Matthias Claus

Dying With Dementia Symptom Burden, Quality of Care, and Place of Death

BACKGROUND No detailed information has been available until now about the care setting, circumstances and place of death, symptom burden, and quality of care of persons with end-stage dementia in Germany. METHODS This cross-sectional study is based on a random sample of 5000 persons who died in the period from 25 May to 24 August 2008 in the German federal state of Rhineland-Palatinate. Their surviving relatives were contacted and asked to participate in a questionnaire survey. Data were obtained in this way for 310 persons with dementia and 931 persons without dementia. RESULTS 42.4% of the persons with dementia died at home. Most patients and their relatives preferred death at home to death anywhere else (94.8% of patients, 77.5% of relatives). Persons living with at least one relative were more likely to die at home (adjusted odds ratio [aOR] 4.69, 95% confidence interval [CI] 2.71-8.11). According to information supplied by the relatives, the overwhelming majority of patients suffered, two days before death, from moderate to severe weakness (94.9%), fatigue (94.4%), disorientation/confusion (86.9%), and appetite loss (86.4%). Other common symptoms were anxiety (61.0%), tension (59.9%), dyspnea (56.7%), and pain (52.5%). The relatives were critical of the quality of care on standard hospital wards, citing the limited temporal availability of staff and limited emotional support. CONCLUSION These data indicate the high symptom burden of persons with dementia in Germany at the end of their lives. They underscore the need for proper palliative care in all of the settings where persons with dementia die. Specialized in- and outpatient palliative care should not be offered only to patients with cancer, but should rather be made available to all who need it.

Factors influencing place of death in Germany.

CONTEXT Knowledge about factors influencing the place of death may be very useful for the planning of public health strategies to improve the situation of terminally ill patients. OBJECTIVES The aim of our study was to determine where people died in the German federal state of Rhineland-Palatinate in 2008. We further wanted to detect which factors had an influence on the place of death. METHODS Our cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate who had died between May 25, 2008 and August 24, 2008. Relatives of these randomly drawn deceased persons were interviewed by means of a written survey. RESULTS After removing duplicates, 4967 questionnaires were sent out. In total, 3832 questionnaires were delivered and 1378 completed, leading to a response rate of 36.0%. Of this group, 38.2% of the deceased died at home, 39.3% in a hospital, 13.4% in a nursing home, 7.5% in a palliative care facility, and 1.6% elsewhere. Suffering from cancer (adjusted odds ratio [AOR]: 1.30; 95% confidence interval [CI]: 1.01-1.68), social support (AOR being married: 1.33; 95% CI: 1.04-1.70; AOR having a nonworking relative: 1.71; 95% CI: 1.28-2.29), a high care level (AOR Care Level II: 2.79; 95% CI: 2.06-3.79, AOR Care Level III: 4.96; 95% CI: 3.40-7.24), and living in a rural municipality (AOR: 1.36; 95% CI: 1.01-1.84) were major factors favoring home death compared with institutional death. CONCLUSION Compared with other European countries, home death is still a frequent event in the federal state of Rhineland-Palatinate. Regional health policy should consider the actual distribution of place of death and corresponding predicting factors when establishing specialized palliative care home services as designed by recent German health legislation.

Hypothenar hammer syndrome: A multicenter case–control study

BACKGROUND The rarely diagnosed hypothenar hammer syndrome (HHS) is due to vascular damage to the distal part of the ulnar artery probably caused by acute or repetitive blunt trauma to the hypothenar region. To date, mainly case reports have been published, while epidemiological data are almost absent. AIM To identify potential risk factors for HHS. METHOD An interview-based multicenter case-control study of 71 patients with HHS and 105 matched controls was conducted with standardized questions regarding disease specific variables, occupation, exposure of the hands to different types of trauma in occupational and leisure context. Medical data were verified from individual medical records. RESULTS Multivariable logistic regression analysis revealed that using the hand as a hammer on a daily basis (adjusted odds ratio [aOR] 17.04, 95% CI 5.51-52.67) daily pressure to the palm of the hand (aOR 4.96, 95% CI 1.39-17.71), and daily exposure to vibrating tools (aOR 3.41, 95% CI 1.03-11.31) were significant risk factors for HHS. CONCLUSIONS This investigation represents one of the largest groups of patients with HHS described so far. Work-related repeated blunt trauma to the palm of the hand significantly increases the risk of HHS.

The mental health of primary care physicians in Rhineland-Palatinate, Germany: the prevalence of problems and identification of possible risk factors.

