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Background: To assess quality of life and unmet needs after stroke, patient-reported outcome measures (PROMs) have gained increasing attention. However, patients' perspectives on assessing PROMs remain unclear, potentially hindering implementation into clinical practice. Therefore, this study explored patients' preferences on assessing PROMs after ischemic stroke. Methods: A paper-based questionnaire was sent to stroke survivors treated at the Department of Neurology, University of Leipzig, Germany. Health-related quality of life (HRQoL, EQ-5D-5L) and preferences regarding different aspects of data collection to assess PROMs were investigated and linked to socio-demographic and medical characteristics. Results: 158 persons were contacted and 80 replies were subsequently analyzed. Mean age was 70.16 years and mean HRQoL was 68.79 (visual analogue scale with a theoretical maximum of 100). Participants showed positive attitudes towards PROMs as they saw potential to improve care of other patients (n = 66/79; 83.54%) or to improve their own situation (n = 53/74; 71.62%). Participants preferred an annual interview after stroke (n = 39/80; 48.75%) and would preferably spend 15–30 min (n = 41/79; 51.90%) to answer a written survey (n = 69/80; 86.25%). The initially treating clinic was preferred as initiator of such surveys (n = 43/79; 54.43%). Stratification revealed that participants with more than 1 h of daily digital media usage preferred email as way of communication. Conclusions: For the first time, this study showed individual preferences on assessing PROMs after ischemic stroke, focusing on the way, time interval, duration, and initiation site of surveys. These insights might help to successfully implement PROMs after stroke and subsequently detect unmet needs and deficits in stroke care. [ABSTRACT FROM AUTHOR]

Backgound: Headache disorders are not only among the most prevalent, they are also among the most disabling disorders worldwide. This paper investigates the association between headache impact on daily life and the socioeconomic status (SES) of headache sufferers. Methods: Data stem from a random general population sample in Germany. Respondents who reported having headache for at least a year and were aged ≥ 18 years were included in the study. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. The impact of headache on daily life was measured using the German version of the Headache Impact Test (HIT-6). Results: Higher headache impact was found in low and medium SES compared to high SES. After adjustment for sociodemographics, headache-related factors (analgesic use, headache duration, headache frequency, migraine diagnosis), depressive symptoms, physical inactivity and obesity, an increased odds ratio of having higher headache impact in low SES compared to high SES was found: OR = 1.83, 95% CI [1.43, 2.23], p =.014. When the interactions "SES*obesity", "SES*depressive symptoms", and "SES*physical inactivity" were added, the results showed a significant interaction effect of "SES*obesity". Obese persons with low SES were 3.64 times more likely to have higher headache impact than non-obese persons with low SES. No significant differences between obese and non-obese persons were found in the medium and high SES groups. Conclusions: SES is an important factor that should not be neglected in headache awareness campaigns and headache treatment. Longitudinal studies are needed in the future to investigate whether lifestyle interventions, such as weight reduction, can help to reduce headache impact in people in lower SES. [ABSTRACT FROM AUTHOR]

This paper presents results on the intergenerational transmission of interpersonal problems. Ninety-eight German mothers, fathers, and their young adult offspring completed the German version of the Inventory of Interpersonal Problems (IIP-D64), which is conceptually based on the assumption of a circumplex structure of eight interpersonal problems. Model learning and psychodynamic theories were used to formulate assumptions about possible intergenerational similarity and dissimilarity, as well as about effects of family and societal context. The results showed the highest intergenerational correlations for three of the eight interpersonal problems in the IIP-D64, namely nonassertiveness, overly strong accommodation, and self-sacrificing tendencies. Intergenerational similarity was found only for mother-offspring dyads for two other problems: domineering and vindictiveness tendencies. No significant intergenerational similarity was found for coldness, social inhibition, or intrusiveness. In-depth analyses revealed higher similarities in families in which at least one parent had an overall IIP-64 score equal to or more than one standard deviation from the norm sample mean (as opposed to families where both parents had overall IIP-64 scores closer to the normative German mean). The findings are tentatively interpreted as suggesting that intergenerational transmission occurs only for problems on one axis of the interpersonal circumplex, i.e., the agency axis, but not for problems on the communality axis. [ABSTRACT FROM AUTHOR]

