Ulla Walter

Burnout prevention: a review of intervention programs.

OBJECTIVE To evaluate the effectiveness of intervention programs at the workplace or elsewhere aimed at preventing burnout, a leading cause of work related mental health impairment. METHODS A systematic search of burnout intervention studies was conducted in the databases Medline, PsycINFO and PSYNDEX from 1995 to 2007. Data was also extracted from papers found through a hand search. RESULTS A total of 25 primary intervention studies were reviewed. Seventeen (68%) were person-directed interventions, 2 (8%) were organization-directed and 6 (24%) were a combination of both interventions types. Eighty percent of all programs led to a reduction in burnout. Person-directed interventions reduced burnout in the short term (6 months or less), while a combination of both person- and organization-directed interventions had longer lasting positive effects (12 months and over). In all cases, positive intervention effects diminished in the course of time. CONCLUSION Intervention programs against burnout are beneficial and can be enhanced with refresher courses. Better implemented programs including both person- and organization-directed measures should be offered and evaluated. PRACTICE IMPLICATIONS A combination of both intervention types should be further investigated, optimized and practiced. Institutions should recognize the need for and make burnout intervention programs available to employees.

Correlates of physical activity of children and adolescents: A systematic review of reviews:

Objective: The aim of this study was to identify promoting and inhibiting correlates associated with the physical activity (PA) of children and adolescents (aged 3–18). The intention was to demonstrate the complexity of correlates of PA and to determine possible influencing factors. Design: A systematic review of reviews. Methods: Systematic database research was carried out in Medline, Cochrane Library, EMBASE, PsycInfo, Springer Link and Thieme Connect. Inclusion criteria were that the study: (a) was classified as a systematic review with or without meta-analysis; (b) was published between 2000 and 2009; (c) dealt with children and adolescents aged 3–18; (d) had as its dependent variable any measure of overall PA; and (e) reviewed associations between quantitatively measured variables and PA. The internal validity of the systematic reviews thus identified was evaluated using a validated quality instrument. Results: Nine systematic reviews without meta-analysis and one systematic review with meta-analysis were selected. Altogether 16 correlates were identified which were consistently associated with PA of children and/or adolescents: sex, age, ethnicity, parental education, family income, socioeconomic status, perceived competence, self-efficacy, goal orientation/motivation, perceived barriers, participation in community sports, parental support, support from significant others, access to sport/recreational facilities und time outdoors. Conclusions: Although the findings of the reviews covered are to some extent heterogeneous, it is possible to identify consistent correlates of PA in children and adolescents. The results show that PA is a complex and multi-dimensional behaviour determined by numerous biological, psychological, sociocultural and environmental factors.

