Corinna Petersen-Ewert

Assessing health-related quality of life in European children and adolescents

Childhood health and illness have changed considerably over the past century calling for an increasing awareness of mental health problems. Consequently, the assessment of mental health problems is of major importance, not only focussing on mental health diagnoses but also on components of health-related quality of life (HRQOL) and functioning with regard to the impact of an illness or injury, medical treatment, or health care policy. Recently, a number of HRQOL measures for children and adolescents have been developed and applied in a number of studies. The current paper presents multi-cultural tools for the assessment of HRQOL, which were developed within European projects, describes the application of these tools in cross-national studies and pinpoints important determinants of HRQOL and mental health problems. Future research needs are discussed.

Teaching post-mortem external examination in undergraduate medical education—The formal and the informal curriculum

In undergraduate medical education, the training of post-mortem external examination on dead bodies might evoke strong emotional reactions in medical students that could counteract the intended learning goals. We evaluated student perception of a forensic medicine course, their perceived learning outcome (via self-assessment) and possible tutor-dependent influences on the overall evaluation of the course by a questionnaire-based survey among 150 medical students in Hamburg, Germany. The majority of students identified post-mortem external examination as an important learning objective in undergraduate medical education and did not feel that the dignity of the deceased was offended by the course procedures. After the course, more than 70% of the students felt able to perform an external examination and to fill in a death certificate. Respectful behavior of course tutors towards the deceased entailed better overall course ratings by students (p<0.001). Our findings highlight the importance of factors such as clearly defined learning goals and course standardization (formal curriculum) as well as tutor behavior (informal curriculum) in undergraduate education in forensic medicine. Furthermore, we suggest embedding teaching in forensic medicine in longitudinal curricula on death and dying and on the health consequences of interpersonal violence.

Identifying children and adolescents with cognitive dysfunction following mild traumatic brain injury—Preliminary findings on abbreviated neuropsychological testing

Objective: Studies on cognitive function in paediatric patients suffering head trauma suggest neuropsychological impairment even after mild traumatic brain injury (MTBI). The present study examined the feasibility of abbreviated neuropsychological testing in different settings in children and adolescents following MTBI. Methods: Within the scope of two prospective studies on psychosocial and cognitive outcome, 71 school-aged children with mild, moderate or severe TBI were assessed. In addition, 15 healthy children were included in the study. The abbreviated instrument comprises three standardized tests measuring attention and memory functions (Digit Symbol, Digit Span, learning trials of the German Auditory Verbal Learning Test). Impairment rates were calculated according to a defined cut-off score for clinically significant cognitive impairment. Results: Abbreviated testing could easily be implemented both in the acute and post-acute clinical setting. Out of the children with MTBI, 12% (shortly after injury) and 30% (2 months after injury), respectively, were classified as cognitively impaired. Following moderate or severe TBI, impairment occurred in 50% of the patients. Healthy children showed the best performance, while children with severe TBI performed worst. Conclusion: Results suggest that abbreviated testing allows detection of MTBI-related cognitive dysfunction. Identified children should be referred to a clinical neuropsychologist for comprehensive assessment.

Autopsy in undergraduate medical education--what do students really learn?

Forensic medicine can provide access to autopsies for students in undergraduate medical education. Previous qualitative studies reported that attending autopsies promotes learning and is helpful in organising information in the context of self-directed learning, covering cognitive, emotional and societal issues. In the present study, learning outcome regarding specific pathophysiological learning objectives of students who attended an autopsy elective (intervention group, n = 32) was estimated in comparison to peer students who signed up for the course but were not selected (control group A, n = 47) and students who had not signed up (control group B, n = 186). Learning outcome (expressed as a percent knowledge gain) was measured by means of comparative self-assessments (CSA). Furthermore, group interviews were conducted to evaluate the attending students’ perceptions and experiences of the course. In the intervention group, the percent knowledge gain for learning objectives reflecting pathophysiological mechanisms was about twice as high than that in the control groups, while all three groups showed comparable knowledge gain for learning objectives covered by mandatory courses that were held during the study period. Results of mandatory post-course assessments showed no statistically significant differences between the intervention and control groups. Therefore, the knowledge gain regarding learning objectives not covered by mandatory courses that was observed in the intervention group reflected the additional benefit of attending the autopsy course. Group interviews with the participants revealed gain of integrated knowledge and understanding of pathophysiological relations as important issues, while negative effects were reported infrequently. Our findings suggest that attendance of a series of autopsies fosters learning and understanding of important issues in medical education and should therefore be part of undergraduate medical curricula wherever possible.

Integration and health-related quality of life of undergraduate medical students with migration backgrounds – Results of a survey

Objective: Most medical faculties in Germany are still lacking differentiated counseling programmes for specific target groups. The purpose of the present study was to determine the quality of life and integration of students with migration backgrounds and their interests in counseling programmes. Methods: Data was collected at the University Medical Center Hamburg-Eppendorf in Germany. Participants were students of the undergraduate medical course; n=890 (89.3%) students without migration backgrounds were compared to n=107 (10.7%) students with an existing migration background. Results: The results showed that medical students with migration backgrounds reported lower scores for health-related quality of life compared to students without a migration background. They felt less accepted and supported by their fellow students and had fewer contacts with other students. Medical students with migration backgrounds were characterised by a higher interest in the implementation of a counseling programme (Z=–3.420; p=.001). Conclusions: In summary, medical students with migration backgrounds were identified as a group with an increased need for a specific counseling service. Lower scores of mental health and feelings of inferior integration set the necessity for early counseling and intervention needs.

