WAZ) for the visually impaired", an auditive electronic daily newspaper. The intention of this project is to take into consideration the needs of the visually impaired, especially of those who acquired the handicap in middle or later age and might feel that not being able to read the daily newspaper anymore reduces their quality of life to a great extent. The central aim therefore is to put the modern computer technology at the disposal of the impaired in a way that enables them to make use of the newspaper without having had previous experience. In a first phase of several months twelve probands in different personal settings will test a first prototype of the newspaper reading machine, a modified and optimated multimedia computer system with modern and speech output, at home. During this period the users will be intensively looked after and undergo psychodiagnostic examination. By means of analysing the data collected in extended talks and questionnaires concrete proposals on how to improve the machine are to be made and a statement about the potential impact of the electronic newspaper on the quality of life of the visually impaired--in the sense of a contribution to their rehabilitation--is to be given.

[Psychological stress of inpatients with acute and chronic lumbar syndrome]. / Psychische Belastung bei stationären Patienten mit akutem und chronischem Lumbalsyndrom.

PURPOSE: As a result of its increasing incidence and social medical implications, low back pain with either chronic or acute symptoms presents a major challenge for our society. The psychological background of pain perception and valuation has been explored in various studies; frequently, no positive correlation was found between subjective pain perception and structural orthopedic findings. METHOD: A symptoms checklist (SCL-90-R) was used to compare a group of patients hospitalized because of low back pain with a group of asymptomatic controls. Additionally, the pain-specific questionnaire (ERSS) was employed to verify the validity of the depressive mood scale by means of the corresponding scale in the SCL-90-R. RESULTS: When the SCL-90-R was given to both groups, significant differences could be observed between the patients and the controls on the scales for somatisation, depressive mood, anxiety, phobias and psychoticism. Moreover, patients with chronic pain had higher scores on the scales for phobias and the global marker of "positive symptom total" (PST) than patients with acute back pain. On the scales for somatisation and insecurity during social contacts, women reported higher levels of psychological distress than men. Age-related differences were not observed. The depressive mood scale of the ERSS appears to be valid. With the SCL-90-R we could demonstrate significant differences between patients with acute and chronic pain, and between the sexes. No differences were found in the age-group comparison. CONCLUSION: In patients with low back pain, psychological parameters have to be taken into account in any comprehensive concept of conservative treatment.

[Connection between disease progress and coping with stress in patients with retinopathy centralis serosa]. / Uber den Zusammenhang zwischen Krankheitsprogredienz und Stressverarbeitung bei Patienten mit Retinopathia centralis serosa.

To illuminate the disease progression in retinopathy centralis serosa, 50 patients were enrolled in a basic study. Evaluated data included medical and sociodemographic data as well as data regarding the patient's coping with everyday conflicts and the disease. Hence, the German multidimensional coping inventory (SVF, Janke, Erdmann u. Boucsein 1985), measuring the trait aspects of coping with everyday troubles, as well as the German coping questionnaire (EFK, Franke 1997), dealing with coping with retinopathy, were applied. We described three different clusters of patients according to active and passive coping strategies. These three clusters also differed in terms of coping with the disease as well as in ophthalmological parameters. To illuminate the individual situation of the members of the clusters, we discuss the specific situation of three patients.