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Biomedical subjects

H Raspe

Publications and source records attributed to H Raspe.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Prevalence of vertebral spinal deformities in women and men in Germany. EVOS group in Germany].

BACKGROUND: The prevalence of radiographically defined vertebral deformities, as a marker of vertebral osteoporosis, was calculated in a population based cross-sectional survey in Germany. METHOD: Lateral spine X-rays were taken according to a standardized protocol and evaluated centrally. Three thousand nine hundred and eighty subjects (2064 male and 1916 female) aged 50 to 79 years, have been examined in 8 German centers. RESULTS: Based on McCloskey's method of deformity definition the age-standardized mean prevalence of vertebral deformities in Germany was 10.2% for males and 10.5% for females. Based on the definition by Melton/Eastell a significant higher prevalence was calculated (males 17.8%, females 18.7%). The prevalence increased with age in both sexes with a steeper increase in females. There was no difference in East and West German populations. There were substantial variations between the centers regarding the prevalence of deformities in females and males.

Aged↗
PubMed1998

[The reliability of radiologic findings for differential diagnosis of vertebral osteoporosis].

BACKGROUND: Radiologically identified vertebral deformities, e.g. wedge-, fish-, or crush-vertebrae are not always a consequence of local osteoporosis. Other frequent pathomechanisms include Morbus Scheuermann, degenerative changes, overt trauma, and congenital dysplasia. This requires differential diagnosis of vertebral deformities. Radiological classification criteria have to satisfy various methodological requirements to ensure reliability of the results. METHODS: Inter-rater reliability of more than 30 radiological findings was assessed in 4 German centres of the European Vertebral Osteoporosis Study (EVOS). One hundred randomly selected EVOS cases from the West-Berlin population, each contributing 2 lateral X-rays from the thoracic and lumbar spine respectively, were independently evaluated by 7 observers. All observers were medical doctors, 4 of them heads or members of clinical radiological departments. Thus each observer read 200 radiographs. Radiological alterations in the form and structure of 13 vertebrale which were considered to be relevant for the differential diagnosis of osteoporosis were recorded in a standardized documentation form. Additionally global judgements (e. g. "osteoporotic spine" yes/no) were required. To quantify agreement Fleiss' kappa (kappa) for nominal data and multiple observers was used.

Aged↗
PubMed1998

[Burden of illness in vertebral deformities. EVOS group in Germany].

BACKGROUND: In the course of the European Vertebral Osteoporosis Study (EVOS) 4060 men and women (target age 50 to 79 years; age and sex-stratified random samples from official population registers) were examined according to the standardized study protocol in 8 German study centres. METHODS: The study programme comprised an initial postal health questionnaire, a medical interview concerning risk factors and health impact and lateral X-rays of the thoracic and the lumbar spine. Vertebral deformities were defined morphometrically. The association between prevalent deformities and subjective health impairments was investigated using 2 different morphometric classifications. The following variables were included as indicators of reduced health: back pain ever/within the last 12 months/currently, back pain intensity, functional capacity (ADL-list), graded back pain, subjective health, depression and grip strength. RESULTS: Bivariate analyses (chi(2) test, t-Test) as well as logistic regression analysis revealed significant associations between vertebral deformities and several negative health outcomes (odds ratios between 0.75 and 4.65, depending on definition of deformity). The associations were stronger in women.

Activities of Daily Living↗
PubMed1998

[Is subjective health status a good predictor of work resumption?].

The aim of the study is to investigate how persons with long term work-disability due to low back pain assess their health status and how the subjective health measurement influence work resumption (n = 663). Information on their subjective health status at 42 days after start of work-disability is set in relation to the outcomes "Continued work disability after 84 days" versus "work resumption". Bi- and multivariate analysis show that information on the subjective health status and the subjective work prognosis differs between both groups already after 42 days. The results show that the subjective health status in connection with the subjective work prognosis is a good predictor for "Non-resumption of work", but not a sufficiently good predictor for "Resumption to work".

Adolescent↗
PubMed1998

Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS).

