Juliane Hardt
Bergische Universität Wuppertal, Institute for Safety Technology, Section of Occupational Health Research, Scientific Coordination
Essen University Hospital, Germany, Institute of Medical Informatics, Biometry and Epidemiology, Scientific Coordinator
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A study on the basis of the BIBB/BAuA survey of 2006
Abstract:
Introduction: Demographic changes emphasise the importance of healthy aging during the working life. This study, which focuses on associations of age and health in the context of the working life, analyses several health indicators on the basis of the BIBB/ BAuA employment survey 2006. The subjectively assessed health status, the prevalence of reported work-related health impairments, the frequency of their treatment by a doctor or therapist and the number of sick-leave days of employees were analysed by age, gender and occupational status.
Methods: 20,000 economically active persons (51.6 % men, mean age: 41.3 years) were surveyed by telephone with regard to psychosocial and health aspects. In this study, chisquare tests were conducted to investigate whether the subjectively assessed health status, the prevalence of work-related impairments and their treatment by a doctor or therapist differed systematically with regard to age, gender and occupational status. The number of sick-leave days was analysed by age and gender and by gender and professional status in the context of a general linear model.
Results: We observed decreases in all four health indicators with increasing age. This trend did not continue for subjects older than 60 years. Women overall reported a worse general health status, more impairments and their treatment than men, although there was no difference in the number of reported sick-leave days. In the analysis by professional status, workers reported more impairments than persons in the other groups.
Conclusions: General health decreases with increasing age, but this trend did not continue in a linear way from the age of 60. One interpretation for this would be the healthy worker effect. Older persons, women and workers reported more health impairments and thus constitute the main target groups for possible prevention measures.
Background: The aim of this cross-sectional study was to establish an online inflammatory bowel disease (IBD) registry for a first picture of the situation of IBD outpatients' treatment in Germany.
Methods: Between March 2006 and July 2007 IBD outpatients from 24 gastroenterological specialist practices and two hospitals in Germany were enrolled in an Internet-based registry to evaluate the outpatients' clinical status, psychological impairments, provided health care, as well as medical treatment and medication costs.
Results: 1032 IBD patients (ulcerative colitis/UC: 519; Crohn's disease/CD: 511; indeterminate colitis: 2) were enrolled in the study (age: 43±14 years/M±SD). Disease duration of all patients averaged 10±8.5 years. In 519 UC-patients (49% male; 33% pancolitis), 66% were in remission as were 55% of CD patients (37 % male; 41 % active smokers). Associated with higher rates of disease activity (CDAI≥150; CAI>4) were corticosteroids (CD, UC), topical medication (UC), relevant reported depressive symptoms (15%; 6-31%) and impairments in sexuality (21%; 9-42%). Relevant medication groups prescribed were oral aminosalicylates (UC: 70%; CD: 47%); immunosuppressive therapy - mostly azathioprine/6 MP (CD: 47%; UC: 26%), and Infliximab (CD: 8%; UC: 3%).
Strongly associated with their clinical disease activity in UC as well as CD patients, 15% (6–31%) reported relevant depressive symptoms and 21% (9–42%) relevant impairments in sexuality.
Conclusions: The registry constitutes a large complemental database for the patient population in Germany. About one third of the IBD patients were not in clinical remission (CDAI ≥150/CAI>4) (CD: 45%; UC: 27%), although high rates of immunosuppressive drugs (CD: 47%; UC 26%) were administered. This study shows a large burden of active disease associated with an unexpectedly high (co)morbidity and high psychosocial impairments, indicating a reduced health state in IBD patients.
© 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
Method: Longitudinal data of 8877 qualified nurses and nursing aids in Germany (n=1639), Finland (n=2335), Italy (n=2314), the Netherlands (n=952), Poland (n=1223) and Slovakia (n=414) from the NEXT study were available for analyses [3]. The questionnaire comprised sociodemographic and institutional factors, nine work-related factors as well as individual factors (overcommitment [4], positive and negative affectivity [5]) that may be associated with burnout. The subjective extent of burnout symptoms was assessed with the scale "personal burnout" (Copenhagen Burnout Inventory [6], [7] at baseline and at one-year follow-up. Uni- and multivariate linear regression analyses were applied to analyze four models of factor groups with increasing model complexity in comparison of the 6 countries.