BACKGROUND The generally high job-related stress level among physicians may lead to various health impairments in the long run. Apart from job-related stress, stress during leisure time and certain personality traits might be risk factors for health impairments. However, very little research on the health situation of primary care physicians (PCPs) in Germany is available. Therefore, the objective of the present study was to systematically assess the stress experience and the health situation of German PCPs. One main focus was on mental health. METHODS In 2009, a state-wide survey among practice-based PCPs in the federal German state of Rhineland-Palatinate (cross-sectional study, n = 2092) was carried out in order to assess stress and strain as well as the health situation. RESULTS 790 participants (37.7%) were eligible for the analyses. One in four PCPs exceeded the cut-off value ≥ 3 for depression in the PHQ-2 (PHQ, Patient Health Questionaire). Moreover, approximately one in six PCPs stated that he or she had used psychotropic drugs or other psychoactive substances at least once in the preceding year. Stress during leisure time, type D personality and low job satisfaction were associated with the presence of mental health impairments in the binary logistic regression analyses. CONCLUSION All in all, it appears that mental health impairments are a common health problem among the PCPs. Target-group-specific measures should be taken in order to reduce the subjective stress level, and to foster mental hygiene. Furthermore, the development of favorable personality profiles and the corresponding behavioral patterns should be supported.

Improving End-of-Life Care in Hospitals: A Qualitative Analysis of Bereaved Families’ Experiences and Suggestions

Objectives: To explore and document the experiences and expectancies of bereaved family members concerning the end-of-life (EOL) care of their deceased relative in a general hospital setting. Methods: Cross-sectional study using a questionnaire that included open-ended questions. Free-text answers were evaluated with qualitative content analysis. A total of 270 family members provided information about improvements in inpatient care. Results: Families described structural deficiencies. Furthermore, they requested a more holistic patient health care beyond medical treatment and expressed the wish for more professional support for families. Discussion: The view of bereaved families confirmed the need for improvement in general hospital EOL care. The results underline the importance of a more holistic EOL care. The application of communication skills training, structured family meetings, and integrated pathways is recommended.

Symptom Prevalence in the Last days of Life in Germany The Role of Place of Death

Investigations have shown that symptom prevalence varies according to the place of death. We sought to assess the symptom prevalence of chronically ill people in Germany and how this prevalence differs depending on the place of death. We sent questionnaires to 5000 bereaved people in Rhineland-Palatinate (Germany), whose relatives died between May 25 and August 24, 2008. In all, 3832 questionnaires were delivered and 1378 completed (response 36.0%). Most decedents had moderate-to-severe weakness (94.5%), fatigue (93.5%), need for help in daily activities (87.9%), and appetite loss (87.4%). Pain and dyspnea were most severe in hospitals; fatigue, confusion/disorientation, and problems with wound care in nursing homes; and need for help in daily activities and overburden of family at home. Associations persisted after adjusting for potential confounders.

140 Sociodemographic and health-related factors associated with temporary work disability in a large german chemical company: results of a cross-sectional study

Introduction With the present study, we aimed to determine the occurrence of temporary work disability within 12 months in a large German chemical company. Furthermore, we assessed the association of sociodemographic and health-related factors with work disability. Methods We used cross-sectional data, surveyed in occupational health checks-ups between January 2011 and December 2014 at the Ludwigshafen site (Germany). A blood sample, physical examination, anamnesis by a physician and a written questionnaire were part of the health check-up. Work disability in the year prior to participation was assessed using a single (categorical) item from the Work-Ability-Index. We used partial proportional odds models for ordinal response variables to assess the association of sociodemographic and health-related factors with work disability. Results Altogether, 17 351 employees participated in the voluntary health check-up. Excluding 386 persons with missing information and trainees, a final sample of 16 965 persons was yielded. Respondents were on average 43.7 (SD: 9.7) years old and predominantly male (79.0%). About one third (32.8%) did not miss a single day, 40.8% up to nine days, 18.5% 10–24 days, 6.8% 25–99 days, and 1.1% 100 days or more. The proportion of respondents being unable to work for ≥10 days in the last 12 months was comparatively high for older persons (31.8%; 50+years) vs younger persons (22.6%; <30 years), manual workers (40.1%) vs managerial staff (8.3%), rotating shift workers (38.9%) vs day workers (21.9%), obese (38.1%) vs non-obese people (19.6%), and smokers (35.3%) vs non-smokers (20.6%). In multivariable analyses, missing ≥10 days was significantly more likely for older respondents, females, manual workers and skilled/supervisory workers (vs. managerial staff), rotating shift workers, obese people, and for smokers and former smokers (vs. non-smokers). Conclusion The findings of the present study could be considered a starting point for the implementation of targeted preventive measures to reduce work disability.

