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Appel KS, Nürnberger C, Bahmer T, Förster C, Polidori MC, Kohls M, Kraus T, Hettich-Damm N, Petersen J, Blaschke S, Bröhl I, Butzmann J, Dashti H, Deckert J, Dreher M, Fiedler K, Finke C, Geisler R, Hanses F, Hopff SM, Jensen BEO, Konik M, Lehnert K, de Miranda SMN, Mitrov L, Miljukov O, Reese JP, Rohde G, Scherer M, Tausche K, Tebbe JJ, Vehreschild JJ, Voit F, Wagner P, Weigl M, Lemhöfer C. Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON). Infection 2024:10.1007/s15010-024-02226-9. [PMID: 38587752 DOI: 10.1007/s15010-024-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. METHODS The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). RESULTS Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001). CONCLUSION The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. TRAIL REGISTRATION NUMBER The cohort is registered at www. CLINICALTRIALS gov under NCT04768998.
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Affiliation(s)
- Katharina S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Carolin Nürnberger
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Maria Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mirjam Kohls
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tanja Kraus
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Nora Hettich-Damm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Julia Petersen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Isabel Bröhl
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jana Butzmann
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hiwa Dashti
- Practice for General Medicine Dashti, Eberswalde, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Karin Fiedler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - Ramsia Geisler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control an Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sina M Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Kristin Lehnert
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Susana M Nunes de Miranda
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lazar Mitrov
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Olga Miljukov
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
| | - Margarete Scherer
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Kristin Tausche
- Department of Internal Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Johannes J Tebbe
- Department of Gastroenterology and Infectious Diseases, Klinikum Lippe, Lippe, Germany
| | - Jörg Janne Vehreschild
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Patricia Wagner
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
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Weigl M, Beeck S, Kraft E, Stubbe HC, Adorjan K, Ruzicka M, Lemhöfer C. Multidisciplinary rehabilitation with a focus on physiotherapy in patients with Post Covid19 condition: an observational pilot study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01747-y. [PMID: 38231399 DOI: 10.1007/s00406-023-01747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9 days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12 years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97 m to 512 ± 87 m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients.
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Affiliation(s)
- Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Physical and Rehabilitation Medicine, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Saskia Beeck
- Department of Orthopaedics and Trauma Surgery, Physical and Rehabilitation Medicine, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Physical and Rehabilitation Medicine, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Municipal Hospital Group, Munich, Germany
| | - Hans Christian Stubbe
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Medicine II, LMU University Hospital Munich, Munich, Germany
| | - Michael Ruzicka
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital, Jena, Germany
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Kisch R, Grill E, Müller M, Pietzner J, Paulus AC, Weigl M. Second opinion and time to knee arthroplasty: a prospective cohort study of 142 patients. BMJ Open 2023; 13:e073497. [PMID: 37827748 PMCID: PMC10582995 DOI: 10.1136/bmjopen-2023-073497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the impact of obtaining a second opinion consultation on time to knee arthroplasty (KA). We further examined the frequency of KA and the determinants of KA following the second opinion. DESIGN Prospective cohort study. SETTING The second opinion programme was implemented at the Ludwig Maximilian University Hospital in Munich. PARTICIPANTS Participants comprised patients with knee osteoarthritis who were insured with one of the largest statutory health insurance Allgemeine Ortskrankenkasse Bayern (mean age 64.3±9.6 years). Patients participated in a second-opinion programme and completed questionnaires on site before and after personal presentation for the second opinion consultation. Follow-up questionnaires were delivered by post at 3 and 12 months after the second opinion consultation. Of the 142 patients included in the study, 47 (33.1%) underwent KA within 12 months after obtaining the second opinion. PRIMARY OUTCOME MEASURES Primary outcome measure was time until patients received KA. Cox proportional hazard modelling was used to calculate the associations between the selected predictors and time that elapsed between receipt of the second opinion to KA. RESULTS Mean time until KA was 17 weeks. Kaplan-Meier curves showed significant differences in time to KA according to the recommendation given at second opinion consultation, knee-related quality of life and Kellgren-Lawrence grade. In multivariate Cox proportional hazard modelling, second opinion recommendation (HR 5.33, 95% CI 1.16, 24.41) and knee-related quality of life (HR 1.03, 95% CI 1.01, 1.06) were significant predictors of time from second opinion to KA. CONCLUSIONS Obtaining a second opinion had significant impact on time to knee replacement. Those who were recommended immediate surgery also underwent surgery more quickly after the second opinion. The effect of knee-related quality of life supports the importance of patient-reported outcome measures in the decision for or against KA.
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Affiliation(s)
- Rebecca Kisch
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital Munich, Munchen, Germany
| | - Martin Müller
- Department for Primary Care and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Jens Pietzner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital Munich, Munchen, Germany
| | - Alexander C Paulus
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital Munich, Munchen, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, University Hospital Munich, Munchen, Germany
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Praschl C, Zopf LM, Kiemeyer E, Langthallner I, Ritzberger D, Slowak A, Weigl M, Blüml V, Nešić N, Stojmenović M, Kniewallner KM, Aigner L, Winkler S, Walter A. U-Net based vessel segmentation for murine brains with small micro-magnetic resonance imaging reference datasets. PLoS One 2023; 18:e0291946. [PMID: 37824474 PMCID: PMC10569551 DOI: 10.1371/journal.pone.0291946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/09/2023] [Indexed: 10/14/2023] Open
Abstract
Identification and quantitative segmentation of individual blood vessels in mice visualized with preclinical imaging techniques is a tedious, manual or semiautomated task that can require weeks of reviewing hundreds of levels of individual data sets. Preclinical imaging, such as micro-magnetic resonance imaging (μMRI) can produce tomographic datasets of murine vasculature across length scales and organs, which is of outmost importance to study tumor progression, angiogenesis, or vascular risk factors for diseases such as Alzheimer's. Training a neural network capable of accurate segmentation results requires a sufficiently large amount of labelled data, which takes a long time to compile. Recently, several reasonably automated approaches have emerged in the preclinical context but still require significant manual input and are less accurate than the deep learning approach presented in this paper-quantified by the Dice score. In this work, the implementation of a shallow, three-dimensional U-Net architecture for the segmentation of vessels in murine brains is presented, which is (1) open-source, (2) can be achieved with a small dataset (in this work only 8 μMRI imaging stacks of mouse brains were available), and (3) requires only a small subset of labelled training data. The presented model is evaluated together with two post-processing methodologies using a cross-validation, which results in an average Dice score of 61.34% in its best setup. The results show, that the methodology is able to detect blood vessels faster and more reliably compared to state-of-the-art vesselness filters with an average Dice score of 43.88% for the used dataset.
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Affiliation(s)
- Christoph Praschl
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Lydia M. Zopf
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA trauma research center, Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Vienna BioCenter Core Facilities GmbH (VBCF), Vienna, Austria
| | - Emma Kiemeyer
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Ines Langthallner
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Daniel Ritzberger
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Adrian Slowak
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Martin Weigl
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Valentin Blüml
- Vienna BioCenter Core Facilities GmbH (VBCF), Vienna, Austria
| | - Nebojša Nešić
- Faculty of Informatics and Computation, Singidunum University, Belgrade, Serbia
| | - Miloš Stojmenović
- Faculty of Informatics and Computation, Singidunum University, Belgrade, Serbia
| | - Kathrin M. Kniewallner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Stephan Winkler
- Department of Medical and Bioinformatics, School of Informatics, Communications and Media, University of Applied Sciences Upper Austria, Hagenberg i. M., Austria
| | - Andreas Walter
- Vienna BioCenter Core Facilities GmbH (VBCF), Vienna, Austria
- Centre of Optical Technologies, Aalen University, Aalen, Germany
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Ecker S, Weigl M, Gaiswinkler S. Good health information for people with a migration background. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Studies show that people with a migration background are often uncertain concerning the kinds of health services that are offered and where to turn to with which health concerns. Some factors, like fears or obstacles (e.g. deductibles), lead to the health system not being used (on time). This is particularly true for those who are socioeconomically or socially disadvantaged. The aim of the project was to get an insight into the information needs of this population group as a basis for producing and disseminating good health information in the future.