Results: Differences in the reported extent of individual and work-related indicators and differences between the prediction models of the six countries were remarkable. Mean levels of burnout measures were lowest in Dutch nurses who also reported better social support, and lower levels of work-family conflict, individual overcommitment and negative affectivity. A model optimizing strategy (stepwise method) with four consecutive linear regression models was applied. Sociodemographic and institutional factors had no effects (R²corr:.004-.051). Individual factors showed substantial effects for five of the six countries (∆R²corr:.115-.251;MD=.172); in contrast to work-related factors (∆R²corr:-.008-.029;MD=.034). When the models were adjusted for burnout level in the first year, model-fit indices again slightly increased (∆R²corr:.075-.202;MD=.180). Models were best predictive for the German and least predictive for the Polish sample.
Discussion: Our results show individual factors to be important predictors for burnout scores of nurses one year later. These findings were supported by the literature of burnout research [8], [9], [10], [11]. However, problems of type III error also need to be considered [cf. [12], [13], [14], [15]. Further analyses should be extended to model specific interaction effects of individual and work-related factors. Such models will provide further evidence for predictor models as well as preventional and interventional concepts.
References
1. Hasselhorn HM, Tackenberg P, Müller BH. Intent to leave nursing in the European nursing profession. In: Hasselhorn HM, Tackenberg P, Müller BH, eds. Working conditions and intent to leave the profession among nursing staff in Europe. Stockholm: National Institute for Working Life and authors; 2003. p. 115-24.
2. Estryn-Behar M, Van der Heijden BI, Oginska H, et al. The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses. Med Care. 2007;45(10):939-50.
3. Hasselhorn HM, Müller BH, Tackenberg P, Kümmerling A, NEXT-Study-Group. NEXT Scientific Report. Wuppertal, Germany: 2005.
4. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, et al. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med. 2004;58(8):1483-99.
5. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063-70.
6. Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress. 2005;19(3):192-207.
7. Borritz M, Kristensen T. Copenhagen Burnout Inventory: Normative data from a presentative Danish population on Personal Burnout and Results from the PUMA Study on Personal Burnout, Work Burnout, and Client Burnout. Copenhagen: National Institute of Occupational Health; 2001.
8. Halbesleben JRB, Buckley MR. Burnout in organizational life. Journal of Management. 2004;30(6):859-79.
9. Jansen PGM, Kerkstra A, bu-Saad HH, Van Der Zee J. The effects of job characteristics and individual characteristics on job satisfaction and burnout in community nursing. International Journal of Nursing Studies. 1996;33(4):407-21.
10. Burisch M. A longitudinal study of burnout: The relative importance of dispositions and experiences. Work & Stress. 2002;16(1):1-17.
11. Bakker AB, Schaufeli WB, Sixma HJ, Bosveld W, van Dierendonck D. Patient demands, lack of reciprocity, and burnout: A five-year longitudinal study among general practitioners. Journal of Organizational Behavior. 2000;21(4):425.
12. Kimball AW. Errors of the Third Kind in Statistical Consulting. Journal of the American Statistical Association. 1957;52(278):133-42.
13
Lu TH. International comparisons: they do help and are essential for avoiding type III error. Injury Prevention. 2001;7(4):270-1.
14.
Schwartz S, Carpenter KM. The right answer for the wrong question: consequences of type III error for public health research. Am J Public Health. 1999;89(8):1175-80.
15.
Rose G. Sick Individuals and Sick Populations. International Journal of Epidemiology. 1985;14(1):32-8.
Methods: Survey data of 1018 IBD patients (65 % female, 58 % CD patients, mean age 42 yrs, disease duration: 13 yrs) on perceived daily stress, mental strains associated with the disease (e.g. anxiety and depression: HADS [5]) and utilization of health care services were analyzed. Scale construction was based on item response theory. Scale properties were investigated with factor analysis, reliability analyses and model-fit statistics (Rasch modelling with Winsteps 3.68®).
Results: A unidimensional scale with good properties (Cronbach's α: .73; person reliability: .76) was constructed with three items on perceived stress (frequency of stress, impairment by stress, suffering from stress and extraordinary strains). Three groups (low, moderate, high perceived stress) were identified, which differed substantially in reported anxiety (d = 1.2) and depression (d = 0.9), in an objective disease activity score (GIBDI) and further symptoms. In addition, the three groups differ concerning preferences for and utilization of various (esp. psychosocial) health services.
