R.A. Fahland

Health-related behaviour, knowledge, attitudes, communication and social status in school children in Eastern Germany

Enhancing health literacy is a keystone in health promotion. Yet, most studies on health literacy are limited to functional literacy levels. Furthermore, little evidence is available from children. Based on Nutbeams outcome model for health promotion, this study aims (i) to elaborate a set of short scales to measure important health literacy domains in children and (ii) to analyse their associations among each other, with health behaviour as an intermediate health outcome, subjective health, social status and gender. The sample comprised 852 school children in fifth grade, aged 9-13 years, in Western Pomerania, Germany. Items were taken from the childs questionnaire to form short scales for health-related knowledge, attitudes, communication and behaviour. The internal consistencies of the communication and attitude scales were 0.73 and 0.57, respectively. Unidimensional scalability of the knowledge and behaviour scales was supported by item response models. Associations between health scales were modest. In regression analyses, social status and gender predicted only health knowledge and communication but not health behaviours, attitudes and self-efficacy. Health knowledge was not associated with any other scale. Our results suggest that targeting one specific component of health literacy in children is likely to exert only small effects on health status and health behaviour.

Assessing a risk tailored intervention to prevent disabling low back pain - protocol of a cluster randomized controlled trial

BackgroundAlthough most patients with low back pain (LBP) recover within a few weeks a significant proportion has recurrent episodes or will develop chronic low back pain. Several mainly psychosocial risk factors for developing chronic LBP have been identified. However, effects of preventive interventions aiming at behavioural risk factors and unfavourable cognitions have yielded inconsistent results. Risk tailored interventions may provide a cost efficient and effective means to take systematic account of the individual risk factors but evidence is lacking.Methods/DesignThis study will be a cluster-randomised controlled trial comparing screening and a subsequent risk tailored intervention for patients with low back pain to prevent chronic low back pain compared to treatment as usual in primary care. A total of 600 patients from 20 practices in each study arm will be recruited in Berlin and Goettingen. The intervention comprises the following elements: Patients will be assigned to one of four risk groups based on a screening questionnaire. Subsequently they receive an educational intervention including information and counselling tailored to the risk group. A telephone/email consulting service for back pain related problems are offered independent of risk group assignment. The primary outcomes will be functional capacity and sick leave.DiscussionThis trial will evaluate the effectiveness of screening for risk factors for chronic low back pain followed by a risk tailored intervention to prevent chronic low back pain. This trial will contribute new evidence regarding the flexible use of individual physical and psychosocial risk factors in general practice.Trial registrationISRCTN 68205910

Welcher Weg führt von chronischen Rückenschmerzen zur Depressivität

BACKGROUND Chronic pain and depression are highly comorbid; however, the longitudinal link is only partially understood. This study examined direct and indirect effects of chronic back pain on depression using path analysis in a general population sample, focussing on cognitive mediator variables. METHODS Analyses are based on 413 participants (aged 18-75 years) in a population-based postal survey on back pain who reported chronic back pain at baseline. Follow-up data were collected after 1 year. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Fear-avoidance-beliefs (FABQ), catastrophizing and helplessness/hopelessness (KRSS) were considered as cognitive mediators. Data were analyzed using path analysis. RESULTS Chronic back pain had no direct effect on depression at follow-up when controlling for cognitive mediators. A mediating effect emerged for helplessness/hopelessness but not for catastrophizing or fear-avoidance beliefs. CONCLUSIONS These results support the cognitive mediation hypothesis which assumes that psychological variables mediate the association between pain and depression. The importance of helplessness/hopelessness is of relevance for the treatment of patients with chronic back pain.

[Back pain and social status among the working population: what is the association? Results from a German general population survey].

BACKGROUND Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain. METHODS In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression. RESULTS Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence. DISCUSSION Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.

[Which route leads from chronic back pain to depression? A path analysis on direct and indirect effects using the cognitive mediators catastrophizing and helplessness/hopelessness in a general population sample].

