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T Kohlmann

Publications and source records attributed to T Kohlmann.

At least 19 recordsLinked to original sources
PubMed2006

[Chronic pain patient's acceptance and satisfaction with their analgesic medication. Development and validation of the QAMPAS questionnaire].

BACKGROUND: A newly developed questionnaire to measure the satisfaction of chronic pain patients with their analgetic treatment is introduced. METHODS: Based on pilot studies, a multidimensional questionnaire (QAMPAS) for the measurement of patient satisfaction was developed. In addition to a module on general patient satisfaction, it includes two specific modules with regard to medical treatment using tablets and transdermal systems (patches). In a validation study the questionnaire was administered at two measurement points to ambulatory chronic pain patients. RESULTS: The QAMPAS subscales possess satisfactory psychometric properties. Medication-specific satisfaction shows a well-differentiated multidimensional structure. With minor limitations, correlations with the general patient satisfaction module and the SF-36 and BPI subscales indicate it to be a valid instrument. CONCLUSION: The QAMPAS questionnaire is a standardized instrument with satisfactory psychometric properties for the measurement of patient satisfaction with their analgesic treatment.

Analgesics↗
PubMed2005

[Missing data in the somatisation subscale of the scl-90-R due to a 'checklist effect': occurrence in different surveys and results of various imputation methods].

Item non-response is a potential threat to the validity of study results. Taking the somatisation subscale of the SCL-90-R as an example, we hypothesise a specific response pattern ("checklist-effect") that is characterised by symptom-free persons not checking the "not at all"-category. The present study analyses the extent and relevance of this postulated "checklist-effect". Our data is derived from a survey of n = 228 blue-collar workers who previously had filed applications for medical rehabilitation benefits (A1-study), and two additional surveys as well. We defined the "checklist-effect" by the following response pattern: (1) at least one missing value and (2) at least one valid item response and (3) no "not at all"-responses. Occurrence of the "checklist-effect" in the three datasets differed widely. 75 % of the responders in the A1-Study had complete data, 16.2 % a postulated "checklist-effect". Imputation of missing values under the assumption of a "checklist-effect" led to a reduction of missing data in the somatisation-subscale from 12.3 % to 0.4 %. Ignoring the "checklist-effect" would overestimate the symptom level. Possible explanations for the effect are discussed. However, the validity of this effect has yet to be proven via methodological studies.

Bias↗
PubMed2005

Risk factors for goiter in a previously iodine-deficient region.

OBJECTIVE: Little information exists from formerly iodine-deficient areas regarding gender-specific risk factors for goiter and their synergisms. The aim of the present study was to investigate such gender-specific risk factors and their interactions in a large population-based sample. METHODS AND RESULTS: The Study of Health in Pomerania (SHIP) comprised 4310 randomly selected participants, aged 20 - 79 years. SHIP was performed in a previously iodine-deficient region. Data from 3915 participants with no known thyroid disorders were analyzed. Goiter was determined by thyroid ultrasound. Sociodemographic characteristics, smoking and alcohol drinking habits, marital status, education level, urine thiocyanate concentrations, and specifically in women, parity and previous or current use of oral contraceptives and hormone replacement therapy, were considered as candidate risk factors for multivariable statistical tests. Only two variables, an advanced age and current smoking, were independently associated with an increased risk for goiter in both genders. Analyses further revealed specific risk factor profiles for goiter which were different among men, pre- and postmenopausal women. CONCLUSION: We conclude that besides previous iodine deficiency, other risk factors for goiter exist which differ between gender. Among the avoidable risk factors, current smoking was strongly associated with the risk of goiter in men and women. These findings should influence activities which are intended to prevent thyroid disease.

Adult↗
PubMed2005

[Instruments for patient-reported outcomes and predictors in German-speaking rehabilitation research--current developments within the "Rehabilitation Sciences" research funding programme].

In 1998, the German Federal Ministry of Education and Research (BMBF) and the German pension insurance scheme established a funding programme for research in rehabilitation. This initiative led to the establishment of eight regional research networks in which numerous research projects were sponsored for eight years (1998-2005). Within the framework of this funding programme, various self-assessment instruments were developed, adapted or improved in order to measure patient-reported outcomes and predictors. In sum, the analyses meet high psychometric standards. In this paper, a comprehensive review is given in five important assessment fields of rehabilitation research in Germany: Health-related quality of life (generic, disease-specific, children and adolescents, preference-based), evaluation of specific therapy and education programmes, motivation, screening for vocational problems and screening for comorbid mental disorders. The instruments are critically discussed, and perspectives for further research are pointed out.