Conclusions: IBD patients report multiple psychosocial impairments [1]. The scale for perceived stress seems to be able to identify IBD patients with severe psychosocial impairments and a high demand for psychosocial attendance, if confirmed in independent samples. To inhance secondary prevention of impairments of chronic disease and allowing for the optimizing of health care services [6] we propose to integrate this indicator for psychosocial impairments into the diagnostic process.
Outline
References
1. Hoffmann JC, Preiss JC, Autschbach F, et al. [Clinical practice guideline on diagnosis and treatment of Crohn's disease]. Z Gastro. 2008;46:1094-146.
2. Hoffmann C, Zeitz M, Bischoff SC, et al. [Diagnosis and therapy of ulcerative colitis: results of an evidence based consensus conference by the German society of Digestive and Metabolic Diseases and the competence network on inflammatory bowel disease]. Z Gastro. 2004;42:979-83.
3. Hardt J, Muche-Borowski C, Conrad S, Balzer K, Bokemeyer B, Raspe H. [Inflammatory bowel diseases as multi-focal disorders: results from a multi-regional survey on bodily and psychosocial problems in IBD patients]. Z Gastro. 2010;48:381-91.
4. Hardt J, Balzer K, Muche-Borowski C, Raspe H. [Examination of a short scale on perceived stress in patients with inflammatory bowel disease]. Zbl Arbmed. 2010;60:318-319.
5.
Herrmann C, Buss U, Snaith RP. [HADS-D Hospital Anxiety and Depression Scale - German Version. A Questionnaire for measuring anxiety and depression in somatic medicine]. Bern: Huber; 1995.
6.
Raspe H, Conrad S, Muche-Borowski C.[Evidence-based and consented pathways for patients with inflammatory bowel diseases (IBD)]. Z Gastroenterol. 2009;47(6):541-62.
Methoden: Der Pretest des CAPI-Instruments wurde an einer Stichprobe von 200 Personen durchgeführt. Das umfangreiche Befragungsinstrument umfasst u.a. 6 Skalen des COPSOQ, der die individuelle Bewertung von Arbeitsbedingungen (z.B. quantitative Arbeitsanforderungen, soziale Unterstützung, Führungsqualität) mit validierten Skalen basierend auf likertskalierten Items erfragt. Für die Items der COPSOQ-Skalen wurden deskriptive Statistiken, Schwierigkeitsindizes, Trennschärfekoeffizienten und interne Konsistenzen (Cronbach's alpha) berechnet sowie Verteilungsannahmen geprüft. Zur Analyse der Konstruktvalidität wurde die Dimensionalität der Skalen geprüft. Nach Interkorrelationsanalysen der Skalen wurden die Item-Werte z-transformiert und mit einer Hauptkomponentenanalyse (Varimax-Rotation) die Faktorenstruktur der verwendeten COPSOQ-Skalen geprüft.
Ergebnisse: Es zeigten sich Decken- und Bodeneffekte für Items in drei der sechs Skalen (soziale Unterstützung, Entwicklungsmöglichkeiten, Einfluss bei der Arbeit). Die Werte aller Items der 6 Skalen waren nicht normalverteilt, Schiefe (Median = -0.14; Range: -1.45 – 1.03) und Kurtosis (Median = -0.62; Range: -1.39 – 1.64) variierten stark. Die Schwierigkeitsindizes für die 6 Skalen variierten von 25-77, die Trennschärfekoeffizienten von 0.57-0.86 (alle signifikant) und Cronbach's alpha von 0.63-0.88. In der Hauptkomponentenanalyse bestätigte sich die angenommene 6-Faktoren-Lösung mit den höchsten Faktorladungen der Items auf dem jeweiligen Skalenfaktor (MW = .760, Range: .518-.864).
Diskussion: Die psychometrische Qualität der COPSOQ-Skalen im CAPI wurde insgesamt als gut bewertet. Die bekannten Decken- und Bodeneffekt bestätigten sich. Schwierigkeitsindizes und Trennschärfekoeffizienten zeigten akzeptable Werte und die faktorielle Struktur konnte bestätigt werden. Die COPSOQ-Skalen scheinen damit für die Verwendung im CAPI ausreichend validiert und werden in der deutschen Version [6] vergleichbar mit Referenzpopulationen eingesetzt.