Methods
In this qualitative study co-researchers conducted guided focus groups (separated by sex) or interviews in their first languages. In total, more than 100 people from 16 different countries of origin were involved in the survey.
Results
In general, a substantial need for multilingual health information prepared in easy-to-understand language was expressed. Some health topics (e.g. the Austrian health system, mental health and available support) were mentioned by many participants. Other issues were relevant for few groups only (e.g. TCM). Gender differences can be seen in some groups but not in all. Besides acquaintances/relatives, general practitioners were named as main source of information. Indications can be derived on how health information should be prepared, designed and distributed. Besides multilingual health information, translation services are needed during appointments but also for the medical reports.
Conclusions
When searching for health information, but also when trying to understand it, language barriers are a major obstacle. Multilingual and culture-sensitive explainer videos on selected topics are an appropriate medium for reaching a broad group of people. Low-threshold multilingual regional contact points could provide an important contribution to health equity, as a guide in the health system, providing information and translation services, and setting health promotion offers.
Key messages
• Language barriers represent a major obstacle for vulnerable population groups with migration background in all stages of the health care process.
• There is a substantial need for adequately prepared multilingual health information.
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Affiliation(s)
- S Ecker
- Health, Society and Equity, Austrian National Public Health Institute , Vienna, Austria
| | - M Weigl
- Health, Society and Equity, Austrian National Public Health Institute , Vienna, Austria
| | - S Gaiswinkler
- Health, Society and Equity, Austrian National Public Health Institute , Vienna, Austria
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Weigl M, Bartl C, Suttner S, Rauh M, Seelbach-Göbel B, Köninger A. Monozentrische Evaluation der Frühgeburtenrate im ersten Lockdown der SARS-CoV-2-Pandemie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Weigl M, Kögel F, Seelbach-Göbel B, Köninger A. Geburtshilfliches Outcome des zweiten Zwillings bei di- versus monochorialen Schwangerschaften bei intendierter vaginaler Geburt. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Katzenberger B, Schwettmann L, Weigl M, Paulus A, Pedron S, Fuchs S, Koller D, Grill E. Behavioural and patient-individual determinants of quality of life, functioning and physical activity in older adults (MobilE-TRA 2): study protocol of an observational cohort study in a tertiary care setting. BMJ Open 2021; 11:e051915. [PMID: 34887277 PMCID: PMC8663098 DOI: 10.1136/bmjopen-2021-051915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Vertigo, dizziness and balance problems (VDB) as well as osteoarthritis (OA) are among the health conditions with the greatest impact on mobility and social participation in older adults. Patients with VDB and OA were shown to benefit from specialised care such as vestibular rehabilitation therapy or joint replacement. However, these effects are not permanent and seem to disappear over time. One important reason might be a decreasing adherence to therapy recommendations. Findings from behavioural economics (BE) can help to shed light on individual effects on adherence behaviour and long-term outcomes of VDB and OA. OBJECTIVE Based on insights from BE concepts (ie, self-efficacy, intention, and time and risk preferences), MobilE-TRA 2 investigates the determinants of functioning and health-related quality of life (HRQoL) 3 and 12 months after discharge from total hip replacement (THR)/total knee replacement (TKR) in patients with OA and after interdisciplinary evaluation for VDB. METHODS AND ANALYSIS MobilE-TRA 2 is a longitudinal observational study with data collection in two specialised tertiary care centres at the university hospital in Munich, Germany between 2020 and 2023. Patients aged 60 and older presenting for their first THR/TKR or interdisciplinary evaluation of VDB at Ludwig Maximilians University (LMU) hospital will be recruited for study participation. Three and twelve months after baseline assessment, all patients will receive a follow-up questionnaire. Mixed-effect regression models will be used to examine BE concepts as determinants of adherence, HRQoL and functioning. ETHICS AND DISSEMINATION The study was approved by the ethics committee at the medical faculty of the LMU Munich under the number 20-727. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Findings will also be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
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Affiliation(s)
- Benedict Katzenberger
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- Munich Center of Health Sciences, Ludwig Maximilians University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig Maximilians University Munich, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Department of Economics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital Munich, Munich, Germany
| | - Alexander Paulus
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital Munich, Munich, Germany
| | - Sara Pedron
- Institute of Health Economics and Health Care Management, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Professorship of Public Health and Prevention, Faculty of Sport and Health Science, Technical University of Munich, Munich, Germany
| | - Sebastian Fuchs
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig Maximilians University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital Munich, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- Munich Center of Health Sciences, Ludwig Maximilians University Munich, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital Munich, Munich, Germany
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Antony G, Antosik J, Weigl M, Marbler C, Laschkolnig A. HIA on lockdown and social distancing to contain the COVID-19 pandemic in Austria – results and lessons learned. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The COVID-19 pandemic and the measures taken created opportunities in various areas of life, but also created new challenges or increased existing ones, which can also have a (direct or indirect) impact on health and well-being of the population or certain population groups. This health impact assessment (HIA) was commissioned to provide an overview of these effects. The foundation of gathering information for the impact assessment was a national literature research and analysis combined with an online survey. In addition, a search of international literature was conducted by the European Observatory on Health Systems and Policies. The impact assessment and an initial collection of recommendations for action were carried out together with relevant stakeholders in the context of several thematically merged online assessment workshops. Positive and negative - direct as well as indirect - impacts on health in different areas of life could be identified, with the negative impacts predominating in proportion. In addition to identifying the impacts, the HIA also identified groups that were particularly affected by the pandemic. In the course of this HIA, it became clear that the direct in indirect health impacts in many areas of life are interrelated (e. g., job loss, family climate, social inclusion, and psychological well-being) and that a separate discussion often fell short. This HIA provides an overview of various impacts and allows first impressions on actions for future measures in regard to the pandemic in various areas of life, according to the HiAP approach.
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Affiliation(s)
- G Antony
- Austrian National Public Health Institute, Vienna, Austria
| | - J Antosik
- Austrian National Public Health Institute, Vienna, Austria
| | - M Weigl
- Austrian National Public Health Institute, Vienna, Austria
| | - C Marbler
- Austrian National Public Health Institute, Vienna, Austria
| | - A Laschkolnig
- Austrian National Public Health Institute, Vienna, Austria
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Weigl M, Pietzner J, Kisch R, Paulus A, Jansson V, Grill E. Effects of a medical second opinion programme on patients' decision for or against knee arthroplasty and their satisfaction with the programme. BMC Musculoskelet Disord 2021; 22:595. [PMID: 34182959 PMCID: PMC8240280 DOI: 10.1186/s12891-021-04465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurances. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty. METHODS The largest statutory health insurance funds in Bavaria offered patients who had been recommended to have knee arthroplasty the opportunity to partake in a second opinion programme which consisted of an in person presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit. RESULTS A total of 141 (66%) of 215 patients who presented for a second opinion participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. After receiving the second opinion 28 of 56 (41%) undecided patients preferred knee arthroplasty, 14 no knee arthroplasty, 14 remained undecided. Four of 46 patients with a preference for "arthroplasty" changed their decision to "no arthroplasty", five of 35 patients from "no arthroplasty" to "arthroplasty". The patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). They rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) (best:1; worst:6). Logistic regression analyses showed that the recommendation of the second opinion physician for joint arthroplasty was associated with the guideline criteria radiological severity of osteoarthritis (p = 0.001) and knee-joint-specific quality of life (p = 0.041). CONCLUSION The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The association of guideline criteria to the second recommendation suggests a high quality of the second opinion. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.