Biomedical Research↗
PubMed2004

A new instrument for assessing quality of life in atopic dermatitis: international development of the Quality of Life Index for Atopic Dermatitis (QoLIAD).

BACKGROUND: Atopic dermatitis (AD) is a chronic or chronically relapsing inflammatory skin condition that can have a considerable impact on those affected. There are a number of instruments available to measure outcome in dermatological conditions but none have been developed specifically for AD. In addition, most measure symptoms and/or daily functioning, which are potential influences on quality of life (QoL) rather than assessments of the construct itself. OBJECTIVES: The aim of the current study was to develop a new instrument specifically designed to measure QoL in adults with AD-the Quality of Life Index for Atopic Dermatitis (QoLIAD). METHODS: The instrument was developed based on the needs-based model of QoL and was produced in several different countries simultaneously. Its content was derived from 65 in-depth interviews with relevant patients in the U.K., Italy and the Netherlands. The initial version of the measure was produced in U.K. English and translations were produced for the Netherlands, Italy, Germany, France and the U.S.A. using a dual translation panel methodology. A Spanish version was developed using the same adaptation process after the instrument was finalized. Field-test interviews were conducted with approximately 20 patients in each country to assess face and content validity. The instrument [in addition to the Dermatology Life Quality Index (DLQI) and the Psychological General Well-Being Schedule (PGWB)] was then administered to up to 300 AD patients in each country at two time points to finalize the instrument and test its psychometric properties. RESULTS: The initial version of the QoLIAD had 56 items that reflected the areas of need fulfillment identified in the qualitative interviews as having been affected by AD: mental and emotional stimulation, physical and emotional stability, security, sharing and belonging, self-esteem, personal development and fulfillment. Comments from patients in field-test interviews resulted in the removal of 14 items, to leave a 42-item instrument that was considered relevant and acceptable. The number of patients participating in the survey were 286 in the U.K., 46 in the Netherlands, 213 in France, 187 in Germany, 178 in the U.S.A. and 83 in Spain. Application of the Rasch model to these data identified the final 25-item QoLIAD. Unidimensionality was confirmed, with deviation of the total scale from the Rasch model evident at a single time point in one country only (the U.K.). All language versions, with the exception of the Dutch measure, had test-retest reliability coefficients in excess of 0.85. The test-retest in the Netherlands was 0.80. However, this country had the smallest sample size and the corresponding reliability for the DLQI was only 0.40. The QoLIAD had adequate internal consistency and the initial indications of construct validity were good. The levels of association with the DLQI indicated that the two instruments measure related but distinct constructs. CONCLUSIONS: The QoLIAD is a practical, reliable, valid and culturally applicable instrument for measuring the impact of AD and its treatment on QoL in clinical trials or in routine clinical practice.

Adolescent↗
PubMed2003

[Musculoskeletal pain in the population].

This review of studies on the prevalence of musculoskeletal pain demonstrates the epidemiologic relevance of this health problem. Based on the results of the German National Health Survey, about 16% of the adult population is affected by severe musculoskeletal pain. Prevalence in women is higher than in men (women: 18%, men: 14%) and dependent on age, with a maximum prevalence occurring around the age of 50 to 60. In a comparison with results on the prevalence of chronic widespread pain, a realistic estimate of the prevalence of clinically relevant musculoskeletal pain can be derived. Findings from longitudinal studies show considerable agreement with respect to the natural course of musculoskeletal pain. Known risk factors-apart from a history of pain experience-are only moderately associated with the occurrence and course of musculoskeletal pain.

Aging↗
PubMed2003

[SF-36 Health Survey in Rehabilitation Research. Findings from the North German Network for Rehabilitation Research, NVRF, within the rehabilitation research funding program].

The SF-36 Health Survey and its 12-item abridged form is an instrument for the assessment of health related quality of life that can be used with healthy persons and patient populations. Its use has been recommended within a large German multicentre rehabilitation research programme. The paper examines missing data across all five study projects of the North German Network for Rehabilitation Research (NVRF) as well as psychometric properties of the instrument. In addition, data were compared to representative norm data using the SF-36 (SF-12) in the German National Health Survey. Results showed that there were few missing data in the SF-36. Examining the impact of age, gender and health status yielded effects of higher age and female gender on missing data. Psychometric analyses showed good to excellent results of the instrument in terms of scale fit and reliability. In terms of convergent validity, medium to high correlation of the SF-36 subscales with comparable instruments (e. g. SCL-90-R) could be found. Summarizing, the SF-36/SF-12 can be recommended for use in rehabilitation research. Analyses regarding sensitivity should be conducted in future studies.

