Biomedical subjects
Publications and source records attributed to H Küfner.
Although the number of patients dependent on legal drugs is estimated to be as high as 1.9 million, very few are in clinical treatment. Research deficits in this area are evident.
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Data on mortality during a 48-month follow-up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over 50 years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) or were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21.7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol-related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wernicke-Korsakoff-syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouts (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow-up periods substance use had a great effect on mortality. The mortality rate for those patients who still abstained from alcohol for after 6 months (4.4%) was only a third of that the patients who had relapsed (12.4%).(ABSTRACT TRUNCATED AT 250 WORDS)
Data on mortality during a 48-month follow-up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over 50 years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) or were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21.7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol-related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wernicke-Korsakoff syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouts (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow-up periods substance use had a great effect on mortality. The mortality rate for those patients who still abstained from alcohol after 6 months (4.4%) was only a third of that for the patients who had relapsed (12.4%).(ABSTRACT TRUNCATED AT 250 WORDS)
In a prospective multicentre study of 1410 alcoholics (73% men) data were collected at five different times: admission, discharge, 6, 18 and 48 months after discharge. The details from the 21 treatment centres involved were acquired from staff-members; follow-up data on patients were collected by personal interviews and/or mailed questionnaires. In all, 85%, 84% and 81% of the patients could be traced, respectively. Additionally, data of patients' sick leave days and in-patient treatment were provided by the health insurance and pension insurance institutions, respectively. Outcome criteria were drinking behaviour, working and partner situation, and subjective complaints. The drinking behaviour was divided into three rough categories: abstinent, improved and unimproved. For 18 months 53% of the patients remained abstinent, 8.5% improved and 38% did not improve. For 48 months 46% remained abstinent, 12% improved and 42% did not improve. During the last 6 months prior to the 48-month data collection 66% were abstinent, 4% improved and 30% did not improve. Only 3% of patients succeeded in maintaining controlled drinking. The percentage of days of sick leave was reduced by 64% and of in-patient treatment from 34.7% to 14.6% during the 18-month period after discharge (in comparison with the 18-month period prior to treatment). Only 21% of the patients regularly attended self-help groups. Out of the patients' variables, ten for men and five for women could be identified as prognostically relevant. In the 48-month follow-up these factors were reconsidered. In men almost all, in women only three of the five factors were confirmed. The treatment variables were evaluated according to the prognosis factors (positive vs negative group). In the 48-month follow-up the treatment variables relevant in the 18-month follow-up were also reassessed. In the positive prognosis group five variables were confirmed, in the negative prognosis group only one. In addition, differentiated indication variables for the three treatment lengths were developed and applied to a model. The following appeared to be clues regarding the length of desirable treatment. For an unfavourable prognosis in both men and women no short-term treatment should be given; medium- or long-term treatment is to be preferred. For a medium prognosis men do better with short-term treatment; for women medium-treatment is preferred. For a favourable prognosis for men medium-term treatment should be avoided; long-term is preferred; for women short-term treatment may also be preferred.
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The purpose of our project was to develop and empirically test a diagnostic instrument which would permit sufficiently reliable differentiation between alcoholics and healthy as well as sick persons and which would also be easy and economical to administer. For this purpose, roughly 250 diagnostically relevant items were selected from the extensive literature on alcoholism and, with a total of 1335 patients (661 of these were alcoholics), were evaluated in three separate phases for their ability to differentiate. The best items were selected on the basis of various statistical criteria and then cross-validated. The result is the Munich Alcoholism Test (MAT) which consists of two complementary parts: a 7-item physician's assessment part and a 24-item self-assessment part. In a cross-validation study on 675 unselected in- and outpatients a validity of r = 0.94 was obtained. The reliability of the self-assessment part was r = 0.84.
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The investigation was carried out in a representative sample of subjects of the Federal Republic of Germany, including West Berlin (n = 1952). The subjects were 20--64 years old. The following were investigated: 1. Social and abusive drinking patterns 2. Relations between drinking behavior and sociodemographic data 3. Relations between drinking behavior and subjective feeling. Of the subjects, 47% consumed alcohol daily or several times a week, 6% called themselves teetotallers. Beer was the preferred beverage. The drinking behavior varied among income classes and vocational groups. Of the whole sample, 8% drank regularly whilst working; 25% of the skilled workers did so. Comparing alcohol consumption and subjective feeling, there was a slight association between elevated mood and frequent alcohol consumption. Of the subjects, 4% were identified as alcohol misusers (7% of the males, 1% of the females). Persons at high risk were men living alone (especially widowed and divorced subjects) and persons of medium income. Regular consumers of hard liquor were at higher risk than consumers of beer or wine. The highest percentage of misuse was found among unskilled and skilled workers and among inhabitants of large cities. There was a slight association between high alcohol misuse index and depressive states, subjective complaints, and paranoid attitudes.
From the extensive literature on alcoholism 250 relevant diagnostic items were selected and tested for their selectivity in 3 independent inquiries among 1335 patients (661 of them alcoholic), both outpatients and inpatients. The outcome is a two-part test: a section of 7 questions answered by the doctor and a self-assessment section comprising 24 questions answered by the patient. Its validity (validity of the whole test r=0.85) and reliability (reliability of the self-assessment section r=0.94) are high. A diagnosis of alcoholism made according to the usual clinical aspects was confirmed in 90% of 675 unselected medical, surgical and psychiatric patients and alcoholism was suspected in a further 8%.
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