253 The association of age and chronotype in day and rotating shift workers of a large german chemical company

Introduction The aim of the present study was to evaluate the association between chronotype and age in day and rotating shift workers. Methods The present cross-sectional study was carried out between October 2012 and February 2015 in a large German chemical company. Employees participating in a regular voluntary occupational health check-up were requested to complete a written questionnaire, which included items on sleeping behaviour extracted from the Munich Chronotype Questionnaire. Inclusion criteria comprised a fully completed questionnaire, not having used an alarm clock on free days, and being employed either as a day or rotating shift worker. Senior executive managers, trainees and interns were excluded. We used univariable and multivariable linear regression analyses to assess the association between age and chronotype (in minutes) in the whole sample and stratified by shift status. Result Altogether 10 348 persons completed the questionnaire, of which 4040 (39.0%) met the inclusion criteria. Participants were on average 41.8 years old (SD: 10.2), mainly male (75.4%) and engaged in day work (82.3%). Mean chronotype was 03:23 (SD: 54 min.) in the total sample, 03:16 (SD: 55 min.) in day and 03:57 (SD: 35 min.) in rotating shift workers. With increasing age, chronotype declined from 04:00 (≤29 years) to 03:08 (≥50 years) in the whole sample, and from 03:54 to 02:59 in day and 04:25 to 03:45 in rotating shift workers. Univariable and multivariable linear regression analyses correspondingly showed a significant decline of chronotype with age in both, day and rotating shift workers. Discussion While day workers could benefit from a chronotype decrease, rotating shift workers could build up an intolerance regarding night work with increasing age. Shift workers might benefit from specific targeted prevention programs including sleep hygiene trainings.

Sickness presenteeism of German teachers: prevalence and influencing factors

Abstract The aim of the present study was to investigate teachers’ sickness presenteeism (SP). We examined the prevalence of SP in a sample of teachers as well as work-related and health-related influencing factors of teachers’ SP. We used a cross-sectional study design. Teachers working at different types of schools in Rhineland-Palatinate (Germany) participated in an online survey. We used Pearson’s Chi-squared test (in case of categorical variables) or Mann–Whitney-U-test (in case of continuous variables) to test for differences between SP and sociodemographic/work-related/health-related factors. Factors influencing SP were identified using multivariable logistic regression analyses. Nine hundred and twenty-four teachers working at 42 different schools completed the questionnaire (response proportion: 50.1%). The prevalence of SP in our study was 57.1%. The multivariable logistic regression analyses showed less support by supervisors (aOR: 1.77; 95-CI: 1.21–2.60), inappropriate administration efforts (aOR: 1.56; 95-CI: 1.16–2.11), and inappropriate recognition of performance (aOR: 1.44; 95-CI: 1.04–198) as well as exhaustion/fatigue (aOR: 2.29; 95-CI: 1.71–3.08) as main predictors of teachers’ SP. SP is widespread among teachers. As SP is associated with impairment of psychological and physical health in the long run, it is important to implement measures to reduce SP. A climate of support and cooperation as well as assistance for ill teachers to deal with work missed due to absence might be useful strategies.

0243 Rotating shift work and prevalence of diabetes mellitus and prediabetes in male employees of a large german chemical company: results of a cross-sectional study

Purpose The aim of the study was to investigate the association between rotating shift work (RSW) and prevalence of diabetes and prediabetes in male employees of a large chemical company. Methods We used cross-sectional data, surveyed in health checks between January 1st2011 and December 31st2014 at BASF SE in Ludwigshafen (Germany). A blood sample, physical examination and anamnesis by a medical officer as well as a written questionnaire were part of the health-check. Diabetes status (no diabetes, prediabetes, diabetes) was assessed via HbA1c-value and information provided by employees themselves. Shift status was surveyed using company records. Partial proportional odds models for ordinal response variables were applied to assess the association of RSW with diabetes status. Results Data on 9765 male employees (40.4% rotating shift workers) with a mean age of 44.3 years (SD: 9.6) could be used for analyses. Prevalence of diabetes and prediabetes in rotating shift workers were 6.4% and 14.2% respectively. Corresponding figures for day workers were 3.6% and 11.5% (p<0.001). Unadjusted analyses yielded an Odds Ratio of 1.85 (95%-CI: 1.53–2.22) for RSW (comparing diabetes with prediabetes/no diabetes). The effect attenuated in the fully adjusted multivariable model (aOR: 1.38; 95% CI: 1.11–1.70) but remained significant. The association between RSW and diabetes status varied by BMI and occupational status. The association was stronger in skilled/supervisory workers and respondents with a BMI <30 kg/m². Conclusions The present study found a significant association between RSW and diabetes which differed by BMI and occupational status. Declaration of potential conflict of interest: All authors are employees of BASF SE.