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Affiliation(s)
- Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Jens Pietzner
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany.,Kliniken an der Paar, Aichach und Friedberg, Germany
| | - Rebecca Kisch
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Alexander Paulus
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians Universität München, Munich, Germany
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11
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Kerschan-Schindl K, Hackl M, Boschitsch E, Föger-Samwald U, Nägele O, Skalicky S, Weigl M, Grillari J, Pietschmann P. Diagnostic Performance of a Panel of miRNAs (OsteomiR) for Osteoporosis in a Cohort of Postmenopausal Women. Calcif Tissue Int 2021; 108:725-737. [PMID: 33427926 PMCID: PMC8166674 DOI: 10.1007/s00223-020-00802-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022]
Abstract
A specific signature of 19 circulating miRNAs (osteomiRs) has been reported to be associated with fragility fractures due to postmenopausal osteoporosis. However, it is unknown whether osteoporotic fractures or low BMD phenotypes are independently contributing to changes in osteomiR serum levels. The first aim was to characterize the abundance, sensitivity to hemolysis, and correlation of osteomiR serum levels, the second objective to evaluate the diagnostic accuracy of osteomiRs for osteoporosis according to the WHO criteria and on basis of major osteoporotic fracture history. Fifty postmenopausal women with osteoporosis (with or without fragility fracture) and 50 non-osteoporotic women were included in this cross-sectional study. The diagnostic performance of osteomiRs for osteoporosis based on the WHO definition or fracture history was evaluated using multiple logistic regression and receiver-operator curve (AUC) analysis. The osteomiR® signature is composed of four clusters of miRNAs providing good performance for the diagnosis of osteoporosis in postmenopausal women defined by WHO criteria (AUC = 0.830) and based on history of major osteoporotic fractures (AUC = 0.834). The classification performance for the WHO criteria and for fracture risk is driven by miR-375 and miR-203a, respectively. OsteomiRs, a signature of 19 emerging miRNA bone biomarkers, are measurable in human serum samples. They constitute a panel of independent bone and muscle biomarkers, which in combination could serve as diagnostic biomarkers for osteoporosis in postmenopausal women.
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Affiliation(s)
- K Kerschan-Schindl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria.
| | - M Hackl
- TAmiRNA GmbH, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - E Boschitsch
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | - U Föger-Samwald
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - O Nägele
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | | | - M Weigl
- TAmiRNA GmbH, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - J Grillari
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Christian Doppler Laboratory for Biotechnology of Skin Aging, Department of Biotechnology, BOKU - University of Natural Resources and Life Sciences Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1220, Vienna, Austria
| | - P Pietschmann
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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Offenbächer M, Toussaint L, Weigl M, Dezutter J, Kohls N, Vallejo M, Rivera J, Sirois F, Hirsch J. POS1484-HPR THE ASSOCIATION OF STIGMA WITH DISEASE VARIABLES IN PATIENTS WITH FIBROMYALGIA (FM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Stigma, defined as social devaluation of an individual, can be an important stressor for chronic pain patients [1]. Not every condition is stigmatized. A relevant factor for illness stigmatization seems to be whether the cause is mental-behavioural or physical. Chronic pain is often regarded as an imaginary illness or caused by psychological problems [2]. Sources of stigma for chronic pain patients are perceived negative attitudes from family members, the general public, and physicians [1]..Objectives:To assess perceived stigma and the associations with disease variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey, and we sent the survey battery to 192 potential participants via postal mail. To measure perceived stigma, we used the Chronic Pain Stigma Scale (CPSS) developed by Reed [3], which has 30 items and 3 subscales (public, physicians, family). We also assessed sociodemographic characteristics, disease related variables (e.g., pain, stress, depression, anxiety), and other health-related factors, including health related quality of life [Healthy Days Core Module (CDC HDQOL-4)], disease specific impact (FIQ), fear avoidance belief questionnaire (physical activity subscale) (FABQ-PA), pain catastrophizing scale (PCS) and pain self-efficacy questionnaire (PSEQ).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). There was no significant gender difference in the stigma subscales, nor was there an association with duration of chronic pain. Table 1 presents the significant Pearson correlations.Table 1.Correlations of CPSS stigma subscales with health variables. *<.05; **<.01; ns=not significant.CPSS-publicCPSS-physicianCPSS-familyRegional pain scalens.19*.20*VAS pain todaynsnsNsFIQ.20*.16*.22**HADS-anxiety.37*.20*.24*HADS-depression.41**.16*.25**CDC-HDQOL-4 General health.19*.18*.22** Physical health.19*nsns Mental health.20*ns.21* Impairment.24*nsnsPerceived stress scale.44**.24**.37**FABQ-PAns-.17*nsPCS.21*nsnsPSEQ.19*ns.18*Conclusion:Perceived stigma in our FM patient cohort has an important impact on a variety of different disease variables including mental and general health, physical functioning, and on pain coping. Stigmatizing attitudes perceived from the general public exhibited the greatest association with most variables in our chronic pain patients. Perceived stigma from physicians and the family were also related to negative disease consequences in our FM patients. To conclude, we assert that assessing and addressing multi-source perceived stigmatization in routine clinical care may improve the management and wellbeing of patients with FM.References:[1]Waugh OC, Byrne DG, Nicholas MK. Internalized stigma in people living with chronic pain. J Pain 2014;15(5):550 e1-10.[2]Werner A, Isaksen LW, Malterud K. ‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain. Soc Sci Med 2004;59(5): 1035-45[3]Reed P. Chronic pain stigma: developement of the Chronic Pain Stigma Scale. 2005.Disclosure of Interests:None declared
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13
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Offenbächer M, Toussaint L, Hirsch J, Weigl M, Kohls N, Vallejo M, Rivera J, Sirois F, Dezutter J. AB0889-HPR PERCEIVED SATISFACTION WITH CHRONIC PAIN CARE IN GERMAN PATIENTS WITH FIBROMYALGIA (FM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In chronic pain care a multidimensional perspective with attention to patients’ cognitions, emotions, and their ability to cope is needed (1). Previous studies are also pointing to the role of experiencing meaningfulness in life in the adjustment to disability.Therefore care should additionally focus on the existential domain of patients’ lives to live up to a holistic care approach (2). However, there are only a few studies on how FM patients are satisfied with practitioners’ attention to multiple aspects of life with a chronic pain condition.Objectives:To assess perceived satisfaction with chronic pain care and its associations with health variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey and sent them in total 192 paper-and-pencil surveys. Sociodemographics, disease related variables (e.g. pain, general health) and psychological variables [e.g. depression, anxiety, hope, stress] were assessed with standardized instruments, including 5 items (answer format 1=very unsatisfied – 10=very satisfied) assessing subjective satisfaction with medical care in different domains with the following questions: How satisfied are you with the attention of your treatment team/physician at home for physiological aspects of your pain (Physio)/ the consequences of the pain on your physical functioning (Physical)/ on your psychological well-being (Mental)/ on your social life (Social)/ on your meaning in life (Meaning).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). The satisfaction with care scale showed good internal consistency and measured one factor. The means of the subscale were: Physio 5.7 (SD=2.5)/ Physical 5.5 (SD=2.5)/ Mental 5.5 (SD=2.6)/ Social 5.0 (SD=2.5)/ Meaning 5.3 (SD=2.6). Correlations of the subscales are depicted in Table 1. There were no associations between pain variables and satisfaction with care, but satisfaction with care was associated with mental health, but not physical health, outcomes.Table 1.Correlations of satisfaction of care with different health variables. Subscales physiological and physical aspects and HADS-anxiety were not significantly correlated. *<.05; **<.01; ns=not significant.PhysioPhysicalMentalSocialMeaningHADS-depression-.10 (ns)-.12 (ns)-.19*-.16*-.14 (ns)General Health .02 (ns) .14 (ns) .13 (ns) .18* .12 (ns)Stress-.15 (ns)-.14 (ns)-.17*-.17*-.13 (ns)Hope .18 (ns) .18 (ns) .26** .26* .22*Conclusion:In this cohort of German FM patients the average satisfaction with care overall, as well as the specific aspects of care, was only moderate. Interestingly we found associations between satisfaction with care in mental, social and meaning in life aspects with psychological well-being pointing to the fact that care for chronic pain patients should also include those aspects in addition to just addressing biomedical aspects.References:[1]Flor H and Turk D. Chronic pain: an integrated approach. Seattle, WA: IASP Press, 2011.[2]Dezutter J, Casalin S, Wacholtz A, et al. Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitat Psychol 2013; 58:334–341.Disclosure of Interests:None declared
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14
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Weigl M, Letzel J, Angst F. Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain. BMC Musculoskelet Disord 2021; 22:330. [PMID: 33812386 PMCID: PMC8019506 DOI: 10.1186/s12891-021-04194-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme. Methods In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period. Results The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172). Conclusions Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04194-9.
