Joachim Kugler

On the relation between neuroticism, self-esteem, and depression: results from the National Comorbidity Survey.

There is evidence that neuroticism and self-esteem, two commonly used personality constructs, are associated with depressive illness. Previous studies on this issue have produced mixed results. Some studies found that neuroticism was a stronger predictor of risk for major depression than was self-esteem. The aim of the current report is to analyze the relationship between neuroticism, self-esteem, and depressive disorders in representative community sample. Data from the National Comorbidity Survey (NCS) were reanalyzed. The diagnostic data were coded using the criteria of DSM-III-R based on a modified version of the Diagnostic Interview. Self-esteem was assessed by an empirically abbreviated form of the Rosenberg Self-Esteem Scale. Neuroticism was measured using the 10-item scale from the Transparent Bipolar Inventory (TBI). Logistic regression analysis and classification and regression tree (CART) analysis were used to determine the associations between neuroticism, self-esteem, sociodemographic variables, and past-year depression disorders. Neuroticism and self-esteem were strongly associated with past-year depression disorders. Significant interactions between the two personality constructs and sociodemographic variables were observed. The results suggest that neuroticism and self-esteem should be evaluated simultaneously when analyzing depression disorders. The assessment of both personality constructs may contribute to further understanding of personality-depression correlation. Such knowledge might prove valuable in designing early interventions and treatment.

Electromechanical and Robot-Assisted Arm Training for Improving Arm Function and Activities of Daily Living After Stroke

Graeme J. Hankey MD, FRACP Section Editor More than two thirds of all patients after stroke have difficulties with reduced arm function. Electromechanical and robot-assisted arm training uses specialized machines to assist rehabilitation in practice and this type of training might improve arm function after stroke. This systematic review examined the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living and arm function and motor strength of patients after stroke and the acceptability and safety of the therapy. We searched the Cochrane Stroke Group Trials Register (last searched October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), MEDLINE (1950 to October 2007), EMBASE (1980 to …

The Effects of Clinical Pathways on Professional Practice, Patient Outcomes, Length of Stay, and Hospital Costs: Cochrane Systematic Review and Meta-Analysis

This paper is a summary version of the previously published Cochrane review. It may increase the reach of the topic to health researchers and practitioners and encourage further discussion. The systematic review aims to summarize the evidence and assess the effect of clinical pathways on professional practice, patient outcomes, length of hospital stay, and hospital costs. The authors searched the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED, and Global Health. Twenty-seven studies considering a total of 11,398 participants were included for analysis. The main results were a reduction in in-hospital complications (odds ratio 0.58: 95% CI [0.36, 0.94] and improved documentation (odds ratio 11.95: 95% CI [4.72, 30.30]) associated with clinical pathways. Considerable variation in study design and settings prevented statistical pooling of results for length of stay (LOS) and hospital costs. The authors concluded that clinical pathways are associated with reduced in-hospital complications and improved documentation.

Electromechanical-Assisted Training for Walking After Stroke Updated Evidence

Improving walking after stroke is one of the main goals of rehabilitation. Electromechanical-assisted gait training uses specialist machines to assist walking practice and might help to improve walking after stroke. Our systematic review examined the effects of electromechanical and robotic-assisted gait training devices for improving walking after stroke and also assessed the acceptability and safety of this type of therapy. We searched the Cochrane Stroke Group Trials Register (last searched April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2012, Issue 2), MEDLINE (1966 to November 2012), EMBASE (1980 to November …

Quality of life and life circumstances in German myasthenia gravis patients

BackgroundMyasthenia gravis (MG) is a chronic neuromuscular disease. Advances in medical therapy have continuously increased the life expectancy of MG patients, without definitively curing the disease. To analyze life circumstances and quality of life (QoL), a large German MG cohort was investigated.Methods and SampleIn cooperation with the German Myasthenia Association, 2,150 patients with confirmed MG were asked to respond to a mailed questionnaire. The standardized questions related to demographic data, impairments, therapeutic course, use of complementary therapies, illness-related costs, and quality of life (SF-36). In total, 1,518 patients participated, yielding a response rate of 70.6%. The average age was 56.7 years, and the proportion of females 58.6%.ResultsDespite receiving recommended therapy, many patients still suffered from MG-related impairments. In particular, mobility and mental well-being were reduced; moreover, quality of life was markedly reduced. Stepwise linear regression analysis revealed illness stability, impairments, mental conditions, comorbid diseases, and employment to be determinants of QoL.ConclusionResults indicate that despite prolonged life expectancy among MG patients, health-related quality of life is low. This outcome resulted mainly from impaired mobility and depression. Physical and mental well-being might be improved by additional therapy options. Additionally, health care resources could be used more efficiently in these patients.

Adherence to Disease Modifying Drugs among Patients with Multiple Sclerosis in Germany: A Retrospective Cohort Study.

