Stress and resources in women attending an inpatient prevention/rehabilitation measure for parents: Secondary analysis of quality assurance data

Questionnaire data from two projects on the development of quality assurance instruments for an inpatient rehabilitation/prevention program for parents were used for a secondary analysis. In this analysis, the associations of gains in a psychosocial resource (parenting self-efficacy) and two types of stressors experienced by mothers at the start of treatment (parenting hassles, depressive symptoms) with general life satisfaction and satisfaction with health at the end of treatment were explored. Structural equation modeling was applied to data from N = 1724 female patients. Potential resource-stressor interactions were tested using the Latent Moderated Structural Equations approach. Results showed that parenting hassles were negatively associated with general life satisfaction and satisfaction with health while self-efficacy gains were weakly positively correlated with both variables. No interaction of parenting hassles and self-efficacy gains was found. Depressive symptoms were negatively associated with both satisfaction measures. In these models, self-efficacy gains were not substantially correlated with life satisfaction, but showed a small association with satisfaction with health. There was no significant interaction of depressive symptoms and self-efficacy gains. The findings imply that interventions for distressed mothers—as exemplarily illustrated by this inpatient setting—should focus on identifying and reducing initial stressors as these may continue to impair mothers’ subjective health despite gains in parenting-related resources

Erfahrungen und Sichtweisen von Pflegeheimbewohnenden mit depressiver Symptomatik während der COVID-19-Pandemie: eine qualitative Studie

Hintergrund: Die COVID-19-Pandemie erfordert umfangreiche Maßnahmen in Pflegeheimen mit dem Ziel der Infektionsvermeidung. Diese Maßnahmen wirken sich auf das Leben der Bewohnenden aus und führen u. a. zu einer Zunahme an Depressivität und anderen negativen Begleiterscheinungen. Ziel der Arbeit: Die Studie hat die Exploration der Erfahrungen und Sichtweisen von Pflegeheimbewohnenden mit depressiver Symptomatik während der Pandemie zum Ziel. Methoden: Es wurden 9 leitfadengestützte Interviews mit Bewohnenden geführt, welche mittels der inhaltlich-strukturierenden Inhaltsanalyse nach Kuckartz ausgewertet wurden. Ergebnisse: Es konnten 3 Hauptthemen identifiziert werden: Empfindungen und Emotionen in Bezug auf die Pandemie, Veränderungen und Einschränkungen durch die Maßnahmen sowie Wünsche vor dem Hintergrund der Pandemie. Die befragten Bewohnenden berichten sowohl von emotionalen Belastungen als auch davon, keine Angst vor einer Infektion und deren Folgen zu haben. Zudem äußern die Befragten z. T. unangenehme Einschränkungen wie das Tragen von Masken, deren Nutzen sie bisweilen kritisch hinterfragen. Weiter werden diverse Wünsche der Bewohnenden in Bezug zur Pandemie wie etwa das Verlassen des Pflegeheims identifiziert. Diskussion: Die Studie zeigt komplexe Empfindungen, Veränderungen und Wünsche bei Pflegeheimbewohnenden aufgrund der Pandemie und der daraus resultierenden Maßnahmen. Dies erfordert einen individuellen Zugang zu den Bewohnenden mit depressiver Symptomatik, um eine Zunahme psychischer Probleme zu vermeiden. Vor diesem Hintergrund ergibt sich die Notwendigkeit einer partizipativen Umsetzung der Gesundheitsschutzmaßnahmen bei der besonders vulnerablen Gruppe der Pflegeheimbewohnenden

Addressing Work-Related Issues in Medical Rehabilitation: Revision of an Online Information Tool for Healthcare Professionals

Background. Medical rehabilitation increasingly considers occupational issues as determinants of health and work ability. Information on work-related rehabilitation concepts should therefore be made available to healthcare professionals. Objective. To revise a website providing healthcare professionals in medical rehabilitation facilities with information on work-related concepts in terms of updating existing information and including new topics, based on recommendations from implementation research. Method. The modification process included a questionnaire survey of medical rehabilitation centers (n=28); two workshops with experts from rehabilitation centers, health payers, and research institutions (n=14); the selection of new topics and revision of existing text modules based on expert consensus; and an update of good practice descriptions of work-related measures. Results. Health payers’ requirements, workplace descriptions, and practical implementation aids were added as new topics. The database of good practice examples was extended to 63 descriptions. Information on introductory concepts was rewritten and supplemented by current data. Diagnostic tools were updated by including additional assessments. Conclusions. Recommendations from implementation research such as assessing user needs and including expert knowledge may serve as a useful starting point for the dissemination of information on work-related medical rehabilitation into practice. Web-based information tools such as the website presented here can be quickly adapted to current evidence and changes in medicolegal regulations