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Affiliation(s)
- Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Josefine Letzel
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Internal Medicine, Klinikum Dritter Orden, Munich, Germany
| | - Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
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15
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Ranker A, Weigl M. Microcurrent therapy - more transparency is needed in used parameters. Clin Rehabil 2021; 35:1073-1074. [PMID: 33508950 DOI: 10.1177/0269215521991753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alexander Ranker
- Department of Rehabilitation Medicine, Hannover Medical School, Hannnover, Germany
| | - Martin Weigl
- Department of Orthopedics, Physical Medicine and Rehabilitation, Ludwig Maximilians University of Munich, Munich, Germany
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16
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Gutenbrunner C, Best N, Glaesener JJ, Lange U, Lemhöfer C, Lichti G, Liebl ME, Reißhauer A, Schwarzkopf S, Steinmetz A, Sturm C, Weigl M, Winkelmann A, Krischak G. Warum der rehabilitativen Versorgung auch und gerade während
der COVID-19 Pandemie besondere Beachtung geschenkt werden muss: Ein Statement
der Deutschen Gesellschaft für Physikalische und Rehabilitative Medizin
(DGPRM). Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2020. [PMCID: PMC7667515 DOI: 10.1055/a-1207-0766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Auch in Deutschland haben die Reaktionen auf die Pandemie mit dem
SARS-Coronavirus-2 zu erheblichen Einschnitten in fast allen
gesellschaftlichen Bereichen geführt und die Prioritäten der
Gesundheits- und Sozialpolitik dramatisch verschoben. Dies betrifft auch die
rehabilitative Versorgung in praktisch allen ihren Dimensionen. Das folgende
Statement der Deutschen Gesellschaft für Physikalische und
Rehabilitative Medizin (DGPRM) möchte einige Aspekte dieser
Entwicklungen aufzeigen und Empfehlungen ableiten.
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Affiliation(s)
| | - Norman Best
- Inst. für Physiotherapie, Universitätsklinikum Jena,
Jena
| | | | - Uwe Lange
- Kerckhoff-Klinik, Department of Rheumatology, Osteology and Physical
Medicine, University Gießen, Bad Nauheim
| | | | - Gabriele Lichti
- Praxis für Physikalische und Rehabilitative Medizin, Klinikum
Bad Salzungen GmbH, Bad Salzungen
| | - Max Emanuel Liebl
- Physikalische Medizin und Rehabilitation, Charité
Universitätsmedizin Berlin, Berlin
| | - Anett Reißhauer
- Physikalische Medizin und Rehabilitation, Charité
Universitätsmedizin Berlin, Berlin
| | - Susanne Schwarzkopf
- Klinik und Institut für Physikalische und Rehabilitative
Medizin und Naturheilverfahren, Fachübergreifende
Frührehabilitation, Klinikum Nürnberg,
Nürnberg
| | - Anke Steinmetz
- Muskuloskeletales Zentrum – Konservative Orthopädie und
Manuelle Medizin, Loreley-Kliniken, Oberwesel
| | - Christian Sturm
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule
Hannover, Hannover
| | - Martin Weigl
- Klinik und Poliklinik für Orthopädie, Physikalische
Medizin und Rehabilitation, Klinikum der Universität München,
München
| | - Andreas Winkelmann
- Klinik für Orthopädie, Physikalische Medizin und
Rehabilitation, LMU München, München
| | - Gert Krischak
- Institut für Rehabilitationsmedizinische Forschung, University
of Ulm, Bad Buchau
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Weigl M, Händl T, Wehler M, Schneider A. [Time-allocation study of nurse and physician activities in the emergency department]. Med Klin Intensivmed Notfmed 2020; 116:229-237. [PMID: 32072195 PMCID: PMC8016769 DOI: 10.1007/s00063-020-00657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/09/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022]
Abstract
Hintergrund Systematische und vergleichende Analysen der Tätigkeiten des ärztlichen und pflegerischen Personals in der Notaufnahme fehlen für den deutschsprachigen Bereich. Ziel der Arbeit Analyse der Aktivitäten des pflegerischen und ärztlichen Personals einer Notaufnahme sowie der Anteile direkten Patientenkontakts und stündlicher Tätigkeitswechsel. Material und Methoden Tätigkeitsanalysen auf Basis teilnehmender Beobachtungen (je 90 min) bei Pflegekräften und Ärzt*innen einer interdisziplinären Notaufnahme eines süddeutschen Krankenhauses der Maximalversorgung. Beobachtete Tätigkeiten wurden anhand eines Klassifikationssystems mitsamt Zeitdauern kodiert. Insgesamt wurden 160 Einzelbeobachtungen (mit einer Gesamtzeit von ca. 240 h) durchgeführt; 99 bei Pflegekräften sowie 61 bei Ärzt*innen. Ergebnisse Notaufnahmeärzt*innen arbeiten 30 % ihrer Zeit in direktem Patientenkontakt, Pflegekräfte hingegen 44 %. Für die Einzeltätigkeiten entfielen die größten Zeitanteile ärztlicher Tätigkeit auf Dokumentation und Schriftarbeit (29,3 %), interne Kommunikation mit Personal (16,9 %) sowie mit Patient*innen (13,6 %). Pflegekräfte verwenden die meiste Zeit auf therapeutische und Behandlungsaktivitäten (27,6 %) sowie interne Kommunikation (17,9 %). Diese Tätigkeiten waren stark fragmentiert: Im Durchschnitt erfassten wir 41,3 Einzeltätigkeiten pro Stunde mit einer durchschnittlichen Dauer von 1,5 min. Pflegekräfte hatten signifikant kürzere Tätigkeitsdauern als Ärzt*innen (F[df = 1] = 4,5; p = 0,04). Tätigkeitsspezifische Analysen ergaben weitere Professionsunterschiede. Diskussion Unsere Ergebnisse liefern erstmalig fundierte Einsichten in die Verteilung und Dauer von ärztlichen sowie pflegerischen Tätigkeiten in der akutmedizinischen Versorgung in der Notaufnahme. Zukünftige Arbeiten sollten sich insbesondere einhergehenden Auswirkungen auf die Leistungsfähigkeit und Beanspruchung des Personals wie auch der Sicherheit und Qualität der Versorgung widmen. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00063-020-00657-4) enthält die Tabelle S1. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- M Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.
| | - T Händl
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - M Wehler
- Zentrale Notaufnahme und IV. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - A Schneider
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.,Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Weigl M, Marbler C, Haas S, Laskowski W. Participatory research in the field of early childhood interventions - how can this be achieved? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The Austrian early childhood interventions programme (“Frühe Hilfen”) is an overall concept of health promotion measures, aiming to support families depending on their individual needs to create good conditions for raising their children. This should contribute to long-term health of the children. The manifold effects of this complex intervention on the families are to be investigated in the future. To do so, a research concept shall be developed using a participatory research approach. A selective literature search was carried out to identify concrete recommendations for participatory research and previous experiences on the participation of parents. Based on these results, semi-structured interviews and group discussions with families were carried out. According to literature, parents have rarely been used as co-researchers. Our experiences show that access to families in burdened life circumstances is possible via the low-threshold structures of our early childhood interventions programme. In 2018, 21 families participated in interviews and group discussions. The latter method is particularly well suited for obtaining targeted information from families and building trust for long-term cooperation. Still, the stressful family situations make it difficult to participate in research activities. Therefore, specific conditions are required. At present, it is clear that it is feasible to involve families and test research methods together. The next step, an equal cooperation of families and researchers, shall be achieved by the use of a research group. A small group started in Spring 2019, eventually being involved in the implementation of some methods during fall 2019. Whether families are willing to participate continuously for a long time in research activities remains unclear, so far.
