Biomedical subjects
Publications and source records attributed to A Kruse.
This paper discusses the importance of cognitive representation and individual patterns of behavior for coping with chronic disease. Chronically ill patients differ very much in their psychic situation. Biographical and situational factors and the future perspective contribute to these interindividual differences. Diagnostic and therapeutical tools are discussed from a psychological perspective.
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This article discusses relevant aspects of the psychological situation of being nursed and refers to the psychosocial conception of competence, and its importance in a differential approach to the multidimensional process of developing rehabilitation programs. The report is based on an empirical study of the coping-styles of the chronically diseased elderly and their relatives. Our purpose is to give an expanded definition of competence and to identify some characteristic conditions causing trouble for the diseased and his family. With regard to inter- and intraindividual differences, some ideas of intervention and help are suggested.
This article discusses the situation of chronically diseased patients and refers to the multidimensional conception of "competence". Our purpose is to enlighten the central position of competence in cognitive structures and coping systems of the patients. A definition of competence is given, the investigation is delineated, and the most important results are discussed, referring to the concept of competence.
Coping patterns of two groups of stroke patients related to their health condition are compared: one group participated in a rehabilitation programme, while the consisted of long-term care patients who had suffered a stroke ten to twenty years before the interview was second group. Similarities and differences between the response hierarchies of the two groups are demonstrated and discussed with special emphasis on the complex cognition and motivation interactions determining success and failure in coping.
The study deals with an investigation of families who have to cope with the stroke of an older family member. The psychological reactions of the patient and the caregiver, related to the chronic disease and home care, are analyzed and a response hierarchy is delineated, as well. Moreover the burden, the patients and primary caregivers report, are given. Additionally, the most important dimensions of the "cognitive representation" the patient holds of his situation are investigated.
There is an increasing number of investigations in multi-generational-families. However, the research focussed on three-generation-family, not on four- or five-generation-family. The paper deals with the description of our investigation in five-generation-families. Moreover some issues of current generational analysis are discussed. The special emphasis is on a description of the relationship between the great-great-grandparents and the great-grandparents.
50 patients in the terminal phase who were treated at home by medical doctors, and their caregivers (one caregiver a family) were interviewed up to six times in a longitudinal study. Additionally, scales for assessing degree of independence in daily living, intensity of pain, and engagement in intra- and extrafamilial relationships were used. --Interindividual differences in perceiving (own) finitude and in coping with it were high in the group of patients and caregivers. Moreover, patients' and caregivers' forms of perceiving and coping with finitude were related. These relations point to the necessity of a "dyadic" perspective in analyzing patterns of perceiving and coping with finitude. --In the group of patients, perceiving own finitude and coping with it was also related to intensity of pain, degree of independence in daily life, degree of perceived social integration, and to the feeling of being needed. Results of our study do not confirm the assumption that there is a characteristic pattern of perceiving and coping with finitude in terminally ill patients and their caregivers.
This article describes the experiences obtained in a study of ambulatory (mobile) rehabilitation with stroke patients. The patients had been treated in a rehabilitation clinic before. The ambulatory rehabilitation, which lasted 18 months, served to maintain and further develop the previous success of in-patient rehabilitation. On the one hand, the research project provided empirical evidence for the success of ambulatory rehabilitation. On the other hand, the experiences obtained through this research project indicate that the success of an ambulatory rehabilitation concept is dependent on optimal co-operation among members of the rehabilitation team (physicians, psychologists, physical therapists, occupational therapists, speech therapists, and nursing staff). In relation, the institutional conditions for effective ambulatory rehabilitation are only met when physicians in private practice, who are responsible for the co-ordination of rehabilitation services, are supported by physicians in regard to time-consuming home visits, and when sufficient numbers of physical therapists, occupational therapists, and speech therapists in private practice are available. Unfortunately, these conditions are not fulfilled in many regions of Germany.
Etiology and pathogenesis of inflammatory bowel disease (IBD) remain obscure. There is substantial evidence that proinflammatory cytokines such as Interleukin-1 beta (IL-1 beta), Interleukin-6 (IL-6) and Tumour Necrosis Factor-alpha (TNF-alpha) exhibit a key role in the the inflammatory process. In situ hybridisation can depict individual cells producing cytokine mRNA. We performed hybridisation with antisense probes specific for IL-1 beta, IL-6 and TNF-alpha on sections of paraffine-embedded biopsies. Specimens obtained from three control persons and six cases of Crohn's disease (CD) were investigated. Only few positive cells were found in tissue sections of control persons, clusters of lamina propria cells or epithelial cells containing cytokine mRNA were not observed. Inflammatory bowel disease tissue contained large numbers of cells producing mRNA specific for the three proinflammatory cytokines assayed. IL-1 beta, IL-6 and TNF-alpha mRNA were predominantly detected corresponding to cells of the lamina propria. Single cells containing mRNA specific for IL-6 were also found among the epithelial lining of intestinal crypts. Epithelial cells containing IL-1 beta and IL-6 mRNA were found in specimens derived from one patient with Crohn's disease. Notably, large amounts of cells containing cytokine mRNA were not only found in inflamed, but also in macroscopically normal mucosa. In conclusion, using proinflammatory cytokines as a model, we established in situ hybridisation on sections of mucosal biopsies permitting further insight into immune activation at individual cell level.
