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M Bullinger

Publications and source records attributed to M Bullinger.

At least 37 records · Page 2Linked to original sources
PubMed2002

Quality of life after multiple trauma--summary and recommendations of the consensus conference.

In October 1999, an international and interdisciplinary consensus conference was held about the assessment and application of quality of life (QoL) measures after multiple trauma. Four working groups represented the following patients: children with traumatic brain injury (TBI); adults with TBI, adults with multiple injuries (but without TBI), and adults with spinal cord injury. According to predefined questions, the groups tried to identify the relevant problems of the patients, at different time points after the traumatic event. A review of the existing instruments for quality of life assessment and the evidence of their application in trauma patients in the scientific literature was performed by each group. Based on the results of these literature reviews it was concluded that there are not enough data to establish "evidence-based" guidelines for QoL assessments in these patients. Nevertheless, the groups comprised of experts clinicians and methodologists, agreed on the Glasgow Outcome Scale and the SF-36 as generic tools for QoL assessment across all trauma patients. It was further recommended to use these generic tools in combination with condition-specific instruments to better reflect the specific problems of the patients. Finally, the whole group suggested that it was not appropriate to view this conference as a "final report" about QoL assessment in trauma patients, but rather it should be seen as a starting point for increased efforts to initiate clinical research projects using QoL as an outcome, to develop better instruments, and to include QoL assessments into daily routines.

Health Planning Guidelines↗
PubMed2001

Generic or disease-specific quality of life scales to characterize health status in allergic rhinitis?

BACKGROUND: In patients with allergic rhinitis (AR), various instruments have been validated for the measurement of quality of life (QOL), which may be greatly reduced. However, it is not clear which QOL instruments should be used for the different types of AR and whether they are sensitive to treatment. METHODS: The QOL of patients suffering from symptomatic seasonal AR (sSAR) (before and during treatment with a topical or systemic antihistamine), symptomatic perennial AR (sPAR), and asymptomatic seasonal AR (aSAR) was determined with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as disease specific and with the Munich Life Dimension List (MLDL) and the Visual Analogue Scale for Quality of Life (VAS-QOL) as generic QOL instruments. RESULTS: The different forms of AR were associated with typical QOL patterns. In sSAR, we found severe limitation of the global QOL, reduced global life satisfaction, high ranking of practical problems, high limitation of activity, and a high degree of disturbance in all subscales of the RQLQ. In sPAR, there were moderate limitation of the global QOL, normal global life satisfaction, high ranking of practical problems, moderate limitation of activity, and a high degree of disturbance by common symptoms. Under antihistamine treatment, both systemic and nasal, a significant improvement of QOL parameters was found, reaching the levels of patients with aSAR after 2 weeks. CONCLUSION: QOL instruments can distinguish the impairment resulting from sSAR from that of sPAR and are sensitive to treatment with topical and systemic antihistamines. However, as the RQLQ was not designed to measure the short-term variations of disease status that appear in SAR, it may not demonstrate the rapid improvement of QOL under antihistamine treatment.

Adult↗
PubMed2001

Why do women suffer from sick building syndrome more often than men?--subjective higher sensitivity versus objective causes.

Office workers often report so-called sick building syndrome (SBS) symptoms affecting the skin, mucous membranes and nervous system. The recurring higher prevalence of SBS in women was investigated using questionnaire and ergonomic data from the German ProKlimA-Project. The hypothesis that working conditions and job characteristics for women are inferior to those of men was tested for groups of risk factors. Finally, gender-specific multiple logistic regression models were compared. It was found that 44.3% of women (n = 888) and 26.2% of men (n = 576) suffer SBS with significant differences between men and women for many variables. Considering sub-groups--supposing the same circumstances in psycho-social and work-related conditions--gender-specific SBS prevalence rates differ as for the whole sample, e.g. 35.9% of women with the most favourable job characteristic suffer SBS (men: 19.4%), 53.0% of women with the most unfavourable job characteristic suffer SBS (men: 33.3%). These results show that women suffer more SBS than men independent of personal, most work-related and building factors. Multiple logistic models define self-reported acute illness, job satisfaction, software quality and job characteristics as significant gender-independent risk factors. Number of persons/room, self-reported allergy and smoking are characteristic female risk factors. Age is a significant risk factor only in men.

Adult↗
PubMed2001

Quality of life after in-patient rehabilitation in children with obesity.