Key messages
Participatory research with families in stressful situations needs time and patience as well as specific conditions, but it is possible. Participation of the target group in the planning phase of further research can lead to relevant insights for programme improvements.
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Affiliation(s)
- M Weigl
- Austrian Public Health Institute (Gesundheit Oesterreich GmbH), Vienna, Austria
| | - C Marbler
- Austrian Public Health Institute (Gesundheit Oesterreich GmbH), Vienna, Austria
| | - S Haas
- Austrian Public Health Institute (Gesundheit Oesterreich GmbH), Vienna, Austria
| | - W Laskowski
- Upper Austrian Health Insurance, Linz, Austria
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19
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Stefan P, Pfandler M, Wucherer P, Habert S, Fürmetz J, Weidert S, Euler E, Eck U, Lazarovici M, Weigl M, Navab N. [Team training and assessment in mixed reality-based simulated operating room : Current state of research in the field of simulation in spine surgery exemplified by the ATMEOS project]. Unfallchirurg 2019; 121:271-277. [PMID: 29546445 DOI: 10.1007/s00113-018-0467-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Surgical simulators are being increasingly used as an attractive alternative to clinical training in addition to conventional animal models and human specimens. Typically, surgical simulation technology is designed for the purpose of teaching technical surgical skills (so-called task trainers). Simulator training in surgery is therefore in general limited to the individual training of the surgeon and disregards the participation of the rest of the surgical team. The objective of the project Assessment and Training of Medical Experts based on Objective Standards (ATMEOS) is to develop an immersive simulated operating room environment that enables the training and assessment of multidisciplinary surgical teams under various conditions. Using a mixed reality approach, a synthetic patient model, real surgical instruments and radiation-free virtual X‑ray imaging are combined into a simulation of spinal surgery. In previous research studies, the concept was evaluated in terms of realism, plausibility and immersiveness. In the current research, assessment measurements for technical and non-technical skills are developed and evaluated. The aim is to observe multidisciplinary surgical teams in the simulated operating room during minimally invasive spinal surgery and objectively assess the performance of the individual team members and the entire team. Moreover, the effectiveness of training methods and surgical techniques or success critical factors, e. g. management of crisis situations, can be captured and objectively assessed in the controlled environment.
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Affiliation(s)
- P Stefan
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland.
| | - M Pfandler
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland
| | - P Wucherer
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| | - S Habert
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| | - J Fürmetz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - S Weidert
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - E Euler
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - U Eck
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
| | - M Lazarovici
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, München, Deutschland
| | - M Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, München, Deutschland
| | - N Navab
- Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality, Institut für Informatik/I‑16, Technische Universität München, Boltzmannstr. 3, 85748, Garching b. München, Deutschland
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Grote M, Maihöfer C, Weigl M, Davies-Knorr P, Belka C. Progressive resistance training in cachectic head and neck cancer patients undergoing radiotherapy: a randomized controlled pilot feasibility trial. Radiat Oncol 2018; 13:215. [PMID: 30400971 PMCID: PMC6219249 DOI: 10.1186/s13014-018-1157-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer cachexia is a prevalent symptom of head and neck neoplasms. The reduction in skeletal muscle mass is one of the main characteristics which can lead to poor physical functioning. The purposes of this pilot randomized controlled trial were to determine the feasibility of progressive resistance training in cachectic head and neck cancer patients during radiotherapy and to explore possible risks and benefits. METHODS Twenty cachectic participants with head and neck cancer receiving radiation were randomized to obtain either a machine supported progressive resistance training (n = 10) or usual care (n = 10). The training took place 3 times weekly for 30 min. Intervention included 3 exercises for major muscle groups with 8-12 repetition maximum for 3 sets each. Bioelectrical impedance analysis, hand-held dynamometry, Six-Minute Walk Test and standardized questionnaires for fatigue and quality of life were used for evaluating outcomes at baseline before radiotherapy (t1), after 7 weeks of radiotherapy (t2) and 8 weeks after the end of radiotherapy (t3). RESULTS All participants (n = 20) completed the trial. No serious adverse events occurred. At the initial assessment the cachectic patients had already lost 7.1 ± 5.2% of their body weight. General fatigue (score 10.7 ± 3.3) and reduced quality of life (score 71.3 ± 20.6) were prevalent in cachectic head and neck cancer patients even before radiotherapy. An average improvement of weight loading for leg press (+ 19.0%), chest press (+ 29.8%) and latissimus pull-down (+ 22.8%) was possible in the intervention group. Participants had at least 13 training sessions. The outcome measures showed nonsignificant changes at t2 and t3, but a trend for a better course of general fatigue and quality of life at t2 in the intervention group. CONCLUSIONS Despite advanced tumor stage and burdensome treatment the intervention adherence is excellent. Progressive resistance training in cachectic head and neck cancer patients during radiotherapy seems to be safe and feasible and may have beneficial effects of general fatigue and quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT03524755 . Registered 15 May 2018 - Retrospectively registered.
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Affiliation(s)
- Manuel Grote
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany. .,Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377, Munich, Germany. .,Present Address: Department of Health Promotion/Occupational Health Management, AOK Baden-Württemberg, 70191, Stuttgart, Germany.
| | - Cornelius Maihöfer
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer' Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Patricia Davies-Knorr
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer' Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
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Schnabel A, Dostert S, Weigl M, Girlich C, Seelbach-Göbel B. Perinatologisches Management bei kompletter Hypophyseninsuffizienz. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Schnabel
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde St. Hedwig, Regensburg, Deutschland
| | - S Dostert
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde St. Hedwig, Regensburg, Deutschland
| | - M Weigl
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde St. Hedwig, Regensburg, Deutschland
| | - C Girlich
- Barmherzige Brüder Regensburg, Klinik für Innere Medizin, Endokrinologie, Regensburg, Deutschland
| | - B Seelbach-Göbel
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde St. Hedwig, Regensburg, Deutschland
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Weigl M, Schnabel A, Fill Malfertheiner S, Huber G, Seelbach-Göbel B. Perinatologisches Management bei Erstdiagnose einer kongenitalen Thrombotisch-Thrombozytopenischen Purpura (TTP) in der Schwangerschaft. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Weigl
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde, Regensburg, Deutschland
| | - A Schnabel
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde, Regensburg, Deutschland
| | - S Fill Malfertheiner
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde, Regensburg, Deutschland
| | - G Huber
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde, Regensburg, Deutschland
| | - B Seelbach-Göbel
- Universität Regensburg, Klinik für Geburtshilfe und Frauenheilkunde, Regensburg, Deutschland
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Winkelmann A, Oettl B, Weigl M. The relation between personal resources and quality of life in patients with fibromyalgia. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ritter S, Storrer D, Weigl M, Krischak G. Status Quo der Wissenschaft und Forschung in der Physikalischen Medizin und Rehabilitation in Deutschland. Phys Med Rehab Kuror 2018. [DOI: 10.1055/a-0596-7918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Zusammenfassung
Fragestellung Die Studie erhebt Strukturen, Forschungsförderungen sowie -themen der Forschung in der physikalischen und rehabilitativen Medizin (PRM) in Deutschland.