Various studies have shown that immigrant women in comparison to non-immigrant women of the same parity have lower rates of epidural anesthesia (EDA). Data from two studies on immigrant obstetric care in Berlin, Germany were analyzed to answer the following question: What reasons do the medical staff see for the lower rate of EDA in immigrant women? Between May and August 2017, 34 interviews with obstetricians and midwives in four obstetric clinics in Berlin were conducted on the topic of obstetric care for immigrant women. After anonymizing the more than 20 h of interview material, transcripts were coded with MaxQDa and analyzed according to the qualitative content analysis.The quantitative data is from an online survey conducted between May and October 2017, in all but one obstetric clinic in Berlin with obstetricians and midwives. Regarding the research question, 121 questionnaires could be analyzed. In the online survey, (multiple answers were possible), the top reason for a lower rate of EDA given was mostly fear on the part of the immigrant women (64%). A language barrier, which results in logistic and time constrictions, is mentioned as the second most frequent reason (50%). The explorative analysis of the interviews shows that doctors and midwives regard cultural aspects such as different expectations on the birth experience as a reason for a lower EDA rate. Furthermore, within the medical staff the impression persists that in some cases the companion decides on the behalf of the patient about the application of an EDA, which from time to time is against the wish of the immigrant woman giving birth. In the view of the medical staff, the reasons for a lower rate of EDA during birth for immigrant women were varied. On one side, this is attributed to the wishes of the respective women ("demand") but on the other side this can be attributed to the health care system ("supply"). In the case of a language barrier, the "supply" and the access of EDA for immigrant women is limited and can be then shifted to the German-speaking companion to make a decision regarding EDA ("structural deprivation of self-determination"). [ABSTRACT FROM AUTHOR]

Purpose: Quality of life (QoL) has been the subject of increasing interest in oncology. Most examinations of QoL have focused on health-related QoL, while other factors often remain unconsidered. Moreover, QoL questionnaires implicitly assume that the subjective importance of the various QoL domains is identical from one patient to the next. The aim of this study was to analyze QoL in a broader sense, considering the subjective importance of the QoL components. Methods: A sample of 173 male urologic patients was surveyed twice: once while hospitalized (t1) and once again 3 months later (t2). Patients completed the Questions on Life Satisfaction questionnaire (FLZ-M), which includes satisfaction and importance ratings for eight dimensions of QoL. A control group was taken from the general population (n = 477). Results: Health was the most important QoL dimension for both the patient and the general population groups. While satisfaction with health was low in the patient group, the satisfaction ratings of the other seven domains were higher in the patient group than in the general population. The satisfaction with the domain partnership/sexuality showed a significant decline from t1 to t2. Multiple regression analyses showed that the domains health and income contributed most strongly to the global QoL score at t2 in the patient group. Conclusion: Health is not the only relevant category when assessing QoL in cancer patients; social relationships and finances are pertinent as well. Importance ratings contribute to a better understanding of the relevance of the QoL dimensions for the patients. [ABSTRACT FROM AUTHOR]

Purpose The study examined the performance of the Work Ability Index in predicting rehabilitation measures and disability pensions, sickness absence and unemployment benefits, and work participation among a sample of workers previously receiving sickness absence benefits. Methods Workers aged 40 to 54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records. Results Data for 2149 participants were included (mean age: 47.8 years; 54.4% women). Mean follow-up was 19 months. Work Ability Index scores were poor (7-27 points) in 21% of the participants, and moderate (28-36 points) in 38.4%. In all, 224 rehabilitation measures and 35 disability pensions were approved. Fully adjusted analyses showed increased risk of rehabilitation measures in workers with poor (HR 4.55; 95% CI 3.14-6.60) and moderate scores (HR 2.08; 95% CI 1.43-3.01) compared to workers with good or excellent scores (37-49 points). The risk of a disability pension increased significantly for workers with poor scores (HR 7.78; 95% CI 2.59-23.35). In addition, poor scores were prospectively associated with a longer duration of sickness absence and employment benefits, and fewer employment days and less income from regular employment. Conclusions The Work Ability Index is a potential tool for following up workers who already have an increased risk of permanent work disability due to previous long-term sickness absence. [ABSTRACT FROM AUTHOR]