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Biomedical subjects

J Siegrist

Publications and source records attributed to J Siegrist.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Family practice management of risk patients with reference to preclinical emergency medicine].

Chances of surviving myocardial infarction or cardiocirculatory arrest depend on an early and appropriate emergency call as well as on bystander CPR. This study uses a questionnaire to assess to what extent these factors guide the private practitioners caring for high-risk cardiac patients. Almost all physicians responding (44%) treat such patients. More than 70% try to include the patients' relatives in a medical briefing. Recognition of early warning signs is discussed with 80% of the patients and 70% of relatives. How to identify acute life-threatening conditions is discussed with 60% of patients and relatives. In case of sudden chest pain and dyspnoea, physicians commonly advise calling the family doctor, a hospital or a regional physician on call. Calling 112, the emergency physician/rescue service, is rarely recommended. Initiating CPR is recommended for an emergency by 30% of the physicians, whereas 20% encourage relatives of patients at risk to take a CPR course. CPR instruction is judged to be generally useful by 50% of physicians, of limited use by 40% and of no use by 10%. When asked why they do not encourage CPR, 15% of physicians said they have no time, 25% cited the inefficiency of the courses, 40% said CPR is psychologically too stressful for laypersons, and 50% felt it was physically too stressful. This study points out the necessity of additional, appropriate instruction of laymen regarding cardiac emergencies.

Cardiopulmonary Resuscitation↗
PubMed1996

[Comprehensive life style changes by coronary patients--an intervention study].

In an intervention trial 31 coronary patients participated in a comprehensive lifestyle change program and 43 control patients received the usual care of the conventional cardiac rehabilitation system. First preliminary findings show that the patients in the intervention group not only improved their health related lifestyle but also increased their exercise capacity and reduced depression, while there was no substantial improvement in the control group. Up to the present, the existing data indicate that German heart patients are able to make comprehensive lifestyle changes and that these changes have positive effects on biomedical and psychosocial variables.

Adult↗
PubMed1996

[Health promotion in the work environment--old and new challenges for public health].

Associations between work and health can be found at many different levels. Work itself can have health hazardous as well as health promoting effects. Work defines status and life-style as well as social security and occupies a large proportion of time in our lives. Until now the process to integrate issues of worksite prevention and health promotion into Public Health proceeds slowly in contrast to other countries e.g. the USA. Weak connections between occupational medicine and Public Health as well as relative few projects focussing on work site in the Public Health Research Associations reflect this trend. Work site public health research according to the guidelines of the Ottawa Charta (WHO) could enhance the transition of approaches justified now in terms of risk and legal liability towards an orientation on health resources and preventive potentials. This transition is promising in regard to the science of public health. However, bottleneck facilities can be identified: the development of appropriate health reports in companies, the implementation and further development of new steering models for worksite interventions (especially the organizational development) and the implementation and further development of appropriate form of quality assurance which can be evaluated.

Accidents, Occupational↗
PubMed1996

[Disciplinary organization of medical sociology--a contribution to the dialogue with social medicine].

According to Karl Popper scientific disciplines are characterized by a body of observational knowledge, a specific methodology and terminology and a set of more or less successful theories. This article tries to delineate the disciplinary structure of medical sociology in terms of five important areas of knowledge: 1. sociology of health lifestyles (prevention); 2. sociology of patients careers (rehabilitation); 3. sociology of client-professional interaction (diagnosis, therapy); 4. sociological (social epidemiological) studies of causes of health and disease; 5. sociology of health care systems. It is argued that intensified exchange according to these areas between the academic disciplines of medical sociology and social medicine is needed to generate a significant impact on future training and research both in medicine and in public health.

Curriculum↗
PubMed1995

Self, social structure, and health-promoting behavior in hypertensive patients.

A description is presented of views on coping with stress due to chronic, socio-emotionally distressing conditions in the course of hypertension. Four theoretical approaches are discussed, and illustrated by recent studies: 1. lack of support, 2. relative deprivation, 3. job strain, 4. effort-reward imbalance. The implications for stress management and patient education are discussed.

Adaptation, Psychological↗
PubMed1995

Emotions and health in occupational life: new scientific findings and policy implications.

A large number of patients suffer from cardiovascular (CV) risk and disease. While many of them have experienced chronic emotional distress at work or at home as a subjectively important risk factor, clinical medicine has so far often disregarded the role of emotional distress in the pathogenesis of CV disease. However, new findings show striking associations. This paper summarizes the evidence from 3 epidemiologic studies on work-related distress and CV risk in middle-aged male populations. The empirical work is based on a theoretical model termed effort-reward imbalance. Workers who exhibit high effort in combination with low reward, and especially with low job security or promotion prospects, suffer from a 3- to 4-fold increased risk of CV disease, and they exhibit higher blood pressure, blood lipids and fibrinogen. Implications of these findings for prevention and intervention are discussed.

Adult↗
PubMed1995

[The effect of long-term monotherapy with preparations from the 4 basic groups of antihypertensive agents on the quality of life in patients with mild and moderate arterial hypertension. The Multicenter Captopril and the Quality of Life Study. The working group of the Multicenter Captopril and the Quality of Life Study].

