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H J Rumpf

Publications and source records attributed to H J Rumpf.

31 records · Page 2Linked to original sources
PubMed1998

Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital: direct or disguised assessment?

OBJECTIVE: The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample. METHOD: Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency. RESULTS: The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p < .0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p < .05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers. CONCLUSIONS: Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

Alcohol Drinking↗
PubMed1998

Prevalence of alcohol dependence and abuse in general practice.

The aim of this study is to deliver representative epidemiological data about the prevalence of alcohol abuse and dependence in general practices in an urban area. In 12 general practices at Luebeck, a Northern German city with 220,000 inhabitants, a total of 929 patients (aged between 14 and 75 years) were screened using the CAGE and the Short Michigan Alcoholism Screening Test. If one of these screening questionnaires or the General Practitioners' assessment of the patient indicated an alcohol problem, the patient underwent a standardized diagnostic interview using the alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry. The prevalence rates according to ICD-10 or DSM-III-R were 3.5% for alcohol abuse and 7.2% for alcohol dependence, the sex ratio was 1:2.8 (female:male). These results are compared with previous findings, and general epidemiological implications of this study are discussed.

Adolescent↗
PubMed1998

[Stages of motivation to change in smokers of the general population].

Secondary preventive measures to reduce cigarette smoking can be effective only if the motivation to change in the target population is taken into account. A useful model to match interventions to the readiness to change differentiates five stages: precontemplation, contemplation, preparation, action, and maintenance. In the USA, general population studies showed that 40% of smokers were in the precontemplation and contemplation stage, respectively, and 20% were in the preparation stage. In Germany, no data according to the distribution of stages among smokers are available; however, such data are necessary to plan population-based interventions. Data with respect to nicotine use, nicotine dependence, and the stages of change were assessed in a representative sample of 4075 respondents in Luebeck, a northern German city, and 46 adjoining communities in a face-to-face interview. The response rate was 70.2%. In this sample, 37.3% were cigarette smokers. Of those smokers with at least one attempt to reduce or quite smoking in the past, 76.4% were in the precontemplation, 17% in the contemplation, and 6.6% in the preparation stage. Including individuals without an attempt to reduce or quit smoking, 95.3% can be allocated to the precontemplation or contemplation stage. Nicotine-dependent smokers were in higher stages compared to smokers without dependence. Severity of dependence was not related to the stages of change. Data demonstrate that common smoking cessation programmes that require the individuals' readiness to change are inappropriate for 95% of the population. Stage-matched interventions are introduced and discussed in the paper. Compared to data from the USA smokers in Germany are more likely to be in early stages of change. Policy-based public health measures are necessary to change these findings.

Adolescent↗
PubMed1997

Development of a screening questionnaire for the general hospital and general practices.

The purpose of this study was to develop a sensitive as well as brief screening questionnaire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test (MAST) in detecting patients with alcohol dependence or abuse in general hospitals and general practices. The number of items was reduced by means of logistic regression and item analysis based on data of 1,167 consecutive admissions of a general hospital who completed both questionnaires. Further data were derived from a sample of 774 patients from 10 randomly selected general practices. A solution with nine items was validated in a second sample of 436 hospital inpatients. In all three samples, cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-III-R or DSM-IV diagnosis. In addition, 103 subjects with negative screening results were interviewed in the second general hospital sample. On grounds of the data of all three samples, a solution of seven items was chosen. This instrument comprises two CAGE and five MAST questions (Leubeck Alcohol Dependence and Abuse Screening Test; LAST) and was significantly higher in sensitivity than CAGE and SMAST. Data were robust in all three samples. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice.

Adolescent↗
PubMed1995

[Coping pattern and adjustment in multiple sclerosis].

A questionnaire (FKV/LIS) was used to study the coping process in 210 patients with multiple sclerosis. By cluster analysis of five coping modes, patients could be divided into two groups of approximately the same size: cluster 1 presented with higher values for "active coping; self-affirmation; religiousness" and lower values for "depression" and "trivialization". In cluster 2, on the other hand, values were higher for "depression" and "trivialization" whereas values were lower for "active coping; self-affirmation; religiousness". Patients in cluster 1 were significantly more contented with life. Mean age and mean duration of illness were higher in cluster 1, suggesting a time-dependent change in the coping process with improvement in adaptation in the course of the disease. The extent of social support was higher in cluster 1. The consequences for psychological intervention are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Physicians' low detection rates of alcohol dependence or abuse: a matter of methodological shortcomings?

Previous research may have underestimated physicians' detection rates of alcohol dependence or abuse because case findings have been based on screening questionnaires instead of using in-depth diagnostic criteria and detection rates have been assessed by analyzing patient records instead of directly interviewing the physician. To test this hypothesis, consecutive patients of a general hospital (N=436) and of 12 randomly selected general practices (N=929) were examined. A two-step diagnostic procedure included screening questionnaires and a diagnostic interview (SCAN). The analysis compares detection rates based on methods used in previous studies to data using more precise methods. Physicians' detection rates ranged from 37.0% to 88.9% in the general hospital and from 11.1% to 74.7% in general practices depending on methods used. The physicians' detection rates could be improved by 10% (general hospital) and 20% (general practice) through the additional use of a screening questionnaire. Of those patients assessed by the physicians as problem drinkers in the general hospital, 13.9% were referred to an addiction consultation-liaison service. Data reveal that physicians' abilities to detect problem drinkers have been underestimated. Routine screening procedures could play a major role in improving detection rates and reminding the physician to intervene.

Adolescent↗
PubMedDate not supplied

Motivation to change drinking behavior: comparison of alcohol-dependent individuals in a general hospital and a general population sample.

