[Self-concept and erectile dysfunction in 45-year-old men : Results of a corollary study of the PROBASE trial]. / Selbstbild und erektile Dysfunktion 45-jähriger Männer : Ergebnisse eines Begleitprojekts der PROBASE-Studie.

BACKGROUND: Self-concept consists of self-perceptions and is influenced by the life course of the person. OBJECTIVES: This study investigated associations between self-concept and erectile dysfunction (ED) in 45-year-old German men. MATERIALS AND METHODS: Forty-five-year-old, heterosexual men who had participated in the PROBASE-study were included. Erectile Function was evaluated using the International Index of Erectile Function (IIEF-6). The presence of ED was defined by IIEF-6 score ≤ 25. Self-concept was assessed using the facets "body image" (three items from the Dresden Body Image Inventory, DKB-35), "perception of masculinity" (three items from the Male Role Norms Scale, MRNS), "perceived social pressure with regard to sexual performance" (four newly constructed items), and "sexual self-esteem" (three newly constructed items). Scores for these facets of self-concept can range from 1 to 5. Higher scores indicate a more positive body image, higher sexual self-esteem, a more modern understanding of masculinity, and greater perceived social pressure. Differences in self-concept between men with ED and without ED were analyzed using the Mann-Whitney-U-test. Furthermore, Cohen's d effect sizes (ES d) were calculated. RESULTS: The responses of 3143 men were analyzed. Men with ED (16.2 %) have significantly lower scores regarding body image (mean 3.6 ± 0.6 vs 3.8 ± 0.5; p < 0.001; ES d = -0.5), perception of masculinity (mean 3.4 ± 0.7 vs 3.7 ± 0.6; p < 0.001; ES d = -0.4), and sexual self-esteem (mean 3.6 ± 0.6 vs 3.9 ± 0.5; p < 0.001, ES d = -0.4) than men without ED. Furthermore, they had significantly higher scores for perceived social pressure (mean 2.1 ± 0.7 vs 1.5 ± 0.5; p < 0.001; ES d = 1.2). CONCLUSIONS: Self-concept and ED are associated in 45-year-old men. Men with ED have a more negative body image, a more traditional understanding of masculinity, more negative sexual self-esteem, and greater perceived social pressure with regard to sexual performance than men without ED.

[Stress Management Interventions at the Workplace Improve Perceived Stress Reactivity of Men at Higher Risk]. / Prävention stressbedingter Gesundheitsschäden in einem Industriebetrieb bei Männern mit erhöhtem Risiko.

A randomised controlled trial was conducted in a metal working plant. The primary endpoint was perceived stress reactivity (Stress Reactivity Scale, SRS). 174 participants were randomly assigned to a stress-management intervention (SMI) (IG) or a waiting control group (CG). N=174 participants (171 male) were recruited at t0, 154 (89%) were still taking part after one year (t1), 131 (76%) after 2 years. The SRS score decreased in both groups. The conducted SMI proved to be effective over both a 1- and a 2-year period.

["Fit4You"--A Programme for Prevention and Reduction of Overweight in Apprentices in the Workplace Setting]. / "Fit4U"--ein Präventionsprogramm zur Vermeidung und Verminderung von Übergewicht bei Auszubildenden im Betrieb.

The effect of health promotion at the worksite for overweight adolescents is not known. This 2-year intervention study examined the effect of a multimodal programme including nutrition counselling, sport, and life-skill training on medical and psychological outcomes. The body mass index increased slightly less in the intervention group. Semistructured interviews at the end showed that participants are highly interested in health promotion at the worksite.

[Effects of inpatient rehabilitation on long-term health-related quality of life in patients with cancer and rheumatoid arthritis: an analysis based on the classification of therapeutic procedures codes (KTL)]. / Einfluss stationärer Rehabilitationsleistungen auf die langfristige gesundheitsbezogene Lebensqualität von Patienten mit Krebs und rheumatoider Arthritis: eine KTL-Daten-Analyse.