Wishes and Needs of Nursing Home Residents: A Scoping Review

Falling birth rates and rising life expectancy are leading to global aging. The proportional increase in older people can be observed in almost all countries and regions worldwide. As a result, more people spend their later years in nursing homes. In homes where person-centered care is implemented, residents report greater satisfaction and quality of life. This approach is based on the wishes and needs of the residents. Therefore, the purpose of this scoping review is to explore the wishes and needs of nursing home residents. A scoping review of the literature was conducted in which 12 databases were systematically searched for relevant articles according to PRISMA-ScR guidelines. Both quantitative and qualitative study designs were considered. A total of 51 articles met the inclusion criteria. Included articles were subjected to thematic analysis and synthesis to categorize findings into themes. The analysis identified 12 themes to which the wishes and needs were assigned: (1) Activities, leisure, and daily routine; (2) Autonomy, independence, choice, and control; (3) Death, dying, and end-of-life; (4) Economics; (5) Environment, structural conditions, meals, and food; (6) Health condition; (7) Medication, care, treatment, and hygiene; (8) Peer relationship, company, and social contact; (9) Privacy; (10) Psychological and emotional aspects, security, and safety; (11) Religion, spirituality; and (12) Sexuality. Nursing home residents are not a homogeneous group. Accordingly, a wide range of needs and wishes are reported in the literature, assigned to various topics. This underscores the need for tailored and person-centered approaches to ensure long-term well-being and quality of life in the nursing home care setting

Psychosoziale Ressourcen und Risikomuster für Burnout bei Medizinstudenten: Querschnittstudie und Bedürfnisanalyse Präventiver Curricularer Angebote [Psychosocial resources and burnout risk factors in medical school: A cross-sectional study and analysis of needs for preventive curricular interventions]

