The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study

Background Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects. Methods The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed. Discussion The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns) with a comparable impact (e.g. on quality of life and/or functional status) will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an instrument for prediction of the deterioration of the illness process and point at possibilities of prevention. The practical consequences of the study results for primary care will be analysed in expert focus groups in order to develop strategies for the inclusion of the aspects of multimorbidity in primary care guidelines

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Do Self-Enhancing and Affiliative Humor Buffer for the Negative Associations of Quantitative and Qualitative Job Insecurity?

The present study examines an important contemporary stressor: Job insecurity, both in terms of losing one’s job as such (i.e. quantitative job insecurity) and losing one’s valued job aspects (i.e., qualitative job insecurity). Moreover, we study whether humor assists in offsetting the negative associations of these types of job insecurity with employee well-being. Specifically, by drawing up the conservation of resources theory, self-enhancing and affiliative humor are framed as personal resources buffering the detrimental relationship of both types of job insecurity with burnout (i.e., exhaustion and cynicism) and work engagement (i.e., vigor and dedication) in a large heterogeneous sample of Belgian employees (N = 3,254). Results evidenced the detrimental main effects of quantitative and qualitative job insecurity as well as the beneficial relations of self-enhancing and affilitative humor on burnout and work engagement. In addition, the buffering role of affiliative humor was supported in the relationships of both quantitative and qualitative job insecurity with burnout. Self-enhancing humor only interacted with qualitative job insecurity in the prediction of exhaustion. The discussion centers around the importance of personal resources attenuating the negative associations of quantitative and quantitative job insecurity, and highlights the different roles of humor for employees’ work-related well-being.status: publishe

Exposure to Workplace Bullying: The Role of Coping Strategies in Dealing with Work Stressors

Studies investigating both work- and individual-related antecedents of workplace bullying are scarce. In reply, this study investigated the interaction between workload, job insecurity, role conflict, and role ambiguity (i.e., work-related antecedents), and problemand emotion-focused coping strategies (i.e., individual-related antecedents) in association with exposure to workplace bullying. Problem-focused coping strategies were hypothesised to decrease (i.e., buffer) the associations between workload, job insecurity, role conflict, and role ambiguity and exposure to bullying, while emotion-focused coping strategies were hypothesised to increase (i.e., amplify) these associations. Results for a heterogeneous sample (=3,105) did not provide evidence for problem-focused coping strategies as moderators. As expected, some emotion-focused coping strategies amplified the associations between workrelated antecedents and bullying: employees using “focus on and venting of emotions” or “behavioural disengagement” in dealing with job insecurity, role conflict, or role ambiguity were more likely to be exposed to bullying. Similarly, “seeking social support for emotional reasons” and “mental disengagement” amplified the associations of role ambiguity and the associations of both role conflict and role ambiguity, respectively. To prevent bullying, organisations may train employees in tempering emotion-focused coping strategies, especially when experiencing job insecurity, role conflict, or role ambiguity.status: publishe

The moderating role of emotion- and problem-focused coping strategies in the association between work stressors and exposure to workplace bullying

© 2017, Boom Lemma Publishers. All rights reserved. Studies on person-related moderators in the association between work-related factors and exposure to workplace bullying are scarce. Therefore, this study investigated whether emotion- and problem-focused coping strategies (i.e., person-related factors) are moderators in the association between workload, job insecurity, role conflict and role ambiguity (i.e., work-related factors), and exposure to workplace bullying. We sampled a representative sample of 1,068 Belgian employees. Structural equation modeling in AMOS confirmed that both work- and person-related factors contribute to exposure to workplace bullying. The results showed that workload, job insecurity, role conflict, and role ambiguity are positively associated with exposure to bullying. Further, emotionfocused coping strategies amplified the positive association between role ambiguity and exposure to bullying. No evidence was found for the moderating role of emotion-focused coping strategies in the association between workload, job insecurity and role conflict, and exposure to bullying. The hypothesis on the buffering role of problem-focused coping strategies was also rejected. To conclude, we advise organizations (a) to reduce workloads, job insecurity, role conflict and role ambiguity, and (b) to teach employees about the possible negative effects of emotion-focused coping strategies especially in combination with role ambiguity.status: publishe

Exposure to Workplace Bullying: The Role of Coping Strategies in Dealing with Work Stressors

Studies investigating both work- and individual-related antecedents of workplace bullying are scarce. In reply, this study investigated the interaction between workload, job insecurity, role conflict, and role ambiguity (i.e., work-related antecedents), and problem- and emotion-focused coping strategies (i.e., individual-related antecedents) in association with exposure to workplace bullying. Problem-focused coping strategies were hypothesised to decrease (i.e., buffer) the associations between workload, job insecurity, role conflict, and role ambiguity and exposure to bullying, while emotion-focused coping strategies were hypothesised to increase (i.e., amplify) these associations. Results for a heterogeneous sample (N = 3,105) did not provide evidence for problem-focused coping strategies as moderators. As expected, some emotion-focused coping strategies amplified the associations between work-related antecedents and bullying: employees using “focus on and venting of emotions” or “behavioural disengagement” in dealing with job insecurity, role conflict, or role ambiguity were more likely to be exposed to bullying. Similarly, “seeking social support for emotional reasons” and “mental disengagement” amplified the associations of role ambiguity and the associations of both role conflict and role ambiguity, respectively. To prevent bullying, organisations may train employees in tempering emotion-focused coping strategies, especially when experiencing job insecurity, role conflict, or role ambiguity

The mediating role of frustration of psychological needs in the relationship between job insecurity and work related well–being

This study aims to test a new process underlying the negative relationship between job insecurity and work-related well-being. Specifically, based on Self-Determination Theory, frustration of the psychological needs for autonomy, belongingness and competence was expected to explain the associations between job insecurity and emotional exhaustion and vigour (i.e. the core energy-related components of burnout and work engagement, respectively). Structural equation modelling using data from a heterogeneous sample of 3185 Flemish employees confirmed that frustration of the three needs mediated the association between job insecurity and both outcomes. These results suggest that job insecurity is related to impaired work-related well-being, because it frustrates employees’ psychological needs. This study contributes to a rather small, but growing body of research on the theoretical explanations of the negative consequences of job insecurity for employees’ work-related well-being.http://dx.doi.org/10.1080/02678373.2012.703900http://www.tandfonline.com/doi/full/10.1080/02678373.2012.703900#abstrac

On the reciprocal relationship between job insecurity and employee well-being: Mediation by perceived control?

© 2014 The British Psychological Society. This study aims to explain the reciprocal relationship between job insecurity and employee well-being (i.e., emotional exhaustion and vigour) by perceived control. Building on appraisal theory and conservation of resources theory, we suggest that perceived control mediates the cross-lagged relationships from job insecurity to employee well-being, and from employee well-being to job insecurity. These hypotheses were tested using repeated-measures data (two waves) from 536 Flemish employees from different organizations and sectors. First, cross-lagged structural equation modelling analyses showed an effect from job insecurity to perceived control, and from perceived control to emotional exhaustion, so that perceived control (partially) mediated the positive cross-lagged relationship from job insecurity to emotional exhaustion. Second, we established a cross-lagged effect from emotional exhaustion to perceived control, although not from perceived control to job insecurity. Third, no cross-lagged paths were found between perceived control and vigour. This study contributes to both appraisal theory and conservation of resources theory by investigating reciprocal relationships that fit the transactional conceptualization of stress within both frameworks. Furthermore, the results of this study highlight perceived control as the process through which the stressor job insecurity impacts on employee well-being.status: publishe