Clinically apparent vertebral deformities are associated with reduced survival. The majority of subjects with radiographic vertebral deformity do not, however, come to medical attention. The aim of this study was to determine the association between radiographic vertebral deformity and subsequent mortality. The subjects who took part in the analysis were recruited for participation in a multicentre population-based survey of vertebral osteoporosis in Europe. Men and women aged 50 years and over were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Radiographs were evaluated morphometrically and vertebral deformity defined according to established criteria. The participants have been followed by annual postal questionnaire--the European Prospective Osteoporosis Study (EPOS). Information concerning the vital status of participants was available from 6480 subjects, aged 50-79 years, from 14 of the participating centres. One hundred and eighty-nine deaths (56 women and 133 men) occurred during a total of 14,380 person-years of follow-up (median 2.3 years). In women, after age adjustment, there was a modest excess mortality in those with, compared with those without, vertebral deformity: rate ratio (RR) = 1.9 (95% confidence interval (CI) 1.0,3.4). In men, the excess risk was smaller and non-significant RR = 1.3 (95% CI 0.9,2.0). After further adjusting for smoking, alcohol consumption, previous hip fracture, general health, body mass index and steroid use, the excess risk was reduced and non-significant in both sexes: women, RR = 1.6 (95% CI 0.9,3.0); men RR = 1.2 (95% CI 0.7,1.8). Radiographic vertebral deformity is associated with a modest excess mortality, particularly in women. Part of this excess can be explained by an association with other adverse health and lifestyle factors linked to mortality.

Aged↗
PubMed1998

Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS).

To study the association between vertebral deformities and subjective health outcome indicators, including back pain and disability, a cross-sectional survey with spinal radiographs and personal interviews was carried out in 36 study centres in 19 European countries on a total of 15,570 men and women aged 50-79 years (population-based stratified random samples). No interventions were done. The main outcome measures were the presence and intensity of current and previous back pain, functional capacity (ADL questionnaire) and overall subjective health. The presence and intensity of back pain and functional and health impairments varied within wide ranges with no obvious regional pattern. However, the associations between negative health outcomes and vertebral deformity were homogeneous between countries and between centres within countries. In logistic regression analyses weak but significant associations between the presence of vertebral deformities and various health indicators were demonstrated. The magnitude of the associations increased with severity and number of deformities. Compared with subjects without deformities those with low-grade deformities had no or only a weakly elevated risk for back pain, disability and impaired subjective health (odds ratios (OR) 1.2-1.3). The odds ratios increased for individuals with single severe deformities (OR 1.3-2.1) and were highest in those with multiple severe deformities (OR 1.7-4.2). The associations between vertebral deformities and negative health outcomes were stronger in men than in women. In this cross-sectional study radiologically assessed vertebral deformities were therefore weakly associated with both current and previous back pain as well as with functional and health impairments in both women and men. Multiple severe deformities were associated with severe and disabling back pain with stronger effects in men.

Activities of Daily Living↗
PubMed1998

[Patient satisfaction after inpatient rehabilitation: different results at different follow-up times?].

UNLABELLED: Different Results at Different Times of Questioning? In 1994 a quality assurance programme for the German medical rehabilitation system was introduced by the national association of pension funds. One of its five parts focussed on patients' satisfaction and health effects. Both domains were to be assessed by postal questionnaires. The first section of the instrument enquired about patients' perceptions and evaluations of both rehabilitation structures and processes. It is well known that satisfaction surveys tend to underestimate the true level of criticism due to social desirability bias. This is especially problematic in the context of quality assurance programmes where criticism can be seen as one driving force of improvement. The magnitude of the bias depends on many factors. In this study we tested the influence of different time intervals between discharge from rehabilitation clinic and first postal contact. DESIGN: We conducted an experimentally varied satisfaction survey among four groups of rehabilitands. If necessary, the first postal questionnaire was followed by two reminders. SETTING: One Bavarian pension fund for blue collar workers. PATIENTS: 520 rehabilitands were recruited from various rehabilitation clinics specialized in muskuloskeletal disorders. About 70% suffered from nonspecific back pain. They were randomly allocated to one of the following time intervals between discharge and postal questionnaire: one, four, eight and twelve weeks. INSTRUMENTS AND TARGET VARIABLES: All patients received an identical questionnaire with 67 items and several subscales. We compared the extent of dissatisfaction between the four groups. RESULTS: The response rate (after two reminders) showed a linear decrease from 97% (postal questionnaire after one week) to 83% (12 weeks). The extent of dissatisfaction did not change systematically though there was a (statistically nonsignificant) tendency towards higher levels of criticism at week twelve. CONCLUSIONS: An experimental variation of time intervals between discharge from rehabilitation and first postal contact does not seem to influence the extent of reported dissatisfaction though it clearly influences the response rate: The later the sending out the lower the response rate. Taking into account additional administrative and organisational aspects of the programme we propose to send out satisfaction questionnaires between 8 and 10 weeks after rehabilitation.