OBJECTIVE: Treating obesity concerns not only medical concomitants and future complications but also quality of life. The study was planned to investigate the effect of obesity and obesity treatment on quality of life in children. DESIGN: In the study presented, quality of life as well as psychosocial, clinical, sociodemographic and family related information was obtained from both children and their parents, at four time points by questionnaires: (1) Prior to in-patient rehabilitation (at home); (2) at the end of the in-patient rehabilitation (in clinics); (3) three months after admission into rehabilitation clinics; and (4) twelve months after admission into rehabilitation clinics. MEASUREMENT: Quality of life (QoL) was assessed in children using the revised German KINDL(R) quality of life questionnaire, a 24 item instrument yielding six dimensions and a total score as well as a chronic generic and an obesity module. Psychosocial determinants included assessments of stress, emotional support, coping and internal locus of control as well as expectations and motivations with regard to the rehabilitation programme. SUBJECTS: Seven large German in-patient rehabilitation clinics participated in the study in which 1019 children participated. These children were suffering from obesity (n=584) or asthma/atopic dermatitis (n=330) or both (n=105). RESULTS: Children as well as parents did not differ across the diagnostic groups in sociodemographic and general clinical variables. QoL in children was dependent on age and gender with increased age over 13 y and female gender being associated with lower self reported QoL. Differences between diagnostic groups were significant, indicating higher impairments in QoL in children with obesity. Multiple regression analysis showed that stress level, coping, as well as lack of emotional support and poor global health explained 37% of the variance of the KINDL(R) total score at the first measure point in the obesity group. Predicting QoL at the end of rehabilitation from data collected at the beginning of the study, psychosocial variables explained 28% of the variance. The results indicate that QoL of children with obesity is affected by age and gender and can be explained by stress, coping and support as well as global health ratings. QoL of obese children differs from the QoL of children with asthma/atopic dermatitis and improves from before to after rehabilitation. QoL after rehabilitation is predicted by psychosocial indicators, health resources and strains. CONCLUSION: The results of the study suggest that QoL assessment in children with obesity is relevant in understanding what life is like for children with obesity, which aspects of their life affect their well-being and how quality of life can be improved through rehabilitation programmes.

Adolescent↗
PubMed2001

[Testing and validation of the German version of the Stroke Impact Scale].

Suitable and psychometrically tested instruments to assess health-related quality of life in stroke patients are still lacking in German speaking countries. The current paper describes the translation and psychometric testing of the German version of the Stroke Impact Scale, which was developed as a self- and proxy- report measure in the United States to assess the consequences of a stroke. The instrument contains 64 Likert-scaled items and assesses eight dimensions of health-related quality of life ("strength", "memory and thinking", "emotion", "communication", "ADL/IADL", "mobility", "hand function", and "participation"). The questionnaire was used in a cross-sectional study of 137 persons with stroke and was psychometrically tested. The results of this psychometric testing show a good acceptance on part of the interviewees. Convergent validity of the SIS dimensions was assessed with correlation of the SIS subscales and subscales of the short form SF-36 and Nottingham Health Profile and criteria-related validity was examined by comparison of mean scores across groups defined by Rankin scores. The reliability of the questionnaire was determined through internal consistency (Cronbach's). The German version of the SIS is a reliable and valid instrument to assess health-related quality of life, but more studies are needed to make statements about sensitivity of the instrument, psychometric quality of the proxy version and suitability of the questionnaire for specific stroke subgroups.

Adult↗
PubMed2001

Eye- and skin symptoms in German office workers--subjective perception vs. objective medical screening.

The question of whether perceived sensation correlates with medical tests was examined using data from the ProKlimA project (1994-1999) in which sensory perception and medical examination of Sick Building Syndrome related complaints were examined in 14 office buildings across Germany. Within the ProKlimA study, a subsample of 817 persons participated in ophthalmological examinations; dermatological tests were conducted on 925 persons using serni quantitative dermatological methods. Participants of both sub-samples responded to a questionnaire assessing sensory perception over 6 sub-scales (eyes, skin nose, mouth, throat and nervous systems) consisting of 9 to 11 items per sub-scale. Non-parametric analysis revealed a significant association between medical tests of symptoms and self-reported complaints regarding skin/eyes. Break up time, a measure of tear film stability, appeared to be the best indicator for self-reported eye complaints. In terms of skin symptoms, low sebaceous secretion and/or low stratum corneum hydration was associated significantly with increased skin complaints. But not all items of the sensory perception modules reflected the medical diagnoses in the same way. For instance the items "rough skin" and "dry skin" described the medical diagnosis "low sebum content" better than "irritated skin", "rash" or "spotty skin". However, sensory perception modules differed in their relationship to medical tests, so that questionnaires may be used as indicators not as substitutes for medical test data. The choice of method has to be determined by the purpose of the research project.