OBJECTIVES: This explorative study investigated associations among the amount of different rehabilitative interventions, based on the classification of therapeutic procedures codes (KTL), and long-term health-related quality of life in patients with cancer or rheumatoid arthritis. METHODS: 3 therapeutic modules of rehabilitative interventions were defined on the basis of KTL codes: (i) somatic interventions, (ii) psychological interventions, and (iii) medical counselling. Based on a median-split, patients were classified in 2 groups with low vs. high amount of rehabilitative interventions. Health-related quality of life was assessed on admission, at discharge from rehabilitative stay, as well as 3 and 12 months after discharge using the SF-12 health survey. RESULTS: 166 patients with chronic arthritis and 159 patients with cancer undergoing inpatient rehabilitation were included in the analysis. Arthritis patients who received a high amount of somatic interventions showed a significant improvement in the SF-12 mental health component summary score up to 12 months after discharge (p<0.05). Cancer patients who received a high amount of psychological interventions showed higher SF-12 physical health component summary scores at 3 and 12 months follow-up (p<0.05). CONCLUSION: The results suggest differential relationships between amount of rehabilitative interventions and long-term rehabilitation outcome in 2 different disease groups. Routine classification of rehabilitative procedures (KTL) codes can be used for analysing dose-response relationships, although open questions remain concerning the validity of KTL codes.

Patient satisfaction during radiation therapy. Correlates and patient suggestions.

BACKGROUND: Assessing patient satisfaction might help to detect so far unknown patient needs and could contribute to quality assurance within the health care system. We evaluated patient satisfaction and its correlates in a consecutive sample of patients undergoing external beam radiation therapy. PATIENTS AND METHODS: Patient satisfaction was evaluated within a prospective study with two validated instruments (FPZ, ZUF-8) during the first week of radiation therapy in two university-based radiation oncology departments. RESULTS: A total of 273 patients could be analyzed. Most patients were irradiated for breast or urogenital cancer. Overall patient satisfaction was high (94.9-98.8%). The most important items for patient satisfaction included the following: "skills of physicians" followed by "physician contact with patients," "care," and "information" (Tab. 2). Neither center nor disease entity correlated with global patient satisfaction. Of the patients, 46% reported that they would have preferred additional information prior to the onset of radiotherapy. Patients who sought additional information reported a lower global patient satisfaction (p < 0.001). In multiple linear regression analysis, the need for more information, male gender, and a higher level of education were significant predictors for lower global patient satisfaction (Tab. 6). CONCLUSION: During the first week of radiation therapy, patients rate patient-physician interaction and communication on treatment and disease as important factors for their satisfaction. Supplying additional information to subsets of patients prior to starting radiotherapy might help to further improve satisfaction.

Routine psychosocial distress screening in radiotherapy: implementation and evaluation of a computerised procedure.

BACKGROUND: To implement distress screening in routine radiotherapy practice and to compare computerised and paper-and-pencil screening in terms of acceptability and utility. METHODS: We used the Stress Index RadioOncology (SIRO) for screening. In phase 1, 177 patients answered both a computerised and a paper version, and in phase 2, 273 patients filled out either the computerised or the paper assessment. Physicians received immediate feedback of the psycho-oncological results. Patients, nurses/radiographers (n=27) and physicians (n=15) evaluated the screening procedure. RESULTS: The agreement between the computerised and the paper assessment was high (intra-class correlation=0.92). Patients' satisfaction did not differ between the two administration modes. Nurses/radiographers rated the computerised assessment less time consuming (3.7 vs 18.5%), although the objective data did not reveal a difference in time demand. Physicians valued the psycho-oncological results as interesting and informative (46.7%). Patients and staff agreed that the distress screening did not lead to an increase in the discussion of psychosocial issues in clinician-patient encounters. CONCLUSION: The implementation of a distress screening was feasible and highly accepted, regardless of the administration mode. Communication trainings should be offered in order to increase the discussion of psychosocial topics in clinician-patient encounters.

Psychological distress in cancer patients assessed with an expert rating scale.

The purpose of this study was to investigate psychosocial stress in a large sample of cancer patients using an expert rating scale. Specific aims were to analyse the relevance of setting variables (type of clinic, contact initiative, therapy) and gender. A total of 6365 patients were assessed in 105 institutions. Univariate and multivariate statistical analysis of setting variables indicated that patients treated in palliative care settings showed highest distress scores compared to patients recruited from hospitals and outpatient clinics (P<0.001). Significant differences were also found for contact initiative (P<0.001); lowest distress was found in patients who were recruited by routine contact. Patients who asked for psychosocial support or who were recruited by the medical staff showed the highest distress scores. The analysis of therapy groups showed that patients receiving radiotherapy or surgery were not more distressed than patients without therapy. The most distressing treatment was chemotherapy. Gender had differential effects on clinic type (P<0.001) and contact initiative (P<0.001) but not on treatment and diagnosis. Expert rating scales are an important complement for self-assessment questionnaires to evaluate psychological distress of cancer patients in psychosocial studies as well as in routine medical care.

Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA-KORA Augsburg Cohort Study 1984-1998.

OBJECTIVE: To examine the contribution of depressed mood in obese subjects on the prediction of a future coronary heart disease event (CHD). DESIGN: A prospective population-based cohort study of three independent cross-sectional surveys with 6239 subjects, 45-74 years of age and free of diagnosed CHD, stroke and cancer. During a mean follow-up of 7 years, 179 CHD events occurred among men and 50 events among women. SUBJECTS: A total of 737 (23%) male and 773 (26%) female subjects suffering from obesity (BMI >or=30 kg/m2). MEASUREMENTS: Body weight determined by trained medical staff following a standardized protocol; standardized questionnaires to assess subsyndromal depressive mood and other psychosocial features. RESULTS: The main effect of obesity to predict a future CHD (hazard ratio, HR=1.38, 95% CI 1.03-1.84; P=0.031) and the interaction term of obesity by depression (HR=1.73, 95% CI 0.98-3.05; P=0.060) were borderline significant, both covariate adjusted for multiple risk factors. Relative to the male subgroup with normal body weight and no depression, the male obese group with no depression was not at significantly increased risk for CHD events (HR=1.17, 95% CI 0.76-1.80; P=0.473) whereas CHD risk in males with both obesity and depressed mood was substantially increased (HR=2.32, 95% CI 1.45-3.72, P>0.0001). The findings for women were similar, however, not significant probably owing to lack of power associated with low event rates. Combining obesity and depressed mood resulted in a relative risk to suffer from a future CHD event of HR 1.84 (95% CI 0.79-4.26; P=0.158). CONCLUSIONS: Depressed mood substantially amplifies the CHD risk of middle-aged obese, but otherwise apparently healthy men. The impact of depression on the obesity risk in women is less pronounced.

[Psychosocial factors as risk for coronary heart disease--status with special reference to the KORA platform]. / Psychosoziale Belastungsfaktoren als Risiko für das Auftreten einer koronaren Herzerkrankung -- Eine Bestandsaufnahme unter besonderer Berücksichtigung der KORA-Forschungsplattform.

Psychosocial factors derived from concepts in health psychology and psychopathology are subject of extensive research to assess their power to predict a future coronary artery disease event in apparently healthy subjects. However, bio-behavioural factors have not been implemented in current guidelines of scoring schemes for calculating the risk of coronary events. The presented data were derived from the population-based MONICA Augsburg studies (S1-S3) conducted between 1984 and 1995. The psychosocial data set was available in approximately 13,000 subjects. The KORA follow-up study assessed the vital status for all participants (except for 56 persons) in 1998. Until then, 772 participants (531 men, 241 women) had died. The depressive symptomatology was derived from the von Zerrssen affective symptom check list combining 24 single symptom items with scores ranging from 0 to 3. Risks of total mortality and myocardial infarction were estimated from Cox proportional hazard ratio (HR) models adjusted for age and survey and multiple risk factors. Male participants with high scores in depression exhibited a significantly increased risk in total mortality (adjusted HR: 1.55; 95 % CI: 1.28 - 1.83, p < 0.0001) and for fatal and non-fatal coronary events (adjusted HR: 1.36; 95 % CI: 1.02 - 1.81, p < 0.035). Female participants reported higher values in depression scores; however, depression was not predictive for subsequent total mortality and fatal and non-fatal events in females. Depression in men yielded a significant interaction with obesity and increased levels of C-reactive protein (CRP). The inclusion of psychosocial factors, as demonstrated for depression, is likely to improve prediction of future adverse cardiovascular and total mortality. These factors may also play a crucial role in genotype-phenotype interaction.

Psychological problems of cancer patients: a cancer distress screening with a cancer-specific questionnaire.