Gesundheit im Alter

ZusammenfassungPrävention zielt auf die Vermeidung oder Hinauszögerung einer gesundheitlichen Beeinträchtigung. Für die Zielgruppe der Älteren gilt es die Selbstständigkeit möglichst dauerhaft zu erhalten und Pflegeund Hilfsleistungen zu vermeiden oder zu reduzieren. Ansatzpunkte sind Maßnahmen, die auf einen gesunden Lebensstil abstellen. Ausreichende Bewegung, Rauchabstinenz und Normalgewicht haben nachweislich positive Effekte auf die medizinisch und ökonomisch relevanten Erkrankungen wie Diabetes mellitus Typ 2, Herz-Kreislauf-Erkrankungen und bestimmte Demenzen. Die wechselseitigen Einflüsse dieser Erkrankungen untereinander erhöhen das präventive Potenzial. Für Präventionsmaßnahmen muss – wie andere Gesundheitsleistungen auch – die Kosten-Effektivität nachgewiesen werden. Für nichtmedikamentöse Prävention liegen nur wenige deutsche Kosten-Nutzen- Studien vor. Internationale Studienergebnisse lassen sich nur eingeschränkt auf deutsche Verhältnisse übertragen. Untersuchungen der Kosten-Effektivität von Prävention für ältere Menschen sind national wie auch international rar. Die Präventionsforschung ist bislang im Vergleich zu anderen Gesundheitsbereichen vernachlässigt worden. Sowohl methodisch, aber auch in Bezug auf spezifische Interventionen und Zielgruppen besteht erheblicher Forschungsbedarf. Für die Gesundheitsökonomie zeigen sich besondere Herausforderungen durch unterschiedliche Zeitprofile und Kostenträger, aber auch in der Bewertung des Humankapitals der Älteren.AbstractThe objective of prevention is to avoid or to delay health impairments and diseases. For older people it is important to maintain their independence and to avoid and reduce the need for external help such as nursing care. Good starting points are the strategies for healthy life-style. Physical activity, smoking abstinence, and normal weight have proven to have their positive medical and economic effect on many chronic diseases such as type 2 diabetes mellitus, cardiovascular diseases, and certain types of dementia. The potential of prevention increases as those diseases affect one another. As for other health care, the cost-effectiveness of preventive measures must also be examined. There are few German studies addressing the cost-benefit of the non-medication prevention. Results from international studies can only partly be transferred to the German context. The cost-effectiveness for prevention for elderly people has been very rarely researched. Research in the field of prevention is so far not very well developed as for other health fields. There is a need for more specific research for methods, interventions and target groups. In health economics major challenges arise from different time schedules and various purchasers, as well as from the evaluation of human capital for elderly.

Maternal occupational exposure to chemical substances and the risk of infants small-for-gestational-age

BACKGROUND The association between maternal occupational exposure to specific chemical substances (organic solvents, carbon tetrachloride, herbicides, chlorophenols, polychlorinated biphenyls, aromatic amines, lead and lead compounds, mercury and mercury compounds) and birth of small-for-gestational-age (SGA) infants was evaluated using data from a prospective cohort study of 3,946 pregnant women in West Germany from 1987 to 1988. METHODS Occupational, medical, and psychosocial information was gathered through a questionnaire from pregnant women who were recruited between 15 and 28 gestational weeks. Exposure to chemical substances at the current workplace was assessed by a job-exposure matrix constructed by Pannett in 1985 and weighted for the number of working hours per week. Women not working at the time of the interview, women with multiple births, and women with stillbirths were excluded from analysis. Data were analyzed using dichotomous and polytomous logistic regression to control for age, smoking status, alcohol consumption, body mass index, and number of former births. RESULTS The results of the dichotomous logistic regression analysis suggest that leather work might be associated with the birth of infants small-for-gestational-age through exposure to chlorophenols (P = 0.02) and aromatic amines (P = 0.05). In the polytomous logistic regression analysis, only the association between exposure to mercury and growth retardation reached statistical significance (P = 0.02); however, the power of the study is limited. Further adjustment for income, shift work, and heavy physical work had no substantial effect on the results. CONCLUSIONS These findings suggest that maternal exposure to specific chemicals at work may be a risk factor for the birth of SGA infants.

Incidence and long‐term risk of de novo malignancies after liver transplantation with implications for prevention and detection

The goal of this study was the characterization of long‐term cancer risks after liver transplantation (LT) with implications for prevention and detection. Site‐specific cancer incidence rates and characteristics were compared retrospectively for 2000 LT patients from a single institution (January 1, 1983 to December 31, 2010) and the general German population with standardized incidence ratios (SIRs); the total follow‐up at December 31, 2011 was 14,490 person‐years. The cancer incidence rates for the LT recipients were almost twice as high as those for the age‐ and sex‐matched general population (SIR = 1.94, 95% CI = 1.63‐2.31). Significantly increased SIRs were observed for vulvar carcinoma (SIR = 23.80), posttransplant lymphoproliferative disorder/non‐Hodgkin lymphoma (SIR = 10.95), renal cell carcinoma (SIR = 2.65), lung cancer (SIR = 1.85), and colorectal cancer (SIR = 1.41). The mean time between transplantation and diagnosis was 6.8 years. The mean age at the time of diagnosis was significantly lower for the cohort versus the general population with similar malignancies [50 years (both sexes) versus 69 and 68 years (males and females), P ≤ 0.006]. Tumors were diagnosed at more advanced stages, and there was a trend of higher grading, which suggested more aggressive tumor growth. Tumor treatment was performed according to accepted guidelines. Surprisingly, 5‐year survival was slightly better in the study cohort versus the general population for renal cell carcinoma, lung cancer, colorectal cancer, and thyroid cancer. Long‐term immunosuppression with different protocols did not lead to significantly different SIRs, although patients treated with mycophenolate mofetil had the lowest SIR for de novo cancers (1.65, 95% CI = 1.2‐2.4). Alcoholic liver disease (SIR = 2.30) and primary sclerosing cholangitis (SIR = 3.40) as indications for LT were associated with an increased risk of de novo malignancies. In conclusion, risk‐adapted cancer surveillance is proposed. Tumor treatment performed according to accepted guidelines appears adequate. Mycophenolate may lead to lower long‐term risks for de novo cancers. Liver Transpl 19:1252–1261, 2013.