Adult↗
PubMed1998

[Measuring patient related outcome criteria in medical rehabilitation: how well do "indirect" and "direct" methods of measuring change agree?].

PURPOSE: To investigate agreement between "indirect" and "direct" methods for measuring outcome of inpatient rehabilitation programmes. METHOD: A consecutive sample of 610 patients with musculoskeletal, cardiopulmonary and other diseases completed questionnaires 2 weeks before and 4 to 6 weeks after inpatient rehabilitation treatment. Overall response rate was 80%. Patient outcome variables were measured at baseline and follow-up. These included 14 items covering general health, pain, functional limitations, sleep, energy, mood, and social contacts. In the follow-up questionnaire patients were also asked to recall their baseline situation and to answer the same items according to this recalled condition and, furthermore, to report directly the perceived change on a 3-point scale ("deteriorated", "unchanged", "improved"). Thus, three different methods for measuring change could be compared: changes observed prospectively between baseline and follow-up, change as the difference of recalled baseline status and observed follow-up status, and perceived change. RESULTS: Spearman correlation coefficients r(S) and Cohen' Kappa statistic were used to analyse association and chance-corrected agreement, respectively, between these three different methods. Correlation and agreement between the different indicators of change was only moderate to fair with r(S) varying between 0.10 and 0.65, Cohen's Kappa ranged between 0.07 and 0.62. Results of principal components analysis indicated that items representing perceived change did not reflect the substantive aspects of change and were assigned indiscriminately to one single component. CONCLUSION: Prospective and retrospective methods for measuring change are not functionally equivalent. Whenever feasible, prospective methods using observed baseline and follow-up data ("indirect" measurement of change) should be used in the evaluation of patient outcome in rehabilitation.

Activities of Daily Living↗
PubMed1998

[Rehabilitation-related expectations and motivations in patients with nonspecific backache. The development of a standardized questionnaire].

The success of rehabilitation programmes is assumed to be influenced by patients' expectations and motivations toward these regimens. Yet only few standardized measurement instruments of these patient attributes are available. This paper is concerned with the development of a standardized questionnaire measuring patients' expectations and motivations with respect to rehabilitation programmes. Basically derived from focus group discussions with chronically ill, we defined and operationalized four dimensions of expectations toward rehabilitation programmes. In applying the questionnaire it could be shown that the instrument is easy to use, shows acceptable psychometric properties and is correlated with relevant patient characteristics.

Activities of Daily Living↗
PubMed1997

The association between clinical findings on physical examination and self-reported severity in back pain. Results of a population-based study.

STUDY DESIGN: A cross-sectional population-based study of back pain. OBJECTIVE: To evaluate the association between clinical findings on physical examination and subjective severity in nonspecific back pain. SUMMARY OF BACKGROUND DATA: Assessment of severity of back pain always has been controversial. Most studies evaluating the role of clinical findings in back pain have been hospital- or clinic-based, often representing a highly select population. This selection is avoided in the population-based approach of the present study. METHODS: Approximately 4,000 German inhabitants of Lubeck, aged 25-74, were selected randomly from the local population registry and received a postal questionnaire. Those who reported "back pain today" (n = 1200) or "back pain within the past 12 months but no back pain before" (n = 75) were invited to come in for a clinical examination. Thirty-four physical measurements were taken. They were divided into four groups: static measurements, dynamic measurements, neurologic findings, and non-organic physical signs. Self-reported severity of back pain was measured by a pain questionnaire and a 12-item activities of daily living list to assess functional disability. RESULTS: Within each of the four groups of physical measurements, those that corresponded best with the subjective severity of back pain could be identified (e.g., rotation, lateral flexion, and fingertip-floor distance, scoliosis, the position of the side plumb line, and pain on percussion of the spine pseudo-Lasegue and hand muscle-strength). Those that corresponded best could be differentiated statistically from less correlative measurements such as kyphosis and lordosis; flexion of the lumbar, thoracic, or cervical spine, abdominal muscle strength, and axial loading. The agreement between the classification of back pain severity based on clinical findings and the classification based on self-reports was moderate (kappa = 0.47). CONCLUSIONS: Assessment of severity in back pain can only partly be based on the clinical findings of a physical examination. There is a relatively weak agreement between the results of physical examination and the subjective reporting of pain and disability.