Activities of Daily Living↗
PubMed2002

[Epidemiology of orofacial pain].

BACKGROUND: Results of international epidemiologic studies indicate that orofacial pain occurs in approximately 10 percent of the adult population. Women are constantly more often affected than men by a ratio of 2:1, on the average. Most studies show a decline of prevalence in older age. Several sources of epidemiologic data about pain in the general population are available in Germany. The German National Health Survey ( n=7,124), besides some smaller studies in specific German regions, provides detailed results about gender- and age-specific prevalence (12 months, 7 days) of orofacial pain. PREVALENCES: With generally somewhat higher prevalence figures, results from the National Health Survey are well in the range of findings of international studies. Prevalence of orofacial pain in the total sample was 16 percent (12 months) and 7 percent (7 days), respectively. With 12 months and 7 days prevalence rates of 20 percent and 9 percent, respectively, women were more frequently affected than men (12 percent, 5 percent). Data from the National Health Survey also demonstrate that occurrence of orofacial pain is often associated with pain in other body regions. Of those with orofacial pain during the past 7 days, less than 10 percent reported orofacial pain as the sole pain problem. 43 percent of those with orofacial pain reported pain in 5 or more other localizations. Orofacial pain was less often reported to be the most severe pain problem than pain in other body regions. Yet, comparisons of pain intensity reported by subjects who felt that orofacial pain was the most severe pain problem during the past 7 days with reports of those who indicated that headache, neck pain, or back pain was their most severe pain show a similar distribution of mild, moderate and severe pain in these four localizations. HEALTH-RELATED QUALITY OF LIFE: Health-related quality of life as measured in the National Health Survey by the SF-36 Short Form questionnaire is strongly affected by orofacial pain. Even controlling for gender, age, and number of pains during the past 7 days statistically significant reduction of scores in 5 out of 6 SF-36 subscales was observed in those with prevalent orofacial pain.

Facial Pain↗
PubMed2002

Health-related quality of life in old age: preliminary report on the male perspective.

Health-related quality of life is a key element of successful aging. With life expectancy increasing, postmenopausal estrogen/gestagen replacement therapy has been under discussion for some time with the aim of achieving a higher quality of life in old age. For a long time, the relevance of hormonal aging was only discussed with reference to women; however, more recent work deals with concepts that affect both sexes. According to recent studies, numerous symptoms and complaints which may impair quality of life, can be attributed to hormonal changes in old age in both women and men. The majority of age-related complaints, such as a decline in physical performance, decreased sexual activity and a deterioration of general well-being, are strongly reminiscent of the symptoms of classical pituitary disorders in adulthood. Since the early 1990s, scientific studies have also been investigating the influence of hormone 'replacement' in elderly men, using, for example, growth hormones. However, until now there has been no suitable measure for assessing the quality of life specifically in elderly men. In a research project aimed at developing a questionnaire (the VITA questionnaire), roughly equal numbers of elderly men and women were asked about their subjective health and quality of life. It was found that men assessed their health-related quality of life very positively in a number of different dimensions of the questionnaire. In the present article the individual aspects of the quality of life of men are described and examples of gender-related differences are presented and discussed.

Affect↗
PubMed2001

Selection pressure for the factor-V-Leiden mutation and embryo implantation.

The factor-V-Leiden mutation is seen in high frequencies in white people, despite its contribution to second-trimester abortion, preterm birth, and deep-vein thrombosis. The reason for its high frequency is not known. We investigated 102 mother-child pairs who had had successful in-vitro fertilisation by intracytoplasmic sperm injection as a model for human implantation. In 90% (9 of 10) of mother-child pairs who carried factor-V-Leiden mutation, the first embryo transfer was successful, compared with 49% (45 of 92) in factor-V-Leiden negative pairs (p=0.018, Fisher's exact test). Furthermore, the median number of unsuccessful transfers was lower in pairs who were positive for the mutation (0, range 0-2) than those who were negative (1, 0-8) (p=0.02, Mann Whitney U test) suggesting that improved implantation rate is an important genetic advantage of the factor-V-Leiden mutation.

Adult↗
PubMed2001

[Outcome measurement in musculoskeletal diseases: recommendation for a core set of scales for use in rehabilitation].