[english] Background: Epidemiologic health data show an increased incidence of psychosomatic disorders in medical doctors and undergraduate medical students as compared with the general public. There is little knowledge about students’ self-assessment of needs with respect to preventive health-promoting interventions.Objectives: Analysis of the psychosocial health resources and risk patterns of medical students at different times throughout their studies. Analysis of students’ self-assessment of psychosocial health-promoting interventional needs.Design: Cross-sectional study of three student cohorts at the beginning, middle, and end of their studies with a student-adapted “Pattern of work-related coping behavior” (AVEM) questionnaire.Participants: Students at the beginning, middle, and near the end of their studies (corresponding mainly to the second, fifth, and tenth semester) at Wurzburg Medical School (N = 360) in Germany.Results: In the beginning 39.1% of the medical school students show a healthy behavioral pattern. The rate decreases to 30.5% in the middle cohort, down to 18.3% at the end of medical school, while burnout patterns marked by lack of ambition and resignation rise from 44.0% at the beginning of studies, to 55.9% at the middle, and up to 65.2% at the end of medical school. There are significant gender differences: Male students rate higher in “career ambition” and “significance of work”, have less “tendency toward resignation”, and score higher in “balance and mental stability”. Female students experience significantly more “social support”.There is a high self-estimated need for supportive interventions: When asked “What preventive interventions should the university offer?”, 85% of the students requested stress management, 79% time management, 77% burnout preventive training, 75% coping techniques for exam nerves, and 63% relaxation techniques.Limitations: The response rate was 90.8%. Although the response rate is comparably high, non-response by part of the students may alter the estimated figures. The study only includes students from one German medical school. Longitudinal data are absent. A longitudinal study has been initiated.Conclusions: There is a high rate of resignation and burnout behavioral patterns among medical students, while healthy patterns decrease the further the students progress in their professional training. There are significant gender differences in the psychosocial patterns.Students express a high need for preventive techniques and interventions. Thus prevention of psychosocial morbidity and motivational interventions are important issues in the training of future physicians. Such interventions should become a mandatory part of the medical curriculum and should take gender aspects into consideration.[german] Hintergrund: Epidemiologische Daten zur Gesundheit von Ärzten und Medizinstudenten zeigen im Vergleich zur Allgemeinbevölkerung eine erhöhte psychische Morbidität. Es gibt wenige Daten dazu, wie der Bedarf an präventiven Maßnahmen von den Medizinstudenten selber eingeschätzt wird.Zielsetzung: Analyse der psychosozialen Ressourcen und der studienbezogenen Verhaltens- und Erlebensmuster bei Medizinstudenten zu unterschiedlichen Zeitpunkten während des Studiums. Bedürfnisanalyse hinsichtlich der von den Studenten selbst gewünschten präventiven Angebote im Ausbildungscurriculum.Studiendesign: Querschnittuntersuchung an drei unterschiedlichen Kohorten von Medizinstudenten am Anfang, in der Mitte und am Ende des Studiums mit einer studentenadaptierten Version des Fragebogens „Arbeitsbezogene Verhaltens- und Erlebnismuster“ (AVEM).Teilnehmer: Studenten am Anfang, in der Mitte und am Ende des Medizinstudiums (entspricht im Wesentlichen Studenten des 2., 5., 10. Semesters) an der Würzburger Universität (n=360).Ergebnisse: Zu Beginn des Studiums zeigen 39,1% ein gesundes Verhaltensmuster (Muster G), im mittleren Studienabschnitt liegt der Anteil bei 30,5%, am Studienende bei 18,3%. Entsprechend finden sich resignative Verhaltensmuster mit Burnout-Tendenzen und Schonungsmuster (Risikomuster B und S) zu Beginn des Studiums bei 44,0%, in der Mitte des Studiums bei 55,9% und am Studienende bei 65,2%. Es zeigen sich signifikante Geschlechtsunterschiede: Männliche Studenten zeigen höhere Werte für „Beruflichen Ehrgeiz“ und „Bedeutsamkeit der Arbeit“, eine geringere „Resignationstendenz bei Misserfolg“ und mehr „Innere Ruhe und Ausgeglichenheit“. Frauen erleben mehr „Soziale Unterstützung“.Es gibt in der Selbsteinschätzung der Studenten einen hohen Bedarf an präventiven Maßnahmen: So wünschten sich 85% der Studenten Angebote zur Stressbewältigung, 79% zum Thema Zeitmanagement, 77% zur Burnout-Prophylaxe, 75% zum Thema Umgang mit Prüfungsangst und 63% zu Entspannungstechniken.Einschränkungen: Die Rücklaufquote der Fragebögen betrug 90,8% Im Vergleich zu ähnlichen Studien ist die Rücklaufquote hoch, dennoch ist eine Verfälschung der Werte durch den Anteil an Studenten, die nicht geantwortet haben, nicht auszuschließen. Die Daten dieser Arbeit beschreiben nur die Situation an einer Medizinischen Fakultät in Deutschland. Es handelt sich nicht um longitudinale Daten. Eine Verlaufsstudie wurde begonnen.Schlussfolgerungen: Die Daten zeigen ein deutliches resignatives Verhaltensmuster und Burnout-Risikoverhalten bei Medizinstudenten, dass umso ausgeprägter ist, je weiter die Studenten im Studium fortgeschritten sind. Es gibt signifikante Geschlechtsunterschiede in den studienbezogenen Verhaltens- und Erlebensmustern.Studenten wünschen in hohem Maße Angebote zur Prävention. Die Prävention psychosozialer Störungen und Maßnahmen, die die berufliche Motivation der Studenten fördern, sind wichtige Themen und sollten Berücksichtigung bei der Gestaltung des Curriculums der ärztlichen Ausbildung finden. Hierbei sollten geschlechtsspezifische Unterschiede berücksichtigt werden

Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780)

Background Musculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved. Methods/Design The cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 % at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients’ discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies. Discussion This study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders

Decreased mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs: A longitudinal analysis

Background Cancer patients' mental health and quality of life can be improved through professional support according to their needs. In previous analyses of the UNSAID study, we showed that a relevant proportion of cancer patients did not express their needs during the admission interview of inpatient rehabilitation. We now examine trajectories of mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs. Methods We enrolled 449 patients with breast, prostate, and colon cancer at beginning (T0) and end (T1) of a 3-week inpatient rehabilitation and 3 (T2) and 9 (T3) months after discharge. We explored depression (PHQ-2), anxiety (GAD-2), emotional functioning (EORTC QLQ-C30), fear of progression (FoP-Q-SF), and global quality of life (EORTC QLQ-C30) using structuring equation models. Furthermore, we evaluated self-reports about expressing needs and utilization of professional help at follow-up. Results Patients with unexpressed needs (24.3%, n = 107) showed decreased mental health compared to other patients (e.g., depression: d T0 = 0.32, d T1-T3 = 0.39). They showed a significant decline in global quality of life at discharge and follow-up (d = 0.28). Furthermore, they had a higher need for support (Cramer's V T2 = 0.10, T3 = 0.15), talked less about their needs (Cramer’s V T2 = 0.18), and made less use of different health care services at follow-up. Conclusion Unexpressed needs in cancer patients may be a risk factor for decreased mental health, quality of life, and non-utilization of professional help in the long term. Further research should clarify causal relationships and focus on this specific group of patients to improve cancer care