A multicenter, controlled, open, randomized trial of antihypertensive and life quality (LQ) effects of monotherapy with captopril vs propranolol, hydrochlorothiazide and nifedipine included 345 males aged 35-60 years with mild and moderate hypertension. The results of 8-month treatment provided the conclusions: the drugs were much alike by antihypertensive efficacy, LQ parameters proved more beneficial in the group on captopril than those on nifedipine and propranolol, hydrochlorothiazide failed to improve life quality, captopril is an effective and safe antihypertensive drug superior to the drugs of 3 other antihypertensive drug groups by positively affecting LQ.

Adult↗
PubMed1995

[Epidemiologic and medical sociological aspects of hypertension].

Cardiovascular diseases are a major determinant of overall and premature mortality in advanced and in rapidly developing societies. In view of their importance it is mandatory to identify underlying risk factors and to guide preventive and therapeutic actions accordingly. Hypertension is one of the most prevalent and well-established cardiovascular risk factors. This paper briefly summarizes some major determinants of high blood pressure from an epidemiologic and sociomedical point of view. Determinants include age, overweight, physical inactivity, salt and alcohol intake, family history of hypertension, race and socio-economic status. The complexity of these influences is discussed by pointing to interactions between genetic and socio-environmental influences, e.g. in the case of age, bodyweight and salt intake. Based on experimental animal research there is now solid evidence on direct links between psychosocial stress, patterns of neuroendocrine activation and elevation of blood pressure. Four theoretical concepts are described which identify conditions of chronic psychosocial vulnerability or protection in man, and their role in explaining the prevalence of hypertension in epidemiologic studies is discussed. The four concepts are labelled "socioemotional support", "lifestyle incongruity", "job strain" and "effort-reward-imbalance at work". Special emphasis is given to the two latter concepts in view of the potential role of occupational life in triggering high blood pressure during middle adulthood. For instance, Table 1 indicates that high job strain, i.e. high demands in combination with low control at work, is associated with a relative risk of 3 of being hypertensive, after adjusting for important confounders.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Life style changes in patients with myocardial infarct in the framework of intramural and ambulatory rehabilitation--results of a German pilot study].

To assess whether German patients would make comprehensive lifestyle changes as designed and successfully tested in the San Francisco Lifestyle Heart Trial, we recruited 25 patients who received usual care, and 15 patients who made lifestyle changes during a 6-week in-hospital rehabilitation program followed by a 3-month ambulatory period. The intervention program consisted of a low-fat vegetarian diet, stress management techniques, aerobic exercises, and group support meetings. The program was well accepted, and high compliance resulted in significant changes in the patients' diet, stress management, and exercise activity. For instance, fat intake dropped from 36% to 9% of total calories. As patients in both groups received 20 mg/day of Pravastatin, a lipid-lowering drug, lipid levels dropped significantly in both groups (30% in the intervention group and 27% in the control group). Thus, the combined effect of behavioral and drug treatment did not result in a substantial additional lipid-lowering effect. Within the intervention group significant improvement in quality of life occurred. In conclusion, the lifestyle heart program can be successfully implemented in a German rehabilitation setting which combines in-hospital and out-patient activities. However, participation in the current program is limited to highly motivated, well educated coronary patients.

Adult↗
PubMed1994

Study of quality of life on rural hypertensive patients. Comparison with the general population of the same environment.

A comparative study about quality of life was made in the community of Riosa--north of Spain--on two groups of subjects: one affected by hypertension (n = 115), stage I and II of WHO, and another of the general population, matched in age, sex and residence with the former group and of the same size. The subjects with loss of self-care or mobility were excluded. The quality of life was evaluated with a standardized measurement approach referring to the spheres of physical, emotional, social and sexual functions. With this study the validation of the Spanish version of the questionnaire was made and the results obtained were found to be more or less the same as those reported by authors in other European countries of similar sociodemographic conditions. Hypertensive patients reported significant lower scores of quality of life than the general population in more than half of the dimensions explored: well-being and physical capacity, social functioning, positive mood and psychological functioning. In conclusion, despite the many limitations inherent to this area of research, a standardized and valid measure of relevant aspects of quality of life in the general population and especially in patients with hypertension, is available in the Spanish language.

Cross-Cultural Comparison↗
PubMed1993

Captopril versus digoxin in patients with coronary artery disease and mild heart failure. A prospective, double-blind, placebo-controlled multicenter study. The CADS Study Group.