In a study on the chances and limits of independent living in old age, we collected data about difficulties in 23 activities of daily living in two sub-samples: participants from the western part of Germany (n = 745), and from the eastern part of Germany (n = 347). Participants were grouped into three patterns of competence by means of cluster analysis. Cluster analyses were calculated separately for participants in the western and eastern parts of Germany. In both sub-samples, we found three patterns of competence: "High competence in most activities of daily living", "reduced competence in some activities of daily living" and "reduced competence in most activities of daily living". Patterns of competence were similar in the sub-samples, but important differences were found in some activities of daily living between participants from the eastern and western parts of Germany (e.g., in "heating home," "washing clothes," "banking"). These differences were due to unfavorable conditions in physical environment. Analysis of the relationship between objective housing conditions (assessed by our research team) and patterns of competence strongly supported this interpretation. Participants in the two sub-samples were more satisfied with their housing conditions as could be expected from our assessment of housing conditions. Successful adaptation to environmental conditions and changes in the aspiration-level can explain these differences. The degree of satisfaction with housing conditions is only a poor predictor for possibilities in increasing competence by intervention and rehabilitation. Most participants wished to keep their household independently as long as possible. Acceptance for homes for the elderly was low.
120 Jewish people who were forced to emigrate from Germany to Israel or Argentinia during the "Third Reich" were interviewed. Interviews dealt with the psychic situation; additionally, scales were applied for measurement of morale, attitudes towards the present situation and the future, and perceived changeability of the situation. The group of emigrants was divided into two subgroups: Emigrants who stayed in foreign countries, and emigrants who returned to Germany in old age. The emigrants were compared with a control-group of german people who were not discriminated against and persecuted, and who were not forced to emigrate. Significant differences between the two groups were found: The emigrants showed a higher degree of perceived changeability and a more positive life-review. Perceived stress and activity in different intra- and extrafamilial roles were higher. Emigrants who had gone back to Germany showed a higher degree of perceived changeability and a lower degree of sorrow concerning personal future than emigrants who stayed in Israel or Argentinia. Perceived stress in extrafamilial roles was higher. Additionally, motives for going back to Germany and for staying in Israel or Argentinia were analyzed.
This paper discusses different situations of family caregiving. It points to special tasks and stresses in the following situations: Help to stroke patients during rehabilitation at home, caregiving to patients who are suffering from a physical or a mental disease, and support of family members who have to cope with impending death. As the analysis makes clear, different situations of caregiving cause different tasks and stresses which should be regarded in discussing the psychic and social situation of caregivers.
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115 geriatric in-patients are included in the current study examining relationships between regions of experienced pain, subjective pain intensity, and psychological variables. An investigation of the connection between psychosomatic limitations (BSS) and pain indicated, that pain patients do not necessarily require psychosomatic-psychotherapeutic treatment (in our study only 21.6%). 61.7% of the study sample reported intense pain at least one body region. These patients differed significantly from those with less pain in terms of their level of functional capacity and need for assistance in daily activities (ADL/IADL). They also displayed a significantly more negative attitude towards aging (PGC) than patients with minimal pain. Hierarchical cluster analyses for applied coping strategies produced five groups within the subgroup of patients suffering from extreme pain. Only within one group "depression" was a significant reaction to health-problems. These results make clear that most of the patients with extreme pain are able to cope effectively with pain.
In a study on chances and limits of independent life in old age, we collected data about sensations of pain in 990 participants. Information about intensity and frequency of pain sensations was combined to differentiate empirically between five patterns of pain sensations. According to severity, these patterns can be ordered hierarchically. 873 persons could be grouped into the five patterns of pain sensations. There was no relationship between chronological age and patterns of pain sensations. The relationship between patterns of pain sensations and degree of independence in everyday life was only weak. Comparing the five patterns of pain sensations in seven psychological variables, we found only few statistically significant differences, mainly between people who had no pain and those who suffered from strong or very strong pain most of the time or permanently. In KLC-measures of external and internal control beliefs related to health and body, in PGC-dimensions attitude towards age, lonely dissatisfaction and agitation as well as in PGC-score for life satisfaction, we found only few and weak differences between patterns of pain sensations. Stepwise multiple regression analysis with the independent variables degree of independence in everyday life, pattern of pain sensations and chronological age could explain 1.4% to 6.7% of variance in those psychological variables. In contrast, patterns of pain sensations greatly differed in NAF-measures of subjective aging. A stepwise multiple regression with the independent variables degree of independence in everyday life and pattern of pain sensations could explain 24.6% of variance. Degree of independence in everyday life alone could explain 17.9% of variance. We hypothesize that effects in most psychological variables are weak, because what people mean by a "good" or personally satisfying life is only partly influenced by their health status.
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