Beliefs of students about growing older and perceptions of working in gerontology Educators in health and social care could do more to overcome the stereotypical views that deter trainees from choosing a career in the specialty, say Alice Coffey and colleagues

An ageing population that is increasing does not necessarily mean an increase in people who require health and social care. However, it is predicted that a wide range of such services is likely to be needed. This demand is set against a shortage of skilled healthcare professionals and a lack of interest in working with older people. There is a particular shortage of skilled gerontological workers in the developed world, made worse by a perceived lack of professional esteem, economic reward and poor working environments in the specialism. Most studies recommend education to enable individuals to develop accurate knowledge about the ageing process and interest in working with older people. There is a discrepancy in the literature as to whether health and social care workers hold positive or negative attitudes towards older people. As attitudes are strongly linked with perceptions of working with older people, this article presents a review of the literature and discussion on attitudes of health and social care students to ageing and perceptions of working with older people.

Psychische Belastung von Erwachsenen mit Neurofibromatose Typ 1: Eine Längsschnittstudie

Neurofibromatosis type 1 (NF1) is a rare genetic disorder with an autosomal dominant inheritance. It is a chronic condition that affects mostly the skin and causes it to grow multiple tumors and also affects the nervous system. The clinical picture is complex with highly variable symptoms and clinical severity. This study explores the psychological distress in 129 adult patients with NF1. It turned out that adults with NF1 have a higher level of psychological distress compared to the general population. The psychological distress is stable within a year. Physicians treating patients with NF1 should consider the psychological distress in NF1 patients. Psychotherapy, psychiatric treatment and psychosocial offers are therefore essential.

Integration von Mitarbeitern in Veränderungsprozesse

ZusammenfassungHintergrundDas „Wilhelm Leuschner Seniorenzentrum“ in Hamburg, das eine stationäre Versorgung bislang angeboten hat, wird durch einen Neubau ersetzt. Die neue Wohnform ist Servicewohnen in ambulant betreuten Hausgemeinschaften für „ältere“ Menschen mit Pflegebedarf. Die Bewohner werden ab dem Umzug in das neue Gebäude ambulant in Form von Hausgemeinschaften betreut. Für die Mitarbeiter verändert sich dadurch das Arbeitsfeld der stationären zur ambulanten Versorgung.ZielstellungZiel dieser Arbeit ist es, die Einstellung der Mitarbeiter hinsichtlich des Umstrukturierungsprozesses zu erfassen und auf dieser Grundlage Empfehlungen zu geben.MethodeEin standardisiertes Erhebungsinstrument wurde entwickelt und eine Fragebogenerhebung im Querschnitt durchgeführt.ErgebnisseDie Kommunikation über den persönlichen Dialog wird als wichtigster Informationsweg wahrgenommen. Weiterhin besteht Informations-, Schulungs- und Beratungsbedarf. Es besteht der Wunsch der Mitarbeiter, sich in den Veränderungsprozess einbringen zu können.SchlussfolgerungMitarbeiter und ihre Kompetenzen sollten stärker in Veränderungsprozesse einbezogen werden.AbstractBackgroundThe “Wilhelm Leuschner Seniorenzentrum” (home for seniors) in Hamburg which has so far offered inpatient care will be replaced by a new building. The new domestic concept includes a residential housing service in household communities for “older” people with care needs. After transferring to the new building, residents will be cared for in an outpatient setting in the form of household communities.AimThe field of work will change from residential to ambulatory care. The aim of this study was to assess the employees attitudes towards the organizational changes and give recommendations on that basis.MethodA standardized assessment instrument was developed and a cross-sectional questionnaire was distributed.ResultsFace-to-face communication was considered to be the most important way to transfer information. More information, preparatory training and advice are needed. The employees wished to be included more in the processes of change.ConclusionsEmployees and their skills should be more involved in changing situations at the workplace.

The German version of the Functional Walking Categories (FWC): translation and initial validation

ABSTRACT Background: Community ambulation is often affected after a stroke. However, no validated assessment in German to measure community ambulation on a participation level exists. Objectives: The purpose was to translate and cross-culturally adapt the Functional Walking Categories (FWC) into German and to assess its validity and reliability in patients with stroke. Methods: Cross-cultural adaptation guidelines were used for translation. Face and content validity were established with the aid of an expert committee. A pilot study with patients after stroke in a neurological rehabilitation setting checked for concurrent validity using Kendall’s tau and reliability using intraclass correlation coefficients. Results: The results indicated that the German version of the FWC has adequate face and content validity. A total of 30 patients (mean age 62 ± 12.315 years, 56.7% female) participated in the study. The FWC correlated well with the Functional Ambulation Categories (tau-b = 0.783), cadence (tau-b = 0.640), gait velocity (tau-b = 0.628), the comfortable 10-m timed walk (tau-b = −0.629), and the fast 10-m timed walk (tau-b = −0.634). Moderate correlations were found between the FWC and step length (tau-b = 0.483) and the Timed Up and Go (tau-b = −0.520), respectively. Intrarater reliability was moderate (ICC = 0.651) while interrater reliability was excellent (ICC = 0.751) (all correlations p < 0.001). However, the study was designed as pilot study, thus, full psychometric property testing was not possible. Conclusions: The German FWC offers a reasonable tool for measuring community ambulation on participation level. However, a user manual seems to be helpful.

Modul 1: Belastungen und Belastungserleben pflegender Angehöriger

Dieses Kapitel stellt die Modulubersicht fur die Schulung fur professionell Pflegende dar. Das Modul 1 mit den Inhalten »Geschichte der Migration in Deutschland«, »Situation pflegender Angehoriger »und »Transkulturelle Kompetenz« wird vorgestellt. Der Schwerpunkt in diesem Kapitel liegt in der Vermittlung und Reflexion des relevanten Hintergrundwissens.