BACKGROUND Chronic pain and depression are highly comorbid; however, the longitudinal link is only partially understood. This study examined direct and indirect effects of chronic back pain on depression using path analysis in a general population sample, focussing on cognitive mediator variables. METHODS Analyses are based on 413 participants (aged 18-75 years) in a population-based postal survey on back pain who reported chronic back pain at baseline. Follow-up data were collected after 1 year. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Fear-avoidance-beliefs (FABQ), catastrophizing and helplessness/hopelessness (KRSS) were considered as cognitive mediators. Data were analyzed using path analysis. RESULTS Chronic back pain had no direct effect on depression at follow-up when controlling for cognitive mediators. A mediating effect emerged for helplessness/hopelessness but not for catastrophizing or fear-avoidance beliefs. CONCLUSIONS These results support the cognitive mediation hypothesis which assumes that psychological variables mediate the association between pain and depression. The importance of helplessness/hopelessness is of relevance for the treatment of patients with chronic back pain.

Epidemiologie und gesundheitsökonomische Aspekte des chronischen Schmerzes

Chronische Schmerzen sind ein weitverbreitetes Gesundheitsproblem, das mit relevanten individuellen Beeintrachtigungen einhergeht, zu erheblichen Kosten im Gesundheitssystem fuhrt und einen grosen volkswirtschaftlichen Schaden anrichtet. Verbreitung, Ursachen und Folgen chronischer Schmerzen werden durch die Epidemiologie beleuchtet. Ungefahr jeder 10. Erwachsene ist durch chronische Schmerzen in seinem Alltag beeintrachtigt, wobei nur minderheitlich eindeutige somatische Ursachen bestehen. Auch Kinder- und Jugendliche berichten haufig von andauernden Schmerzproblemen. Bei Erwachsenen ist der Rucken am haufigsten betroffen, bei Jugendlichen stehen Kopf-, bei Kindern Bauchschmerzen im Vordergrund. Kosten bedingen Schmerzen durch die Inanspruchnahme medizinischer Leistungen sowie durch Arbeitsausfalle. Ruckenschmerzen verursachen in Deutschland die hochsten Gesamtkosten aller Schmerzprobleme, wobei Schatzungen je nach Methodik stark variieren.

Implementation and evaluation of the population-based programme "health literacy in school-aged children" (GeKoKidS)

AimHealth literacy (HL) is a key outcome of health education. Low HL is associated with a higher risk of health-related impairments and high health-related costs. This article therefore describes the contents and evaluation of the school-based programme “Health literacy in school-aged children” (GeKoKidS) and its acceptance by teachers. A second focus of the study is the description of methods to increase the response of schools, students and parents as a crucial condition for the validity and generalizability of results from epidemiologic prevention studies.Subjects and methodsThe evaluation of the prevention program GeKoKidS included 5th grade students aged 9–13 years in schools in the region of Greifswald and East Pomerania [longitudinal randomised control group pre-post design (RCT)]. Data collections took place within the extended school dentist examination visits at the beginning of the 2007/2008 school year and at the beginning of the second half term of the 2008/2009 school year. This included medical examinations and self-completion questionnaires of students, parents and teachers. The study was authorised by the data protection commissioner of Mecklenburg-West Pomerania, the Ministry of Education, Science and Culture of Mecklenburg-West Pomerania and the Ethics Commitee of the Ernst Moritz Arndt University Greifswald. Based on the authorisation of the data protection concept and concerns about selective response, parents were not granted a consent but rather a right to refuse participation.In order to attain a high participation rate of the schools, the school principals were informed about the research project by an invitation letter, telephone calls and personal visits. Additionally an agreement on participation was handed out to all schools as a binding criterion for participation. By signing this agreement schools committed to using the offered teaching material, to participate in teacher training and evaluation, and to provide resources with respect to time and space.At the beginning of the 2007/2008 school year, all parents of 5th grade students were informed about the research project, the prevention programme and aspects of data protection. In order to increase the response rate parents also received a supporting letter from the Minister of Education, Science and Culture of Mecklenburg-West Pomerania, which mainly provided information about the importance of the research project and asked for support of this study.ResultsIn Greifswald/East Pomerania, 19 of 22 schools with 5th year classes participated in GeKoKidS (response rate: 86.3%). Out of 914 eligible students in the participating schools, 882 children (96.4%) took part in the school dentist examinations. A total of 863 children (94.4%) participated in the extended school dentist examination; 852 children (93.2%) took part in the student survey. In the parental survey 721 parents participated (response rate: 78.8%). A high level of acceptance referring to teacher training and the appropriateness of the GeKoKidS programme was achieved.ConclusionAs shown by the low rate of refusal, the programme and the evaluation study were well accepted. Possible reasons for these results could be the chosen procedure of establishing contact with schools before sending the questionnaires and the parent’s right to refuse their childs participation instead of giving an active confirmation. Because of this high response rate, the database enables comprehensive conclusions to be reached on the health-related state of students in Greifswald/East Pomerania.