Environment, Controlled↗
PubMed2000

[Subjective health and health behavior of children and adolescents--a survey of Hamburg students within the scope of school medical examination].

The subjectively perceived health of children and adolescents has received little attention in Public Health research so far. In co-operation with school physicians of Hamburg, Eimsbuettel, 1,501 children and adolescents (grades 4 and 8, as well as their parents) were questioned with regard to health-related quality of life and health behaviour, using among others the short form of the KINDL Quality of Life Questionnaire and established psychosocial instruments. High values in the KINDL scale were found in 75% of the students, the mean value of the 0-100 transformed KINDL total scale was around 80. Adolescents--and in this group specifically the girls--reported significantly lower quality of life scores. Psychosocial strain, presence of disease and school absenteeism were negatively associated with quality of life ratings. Health-related behaviours in terms of resources in the area of food intake and risk behaviours in terms of addiction, obesity and stressors correlated with subjective health as expected. In multiple regressions these factors explained 20% of the KINDL-score variance in the total group. Taking into account indicators of functional status and life satisfaction, the percentage of explained variance increased to over 50%; here these predictors yielded a correct classification of high vs. low self-reported quality of life in 90% of the cases. The study shows that subjective health is a methodologically adequate and scientifically interesting indicator which in the public health area can be used in epidemiological research, in health reporting and in school physicians' practice to identify young persons with quality of life impairments in order to provide early and in-focus support to this group.

Adolescent↗
PubMed1999

The World Health Organization WHOQOL-100: tests of the universality of Quality of Life in 15 different cultural groups worldwide.

The World Health Organization Quality of Life assessment (WHOQOL-100) was developed simultaneously across 15 international field centers and includes 24 facets relating to quality of life, which are grouped into 4 larger domains: physical, psychological, social relationships, and environment. It also includes 1 facet examining overall quality of life and general health perceptions. This article examines the extent to which the WHOQOL-100 assesses quality of life perceptions in different cultures and whether it is structurally comparable in these cultures. Regression analysis showed all 4 domains to be important in assessing quality of life in each of the 15 centers. Structural equation modeling suggested further support for the proposal that there are universal facets and domains that are cross-culturally important in determining quality of life and suggested that the ordering of facets within domains is comparable across cultures.

Adult↗
PubMed1999

The psychological cost of aircraft noise for children.

Psychological effects of aircraft noise exposure on children have only recently been addressed in the References. The current study took advantage of a natural experiment caused by the opening of a major new airport, exposing children in a formerly quiet area to aircraft noise. In this prospective longitudinal investigation, which employed non-exposed control groups, effects of aircraft noise prior to and subsequent to inauguration of the new airport as well as effects of chronic noise and its reduction at the old airport (6 and 18 month post relocation), were studied in 326 children aged 9 to 13 years. The psychological health of children was investigated with a standardized quality of life scale as well as with a motivational measure derived from the Glass and Singer stress aftereffects paradigm. In addition a self report noise annoyance scale was used. In the children studied at the two airports over three time points, results showed a significant decrease of total quality of life 18 month after aircraft noise exposure as well as a motivational deficits operationalized by fewer attempts to solve insoluble puzzles in the new airport area. Parallel shifts in children's attributions for failure were also noted. At the old airport parallel impairments were present before the airport relocation but subsided there after. These findings are in accord with reports of impaired psychological health after noise exposure and indicate the relevance of monitoring psychological parameters as a function of environmental stressors among children.

Adolescent↗
PubMed1999

The sick-building-syndrome--do women suffer more?

According to recent literature reviews, women seem to be especially prone to report symptoms of the so-called Sick-Building-Syndrome. In a large German study into the Sick-Building-Syndrome (the ProKlimA-project) 4596 persons from 14 buildings around Germany filled out a questionnaire regarding Sick-Building-symptoms and potential psychosocial determinants. The present article presents questionnaire results from 2517 female employees (as compared to 2079 male employees) which showed that women report higher scores in sensory irritation, a higher bodily complaint rate and more negative evaluation of the indoor climate. In addition most psychosocial variables showed less favourable scores for women as compared to men. Gender stratified logistic regression analysis suggests an effect of less favourable working conditions under which women are employed. Thus although women are more prone to express impairments in wellbeing, such expression has to be critically evaluated against the background of their living and working conditions.

Female↗
PubMed1999

The sick building syndrome as a subjective perception-theoretical approach and assessment methods.