Methode Über einen Fragebogen wurde der Status Quo der Forschung in Deutschland zum Jahr 2016 im Bereich der PMR erfasst. Dieser wurde an 109 Einrichtungen, v. a. Institute, Universitäten und Kliniken verschickt. Die Auswertung erfolgte deskriptiv.
Ergebnisse Rund 77% von 32 rückmeldenden Einrichtungen in der PMR erhielten Drittmittelförderungen. Die wichtigsten Fördermöglichkeiten waren Stiftungen, die Deutsche Rentenversicherung Bund sowie leistungsorientierte Mittelvergabe (LOM) an den Universitäten. Forschung zur Rehabilitation überwiegt gegenüber der Forschungsaktivität in der physikalischen Medizin. Die Themen sind hierbei breit gefächert und reichen von Therapiemittelforschung bis hin zu Rehabilitationszugang und -bedarf. Dabei kommen vorwiegend quantitative Methoden zum Einsatz
Schlussfolgerung Die Erhebung gibt Hinweise auf die bestehende Forschungsstruktur im Bereich der PRM sowie der inhaltlichen Themenfelder. Die Forschung im Bereich der physikalischen Medizin ist gegenüber der Rehabilitationsforschung unterrepräsentiert.
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Affiliation(s)
- Sabrina Ritter
- Institut für Rehabilitationsmedizinische Forschung, Universität Ulm, Bad Buchau, Germany
| | - Daniela Storrer
- Institut für Rehabilitationsmedizinische Forschung, Universität Ulm, Bad Buchau, Germany
| | - Martin Weigl
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, München, Germany
| | - Gert Krischak
- Institut für Rehabilitationsmedizinische Forschung, Universität Ulm, Bad Buchau, Germany
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Affiliation(s)
- M Weigl
- Austrian Public Health Institute, Vienna, Austria
| | - J Strizek
- Austrian Public Health Institute, Vienna, Austria
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Weigl M. Evaluation of a risk screening project, example from early childhood intervention networks. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Weigl
- Gesundheit Österreich GmbH, Vienna, Austria
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Weigl M, Wild H. European validation of The Comprehensive International Classification of Functioning, Disability and Health Core Set for Osteoarthritis from the perspective of patients with osteoarthritis of the knee or hip. Disabil Rehabil 2017; 40:3104-3112. [DOI: 10.1080/09638288.2017.1377295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
| | - Heike Wild
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
- Gesundheitszentrum Chiemgau, Traunstein, Germany
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Petzke F, Brückle W, Eidmann U, Heldmann P, Köllner V, Kühn T, Kühn-Becker H, Strunk-Richter M, Schiltenwolf M, Settan M, von Wachter M, Weigl M, Häuser W. Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom. Schmerz 2017; 31:246-254. [DOI: 10.1007/s00482-017-0201-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Haas S, Weigl M, Winkler P. Frühe Hilfen für Familien mit Migrationshintergrund. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- S Haas
- Gesundheit Österreich (GÖG), Nationales Zentrum Frühe Hilfen (NZFH.at)
| | - M Weigl
- Gesundheit Österreich (GÖG), Nationales Zentrum Frühe Hilfen (NZFH.at)
| | - P Winkler
- Gesundheit Österreich (GÖG), Nationales Zentrum Frühe Hilfen (NZFH.at)
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Baumueller E, Winkelmann A, Irnich D, Weigl M. Electromyogram Biofeedback in Patients with Fibromyalgia: A Randomized Controlled Trial. Complement Med Res 2017; 24:33-39. [DOI: 10.1159/000454692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background/Aim: Electromyogram (EMG) biofeedback is used in chronic pain but its effectiveness in patients with fibromyalgia is unclear. The objective of this randomized controlled clinical trial was to evaluate the effectiveness of EMG biofeedback in patients with fibromyalgia. Methods: Patients were recruited from a waiting list at the fibromyalgia day care clinic at the University Hospital Munich. The study intervention comprised 14 sessions of EMG biofeedback during 8 weeks in addition to the usual care. The control intervention was usual care alone. Assessments were scheduled before intervention (T0), after intervention (T1), and 3 months after the end of intervention (T2). The primary outcome measure was the Fibromyalgia Impact Questionnaire (FIQ). Secondary outcome measures included additional patient-oriented measures and the pressure-pain threshold in the trapezius muscles. Effectiveness was analyzed by significance tests and standardized effect sizes (ES). Results: 36 patients completed the study. EMG biofeedback did not improve the health status (FIQ, T1: p = 0.95, ES = 0.02; T2: p = 0.52, ES = 0.26). Among the secondary outcome measures, only the pressure-pain threshold at the trapezius muscles showed an improvement in the intervention group (T1: p = 0.016, ES = 0.84). Conclusion: EMG biofeedback showed no health status improvement in patients with fibromyalgia.
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Abstract
BACKGROUND Although psychosocial risk evaluation (PRE) is legally required, implementation is often suboptimal. Occupational health specialists face various challenges in implementing a systematic PRE process. AIMS To evaluate if a checklist strengthens the competencies of occupational physicians in PRE design and implementation. METHODS A prospective pilot survey with a baseline and follow-up assessment at 12 months was conducted with occupational physicians who applied the checklist. Three outcome criteria were assessed: (i) physicians' general competence in PRE, (ii) physicians' self-reported skills in PRE and (iii) feasibility of the checklist. RESULTS Twenty-four occupational physicians participated. Checklist users reported increased competence in PRE at follow-up, increasing in competence twice as much as physicians who did not use the checklist during the study period although this was not statistically significant. With regard to specific skills over time, checklist users reported increased knowledge of the PRE procedure (P < 0.05), as well as increased strategic planning for PRE (P < 0.01). All feasibility criteria were rated positively. CONCLUSIONS Our checklist may help occupational health clinicians to overcome the barriers that are responsible for the gap between official recommendations and occupational health and safety practice in PRE. However, our results are based on a preliminary study with a limited sample size.
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Affiliation(s)
- M Weigl
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany,
| | - A Müller
- Institute of Occupational and Social Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - A Paramythelli
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany
| | - P Angerer
- Institute of Occupational and Social Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - R Petru
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany
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Haas S, Weigl M, Unger T, Winkler P, Sagerschnig S, Anzenberger J, Juraszovich B, Gruber G. Can early childhood intervention networks support health equity? Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw173.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Haas S, Weigl M, Winkler P, Sagerschnig S, Knaller C, Gruber G. Early Childhood Networks - Strategy and implementation in Austria. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv173.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haas S, Weigl M, Winkler P, Sagerschnig S, Knaller C, Gruber G. Early Childhood Networks – Strategy and implementation in Austria. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weigl M, Müller A, Angerer P, Petru R. [Psychosocial Risk Evaluation in the Workplace: Expert-based Development of a Checklist for Occupational Physicians]. Gesundheitswesen 2015; 78:e14-22. [PMID: 26335655 DOI: 10.1055/s-0035-1555944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The implementation of psychosocial risk assessment at the workplace often fails in practice. One reason is the lack of competence of those who are in charge of the process. We present a checklist for the effective implementation of psychosocial risk assessment at workplace. This tool shall support occupational physicians in the preparation, planning and implementation of a psychosocial risks assessment process. Based on a stepwise development and validation process, specific steps and factors for the successful implementation were identified qualitatively with 15 occupational physicians and experts. This was conducted in a 2-stage Delphi study. In the following, the identified steps and factors were transferred into a checklist. Subsequently, the checklist was evaluated in a focus group of occupational physicians (user evaluation). Thereafter, the contents were subjected to an expert evaluation. Our checklist for the effective implementation of the process of psychosocial risk management in the workplace aims to strengthen the competence of occupational physicians, especially in the implementation of risk assessments in small and medium-sized enterprises (SMEs).