The general hospital would be especially suited to initiate interventions if hospitalized alcohol-dependent individuals were particularly motivated to change their drinking behavior. This study compares the readiness to change of alcohol-dependent persons in the general hospital and the general population. Stages of change according to the model of Prochaska and DiClemente [6] are assessed using the Readiness to Change Questionnaire (RCQ) in two representative samples: 118 alcohol-dependent subjects admitted to a general hospital (sample 1) and 50 alcohol-dependent individuals in the general population (sample 2). In sample 1, alcohol-dependent persons were identified in 1167 consecutive admissions using screening questionnaires and a diagnostic interview (SCAN). In sample 2, alcohol dependence was assessed in 4075 individuals using a German version of CIDI. The distribution of stages of change differed significantly (p < 0.0001) between the groups, revealing a shift towards higher stages in the hospital subjects. Logistic regression analysis revealed that the stages of readiness to change and age contributed in predicting whether subjects belonged to the general hospital or the general population sample. Findings suggest that the general hospital is a suitable site to initiate interventions for alcohol-dependent individuals.

Adult↗
PubMedDate not supplied

Estimating prevalence of alcohol abuse and dependence in one general hospital: an approach to reduce sample selection bias.

Prevalence estimates of alcohol abuse or dependence in general hospitals are often limited to single wards, small data collecting periods or insufficient diagnostic procedures. Therefore, the present study aimed to ascertain alcohol abuse or dependence in one general hospital, to compare prevalence data for all the 11 wards and 6 intake months, to establish if screening is sufficient or if a two-step diagnostic procedure is needed, and to determine whether information for an alcohol diagnosis on suspicion is available. A sample of 1309 medical or surgical in-patients were screened by questionnaires or medication for withdrawal, and, if screening-positive, were interviewed with the alcohol section of a standardized psychiatric interview. In screening-negative patients, a diagnosis on suspicion was given if medication to treat withdrawal had been used, or if there was evidence of single criteria of alcohol dependence, somatic disorders from alcohol drinking, raised laboratory parameters on grounds of alcohol drinking or of self-reported high alcohol consumption. Of the medical and surgical in-patients, 20.7 and 16.0% respectively were alcohol abusers or dependents, with a range of prevalence rates of alcohol abuse or dependence among wards of 11.1-32.9% and among intake months between 11.3 and 28.7%. Of the medical department in-patients, 1.9%, and of the surgical in-patients, 2.1%, were screened as false-positive cases. In addition, 5.5% of the medical and 12.0% of the surgical patients were given a diagnosis on suspicion. It is concluded that all general wards and different intake months should be taken into account when estimating prevalence of alcohol abuse or dependence in a general hospital.

Adolescent↗
PubMedDate not supplied

Alcohol-related diseases in general hospital patients.

To determine the prevalence and spectrum of alcohol-related diseases in a general hospital inpatient population, data of 1288 patients newly admitted to a city general hospital, who had been examined with regards to alcoholism, were surveyed. The sample consisted of 625 medical and 663 surgical patients aged 18-64 years. In 21% (29.3% of the men and 9.4% of the women), inpatient treatment was due to an alcohol-related disorder. The highest occurrence was found in the 35-55 year-olds. Frequently diagnosed disorders in alcohol-dependent patients included delirium tremens (12.8%), seizures (11.4%), head injuries (9.4%) and cirrhosis of the liver (8.1%), whereas alcohol abusers had often been injured. Excluding patients with alcohol-related diseases decreases the proportion of men in the sample by 6.2%. The prevalence of physically-damaged alcoholic patients in general hospitals suggests that preventative measures, such as consultation services, could be applied efficiently in this setting.

Adolescent↗
PubMedDate not supplied

Comparison of cage and mast with the alcohol markers CDT, gamma-GT, ALAT, ASAT and MCV.

Many alcoholics deny abuse. To screen greater samples for alcohol dependence, short questionnaires, e.g. the CAGE or MAST are often applied. Frequently laboratory parameters [i.e. 'alcohol markers', such as carbohydrate-deficient transferrin (CDT), gamma-glutamyl transferase or mean corpuscular volume of erythrocytes] are used to support the diagnosis of long-standing heavy alcohol consumption. In this study, the self-ratings (CAGE and MAST) were compared with the above laboratory parameters in an unselected sample of 204 patients admitted to a general hospital. The sensitivities, specificities, and positive (PPV) as well as negative predictive values of the CAGE, the MAST, and the alcohol markers were calculated along with the reported alcohol consumption or the ICD-10 diagnosis as standard. According to recent harmful alcohol consumption levels (women >225 g/week: men >350 g/week), the sensitivities and the PPVs were rather low in all tests (sensitivity <60%; PPV <50%). With the ICD-10 diagnosis as standard, the CAGE and MAST showed a rather high specificity (>95%) and PPV (about 90%). CDT revealed the best PPV of all alcohol markers (60%). However, the sensitivity of the CAGE, MAST, and the alcohol markers for the ICD-10 diagnosis was rather poor (<60%). This low sensitivity impedes the usefulness of these questionnaires and alcohol markers as screening tests for alcoholism in general hospitals.

Adult↗
PubMedDate not supplied

[Regional differences in the prevalence of high-risk alcohol drinking: secondary analysis of the East-West health survey].

Basing on a reanalysis of the public use file "Health Survey East and West Germany", the regional distribution of at risk alcohol consumption in Germany was examined in a representative sample of 7,466 adults. Substantial differences were seen in the prevalence rates between the German Federal Lands (provincial states), also if the social class, number of inhabitants of the community, unemployment as well as age and sex are statistically controlled. Besides a higher prevalence in the Eastern parts of Germany with the newly formed Federal Lands, there is a decrease in prevalence from south to north, mainly caused by the frequency of beer consumption. The results underline the importance of specific regional epidemiological data for public health-related interventions.

Adult↗