No abstract

During the COVID-19 pandemic in Germany, non-pharmaceutical interventions were imposed to contain the spread of the virus. Based on cross-sectional waves in March, July and December 2020 of the COVID-19 Snapshot Monitoring (COSMO), the present study investigated the impact of the introduced measures on the perceived access to health care. Additionally, for the wave in December, treatment occasion as well as utilization and satisfaction regarding telemedicine were analysed. For 18–74-year-old participants requiring medical care, descriptive and logistic regression analyses were performed. During the less strict second lockdown in December, participants reported more frequently ensured access to health care (91.2%) compared to the first lockdown in March (86.8%), but less frequently compared to July (94.2%) during a period with only mild restrictions. In December, main treatment occasions of required medical appointments were check-up visits at the general practitioner (55.2%) and dentist (36.2%), followed by acute treatments at the general practitioner (25.6%) and dentist (19.0%), treatments at the physio-, ergo- or speech therapist (13.1%), psychotherapist (11.9%), and scheduled hospital admissions or surgeries (10.0%). Of the participants, 20.0% indicated utilization of telemedical (15.4% telephone, 7.6% video) consultations. Of them, 43.7% were satisfied with the service. In conclusion, for the majority of participants, access to medical care was ensured during the COVID-19 pandemic; however, access slightly decreased during phases of lockdown. Telemedicine complemented the access to medical appointments.

The assessment of safety data has become a standard across many clinical interventions. The aim of this systematic review is to investigate the extent to which harm is addressed within psychotherapy study protocols. The review includes study protocols of randomized controlled trials published between 2004 and 2017 investigating the effects of psychotherapy in adult patients with affective disorders, phobia, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and/or personality disorders. We conducted a systematic search in the CENTRAL, Medline, PsycINFO, and Web of Science databases as well as in relevant journals. In total, 115 study protocols were included, examining 168 psychotherapy and 85 control conditions. These protocols differed considerably in the way they conceptualized harm: 77 explicitly addressed harm, 62 considered serious adverse events, and 39 considered adverse events. Although serious adverse events were defined somewhat consistently, adverse events were not. Our results imply that clinical researchers do not apply standardized approaches with regard to harm concepts, assessment, and management. To gather data on frequencies of harmful effects, we argue a higher degree of standardization would be useful. Feasible recommendations are provided based on examples Bernhard Strauss contributed equally to supervision and served as support for methodology, validation, original draft, and writing, review, and editing. Christoph Flückiger served as support for data curation and writing, review, and editing. Francesca Färber served as lead for methodology and project administration, contributed equally to conceptualization, funding acquisition, and supervision, and served as support for data curation, formal analysis, and investigation. Jenny Rosendahl served as editor.

Objectives-This study aims to systematically review research on the association between resilience as a personality trait and mental health in older adults and to meta-analytically quantify this relation. Methods-We included studies assessing older adults (mean age 60 years or older), measuring trait resilience with a version of the Resilience Scale (RS) by Wagnild and Young and mental health. We conducted a comprehensive search in Medline, Web of Science, PsycInfo, PubPsych, ProQuest Dissertations and Theses Full Text database and the theses database of the German National Library for eligible studies. Study data on associations between resilience and mental health were aggregated using a random-effects model. Results-Twenty-seven studies with 13 444 participants were included. Trait resilience and mental health were strongly interrelated (r = 0.40, 95% CI [0.36; 0.44]) with substantial heterogeneity (I 2 = 83%). Published studies revealed larger associations between resilience and mental health (r = 0.41 [0.37; 0.45]) than unpublished studies (r = 0.25 [0.11; 0.38]). Conclusions-Higher levels of resilience are associated with better mental health in older persons. Because associations were solely assessed cross-sectionally, longitudinal studies are highly needed to draw causal inferences.