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Affiliation(s)
- M Weigl
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München
| | - A Müller
- Institut für Arbeitsmedizin und Sozialmedizin, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | - P Angerer
- Institut für Arbeitsmedizin und Sozialmedizin, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | - R Petru
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität, München
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Passauer-Baierl S, Chiapponi C, Bruns CJ, Weigl M. [Teamwork in the operating theatre: the German Observational Teamwork Assessment for Surgery (OTAS-D) and its first application in Germany]. Zentralbl Chir 2014; 139:648-56. [PMID: 25531636 DOI: 10.1055/s-0034-1383233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The quality of surgical teamwork contributes to performance of the operating theatre team, service quality and patient safety in surgery. Observational tools are a feasible and reliable way to capture and evaluate teamwork in the operating theatre (OT). We introduce the German version of the Observational Teamwork Assessment for Surgery (OTAS-D) and present the first observational results from German OTs. METHODS Quality of surgical teamwork was assessed with observational teamwork assessment for surgery (OTAS-D). It evaluates five dimensions of OT teamwork: communication, coordination, cooperation/backup behaviour, leadership, and team monitoring/situation awareness. Each dimension is evaluated for each profession (surgical, nursing, and anaesthesia team) as well for each phase of the procedure (pre-, intra-, and post-operative). We observed n = 63 procedures, mainly in abdominal/general and orthopaedic surgery. Additionally, all OT team members scored their individual evaluation of the intra-operative teamwork (standardised 1-item questions). RESULTS The OTAS-D evaluations showed meaningful results and differences for the OT professions as well as across the different phases of the procedures. Overall, a medium to good level of the OT teamwork was observed. There were no differences in regard to type of surgery (minimally invasive vs. open) or surgical specialties. With an increased coordination of the surgical team we observed a significantly increased cooperation of the nursing team (r = 0.36, p = 0.004). Concerning the OT staffs self-reports, the surgical and nursing teams reported higher scores for quality of surgical teamwork during the procedure than their anaesthesia team members. No significant relationships between observed quality of OT teamwork and self-reports were found. CONCLUSIONS The German version of OTAS-D is a psychometrically robust method to capture the quality of teamwork in operating theatres. It enables the analyses of teamwork between the surgical, nursing and anaesthesia professions in acute surgical care. Limitations of the first application results are considered. Finally, potential applications for surgical teaching, research and quality management are discussed.
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Affiliation(s)
- S Passauer-Baierl
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Universität München, Deutschland
| | - C Chiapponi
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - C J Bruns
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - M Weigl
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Universität München, Deutschland
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Schneider A, Weigl M, Petru R, Angerer P. How do junior doctors' work characteristics relate to burnout and work engagement? Results from a German longitudinal cohort study. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Haug P, Rominger V, Speker N, Weber R, Graf T, Weigl M, Schmidt M. Influence of Laser Wavelength on Melt Bath Dynamics and Resulting Seam Quality at Welding of Thick Plates. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.phpro.2013.03.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weigl M, Müller A, Vincent C, Angerer P, Sevdalis N. The association of workflow interruptions and hospital doctors' workload: a prospective observational study. BMJ Qual Saf 2011; 21:399-407. [DOI: 10.1136/bmjqs-2011-000188] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Weigl M, Müller A, Angerer P. [Impact of demographic changes - analysis and possible implications for the example of a specialist hospital]. Gesundheitswesen 2011; 74:283-90. [PMID: 21387216 DOI: 10.1055/s-0031-1271716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The ongoing demographic development creates distinctive challenges for the management of hospitals. Due to the demographic change hospitals will be more and more dependent on the work ability and performance of an aging workforce. Therefore, age-specific work design and interventions are inevitable to create a work environment that sustainably promotes health and well-being. This study reports the work conditions, health impairments (work ability, musculoskeletal complaints), and turnover intentions (intentions to leave the organisation within the previous year, intentions to leave before official retirement age) of N=210 employees working in a specialist hospital. Age-specific analyses show that correlations between working conditions, health, and turnover intention differ substantially across the age groups. From the results an exemplary approach for the analysis and management of demography-related challenges for hospital employees has been deduced. With it, this study presents a promising strategy to identify age-related work stressors and health complaints and to promote health and well-being of hospital employees in different age groups.
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Affiliation(s)
- M Weigl
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians Universität München.
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Weigl M, Muller A, Zupanc A, Glaser J, Angerer P. Hospital doctors' workflow interruptions and activities: an observation study. BMJ Qual Saf 2011; 20:491-7. [DOI: 10.1136/bmjqs.2010.043281] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Falkert A, Endress E, Weigl M, Seelbach-Göbel B. Three-dimensional ultrasound of the pelvic floor 2 days after first delivery: influence of constitutional and obstetric factors. Ultrasound Obstet Gynecol 2010; 35:583-588. [PMID: 20084643 DOI: 10.1002/uog.7563] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Morphological changes of the pelvic floor during pregnancy and delivery can be visualized by three-dimensional (3D) perineal ultrasound. The aim of this study was to compare biometric measurements of the levator ani muscle according to maternal constitutional factors, delivery mode and size of the baby immediately after the first delivery. METHODS In this prospective observational study, 130 primiparae were recruited (all of them Caucasians with singleton pregnancy and cephalic presentation). A 3D perineal ultrasound scan was performed on the second day after delivery with standardized settings. Volumes were obtained at rest and on Valsalva maneuver, and biometric measurements of the levator hiatus were determined in the axial plane. Different obstetric and constitutional parameters were obtained from our clinical files. RESULTS All biometric measurements of the levator hiatus were significantly greater in the vaginal delivery group than in the Cesarean section group (P < 0.001), whereas subgroup analysis within the vaginal (spontaneous vs. operative vaginal) and Cesarean (primary vs. secondary) delivery groups did not show statistically significant differences. There was no demonstrable influence of maternal constitutional factors (age, body mass index (BMI)) or different obstetric parameters (length of second stage of labor, episiotomy, maternal injuries) on levator hiatus size postpartum, even in subgroups that delivered vaginally. Women with de novo postpartum stress incontinence showed a significantly higher mean levator hiatus transverse diameter and larger hiatal area on Valsalva maneuver (P < 0.05). There was also a positive but very weak correlation between the newborn's head circumference and hiatal dimensions at Valsalva maneuver (P < 0.05). CONCLUSIONS Pelvic floor imaging by 3D ultrasound is easily accessible even on the first days after delivery and can provide useful information on morphological changes of the levator ani muscle. In our study, women with vaginal or operative vaginal delivery had a significantly larger hiatal area and transverse diameter than women who delivered by Cesarean section. Maternal constitutional factors (BMI, age) and duration of second stage of labor had no influence on the biometric measurements of hiatal area, whereas weight and head circumference of the baby showed a positive correlation with area of the levator hiatus.
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Affiliation(s)
- A Falkert
- Krankenhaus Barmherzige Brüder-Frauenklinik St. Hedwig, Department of Obstetrics and Gynecology, University of Regensburg, Regensburg, Germany.