By application of a standardized core set of outcome measurement instruments, comparison between studies as well as meta-analyses in rehabilitation research can be facilitated. The German Society for Rheumatology has commissioned its working group on rehabilitation with the development of a proposal for such a core set of outcome measurement instruments. In a first step, dimensions for outcome measurement in rehabilitation were defined by a group of experts which represented rehabilitation hospitals, acute care hospitals, and research groups specialized in outcome measurement. The Delphi method was used in a multiple step consensus process. In a second step, instruments and procedures to operationalize the relevant dimensions were chosen. Reliability, validity, sensitivity to change, and practicability were used as criteria for selecting measurement instruments. The main intention of the proposed core set of outcome measurement instruments is to facilitate the processes of planning and carrying out rehabilitation research studies. Furthermore, the proposed instruments can be used for clinical documentation systems as well as for internal or external quality assurance programs.

Arthritis, Rheumatoid↗
PubMed2001

International development of the Quality of Life in Depression Scale (QLDS).

BACKGROUND: The Quality of Life in Depression Scale (QLDS) employs the needs-based model of quality of life (QoL) and was developed in the UK and The Netherlands as an outcome measure for clinical trials. This paper describes the production and psychometric assessment of nine new language versions for Canada (French and English), Denmark, France, Germany, Italy, Morocco, Spain and the US. METHODS: Three adaptation stages were employed; production of conceptually equivalent translations, field-test interviews and assessment of reliability and construct validity by survey of patients with major depression. RESULTS: Few problems were experienced with producing conceptually equivalent translations, except in Morocco. Patients in the field-test interviews found the instrument to have appropriate content and to be easy to complete. Internal consistency and test-retest reliability were excellent for all language versions and scores were found to relate appropriately to measures of depression severity and health status. LIMITATIONS: Further investigation is required of the ability of the measure to assess individuals at the extremes of the QoL continuum. Data collected with the Arabic QLDS should not be combined with those from other countries. CONCLUSIONS: The QLDS is the first instrument designed to assess QoL in depression based on a coherent model of the construct. Each language version has been shown to be well accepted by respondents and to have excellent psychometric properties. As the instrument is now available in a large number of languages, the QLDS is the QoL instrument of choice for inclusion in clinical trials of interventions for depression.

Adult↗
PubMed2001

Low prevalence of large intraventricular haemorrhage in very low birthweight infants carrying the factor V Leiden or prothrombin G20210A mutation.

UNLABELLED: The influence of genetic factors that increase coagulation on the extension of intraventricular haemorrhage (IVH) in very low birthweight infants has not been studied previously. This study investigated the frequency and effect of the factor V Leiden and prothrombin G20210A mutations in a population-based cohort of 305 preterm infants with a birthweight below 1500 g. The overall prevalence of IVH was similar in infants with (n = 43) and without (n = 262) prothrombotic mutations (18.6% vs 16.4%, respectively). However, infants with prothrombotic mutations had a significantly reduced risk of developing extension to IVH grade II or more [p = 0.023, odds ratio (OR) 0.11, 95% confidence interval (CI) 0.02-0.5]. The carrier state of a factor V Leiden or prothrombin G20210A mutation was still predictive for a low rate of IVH grade II-IV if possible confounding variables were included in a multivariate regression model (OR 0.12; 95%CI: 0.017-0.86). CONCLUSION: The data suggest that the factor V Leiden and prothrombin G20210A mutations lead to improved control of intraventricular bleeding in very low birthweight infants.

DNA Mutational Analysis↗
PubMed2001

Factors associated with health status of older Americans.

BACKGROUND: health status is increasingly used as a measure of healthcare effectiveness. How diseases and symptoms are associated with health status is not completely understood. OBJECTIVES: to find diseases, symptoms and demographic factors associated with physical and mental health status in older Americans. METHODS: we analysed data from a survey of over 100 000 Medicare beneficiaries aged 65 and older. We used the short-form 36 physical and mental summary scores as measures of health status. Other data collected included demographic details, symptoms and diagnoses. RESULTS: age as a single variable explained 4% of variation in physical health status. Adding other demographic information and increased disease burden explained variation to 8% and 27% respectively. Together, shortness of breath, back pain, difficulty getting in and out of chairs, arthritis of hip or knee, a recent change in health and age explained 54% of variation. All available variables explained 59%. The role of age as an independent factor decreased markedly after disease and symptoms were considered. Similar factors were associated with lower mental health status, but age was not. CONCLUSION: these data suggest that heart and lung disease and back pain are the most important factors affecting the average physical health status of older people. Sex, marital status and race have very little independent effect. Efforts to improve average physical health status scores might best be targeted at these conditions rather than demographic characteristics. Mental health status does not decline with age, and similar factors affect it but to a lesser degree.

Aged↗
PubMed2001

Health outcomes. New quality measure for Medicare.