We conducted a prospective, double-blind, placebo-controlled multicenter trial in order to evaluate the long-term effects of captopril (50 mg/day), digoxin (0.25 mg/day) and placebo on quality of life, cardiovascular events, clinical symptoms and exercise tolerance in patients with documented myocardial infarction, resulting in regional wall motion abnormalities, and with mild heart failure (NYHA class II to III without treatment) and exercise not limited by angina. 222 patients were studied, 63 were randomized to captopril, 66 to digoxin, 67 to placebo. Follow-up was conducted for two years. Base line characteristics in the three treatment groups were similar. After one year of therapy, digoxin had significantly improved general well-being (p < 0.01 vs captopril), symptom score (p < 0.05 vs captopril and placebo), and vitality (p < 0.05 vs captopril). Digoxin improved NYHA class in 45% as compared to placebo (28%, p < 0.05). Worsening of angina was more frequent with captopril as compared to digoxin (p < 0.05). However, cardiovascular events during follow-up were lower in the captopril group as compared to placebo and digoxin (p < 0.01 captopril vs placebo). No differences between groups were observed in baseline and follow-up exercise tolerance between the three groups. Dizziness during upright tilt and cough were more frequent with captopril as compared to digoxin or placebo. After two years of follow-up (captopril n = 32, digoxin n = 29, placebo n = 27) general well-being was improved with both digoxin and captopril (p < 0.004 and p < 0.03 vs placebo).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Promoting competence in training courses in Germany--complementary education in health sciences and social medicine and the Düsseldorf University].

The article summarises the aims, organisational background and essential contents of the postgraduate training programme offered by the Medical Faculty of the University in cooperation with the Academy of Public Health at Düsseldorf. The five topical areas which define the essence of the two years curriculum are described. On the basic of this knowledge, participants are expected to successfully solve theoretical, methodological and practical problems in different areas of medically oriented public health activities.

Curriculum↗
PubMed1992

[Health behavior of young adults: empirical analysis of complex behavior patterns and their determinants].

Complex associations between alcohol consumption, cigarette smoking, eating habits and physical exercise are explored. Data from the 1985 German Cardiovascular Prevention Study are used to explore associations between these behaviours, separate for young men (n = 561) and young women (n = 509) between 25 to 34 years of age. Analyses concern three forms of associations: 1. associations between different categories of single health behaviours; 2. associations between various health behaviours, and 3. associations between health behaviours, and their social determinants. Contingency tables, cluster analyses and logistic regression analyses are applied. Cluster analyses identified subgroups with particular health behaviour patterns. One distinct pattern, similarly among men and women, was typified by increased physical exercise, less smoking and increased beer consumption. For young men, results from regression analyses showed significant effects of higher income and positive health attitudes on belonging to this distinct cluster. For young women cluster membership was significantly correlated with higher education and positive health attitudes. Results of the statistical analyses demonstrate the usefulness of a multi-methods approach in studying complex behaviour patterns. Finally the relevance of the present findings for future studies and applications is indicated.

Adult↗
PubMed1992

The role of hypertension, left ventricular hypertrophy and psychosocial risks in cardiovascular disease: prospective evidence from blue-collar men.

Epidemiological studies have demonstrated that, compared with the population as a whole, there is increased cardiovascular morbidity and mortality among lower socio-economic groups. To explore determinants of the increased risk within this group, a prospective 6.5 year investigation of a cohort of 416 middle-aged (40.8 +/- 9.6 years) male blue-collar workers was undertaken. In addition to established somatic and behavioural risk factors, psychosocial influences that measured chronic occupational stress in terms of an imbalance between high effort and low reward were assessed. Multivariate logistic regression analysis shows that hypertension (odds ratio (o.r.) 3.85; 95% CI 1.59-9.34), left ventricular hypertrophy (o.r. 3.62; 95% CI 1.06-12.37), hyperlipidaemia (o.r. 2.55; 95% CI 1.08-6.00), status inconsistency (measuring low reward at work) (o.r. 2.86; 95% CI 1.04-7.80) and 'immersion' (measuring high intrinsic effort at work) (o.r. 3.57; 95% CI 1.22-10.47) independently contribute to the prediction of fatal or non-fatal cardiovascular events (acute myocardial infarction, stroke). Expected probabilities of cardiovascular events are clearly elevated if the combined effects of left ventricular hypertrophy and psychosocial risks are analysed. In conclusion, increased incidence of cardiovascular disease among lower socio-economic groups is explained by a co-manifestation of established risk factors including left ventricular hypertrophy (by ECG) and psychosocial factors measuring chronic stress at work.

Adult↗
PubMed1991

[Quality of life of hypertensive physicians with hypertension therapy. Randomized double-blind study of 237 female and male physicians with high blood pressure].

In a group of 237 hypertensive male and female physicians, a placebo-controlled randomized double-blind, cross-over trial was performed to investigate the effects of the ACE inhibitor captopril on blood pressure and well-being. A thoroughly tested standardized measurement of well-being was employed. On the basis of the multivariate linear model, differences in the response to treatment (t-tests for cross-over differences) were investigated in terms of the seven parameters of well-being measured. In comparison with placebo, captopril (50 mg once daily) had a significant effect on five of the seven parameters. Thus, mood, general well-being, work performance, regeneration and quality of sleep all improved under treatment. It was also found that these improvements were not an immediate consequence of blood pressure reduction. The standardized evaluation employed here thus proved to be an informative additional evaluation criterion of antihypertensive therapy.

Captopril↗