The purpose of this study was to assess the psychological distress of cancer patients in a disease-specific manner as well as the demographic and medical variables that have an impact on the distress. Psychological distress was assessed with the Questionnaire on Stress in Cancer Patients revised version, which has been developed and psychometrically evaluated in Germany. It consists of items about 23 cancer-specific stress situations, which have to be answered in terms of relevance and amount of distress. A heterogeneous sample of 1721 cancer in- and outpatients was assessed. For the total group, the most important distress is the fear of disease progression. We consider between 23.4% (ca. of the upper gastrointestinal tract) and 40.9% (breast cancer patients) as highly distressed. The most distressed diagnostic subgroups are patients with soft tissue tumours and breast cancer patients. There are no global (general) stress factors, as the relevant demographic and medical 'risk factors' varied between the diagnostic subgroups. Cancer-specific distress questionnaires give a more precise insight into patients' experience than general or psychiatric questionnaires. They are not only used in large screening studies but also in routine medicine, particularly when the objective is to identify patients to whom psycho-oncological support is to be given.

[Differential and common characteristics of patients with atypical facial pain and craniomandibular dysfunction]. / Differenzielle und gemeinsame Merkmale bei Patienten mit atypischem Gesichtsschmerz und kraniomandibularer Dysfunktion.

BACKGROUND: Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP. METHOD: A total of 124 consecutive patients with CMD ( n=108) or AFP ( n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist. RESULTS: The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor ( p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status. CONCLUSIONS: CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.

[Psychic and somatic findings in jaw or facial pain of unclear origin. Comparison of patients with severe and mild symptoms]. / Psychische und somatische Befunde bei ätiologisch nicht eindeutigen Kiefer- bzw. Gesichtsschmerzen Vergleich zwischen hoch und niedrig symptomatischen Patienten.

BACKGROUND: Both for medical and dental specialists, patients with facial arthromyalgia (FAM) and acute or chronic atypical facial pain (AFP) often represent a clinical challenge. Only few empirical studies address the possible interaction between facial pain and increased psychosocial stress with a thereby heightened risk for a chronic course of disease. OBJECTIVE: To evaluate whether FAM or AFP - patients initially presenting with high vs. low pain intensity differ in somatic, psychosocial and socioeconomic parameters. METHOD: We chose to study a population with a primary diagnosis of myofascial pain of the jaw muscles or atypical facial pain and excluded patients with disc displacement, acute arthritis and severe arthrosis. Within nine months, 124 consecutive patients with FAM ( n=108) or AFP ( n=16) were referred to the departments of maxillary surgery, dentistry or neurology of two interdisciplinary academic pain centers. Using the patients'ratings on a 100 mm visual analogue scale concerning their pain intensity, the group was divided in a subgroup initially presenting with low (VAS5; n=45). Psychometric evaluation was conducted with the SCL-90R (general psychopathology), the State-Trait-Anger-Expression Inventory (STAXI) and a special questionnaire addressing different aspects of chronic pain (modified SBAS-IV). All patients were assessed by a maxillary surgeon/specialized dentist with the help of a detailed, standardized clinical examination (Helkimo-Index). RESULTS: The group of FAM-/AFP - patients according to our inclusion-/exclusion - criteria presenting with a high pain intensity showed more psychosocial withdrawal ( p=0.013), a worse self-rated psychological status ( p=0.033) and a trend towards more somatization ( p=0.093) than patients with lower pain intensity. There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for belonging to the high (extensive) pain group. CONCLUSIONS: These data suggest that FAM-/ AFP - patients initially presenting with a high pain intensity have an increased risk for psychosocial stress and maladaptive coping behaviour. As both variables are empirically validated risk factors for a chronic course in pain-related disease, these patients should be of special interest for an interdisciplianary therapeutic setting including psychotherapeutic approaches.

Identifying somatization disorder in a population-based health examination survey: psychosocial burden and gender differences.