Welcher Weg führt von chronischen Rückenschmerzen zur Depressivität?Which route leads from chronic back pain to depression?

BACKGROUND Chronic pain and depression are highly comorbid; however, the longitudinal link is only partially understood. This study examined direct and indirect effects of chronic back pain on depression using path analysis in a general population sample, focussing on cognitive mediator variables. METHODS Analyses are based on 413 participants (aged 18-75 years) in a population-based postal survey on back pain who reported chronic back pain at baseline. Follow-up data were collected after 1 year. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Fear-avoidance-beliefs (FABQ), catastrophizing and helplessness/hopelessness (KRSS) were considered as cognitive mediators. Data were analyzed using path analysis. RESULTS Chronic back pain had no direct effect on depression at follow-up when controlling for cognitive mediators. A mediating effect emerged for helplessness/hopelessness but not for catastrophizing or fear-avoidance beliefs. CONCLUSIONS These results support the cognitive mediation hypothesis which assumes that psychological variables mediate the association between pain and depression. The importance of helplessness/hopelessness is of relevance for the treatment of patients with chronic back pain.

Welcher Weg führt von chronischen Rückenschmerzen zur Depressivität?@@@Which route leads from chronic back pain to depression?: Eine Pfadanalyse zu direkten und indirekten Effekten unter Berücksichtigung kognitiver Mediatoren des Katastrophisierens und der Hilf-/Hoffnungslosigkeit in einer Allgemeinbevölkerungsstichprobe@@@A path analysis on direct and indirect effects using the cognitive mediators catastrophizing and helplessness/hopelessness in a general population sample

BACKGROUND Chronic pain and depression are highly comorbid; however, the longitudinal link is only partially understood. This study examined direct and indirect effects of chronic back pain on depression using path analysis in a general population sample, focussing on cognitive mediator variables. METHODS Analyses are based on 413 participants (aged 18-75 years) in a population-based postal survey on back pain who reported chronic back pain at baseline. Follow-up data were collected after 1 year. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Fear-avoidance-beliefs (FABQ), catastrophizing and helplessness/hopelessness (KRSS) were considered as cognitive mediators. Data were analyzed using path analysis. RESULTS Chronic back pain had no direct effect on depression at follow-up when controlling for cognitive mediators. A mediating effect emerged for helplessness/hopelessness but not for catastrophizing or fear-avoidance beliefs. CONCLUSIONS These results support the cognitive mediation hypothesis which assumes that psychological variables mediate the association between pain and depression. The importance of helplessness/hopelessness is of relevance for the treatment of patients with chronic back pain.

Rückenschmerz und Sozialschicht bei Berufstätigen@@@Back pain and social status among the working population: Ergebnisse einer deutschen Bevölkerungsstichprobe@@@What is the association? Results from a German general population survey

BACKGROUND Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain. METHODS In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression. RESULTS Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence. DISCUSSION Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.