Activities of Daily Living↗
PubMed1997

[Determinants of the quality of life in chronic renal failure].

Dialysis patients, waiting for kidney transplantation, were asked about their quality of life. Data from 1027 persons have been collected. Compared to a population sample by the "Nottingham Health Profile" (NHP), dialysis patients showed double the frequency of symptoms--only for the subscale "pain" no significant difference could be recognised. Duration of dialysis treatment reduces the quality of life considerably: increasing troubles have been observed through different quality of life scales. Age shows less important influence concerning "pain" and "physical mobility", even a decrease of symptoms in elder patients has been demonstrated by NHP-subscales for "emotional reaction" and "social isolation". Gender, education, kind of disease and dialysis treatment, and the fact of former transplantations had only marginal influence on some different dimensions of life quality. The study demonstrates in which way the patients perception of life quality could be operational and integrated in analysis and evaluation of therapeutic procedures.

Activities of Daily Living↗
PubMed1997

[Healthy life style. Perspectives of prevention in modern society].

Clinical prevention is defined as the application of all individual practice contacts of patients and physicians during the screening after risky habits or living conditions for the following specific consultation (i.e., aiming for "free of tobacco") and/or induction of specific interventions (i.e., medical check-up, health examination, immunization). All data available up to now are demonstrating that the theoretically accessible options for clinical prevention are realized merely imperfectly by physicians and/or are hardly accepted by the patients. This may be due to the restricted perception and clarification of three problem areas; they are separately discussed: 1. The clinical prevention is also part of a comprehensive "prevention politic" and needs adequate general conditions. I.e., it is generally unclear, who is supposed to take care of the health promotion and prevention: the government with its public health services, the health insurances, the society of panel physicians? 2. Clinical prevention is more distant to a strict outcome orientation than other medical areas. There is a lack of a firm proof of its individual, epidemiological, cultural, and economical effects - namely the positive and negative ones. 3. (Clinical) prevention is especially exposed to ethical tensions. The protection of the patient's (or the client's) autonomy plays a particular role. If it is possible 1. to reduce the fear of physicians and patients for the political implications of clinical and medical prevention more than in the past, 2. to work out and distribute convincing empirical proofs of the desired (and undesired) effects of prevention, and 3. to discuss the ethical tensions typical of prevention as well as to reduce them in each single case, the program of clinical prevention would have a real chance in Germany. Otherwise it has to be feared that there will only be "Medical Prevention Weeks".

Ethics, Medical↗
PubMed1997

[Quality assurance by patient surveys in medical rehabilitation: assessment and evaluation of rehabilitation structures and processes ("satisfaction of rehabilitation patients")].

Since 1994 Germany's statutory pension insurance schemes have been developing a multifaceted programme to assure and optimize the quality of their medical rehabilitation measures. One part aimed at developing a postal questionnaire for patients 8 to 12 weeks after rehab. It comprises two sections: one for the assessment of patients' perceptions and ratings in relation to rehab structures and processes, the other of changes of their health status. The article describes the development of the first part ("rehabilitee satisfaction"). We basically defined relevant sectors and qualities of medical rehab, analysing existing questionnaires, letters of complaint, results of expert interviews and patient focus groups. Mainly based on results from one large study of rehabilitees from two different pension insurance schemes (for blue or white collar workers), we report on psychometric properties of the final instrument, especially its contents, reliability, internal structure, validity and reference values. In February 1997, the instrument was accepted by the association of German pension schemes and may now be used in the routine phase of the quality programme, except for patients with psychosomatic disorders or substance abuse.

Activities of Daily Living↗
PubMed1996

[A leukemia cluster in the Pinneberg district. Results of an incidence study by the epidemiologic task force of the Schleswig-Holstein Medical Association].