The SBS is characterised by irritations of mucosa, vegetative complaints such as headache and fatigue as well as mental health impairment, depression and irritability (WHO definition). Since well-being is a subjective perception, the individual self report is mandatory. In the ProKlimA project a modular questionnaire was developed in which SBS symptoms, general aspects of well-being and function as well as psychosocial characteristics were included in a modular fashion. Assessment included sensory irritation (SI list), psychosocial characteristics (POMS) and bodily complaints, assessed with a standard German complaint list (BL). In addition the individual indoor-air perception, stress reactions, the perceived work-environment, health locus of control, life satisfaction and work related use were assessed. Analysis of the questionnaire filled out by 4596 employees at the first measure point showed a high consistency of responses. Psychometric testing showed a high reliability and acceptable validity of the questionnaire. The results suggests that well-being within the SBS complex can be assessed in a methodological way and that the developed questionnaire can be used to assess SBS symptomatology as well as psychosocial determinants also in further SBS studies.

Germany↗
PubMed1998

[Health-related quality of life. Long-term survival in patients with ARDS following extracorporeal membrane oxygenation (ECMO)].

UNLABELLED: Treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) can be lifesaving but requires maximal use of intensive care resources over prolonged periods of time, resulting in high costs. Little is known about the health-related quality of life (HRQL) in long-term survivors. This case-controlled retrospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy. METHODS: 14 long-term survivors of ARDS (APACHE II score = 24, Lung Injury Score = 3.25, median values) treated using ECMO between 1992 and 1995 (median time interval between data collection and discharge from the ICU 16 months) and 14 ARDS-patients conventionally treated during the same period (group I) were identified and completed the SF-36 Health Status Questionnaire (Medical Outcome Trust, Boston, USA). 14 healthy subjects (group II) were drawn at random from a large data base generated to provide normal values for the SF-36 in a German population. All three groups were comparable with respect to sex and age. RESULTS: Long-term survivors of ECMO-therapy reported significant reductions in physical functioning when compared with patients treated by mechanical ventilation alone (group I, -12.5%, p < 0.05) and with healthy controls (group II, -50%, p < 0.05) and showed a higher incidence of chronic physical pain (+5% and +24%, respectively, p < 0.05). There were no differences with regard to the mental health dimensions of the SF-36 (e.g. vitality, mental health index or social functioning) between ECMO-patients and all controls. Nine patients (64.3%) from the ECMO group versus all patients treated conventionally (group I) had full-time employment (p = 0.46, Chi2 test). CONCLUSIONS: The majority of long-term survivors of ECMO-treatment show good physical and social functioning, including a high rate of employment. The more aggressive approach of ECMO-therapy and a possibly more severe underlying disease process may explain impairments in health-related quality of life outcomes after ECMO-treatment. Despite these limitations, long-term survivors of ECMO-therapy are able to reach a highly satisfactory health-related quality of life.

APACHE↗
PubMed1998

[Perspectives of patients with terminal renal failure: quality of life and psychological adjustment before and in the first year after heart transplantation].

This prospective study was designed to compare quality of life, life satisfaction, and subjective ratings of health before and at variable time intervals after heart transplantation (HTx). 175 patients were included between February 1994 and December 1997. Every six months before and 1 1/2, 3, 6, and 12 months after HTx, they received the following standardized and validated questionnaires: German SF 36, heart failure and specific transplant symptom list, global quality of life assessment, Munich life quality dimension list, expected/experienced life changes after HTx. Inclusion criteria were the acceptance of the patient on the waiting list for HTx, good command of the German language, and a minimum age of 18 years. During data evaluation, median (Me), mean (M), and standard deviation (SD) were created from individual parameters. Quality of life was rated as very poor by 84% of patients with congestive heart failure. Only 6 weeks after HTx, 74% rated their quality of life as significantly better. Before HTx 80% were very unsatisfied about their health status and 87% about physical performance. Six weeks after HTx, this parameter improved significantly and 76% were very satisfied about their health status and 50% about physical performance. While somatic changes expected before HTx corresponded well with experienced ones, psychological improvements were smaller than expected, but one year after HTx they were significant (before: M = 3.66; SD = 0.9; Range (R) = 3.78 vs 12 months postop: M = 4.61; SD = 0.6; R = 2.67; p < 0.05). Quality of life correlated before HTx best with subjectively rated health (r = 0.61, p < 0.01) and 6 months after with satisfaction about health status (r = 0.76, p < 0.01). Only in 25% were expected improvements fulfilled regarding sexual activity/satisfaction, professional situation, and recreational activities. 90% of post-transplant patients reported physical complaints, most by effects of immunsuppression, but were coping well. The study shows that already 6 weeks after successful HTx all quality of life parameters improved significantly. Despite some unfulfilled expectations and complaints, the postoperative life situation of HTx patients appeared significantly improved.

