Das Gesundheitsverhalten von HausärztInnen und RechtsanwältInnen im Vergleich

Ziel dieser Arbeit ist der Vergleich des Gesundheitsverhaltens von HausärztInnen und RechtsanwältInnen in den Bereichen Ernährung, Körpergewicht, körperliche Aktivität, Rauchen, Stress und der Inanspruchnahme medizinischer Leistungen. Methode: Postalische Umfrage an je 350 AnwältInnen und HausärztInnen in Köln, der Rücklauf betrug 30,7% bei den HausärztInnen bzw. 37% bei den AnwältInnen. Ergebnisse: Hinsichtlich Soziodemographie und Arbeitszeitbelastung stellen sich HausärztInnen und AnwältInnen als sehr gut geeignete Vergleichsgruppen dar. HausärztInnen ernähren sich gesünder, aber zu 70% immer noch ungünstig im Sinne der zugrundegelegten Nahrungsmittelliste. Sie sind mit 32% weniger übergewichtig als AnwältInnen; sie geben an, sich in den Kategorien „Gymnastik, Aerobic“ und „andere Bewegungsarten“ öfter zu bewegen als AnwältInnen. In beiden Gruppen finden sich ca. 20% RaucherInnen, ÄrztInnen konsumieren jedoch deutlich weniger Zigaretten pro Tag. Beide Gruppen fühlen sich in vergleichbarem Umfang belastet und beansprucht, dabei geben HausärztInnen mehr Belastungsfaktoren an. HausärztInnen konsultieren deutlich seltener andere ÄrztInnen und nehmen zu 56,7% - ähnlich den AnwältInnen – an Krebsfrüherkennungsmaßnahmen teil. Schlussfolgerungen: Berücksichtigt man bias- Verzerrungen im Antwortverhalten, so ist das Gesundheitsverhalten von HausärztInnen nicht wesentlich besser als das von AnwältInnen, und keineswegs optimal. Die Reflexion über eigene Gesundheitsverhaltensweisen und diesbezüglicher Überzeugungen ist unabdingbar für effektive und authentische Gesundheitsberatung von PatientInnen. Gesundheitsberatung und –aufklärung kann nicht nur über kognitive Strategien vermittelt werden. Primärprävention, Salutogenese, psychosoziale Gesundheitskonzepte und Beratungsstrategien sollten in Aus- Fort- und Weiterbildung einen höheren Stellenwert erlangen, Präventionsarbeit muss angemessen vergütet werden

Tagesrhythmische Untersuchungen zur Elektroakupunktur nach Voll-eine Einschätzung zur chinesischen Organuhr

ZUSAMMENFASSUNG Die Elektroakupunktur nach VOLL, eine Methode, die in den 60er Jahren entwickelt wurde, beschäftigt sich mit dem „Energiehaushalt“ des Organismus, indem sie an festgelegten Hautmesspunkten, die in der Regel Akupunkturpunkten aus der traditionellen chinesischen Medizin entsprechen, modifizierte Hautwiderstandsmessungen vornimmt. Die Hautmesspunkte liegen auf Meridianen, also gedachten Energieleitbahnen. Jedem Meridian wird ein Organsystem zugeordnet, wobei ein anatomischer Bezug bis heute noch nicht eindeutig bewiesen ist. Prinzip der Messung ist, mit einer aus Messing bestehenden Punktelektrode (Messgriffel) bei einer Anpresskraft von 5 Newton auf die Haut des Probanden (gemessen wird an den Extremitäten) einen Messstrom durch den Körper des Probanden zu schicken, wodurch das betreffende Organsystem „gereizt“ werden und eine elektrische „Antwort“ zurückschicken soll. Die Chinesische Organuhr ordnet jedem Organsystem im Laufe eines Tages eine Maximalzeit zu, während der ein Funktionsoptimum durch maximale Versorgung mit Energie erreicht werden soll. Diese Maximalzeiten ändern sich im 2-Stunden- Rhythmus. Beginn des Energiekreislaufes ist mit 3.00 Uhr die Lunge, um 5.00 Uhr folgt Dickdarm, um 7.00 Magen, 9.00 Milz, anschließend Pankreas, Herz, Dünndarm, Harn-blase, Nieren, Kreislauf, Endokrinium (Dreifach-Erwärmer), Gallenblase und schließ-lich die Leber. Geprüft wurde, ob bei Messungen an Hautpunkten in zweistündigem Abstand über 24 Stunden Schwankungen der Messwerte festzustellen sind, und ob diese einen Bezug zur chinesischen Organuhr aufweisen. Dazu wurden 16 Probanden, bei denen keine akuten oder chronischen Erkrankungen vorlagen, untersucht. Die Versuche fanden in der Klimakammer des FG für Arbeits-physiologie unter strengen Ruhebedingungen sowie konstanter Raumtemperatur und Luftfeuchtigkeit und weitgehender Reizabschirmung statt. Auch die Nahrungsaufnahme erfolgte standardisiert (Rhythmuskost). Messbeginn war 13.00Uhr, wobei diese erste Messung als Vormessung nicht in die Wertung einging. Der untersuchte Zeitraum war also 15.00 Uhr (Tag1) bis 15.00Uhr (Tag2). Bei jeder Messung wurden jeweils 24 Hautmesspunkte (11 Organdoppelmesspunkte für paarige Organe, 2 Einzelmesspunkte für unpaarige Organe) an Händen und Füßen in festgelegter Reihenfolge untersucht. Zusätzlich wurden bei jedem Messdurchgang Puls, Atmung und Oraltemperatur gemes-sen. Insgesamt wurden 13 Messungen im Abstand von 2 Stunden durchgeführt und über ein angeschlossenes Computerprogramm gespeichert. Für alle Organsysteme fand sich ein prinzipiell ähnlicher Verlauf mit nächtlichen Minimalwerten (3.00) und Maximalwerten am Tage (15.00), wobei die Messkurven sinusähnlich waren. Auch die physiologischen Parameter zeigten einen Verlauf mit kleinsten Werten in den frühen Morgenstunden (3.00) und Maximalwerten gegen 15.00 Uhr. Insgesamt unterliegen die Messwerte also tagesrhythmischen Schwankungen in der Weise, wie sie für einige physiologische Parameter bereits früher gezeigt werden konnten. Diese Schwankungen für die untersuchten Hautpunkte waren sehr ähnlich und wiesen keine individuell spezifische Rhythmik auf, die sie voneinander stark unterscheiden würde. In Bezug auf die Chinesischen Organuhr lässt sich daher feststellen, dass die ihr eigene Organrhythmik mit der in der vorliegenden Untersuchung angewendeten Messmethode nicht nachgewiesen werden konnte