OBJECTIVE: A new measurement of health care quality for Medicare beneficiaries has been implemented by the Health Care Financing Administration (HCFA). This paper describes the program, presents baseline data and highlights associated issues. DESIGN: The Health Outcomes Survey (HOS) is a longitudinal cohort mail survey. Changes in population health status after 2 years will be evaluated on an individual plan level. SETTING: Two-hundred and eighty-seven US Medicare managed care plans. MAIN OUTCOMES MEASURES: Physical component and mental component summary scales derived from the SF-36. FINDINGS: Baseline data documented lower health status in older populations, while functional limitations and disease prevalence were higher. Among different plans, mean functional levels were found to be similar, although a few plans contained populations with exceptionally low levels. These data do not support the assertion that enrolees in for-profit plans are healthier than non-profit plans. CONCLUSIONS/IMPLICATIONS: The HOS is the first large-scale program to evaluate health outcomes among older Americans. HCFA recognizes several technical and policy issues. Technical issues include possible biased reporting for subpopulations, the validity of proxy responses and respondent burden. Policy issues concern the appropriateness of using a generic measure such as the SF-36 and how much change in health status can be attributed to quality of health care. HCFA plans to extend the HOS to beneficiaries in traditional Medicare. The HOS project is expected to encourage more efforts to maintain or improve the health status of the Medicare managed care population.

Aged↗
PubMed2000

Excess triiodothyronine as a risk factor of coronary events.

BACKGROUND: Abnormalities in cardiac function, eg, arrhythmias and congestive heart failure, often accompany thyrotoxicosis. A relationship between thyroid hormone excess and the cardiac complications of angina pectoris and myocardial infarction (MI) remains largely speculative. METHODS: The results of thyroid function studies on blood samples drawn from a total of 1049 patients (aged 40 years or older) immediately on emergency medical admission were related to frequencies of angina pectoris and myocardial infarction as determined according to current diagnostic algorithms. After 3 years, those patients who had initially presented with angina pectoris or acute MI were observed for subsequent coronary events; of these (n=185), 98% of the subjects (n=181) could be reevaluated. RESULTS: On hospital admission, the relative rate of angina pectoris and MI was markedly high (odds ratio, 2.6; 95% confidence interval, 1.3-5.2; P=.007) in patients with elevated serum free and total triiodothyronine (T(3)) levels. An initially elevated free T(3) level was a risk factor for subsequent coronary events during the 3-year follow-up (adjusted odds ratio, 4.8; 95% confidence interval, 1.3-17.4; P=.02). CONCLUSIONS: An elevation of serum free T(3) levels at hospital admission is associated with a 2.6-fold greater likelihood of the presence of a coronary event. Moreover, an initially elevated T(3) level is associated with a 3-fold higher risk of developing a subsequent coronary event during the next 3 years. Excess T(3) seemed to be a factor associated with the development and progression of acute myocardial ischemia.

Adult↗
PubMed2000

Influence of occupational factors on the relation between socioeconomic status and self-reported back pain in a population-based sample of German adults with back pain.

STUDY DESIGN: Population-based cross-sectional postal survey and interview substudy. OBJECTIVES: To examine the association between socioeconomic status and severe back pain and to determine whether this association can be explained by occupational factors. SUMMARY OF BACKGROUND DATA: Like other disorders, back pain and its consequences are inversely related to indicators of high socioeconomic status. METHODS: The associations between indicators of socioeconomic status and presence or severity of current back pain (no back pain or back pain of low intensity and low disability versus back pain with high intensity and/or high disability) were investigated in a survey among German adults 25 to 74 years of age (n = 2731) and an interview substudy of 770 participants with a recent history of back pain.- RESULTS: In the survey, educational level was inversely associated with back pain and severe current back pain. Similarly, in the interview substudy, educational level, vocational training, occupational class, household income, and health insurance status were inversely related to severe current back pain. Age-adjusted and gender-adjusted odds ratios were 0.36 (95% confidence interval [CI] 0.25-0.52) for immediate educational level and 0.37 (95% CI 0.18-0.73) for high educational level. Recalled work tasks at the onset of back pain were significant risk factors of severe current back pain (heavy physical work: odds ratio [OR] 1.77, 95% CI 1.06-2.93; work in bent position among males: OR 1.89, 95% CI 1.03-3.46). After adjusting for occupational class or work tasks, the association between educational level and severe current back pain remained unchanged.- CONCLUSIONS: The findings support the hypothesis that severe back pain is less prevalent among adults of higher socioeconomic status. The underlying mechanism could not be explained by differences in self-reported occupational factors.

Adult↗