Zusammenfassung Eine Kernaufgabe von Public Health ist die kontinuierliche Erfassung und Analyse von gesundheitsbezogenen Daten zu relevanten Krankheiten (Surveillance). Sie dient der zeitnahen Umsetzung von Maßnahmen zum Schutz der Gesundheit in der Bevölkerung. Dafür müssen relevante Informationen zur richtigen Zeit und in geeigneter Weise für die entscheidenden Zielgruppen bereitgestellt werden (Dissemination). Eine Disseminationsstrategie unterstützt die effektive Ergebniskommunikation und berücksichtigt 3 Kernfragen: (1) „Was sind die relevanten Inhalte der Surveillance?“, (2) „Wer benötigt welche Informationen?“ und (3) „Wie werden die Ergebnisse den Zielgruppen bereitgestellt?“ Die Digitalisierung eröffnet hierbei neue Möglichkeiten für die Gestaltung der Formate. Seit 2015 wird am Robert Koch-Institut die Diabetes-Surveillance aufgebaut. In einem strukturierten Konsensprozess wurden 4 gesundheitspolitisch relevante Handlungsfelder mit 40 Kennzahlen (Indikatoren) definiert. Anschließend wurden gemeinsam mit dem wissenschaftlichen Projektbeirat unter Berücksichtigung neuer Möglichkeiten durch die Digitalisierung erste Publikationsformate erarbeitet. Neben Artikeln in Fachzeitschriften stellen der Bericht „Diabetes in Deutschland“ und eine Webseite mit interaktiver Visualisierung der Ergebnisse die wichtigsten Formate der ersten Projektphase dar. Begleitend werden Twitter und Youtube für die Erhöhung der Reichweite genutzt. In der nächsten Projektphase steht neben der Weiterentwicklung des Indikatorensets der Ausbau der Dissemination hin zu einer nutzer- und handlungsorientierten Berichterstattung im Mittelpunkt. In engem Austausch mit dem wissenschaftlichen Beirat sollen Anforderungen der Zielgruppen erfasst und in der Entwicklung weiterer Formate berücksichtigt werden.

Zusammenfassung Ziele In diesem Beitrag werden 3 Studien vorgestellt, in denen Patienten mit einer aktuellen oder vergangenen schweren körperlichen Erkrankung und ihre Partner in Hinblick auf dyadische Konkordanz sowie Geschlechts- und Rollenunterschiede in psychischer Belastung und Resilienz untersucht worden sind. Methoden In Studie 1 wurden 55 Patienten und deren Partner im Mittel 4,5 Jahre nach einer schweren Sepsis untersucht. Studie 2 berücksichtigte 49 Lungenkrebspatienten, mehrheitlich im metastasierenden Tumorstadium, und ihre Partner. In Studie 3 wurden 69 Krebspatienten mit unterschiedlichen Tumorentitäten und Tumorstadien, die sich einer ambulanten homöopathischen Zusatzbehandlung unterzogen, und ihre Partner eingeschlossen. Zur Erfassung der psychischen Belastung wurde in allen Studien die Hospital Anxiety and Depression Scale (HADS) und zur Messung von Resilienz als Persönlichkeitsmerkmal die Kurzform der Resilienzskala RS-13 eingesetzt. Die jeweiligen Befunde wurden über die 3 Studien hinweg meta-analytisch zusammengefasst. Ergebnisse Es zeigte sich eine dyadische Konkordanz zwischen Patient und Partner hinsichtlich Angst (r=0,29 [0,06; 0,48], I2=55%) und Depressivität (r=0,44 [0,31; 0,55], I2=0%), nicht jedoch für Resilienz. Geschlechtsunterschiede zeigten sich für Angst konsistent über alle 3 Studien hinweg, sowohl Patientinnen als auch Partnerinnen wiesen eine stärkere Angstsymptomatik auf als Patienten und Partner (d=0,58 [0,26; 0,91], I2=0% für Patienten; d=0,53 [− 0,06; 1,12], I2=69% für Partner). Heterogene Befunde lagen dagegen für Geschlechtsunterschiede in der Depressivität als auch für Rollenunterschiede vor. Eine höher ausgeprägte Resilienz geht mit geringerer psychischer Belastung sowohl bei Patienten als auch bei Partnern einher. Darüber hinaus gibt es Hinweise, dass Resilienz auch einen protektiven Effekt für die psychische Belastung des Partners haben kann. Diskussion und Schlussfolgerung Basierend auf den vorliegenden Erkenntnissen zu dyadischen Zusammenhängen in der psychischen Belastung zwischen Patienten und deren Partnern sollten körperliche Erkrankungen grundsätzlich immer aus systemischer Perspektive betrachtet werden. Die psychische Belastung sowohl von Patienten als auch von deren Partnern bedarf einer besonderen Beachtung im psychosozialen Unterstützungsprozess, ebenso sollten partnerschaftliche Ressourcen in der Bewältigung der Erkrankung Berücksichtigung finden.

Introduction: Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. Methods: This study is designed as a multicentre randomised controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over twelve months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after twelve and three months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. Discussion: After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants' behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. Trial registration: German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022.

No abstract