After regional media had reported in early 1995 of multiple leukaemia cases in a small community in the state of Schleswig-Holstein, an "Epidemiological Task Force" was asked to review the existing evidence for a possible cluster. The Task Force is a small group appointed in 1994 by the regional Medical Association and the state's ministry of social affairs. It includes five professionals from the fields of environmental toxicology and hygiene, Public Health, epidemiology and cancer pathology. In agreement with the local Public Health administration and the ministry the Task Force organized a retrospective screening of all incident leukaemia, lymphoma and myeloma cases (ICD-9 codes 200-208) within a (5-10 km) around the small community (population on December 31st 1993: 72000) that had occurred after January 1st 1990. Any practising physician (response rate 78%), hospital (100 %), oncological centre (100%), and tumour registry (100%) serving the region were asked to notify all relevant cases to the Task Force. Additionally spontaneous case reports were elicited, and all death certificates from the a.m. time period were screened for by two Public Health administrations. We identified 202 single cases for further analysis. Comparative data for the entire region and single communities came from two cancer registries, the Danish and that of the state of Saarland/FRG, and allowed for calculating the expected number of cases by indirect standardisation. While Hodgkin's lymphomas and myelomas were (insignificantly) less frequent than expected, an excess of non-Hodgkin's lymphomas and leukaemias (all types combined) was observed. Standardised incidence ratios for the whole region varied between 1.54 and 1.68 with significant and consistent increases only for the group of leukaemias among adults (aged 15+). All results were reported to both the public and administrative/professional bodies together with specific recommendations. The reactions showed a good acceptance of the Task Force and its work.

Adolescent↗
PubMed1996

[Hannover Functional Questionnaire in ambulatory diagnosis of functional disability caused by backache].

This paper describes conceptual and clinimetric aspects as well as fields of application of the Hannover Functional Ability Questionnaire for measuring back pain-related disability (FFbH-R). The FFbH-R belongs to a series of short self-administered questionnaires for the assessment of functional limitations in activities of daily living among patients with musculoskeletal disorders. In addition to the FFbH-R, a specific version is available for patients with polyarticular diseases (the FFbH-P), as well as a combined version of both questionnaires. A new questionnaire for patients with osteoarthritis is currently being developed. Data from various studies indicate that the FFbH-R meets the relevant psychometric criteria of acceptability, reliability, validity, and sensitivity to change. It has been successfully applied in (observational and controlled) clinical studies, in epidemiologic surveys, and in compensation disability evaluation.

Activities of Daily Living↗
PubMed1996

[Measuring functional capacity in backache patients in rehabilitation: a comparison of standardized questionnaires].

In recent years, subjective assessment of functional ability by patients has become an important diagnostic instrument in rehabilitation medicine. We compared three self-administered standardized questionnaires for measuring functional capacity in patients with back pain (the back pain-specific version of the Hannover Functional Ability Questionnaire, the Roland & Morris Scale, and the Measurement of Patient Outcome Scales) with respect to feasibility, reliability, and validity. The sample comprised 119 patients treated for back pain in a rehabilitation clinic in North Germany. Besides measures of functional ability, anamnestic and psychosociological data were collected in addition. Mobility of the spine was assessed by simple clinical tests. The three questionnaires differed only slightly with regard to their psychometric properties and appeared to be equally well suited for measuring functional ability in patients with back pain. The decision for one of the instruments should be based on practical considerations (time for completion, feasibility, availability of reference data).

Activities of Daily Living↗
PubMed1996

[Patient "satisfaction" in medical rehabilitation--a useful outcome indicator?].

Within the context of a five-part quality assurance programme for rehabilitation hospitals issued by the German Association of Statutory Pension Scheme Underwriters (Verband Deutscher Rentenversicherungsträger) we developed a multisectional questionnaire to assess patient satisfaction with rehabilitation measures. This questionnaire records the patients' perceptions and ratings of rehabilitation structures and processes as well as the results of then. The article describes basic positions, chances and risks of assessing this measure of satisfaction as well as the development of our questionnaire. The dimensions of patients satisfaction are based on the differentiation between various sectors of clinical output and capacity (Leistungsbereiche) und demands on medical service and capacity (Leistungsansprüche). The questionnaire includes rating and reporting questions. Since it will be complemented by a second part on health outcomes, this "research tool" will be used routinely to compare hospitals on the basis of an annual random sample (15%) of all rehabilitation patients.

Germany↗