Despite its enormous medical burden, little is known about the epidemiology of somatization in the community. The present study screened a representative population-based survey of 7,466 subjects in the age range of 25 to 69 years for the occurrence of somatization. A total of 137 (1.84%) individuals experienced six or more symptoms from at least two different body sites without an identifiable organic cause. These patients exhibited a lower quality of life (P < or = 0.0001) and suffered from higher levels of emotional stress (P < or = 0.0001) than their counterparts in the healthy subsample (n=906). Somatization was not associated with a medical diagnosis, but disability days, the use of medical services, and the level of medication was higher in the somatization disorder group (P < or = 0.004). The somatization risk was only 1.6-fold higher for women in comparison to men but escalated for women rapidly to an approximately 4-fold risk when being female was combined with low social class and high emotional distress. Against expectation, the somatization risk for men also mounted 3-fold under the identical risk constellation.

Gender differences of symptom reporting and medical health care utilization in the German population.

AIM: Gender differences in morbidity have been widely confirmed in representative health surveys in North America and Europe. Significantly more women than men suffer from somatic complaints. It is less clear whether differences in symptom reporting provide an impact on health care utilization and to which degree psychosocial factors exhibit confounding influence. METHODS: We analyzed data from a representative health examination survey in Germany with 7466 participants in the age range of 25 to 69 years. RESULTS: The analysis confirmed an overall excess in female symptom reporting, both in the total sample (n = 7460; p < or = 0.001) and in the healthy subsample (n = 906, p < or = 0.01). Also, female utilization of medical services was higher (p < or = 0.0001). A simultaneous age related increase in the prevalence of symptom reporting in both groups peaked in the age group of 55-59 years followed by a subsequent slight decrease in higher age groups whereas utilization steadily increased over the adult life span in both sexes. As expected, more medical utilization was associated with higher symptom reporting levels. Nevertheless, females constantly exhibited more medical utilization than males in all symptom reporting groups. Age and marital status had no univariate influence on symptom reporting whereas low social class status (p = 0.001), poor perceived/self assessed health (p < 0.0001), and high levels of chronic distress (p < 0.0001) were associated with more symptom reporting. In multivariate analysis, the female gender lost its significance on heightened symptom reporting. Poor perceived/self assessed health had the most pronounced impact on symptom count (F-value 59.1; p < 0.001). CONCLUSIONS: The present study confirms a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization are not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor perceived/self assessed health.

[Psycho-neurogenic factors as a cause of life-threatening arrhythmias]. / Psycho-neurogene Faktoren bei der Genese lebensbedrohlicher Arrhythmien.

Tachyarrhytmias often occur during increased emotional arousal or mental excitation. The implantable cardioverter defibrillator (ICD) allows the exact documentation of arrhythmic episodes and their time of onset. Therefore, the type of arrhythmia can be differentiated as well as the circumstances surrounding the event. These features allow the assessment of possible psychic arrhythmogenic factors in the natural environment. We analyzed the ICD-protocols of three male patients (in ages between 60 and 68), whose devices had successfully terminated a ventricular tachycardia and compared the onset of the episodes with the patients' detailed descriptions of the corresponding life situations. The analysis of the circumstances at the time of arrhythmia-onset revealed a relationship between the occurrence of life-threatening arrhythmias in natural environment and emotional stress. The stressors could be defined as situations of increased vulnerability leading to sympathetic excitation. The induction of tachyarrhythmia was promoted in case 1 by acute psychic distress (public speaking), by the increasing panic-attack-like vicious circle of the cognitive anticipation of an unfavorable outcome (case 2), and an adverse anger reaction superimposed on persistent feelings of help- and hopelessness (case 3). These findings are in line with several experimental and epidemiological studies providing evidence for a relationship between psychic arousal and the induction of tachyarrhythmias. The knowledge of emotional and mental factors that function as a trigger for arrhythmias may lead to new therapeutic approaches in the prevention of sudden cardiac death.

Psychometric properties of the Questionnaire on Stress in Patients with Diabetes--Revised (QSD-R).

This study reports the psychometric properties of a 45-item diabetes-specific questionnaire, the Questionnaire on Stress in Patients with Diabetes--Revised (QSD-R), a modified and shortened version of the QSD (G. Duran, P. Herschbach, S. Waadt, A. Zettler, & F. Strian, 1995). The QSD-R was filled out by 1,930 individuals with insulin-dependent diabetes mellitus and noninsulin-dependent diabetes mellitus. Eight consistent scales were identified (values of Cronbach's alpha: .69-.81). The test-retest reliability for the total score after a 5-week interval was rtt = .63. The results provide evidence for the reliability and validity of this instrument.