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Falkert A, Endreß E, Weigl M, Seelbach-Göbel B. Postpartale 3D-Sonographie des Beckenbodens: Einfluss von konstitutionellen und geburtshilflichen Faktoren. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Weigl M, Grabner M, Helle G, Schleser GH, Wimmer R. Characteristics of radial growth and stable isotopes in a single oak tree to be used in climate studies. Sci Total Environ 2008; 393:154-161. [PMID: 18207218 DOI: 10.1016/j.scitotenv.2007.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 12/11/2007] [Accepted: 12/12/2007] [Indexed: 05/25/2023]
Abstract
In this study we have analyzed the variability of tree-ring widths and stable isotopes (delta(13)C and delta(18)O) of a single sessile oak tree (Quercus petraea (Matt.) Liebl.) since these parameters are critical in reconstructing the environment, particularly climatic conditions. Tree rings were separated into early- and latewood (EW(t); LW(t)), tree ring (TR(t)), and transfer tree ring (TTR(t), the latter being the latewood plus the earlywood of the subsequent year. Mean sensitivity, simple correlation, partial correlation and autocorrelation analyses were applied to describe data and relationships. Although this research focused on a single tree, the results compared well with average site data. Widths and delta(18)O values showed generally low autocorrelation for all tree-ring components, whereas delta(13)C revealed highly significant autocorrelations for most tree-ring components. Mean sensitivity of the standardized values turned out to be high for delta(18)O, marginally lower for width and the lowest for delta(13)C. Correlation analyses have proven that the relationships within the tree-ring widths or within the isotope parameters are much stronger than across widths and isotope parameters. The study demonstrates the unique potential of all measured tree-ring data to be used as climate proxies.
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Affiliation(s)
- Martin Weigl
- Competence Center for Wood Composites and Wood Chemistry, A-4021 Linz, Austria.
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Weigl M, Cieza A, Cantista P, Reinhardt JD, Stucki G. Determinants of disability in chronic musculoskeletal health conditions: a literature review. Eur J Phys Rehabil Med 2008; 44:67-79. [PMID: 18385630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Knowledge of the determinants of disability in musculoskeletal conditions (MSC) is critical for reducing their burden. No epidemiologic studies from a truly comprehensive perspective consider environmental factors (EF) and personal factors (PF) as determinants of disability. However, one can identify candidate EF from the International Classification of Functioning, Disability and Health (ICF) Core Sets for rheumatoid arthritis (RA), osteoporosis (OP), osteoarthritis (OA), low back pain (LBP) and chronic wide spread pain (CWP). The objective of this literature review was to contribute to the validation of the EF from the ICF Core Sets for MSC and the candidate PF from a (ICF) Delphi exercise, as well as from the report of the Bone and Joint Decade (BJD) Health Strategy Project. The results of the literature search focus on reviews published between January 1991 and March 2006 that contained information on EF and PF that determine disability in LBP, RA and OA. Many PF and EF included in the ICF Core Sets were confirmed as potential determinants of disability. However, regarding some contextual factors, in particular EF referring to the physical environment, there is a lack of reviews and clinical studies that have investigated their relevance to disability. The predominant medical model in studies on disability in MSC may explain this lack of evidence. However, the increasing attention given to the integrative model of functioning, disability and health of the World Health Organization (WHO) and the approval of the ICF by the World Health Assembly in 2001 may stimulate future research on the effect of EF and PF on disability.
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Affiliation(s)
- M Weigl
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian-University, University Hospital Munich, Marchioninistrasse 15, Munich, Germany
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Gil FP, Weigl M, Wessels T, Irnich D, Baumüller E, Winkelmann A. Parental Bonding and Alexithymia in Adults With Fibromyalgia. Psychosomatics 2008; 49:115-22. [DOI: 10.1176/appi.psy.49.2.115] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- P Angerer
- Institut und Poliklinik für Arbeits-, Sozial und Umweltmedizin, Klinikum der Universität München, Ziemssenstr. 1, 80336 München.
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Abstract
Musculoskeletal conditions (MSC) are common throughout the world and their impact on individuals is diverse and manifold. Knowledge of the determinants for disability and of strategies for prevention and rehabilitation management according to the scientific evidence is critical for reducing the burden of MSC. The first section of this chapter reviews the evidence for common determinants of functioning and disability in patients with MSC. We have focussed on environmental factors (EF) and personal factors (PF) and have structured them according to the International Classification of Functioning, Disability and Health (ICF) framework. The second section discusses prevention strategies. Generally, prevention needs to address those EF and PF that were presented in the first section. The final section describes modern principles of rehabilitation and reviews the evidence for specific rehabilitation interventions.
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Affiliation(s)
- Martin Weigl
- Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian-University, Munich, Germany, and Hospital Geral de Santo António, Porto, Portugal
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Weigl M, Cieza A, Kostanjsek N, Kirschneck M, Stucki G. The ICF comprehensively covers the spectrum of health problems encountered by health professionals in patients with musculoskeletal conditions. Rheumatology (Oxford) 2006; 45:1247-54. [PMID: 16567355 DOI: 10.1093/rheumatology/kel097] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate, whether the International Classification of Functioning, Disablity and Health (ICF) comprehensively covers the spectrum of health problems encountered by medical doctors and physiotherapists in patients with musculoskeletal conditions. METHODS A worldwide e-mail survey with questionnaires that requested lists of relevant areas in the ICF components-body functions, body structures, activities and participation, and environmental factors-in patients with rheumatoid arthritis, osteoarthritis, low back pain and osteoporosis was conducted. The suitability of linking the named concepts to the ICF as well as the precision of the linking was characterized by assigning the concepts to six groups. RESULTS All concepts that were named by the experts could be linked to the ICF, with the exception of personal factors. Between 32% (environmental factors) and 51% (activities and participation) of the named concepts were linked to an ICF category with an identical meaning and the same grade of precision. All other named concepts were linked to ICF categories with a lower level of precision, or encompassed more than one ICF category, or were linked to an ICF category with a related, but not identical meaning. CONCLUSIONS The ICF covers comprehensively the spectrum of problems encountered in patients with musculoskeletal conditions by clinical experts throughout the world. This strengthens the validity of the ICF in the view of the users and will encourage the use of ICF-based applications such as the ICF checklist and the now-developed ICF Core Sets.
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Affiliation(s)
- M Weigl
- Department of Physical Medicine and Rehabilitation, University Hospital Munich, 81377 Munich, Germany
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Weigl M, Angst F, Aeschlimann A, Lehmann S, Stucki G. Predictors for response to rehabilitation in patients with hip or knee osteoarthritis: a comparison of logistic regression models with three different definitions of responder. Osteoarthritis Cartilage 2006; 14:641-51. [PMID: 16513373 DOI: 10.1016/j.joca.2006.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 01/03/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify pre-treatment predictors of who will benefit from a 3-4-week comprehensive rehabilitation intervention in patients with osteoarthritis (OA) of the knee or hip. METHODS A prospective cohort study with assessments at admission to the clinic and after 6 months was conducted. Two hundred and fifty patients from the rehabilitation clinic Rehaclinic Zurzach, Switzerland, were included. Three different measures of response to a 3-4-week comprehensive rehabilitation intervention were used: one indirect measure (minimal clinically important difference (MCID) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score=18% improvement), one direct measure (transition question) and a combination of both criteria. Responders were predicted by a sequential logistic regression analysis with nine personal variables, five lifestyle risk factors, seven psychological status variables and the WOMAC global baseline score. RESULTS The set of statistically significant predictors was dependent on the definition of response. The comparison of predictors that were statistically significant in any of the prediction models showed similar odds ratios (ORs) for the majority of predictors across three regression models with the different response definitions as dependent variable. Female gender, absence of depressive symptoms (dep), history of complementary medicine (cm) and low comorbidity (com) were the most stable predictors and had ORs above 2.0 (female) and above 1.5 (dep, cm, com) across the three regression models with different response definitions. CONCLUSION A set of predictors for the outcome of rehabilitation in patients with OA was identified. If these predictors could be confirmed in future research, this knowledge might help to adopt and individualize the treatment of patients who are, at present, less likely to respond.
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Affiliation(s)
- M Weigl
- Department of Physical Medicine and Rehabilitation, University Hospital Munich, Marchioninistrasse 15, 81377 Munich, Germany
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