Redox and pH gradients drive amino acid synthesis in iron oxyhydroxide mineral systems

Iron oxyhydroxide minerals, known to be chemically reactive and significant for elemental cycling, are thought to have been abundant in early-Earth seawater, sediments, and hydrothermal systems. In the anoxic Fe^(2+)-rich early oceans, these minerals would have been only partially oxidized and thus redox-active, perhaps able to promote prebiotic chemical reactions. We show that pyruvate, a simple organic molecule that can form in hydrothermal systems, can undergo reductive amination in the presence of mixed-valence iron oxyhydroxides to form the amino acid alanine, as well as the reduced product lactate. Furthermore, geochemical gradients of pH, redox, and temperature in iron oxyhydroxide systems affect product selectivity. The maximum yield of alanine was observed when the iron oxyhydroxide mineral contained 1:1 Fe(II):Fe(III), under alkaline conditions, and at moderately warm temperatures. These represent conditions that may be found, for example, in iron-containing sediments near an alkaline hydrothermal vent system. The partially oxidized state of the precipitate was significant in promoting amino acid formation: Purely ferrous hydroxides did not drive reductive amination but instead promoted pyruvate reduction to lactate, and ferric hydroxides did not result in any reaction. Prebiotic chemistry driven by redox-active iron hydroxide minerals on the early Earth would therefore be strongly affected by geochemical gradients of E_h, pH, and temperature, and liquid-phase products would be able to diffuse to other conditions within the sediment column to participate in further reactions

Effect of advertising for a state-based health insurance marketplace on information-seeking behavior

Introduction • Kentucky was an early success stories under the Affordable Care Act through its statebased marketplace, known as kynect • The state sponsored an award-winning multimedia campaign to create awareness and educate its residents about the opportunity to gain coverage • In 2015, the new administration failed to renew a contract that resulted in the cancellation of television advertising for the final four weeks of the 2016 open enrollment period • We leverage this change to identify whether a dose-response relationship exists between state-sponsored television advertising and information seeking about health insurance Methods • Advertising data from 10 media markets across Kentucky was obtained for October 2013 through January 2016 from Kantar Media/CMAG through a partnership with the Wesleyan Media Project • State-level information-seeking was derived from reports made by the Office of the Kentucky Health Benefit Exchange to the Centers for Medicare and Medicaid Services obtained via public records request • Policy variable – state-level population-weighted average count of kynect ads per week • Outcomes – 1) calls to the kynect call center, 2) page views (number of individual pages viewed), 3) visits (including repeats from the same IP address), 4) unique visitors (excluding repeats) for the kynect web site • Linear regression models used to describe how changes in kynect advertising volume affected these outcomes, adjusting for other advertising (healthcare.gov, insurers, insurance agencies, nonprofits, and other state governments), open enrollment periods, and other relevant time periods (e.g., week of Thanksgiving, week of Christmas, etc.) Results • Advertising for kynect fell from an average of 58.8 and 52.3 ads per week during the 2014 and 2015 open enrollment periods, respectively, to 19.4 during the first nine weeks of the 2016 open enrollment period and none during the last four weeks • Each additional kynect ad per week during open enrollment was associated with – 7,973 additional page views for kynect website – 390 additional visits for kynect website – 388 additional unique visitors for kynect website • Advertising was not significantly associated with calls to the kynect call center Conclusions • State-sponsored television advertising was a key driver of information-seeking behavior in Kentucky during the 2014-2016 open enrollment periods • Our findings add to previous evidence indicating that government-sponsored media campaigns are associated with increased enrollment for health insurance exchanges • Reductions in public outreach efforts could have negative effects on the individual market if consumers are uncertain about the continued availability of coverage and so-called “healthy procrastinators” fail to enroll as a result, contributing to lower enrollment and potentially a worse risk pool for insurers Implications • Misconceptions about eligibility and deadlines for enrollment in health insurance coverage are barriers to having all eligible individuals covered • Given the uncertain future of the ACA and the individual non-group market for health insurance in the United States, our findings indicate that state-sponsored media campaigns can be an effective strategy for encouraging information-seeking behavio

