Ist Gesundheit das höchste Gut? - Ergebnisse einer bevölkerungsrepräsentativen Umfrage zur subjektiven Bedeutung von Gesundheit

Quality of Life Domains in Breast Cancer Survivors: The Relationship Between Importance and Satisfaction Ratings

Objectives

Quality of life (QoL) has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two.

Methods

A sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction (FLZ-M), which measures participants' satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls.

Results

Compared with the general population sample, the patients were less satisfied with their health and more satisfied with all other QoL domains. The subjective importance of health was lower in the patients' sample (Effect size: d = 0.38). Satisfaction with health and importance of health were slightly positively correlated (r between 0.05 and 0.08). The effect of QoL domain importance on general QoL was small (beta between −0.05 and 0.11), and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible.

Conclusion

In addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers' attention.

Intra-individual trajectories of subjectively prioritizing health over other life domains

Subjectively prioritizing health over other life domains is an indicator of health motivation and is associated with higher levels of health behaviors and more effective health behavior self-regulation. However, little is known about when individuals prioritize health over other life domains and which factors predict prioritizing health. Here, we examine 3644 older adults in Germany (mean age 60.79) over a period of 6-9 years from DEAS, a population-representative survey. Latent growth curves were estimated to examine individual change in prioritizing health. Socio-structural (gender, educational attainment) and indicators of health status (baseline status and change in [a] number of illnesses, [b] functional health, and [c] self-rated health) were tested as predictors of changes in health prioritization. Participants prioritized health over other life domains, and this increased over time. Women and those with worse health status (lower functional and lower self-rated health) prioritized health more than men and those with better health status, respectively. Lower educational attainment was associated with higher increases in prioritizing health, and interactions between educational status and health indicators show that increases are larger in those with worse health and lower educational attainment. This indicates individual differences in the degree and the changes of prioritizing health.

Importance of and Satisfaction with Domains of Health-Related Quality of Life in Cancer Rehabilitation

Instruments for measuring health-related quality of life (HRQoL) generally do not consider the subjective importance of the dimensions they comprise. The aims of this study were to analyze the subjectively perceived importance of the dimension of HRQoL and to investigate their relationship to the satisfaction ratings with these dimensions. A total of 1108 participants enrolled in a cancer rehabilitation program were surveyed. Patients rated eight dimensions of HRQoL (physical functioning, autonomy, emotional stability, cognitive functioning, social relationships, vitality, absence of pain, and sleep quality), as well as global health in terms of how important those dimensions are to them, and how satisfied they are with them. The dimensions with the highest importance ratings were autonomy and social relationships. There were only small sex differences in the importance ratings, but younger patients rated health as being more important than older patients did. The correlations between the importance ratings and the satisfaction ratings of the specific HRQoL dimensions ranged from −0.06 to 0.40, and the correlation between importance and satisfaction for global health was 0.01. Importance ratings provide relevant information for health care professionals in addition to the HRQoL assessments in the context of cancer rehabilitation.

Should coronavirus policies remain in place to prevent future paediatric influenza deaths?

The 2019-2020 to 2020-2021 influenza seasons in the USA saw a dramatic 99.5% decrease in paediatric mortality, with only one influenza death recorded during the latter season. This decrease has been attributed to a substantial reduction in transmission, resulting from the various restrictive measures enacted during the COVID-19 pandemic, onset March 2020. The relative disappearance of influenza raises specific policy questions, such as whether these measures should be kept in place after COVID-19 transmission reaches acceptable levels or herd immunity is achieved. Given the nature of these measures as liberty restricting, it is worth discussing their intended outcome and what values they promote. Do these measures in fact promote health, or simply give the comfort of safety while undermining long-term health and individual liberties? I argue that the year-long endurance of the pandemic well into 2021 may have flattened our value landscape into one where health reigns supreme. Discussions are underway regarding whether we should modify previously accepted health risks, such as the risk of contracting influenza. In this paper, I attempt to clarify the values that motivate our policies and discuss how our present historical context has appreciated the value of health. I also provide an analysis of various pandemic policies and their relation to influenza paediatric deaths. Ultimately, the cost of certain measures on values such as education, socialisation and liberty, among others, is too high to justify their use beyond regulating the spread of COVID-19.

Two aspects of health literacy and their importance for the use of health-promotion measures by teachers in the school setting

Purpose

Teachers are exposed to many stressors. Compared to other occupational groups, they are more frequently affected by psychosomatic complaints. In recent decades, numerous prevention and intervention measures for promoting health have been developed and implemented for this target group. However, it remains unclear how the uptake of health-promotion measures (HPMs) by teachers can be increased in order to prevent stress-related disorders. This paper examines two facets of health literacy—health awareness and health value—in terms of their importance in both the take-up and intended take-up of HPMs.

Design/methodology/approach

In the 2017/2018 school year, data were collected by paper and pencil from a representative sample of 830 teachers across all school types in the German State of Brandenburg.

Findings

Teachers who place great value on their own health show significantly higher levels of take-up and intended take-up of HPMs. The findings regarding health awareness are more heterogeneous. Further associations were found with age and psychosocial stress.

Originality/value

While there has been growing academic interest in developing HPMs for teachers, there has been relatively little focus on the factors that may influence the implementation and uptake of these measures. The paper contributes to addressing this gap by shedding light on the relevance of two facets of health literacy. Strengthening the perceived importance of health could be a starting point for increasing the use of HPMs by teachers and thus improving their health.

Perspective: Classifying Orthorexia Nervosa as a New Mental Illness-Much Discussion, Little Evidence

Significant prevalence rates of pathological healthful eating and its extreme form, orthorexia nervosa (ON), the pathological obsession with healthy eating, have led to increased efforts to understand this phenomenon's clinical relevance. This narrative review qualitatively summarizes existing evidence on the (psycho-)pathology and consequences of ON and offers an interpretation within the frame of existing theories and models of psychiatric disease. Adding to the controversy in the field of ON, this review offers important critiques and identifies gaps in our current understanding of ON as a (distinct) mental illness.

On the evidentiary standards for nutrition advice

This paper evaluates the application of evidentiary standards originating from evidence-based medicine in nutrition advice. It shows that it is problematic to criticize nutrition recommendations for not being based on randomized controlled trials. Due to practical, ethical and methodological and reasons, it is difficult to conduct rigorous randomized controlled trials for acquiring evidence that is relevant for achieving the goals of population-level nutrition recommendations. Given the non-epistemic goals of the dietary recommendations, criteria of acceptable evidence should be adapted to the goals of the practice and the practical, ethical, and methodological constraints of the situation.

Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross-sectional analysis of the LuLa-cohort

Objective

Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs.

Methods

The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients’ health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression.

Results

Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02–3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97–2.49), a higher age (OR: 1.06; 95% CI: 1.03–1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01–1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82–0.97) was detrimental.

Conclusion

A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician–patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome.

Psychiatry in Germany 2012

Healthcare in Germany is characterized by a dichotomy of a private and a public healthcare sector, which also pertains to mental healthcare. While the prevalence figures of mental disorders in Germany remained fairly constant over the last 15 years, utilization rates of healthcare services due to mental disorders increased by 70-80% including inpatient and outpatient services, sick leave cases and cases of early retirement due to mental disorders. Several challenges are currently evident for mental healthcare in Germany, ranging from interesting a sufficient number of medical students for this field of medicine, dealing with the yet unforeseeable consequences of a novel mental hospital remuneration system, better integration of services and remuneration providers, to elucidating the causes of the increasing utilization rates. Mental healthcare research will take centre stage in addressing these challenges.