Activities of Daily Living↗
PubMed1998

Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment.

This article describes the methods adopted by the International Quality of Life Assessment (IQOLA) project to translate the SF-36 Health Survey. Translation methods included the production of forward and backward translations, use of difficulty and quality ratings, pilot testing, and cross-cultural comparison of the translation work. Experience to date suggests that the SF-36 can be adapted for use in other countries with relatively minor changes to the content of the form, providing support for the use of these translations in multinational clinical trials and other studies. The most difficult items to translate were physical functioning items, which used examples of activities and distances that are not common outside of the United States; items that used colloquial expressions such as pep or blue; and the social functioning items. Quality ratings were uniformly high across countries. While the IQOLA approach to translation and validation was developed for use with the SF-36, it is applicable to other translation efforts.

Cross-Cultural Comparison↗
PubMed1998

Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Increasingly, translated and culturally adapted health-related quality of life measures are being used in cross-cultural research. To assess comparability of results, researchers need to know the comparability of the content of the questionnaires used in different countries. Based on an item-by-item discussion among International Quality of Life Assessment (IQOLA) investigators of the content of the translated versions of the SF-36 in 10 countries, we discuss the difficulties that arose in translating the SF-36. We also review the solutions identified by IQOLA investigators to translate items and response choices so that they are appropriate within each country as well as comparable across countries. We relate problems and solutions to ratings of difficulty and conceptual equivalence for each item. The most difficult items to translate were physical functioning items that refer to activities not common outside the United States and items that use colloquial expressions in the source version. Identifying the origin of the source items, their meaning to American English-speaking respondents and American English synonyms, in response to country-specific translation issues, greatly helped the translation process. This comparison of the content of translated SF-36 items suggests that the translations are culturally appropriate and comparable in their content.

Cross-Cultural Comparison↗
PubMed1998

Testing the equivalence of translations of widely used response choice labels: results from the IQOLA Project. International Quality of Life Assessment.

The similarity in meaning assigned to response choice labels from the SF-36 Health Survey (SF-36) was evaluated across countries. Convenience samples of judges (range, 10 to 117; median = 48) from 13 countries rated translations of response choice labels, using a variation of the Thurstone method of equal appearing intervals. Judges marked a point on a 10-cm line-representing the magnitude of a response choice label (e.g., "good" relative to the anchors of "poor" and "excellent"). Ratings were evaluated to determine the ordinal consistency of response choice labels within a response scale; the degree to which differences between adjacent response choice labels were equal interval; and the amount of variance due to response choice label, country, judge, and interaction between response choice label and country. Results confirmed the hypothesized ordering of response choice labels; the percentage of ordinal pairs ranged from 88.7% to 100% (median = 98.2%) across countries and response scales. Examination of the average magnitudes of response choice labels supported the "quasi-interval" nature of the scales. Analysis of variance (ANOVA) results supported the generalizability of response choice magnitudes across countries; labels explained 64% to 77% of the variance in ratings, and country explained 1% to 3%. These results support the equivalence of SF-36 response choice labels across countries. Departures from the assumption of equal intervals, when observed, were similar across countries and were greatest for the two response scales that are recalibrated under standard SF-36 scoring. Results provide justification for scoring translations of individual items using standard SF-36 scoring; whether these items form the same scales in other countries as they do in the United States is evaluated with tests of scaling assumptions.

Analysis of Variance↗
PubMed1998

Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population samples in 11 countries (n = 1483 to 9151) were used to assess data quality and test the assumptions underlying the construction and scoring of multi-item scales from the SF-36 Health Survey. Across all countries, the rate of item-level missing data generally was low, although slightly higher for items printed in the grid format. In each country, item means generally were clustered as hypothesized within scales. Correlations between items and hypothesized scales were greater than 0.40 with one exception, supporting item internal consistency. Items generally correlated significantly higher with their own scale than with competing scales, supporting item discriminant validity. Scales could be constructed for 93-100% of respondents. Internal consistency reliability of the eight SF-36 scales was above 0.70 for all scales, with two exceptions. Floor effects were low for all except the two role functioning scales; ceiling effects were high for both role functioning scales and also were noteworthy for the Physical Functioning, Bodily Pain, and Social Functioning scales in some countries. These results support the construction and scoring of the SF-36 translations in these 11 countries using the method of summated ratings.

Cross-Cultural Comparison↗