Evaluating an implementation strategy in cardiovascular prevention to improve prescribing of statins in Germany: an intention to treat analysis

BACKGROUND: The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins. METHODS: We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients >= 35 years who were counselled before and after the study period were analysed (each n > 75000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients' overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes). RESULTS: There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect. CONCLUSION: Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician's prescribing behaviour is affected by an established health care system, which is not easy to change.Trial registration: ISRCTN71348772

Heartburn or angina? Differentiating gastrointestinal disease in primary care patients presenting with chest pain: a cross sectional diagnostic study

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal (GI) disease is one of the leading aetiologies of chest pain in a primary care setting. The aims of the study are to describe clinical characteristics of GI disease causing chest pain and to provide criteria for clinical diagnosis.</p> <p>Methods</p> <p>We included 1212 consecutive patients with chest pain aged 35 years and older attending 74 general practitioners (GPs). GPs recorded symptoms and findings of each patient and provided follow up information. An independent interdisciplinary reference panel reviewed clinical data of each patient and decided about the aetiology of chest pain. Multivariable regression analysis was performed to identify clinical predictors that help to rule in or out the diagnosis of GI disease and Gastroesophageal Reflux Disease (GERD).</p> <p>Results</p> <p>GI disease was diagnosed in 5.8% and GERD in 3.5% of all patients. Most patients localised the pain retrosternal (71.8% for GI disease and 83.3% for GERD). Pain worse with food intake and retrosternal pain radiation were associated positively with both GI disease and GERD; retrosternal pain localisation, vomiting, burning pain, epigastric pain and an average pain episode < 1 hour were associated positively only with GI disease. Negative associations were found for localized muscle tension (GI disease and GERD) and pain getting worse on exercise, breathing, movement and pain location on left side (only GI disease).</p> <p>Conclusions</p> <p>This study broadens the knowledge about the diagnostic accuracy of selected signs and symptoms for GI disease and GERD and provides criteria for primary care practitioners in rational diagnosis.</p

Differential diagnosis in primary care: Conception and implementation of a new elective seminar – an experience report

Primary care is in a unique position to teach the broad spectrum of differential diagnoses. We developed and piloted a new elective seminar ‘Differential Diagnosis in Primary Care’. With the help of simulation patients, training models, interactive small group work, and short lectures we addressed common complaints presented in the daily routine of primary care like vertigo, dyspnoea, chest or abdominal pain. We put a special focus on the diagnostic accuracy of history and physical examination. The final examination was conducted as an objective structured clinical examination

Redox and pH gradients drive amino acid synthesis in iron oxyhydroxide mineral systems

Iron oxyhydroxide minerals, known to be chemically reactive and significant for elemental cycling, are thought to have been abundant in early-Earth seawater, sediments, and hydrothermal systems. In the anoxic Fe^(2+)-rich early oceans, these minerals would have been only partially oxidized and thus redox-active, perhaps able to promote prebiotic chemical reactions. We show that pyruvate, a simple organic molecule that can form in hydrothermal systems, can undergo reductive amination in the presence of mixed-valence iron oxyhydroxides to form the amino acid alanine, as well as the reduced product lactate. Furthermore, geochemical gradients of pH, redox, and temperature in iron oxyhydroxide systems affect product selectivity. The maximum yield of alanine was observed when the iron oxyhydroxide mineral contained 1:1 Fe(II):Fe(III), under alkaline conditions, and at moderately warm temperatures. These represent conditions that may be found, for example, in iron-containing sediments near an alkaline hydrothermal vent system. The partially oxidized state of the precipitate was significant in promoting amino acid formation: Purely ferrous hydroxides did not drive reductive amination but instead promoted pyruvate reduction to lactate, and ferric hydroxides did not result in any reaction. Prebiotic chemistry driven by redox-active iron hydroxide minerals on the early Earth would therefore be strongly affected by geochemical gradients of E_h, pH, and temperature, and liquid-phase products would be able to diffuse to other conditions within the sediment column to participate in further reactions

Are fear-avoidance beliefs in low back pain patients a risk factor for low physical activity or vice versa? A cross-lagged panel analysis

Objective: The assumption that low back pain (LBP) patients suffer from “disuse” as a consequence of high fear-avoidance beliefs is currently under debate. A secondary analysis served to investigate whether fear-avoidance beliefs are associated cross-sectionally and longitudinally with the physical activity level (PAL) in LBP patients

Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care

Background: Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Methods: Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. Results: More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Conclusions: Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more beneficial