Health in the context of growing old: social representations of health.

Senior citizens have become a major part of the clientele of general practitioners and home care nurses due to a major demographic transition in most western countries. How do the health concepts in professional practice reflect these trends? Research has largely investigated the health concepts of lay people. This study is focused on the representations of health in old age held by two groups of professionals— general practitioners and nurses—both working in home care with elderly people in two German cities. The results show how health professionals use an extended concept of health, which focuses on the life situation of the old person, on autonomy, self-determination or independence and on how the elderly manage disease and physical restrictions.

Krankheitslast und Gesundheit im Alter

ZusammenfassungIn der zweiten Lebenshälfte nehmen die körperlichen und psychosozialen Beeinträchtigungen besonders durch chronische Erkrankungen und Multimorbidität erheblich zu. Auch wenn sich in den vergangenen Jahrzehnten die Gesundheit der Älteren deutlich verbessert hat, bestehen weiterhin große und häufig unterschätzte präventive Potenziale. Der Beitrag gibt auf der Basis von Surveys, Daten der Kassenärztlichen Vereinigung und Krankenkassendaten einen Überblick über die Krankheitslast, die Gesundheit und das Gesundheitsverhalten der Älteren in Deutschland. Ziel ist es, präventionsrelevante Bereiche sowie Ansätze zur Prävention aufzuzeigen. Erforderlich sind Strategien, die neben der körperlichen auch die psychische und soziale Dimension des Alterns berücksichtigen. Noch hemmen vielfach system-, betroffenen- und professionenbezogene Faktoren ihre Realisierung. Als primäre professionelle Ansprechpartner für die Zielgruppe spielen Ärzte und Pflegekräfte eine besonders wichtige Rolle. Allerdings sind Prävention und Gesundheitsförderung im Alter gesamtgesellschaftliche Aufgaben, die die adäquate Einbeziehung weiterer Berufsgruppen sowie eine deutliche Weichenstellung in der Politik erfordern.AbstractDue to chronic illness and multimorbidity, the physical and psychosocial impairments increase significantly in the second half of life. Even though the health condition of the elderly has improved in recent years, the potential for prevention in older people is still undervalued. On the basis of surveys, data from the Association of CHI Physicians and health insurance data, this article provides a review of health and health behaviour of the elderly in Germany. It aims to point out areas of particular relevance for prevention and preventive approaches. Strategies that consider mental and social aspects of aging beside the physical ones are necessary. Systematic, personal and professional factors still inhibit the realisation of these strategies. In this context, doctors and nurses are particularly important as primary professional contact persons for the target group. However, prevention and health promotion in that age group are social tasks, which need the appropriate involvement of further professionals and an explicit political agenda setting.