Background Long-term therapies such as disease modifying therapy for Multiple Sclerosis (MS) demand high levels of medication adherence in order to reach acceptable outcomes. The objective of this study was to describe adherence to four disease modifying drugs (DMDs) among statutorily insured patients within two years following treatment initiation. These drugs were interferon beta-1a i.m. (Avonex), interferon beta-1a s.c. (Rebif), interferon beta-1b s.c. (Betaferon) and glatiramer acetate s.c. (Copaxone). Methods This retrospective cohort study used pharmacy claims data from the data warehouse of the German Institute for Drug Use Evaluation (DAPI) from 2001 through 2009. New or renewed DMD prescriptions in the years 2002 to 2006 were identified and adherence was estimated during 730 days of follow-up by analyzing the medication possession ratio (MPR) as proxy for compliance and persistence defined as number of days from initiation of DMD therapy until discontinuation or interruption. Findings A total of 52,516 medication profiles or therapy cycles (11,891 Avonex, 14,060 Betaferon, 12,353 Copaxone and 14,212 Rebif) from 50,057 patients were included into the analysis. Among the 4 cohorts, no clinically relevant differences were found in available covariates. The Medication Possession Ratio (MPR) measured overall compliance, which was 39.9% with a threshold MPR≥0.8. There were small differences in the proportion of therapy cycles during which a patient was compliant for the following medications: Avonex (42.8%), Betaferon (40.6%), Rebif (39.2%), and Copaxone (37%). Overall persistence was 32.3% at the end of the 24 months observation period, i.e. during only one third of all included therapy cycles patients did not discontinue or interrupt DMD therapy. There were also small differences in the proportion of therapy cycles during which a patient was persistent as follows: Avonex (34.2%), Betaferon (33.4%), Rebif (31.7%) and Copaxone (29.8%). Conclusions Two years after initiating MS-modifying therapy, only 30–40% of patients were adherent to DMDs.

Factors Associated with Patient Satisfaction in Surgery: The Role of Patients' Perceptions of Received Care, Visit Characteristics, and Demographic Variables

BACKGROUND Measures of satisfaction of surgical patients can be used to evaluate and redesign the process of care or to complement established procedures to improve quality of services. However, study findings regarding aspects of patient satisfaction are often inconsistent and depend on the setting. The primary goals of this research were to identify factors associated with satisfaction among patients in a surgical setting. MATERIALS AND METHODS Data used in this study were obtained from randomly selected 2699 surgical patients discharged during January-December 2008 from 26 hospitals who responded to a mailed survey. The instrument assessed satisfaction regarding 23 items of perceived care, patient demographic, and visit characteristics. Bivariate and multivariate techniques were used to reveal relations between indicators and overall satisfaction. RESULTS Bivariate statistics showed strong relations between overall satisfaction and perceived care with weaker findings pertaining to demographic and visit characteristics. The Multivariate logistic regression predicting overall satisfaction demonstrated that patients receiving surgical services predominantly have similar demands and priorities regardless of age and gender. The strongest factors were (P < 0.05) the interpersonal manner of medical practitioners and nurses, organization of operations, admittance, and discharge, as well as perceived length of stay. CONCLUSIONS This study identified factors that are related to satisfaction of surgical patients and indicated the intensity of this relationship. These findings support health care providers and medical practitioners with valuable information to meet needs and preferences of patients receiving surgical services.

Problems reported by elderly patients with multiple sclerosis.

&NA; Multiple sclerosis (MS) is one of the most common organic neurological diseases of the central nervous system. Because of improved therapies, nurses are confronted with elderly MS patients, but little is known about the specific problems of these patients. This survey analyzed problems in elderly MS patients. Fifty‐three MS patients (44 female. 9 male; average age 73 years, average course of MS 25.3 years) from the Berlin Section of the German Multiple Sclerosis Association were evaluated by using a standardized questionnaire, considering social situation, daily problems, disease course, and disabilities, and by using the expanded disability status scale (EDSS). Elderly MS patients reported impaired mobility and inability to use public transportation; about 96% presented EDSS scores above 6.0. Nearly 50% complained about spasticity and pain due to spasticity. More than 70% suffered from bladder dysfunction. Problems with sleep and fatigue were present in less than 20%, but interrupted sleep was common. Selfcare impairments were reported by 50%‐75% of the patients. and most of them required professional help. Depressive moods and thoughts about committing suicide were mentioned by more than 30% of the patients. Elderly MS patients experience physical and psychosocial impairments. Healthcare professionals should consider increasing independence and avoiding nursing home admissions in the management of elderly MS patients.

Analysis of factors associated with patient satisfaction in ophthalmology: the influence of demographic data, visit characteristics and perceptions of received care.

Citation information: Schoenfelder T, Klewer J & Kugler J. Analysis of factors associated with patient satisfaction in ophthalmology: the influence of demographic data, visit characteristics and perceptions of received care. Ophthalmic Physiol Opt 2011, 31, 580–587. doi: 10.1111/j.1475‐1313.2011.00869.x

Smoking and its Association with Disability in Chronic Conditions: Results from the Canadian Community and Health Survey 2.1

The aim of the present study was to evaluate the association between smoking, chronic conditions, and short-term disability in a representative community sample. The analysis was based on data from 115,548 respondents from the Canadian Community and Health Survey (CCHS-2.1), a nationally representative survey. Smoking status, chronic conditions, and short-term disability were assessed by self-report. The population prevalence of current smoking was 23.5%. More than half of the subjects (51.9%) reported at least one chronic condition. Although a large number of subjects with chronic conditions had stopped smoking (33.7%), a high prevalence of current smoking remained (22.9%) among subjects with chronic conditions. Disability was markedly elevated in smokers with chronic medical conditions. Subjects with chronic conditions who smoked were more likely to report disability days than subjects with chronic conditions who never smoked (27.2% and 20.5%, respectively). Our results suggest that smoking is associated with short-term disability in subjects with chronic health problems.