Morbidity and health in old age. A challenge for prevention and health care

ZusammenfassungIn der zweiten Lebenshälfte nehmen die körperlichen und psychosozialen Beeinträchtigungen besonders durch chronische Erkrankungen und Multimorbidität erheblich zu. Auch wenn sich in den vergangenen Jahrzehnten die Gesundheit der Älteren deutlich verbessert hat, bestehen weiterhin große und häufig unterschätzte präventive Potenziale. Der Beitrag gibt auf der Basis von Surveys, Daten der Kassenärztlichen Vereinigung und Krankenkassendaten einen Überblick über die Krankheitslast, die Gesundheit und das Gesundheitsverhalten der Älteren in Deutschland. Ziel ist es, präventionsrelevante Bereiche sowie Ansätze zur Prävention aufzuzeigen. Erforderlich sind Strategien, die neben der körperlichen auch die psychische und soziale Dimension des Alterns berücksichtigen. Noch hemmen vielfach system-, betroffenen- und professionenbezogene Faktoren ihre Realisierung. Als primäre professionelle Ansprechpartner für die Zielgruppe spielen Ärzte und Pflegekräfte eine besonders wichtige Rolle. Allerdings sind Prävention und Gesundheitsförderung im Alter gesamtgesellschaftliche Aufgaben, die die adäquate Einbeziehung weiterer Berufsgruppen sowie eine deutliche Weichenstellung in der Politik erfordern.AbstractDue to chronic illness and multimorbidity, the physical and psychosocial impairments increase significantly in the second half of life. Even though the health condition of the elderly has improved in recent years, the potential for prevention in older people is still undervalued. On the basis of surveys, data from the Association of CHI Physicians and health insurance data, this article provides a review of health and health behaviour of the elderly in Germany. It aims to point out areas of particular relevance for prevention and preventive approaches. Strategies that consider mental and social aspects of aging beside the physical ones are necessary. Systematic, personal and professional factors still inhibit the realisation of these strategies. In this context, doctors and nurses are particularly important as primary professional contact persons for the target group. However, prevention and health promotion in that age group are social tasks, which need the appropriate involvement of further professionals and an explicit political agenda setting.

Social Representations of Health Held by Health Professionals: the Case of General Practitioners and Home-care Nurses

To date, social representations research in the field of health and illness has focused mainly on lay representations of health. In the context of the “New Public Health”, the more general concept of health (instead of the more reduced concept of curing illness) has become a major target for professional work. From this trend, the following research questions can be drawn: do health professionals hold a concept of health? If so, what is the major focus of such a concept? And does it include topics from the New Public Health discourse? Following a short review of the research into social representations of health, some preliminary results of a qualitative research study are presented. This study focused on representations of health held by two groups of professionals - general practitioners and nurses - both working in home care with elderly people in two German cities. The first results of this study found that, in both groups, different types of health concepts can be identified. In both groups, a strong reference was made to the World Health Organization definition. Among other concepts, a relative concept of health was held. The concepts are expressed with reference to the specific clientele of home-care work. The results are discussed with reference to the differences and overlaps with the other research on health concepts.

Educational campaign on stroke in an urban population in Northern Germany: influence on public stroke awareness and knowledge

Background Public stroke awareness and knowledge may be supportive for stroke prevention and emergency care-seeking behavior after the acute event, which is highly important for early treatment onset. Aims In an urban population in Northern Germany (Hannover), a six-month stroke educational campaign was conducted. We expected an increase in stroke knowledge and awareness thereafter. Methods Computer-assisted telephone interviews were randomly conducted among 1004 representative participants before and 1010 immediately after the educational multimedia campaign. The computer-assisted telephone interviews focused on questions about stroke knowledge and interventions remembered. Results Knowledge of stroke risk factors increased during the campaign for overweight, physical inactivity, old age, and stroke in family (P < 0·05). The knowledge of stroke warning signs was low, although it significantly increased during the campaign (P < 0·001) as paresis/weakness (46%) and speech problems (31%) were most frequently named. The majority of respondents indicated that the first action after suffering from stroke should be calling emergency care (74% before vs. 84% after campaign, P < 0·001). Conclusions Our data indicate that stroke knowledge and awareness, which could provide earlier presentation to the emergency unit for timely treatment onset, are still low in urban Northern Germany but may decisively be increased by educational campaigns.