Gliederung
Literatur
1. du Prel JB, Hardt J, Rauch A, Rose U, Schröder H, Steinwede J, Swart E, Trappmann M, Müller BH, Hasselhorn HM, Peter R, the lidA Study Group. A prospective longitudinal investigation of work-related health determinants of an aging workforce in Germany – the lidA Study. Longitudinal and Life Course Studies. 2010;1(3 Suppl):281.
2. Lienert G, Raatz U. Testaufbau und Testanalyse. Weinheim: Beltz Psychologie Verl.-Union; 1998.
3. Bühner M. Einführung in die Test- und Fragebogenkonstruktion. 3rd ed. München, Boston: Pearson Studium; 2010
4. Streiner D, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford; New York: Oxford University Press; 2008.
5.
Pejtersen JH, Kristensen TS, Borg V, Björner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24.
6.
Methoden zur Erfassung psychischer Belastungen – Erprobung eines Messinstrumentes (COPSOQ). Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA), Fb 1058. Berlin: BAuA; 2005.
A study on the basis of the BIBB/BAuA survey of 2006
Abstract:
Introduction: Demographic changes emphasise the importance of healthy aging during the working life. This study, which focuses on associations of age and health in the context of the working life, analyses several health indicators on the basis of the BIBB/ BAuA employment survey 2006. The subjectively assessed health status, the prevalence of reported work-related health impairments, the frequency of their treatment by a doctor or therapist and the number of sick-leave days of employees were analysed by age, gender and occupational status.
Methods: 20,000 economically active persons (51.6 % men, mean age: 41.3 years) were surveyed by telephone with regard to psychosocial and health aspects. In this study, chisquare tests were conducted to investigate whether the subjectively assessed health status, the prevalence of work-related impairments and their treatment by a doctor or therapist differed systematically with regard to age, gender and occupational status. The number of sick-leave days was analysed by age and gender and by gender and professional status in the context of a general linear model.
Results: We observed decreases in all four health indicators with increasing age. This trend did not continue for subjects older than 60 years. Women overall reported a worse general health status, more impairments and their treatment than men, although there was no difference in the number of reported sick-leave days. In the analysis by professional status, workers reported more impairments than persons in the other groups.
Conclusions: General health decreases with increasing age, but this trend did not continue in a linear way from the age of 60. One interpretation for this would be the healthy worker effect. Older persons, women and workers reported more health impairments and thus constitute the main target groups for possible prevention measures.
Background: The aim of this cross-sectional study was to establish an online inflammatory bowel disease (IBD) registry for a first picture of the situation of IBD outpatients' treatment in Germany.
Methods: Between March 2006 and July 2007 IBD outpatients from 24 gastroenterological specialist practices and two hospitals in Germany were enrolled in an Internet-based registry to evaluate the outpatients' clinical status, psychological impairments, provided health care, as well as medical treatment and medication costs.
Results: 1032 IBD patients (ulcerative colitis/UC: 519; Crohn's disease/CD: 511; indeterminate colitis: 2) were enrolled in the study (age: 43±14 years/M±SD). Disease duration of all patients averaged 10±8.5 years. In 519 UC-patients (49% male; 33% pancolitis), 66% were in remission as were 55% of CD patients (37 % male; 41 % active smokers). Associated with higher rates of disease activity (CDAI≥150; CAI>4) were corticosteroids (CD, UC), topical medication (UC), relevant reported depressive symptoms (15%; 6-31%) and impairments in sexuality (21%; 9-42%). Relevant medication groups prescribed were oral aminosalicylates (UC: 70%; CD: 47%); immunosuppressive therapy - mostly azathioprine/6 MP (CD: 47%; UC: 26%), and Infliximab (CD: 8%; UC: 3%).
Strongly associated with their clinical disease activity in UC as well as CD patients, 15% (6–31%) reported relevant depressive symptoms and 21% (9–42%) relevant impairments in sexuality.
Conclusions: The registry constitutes a large complemental database for the patient population in Germany. About one third of the IBD patients were not in clinical remission (CDAI ≥150/CAI>4) (CD: 45%; UC: 27%), although high rates of immunosuppressive drugs (CD: 47%; UC 26%) were administered. This study shows a large burden of active disease associated with an unexpectedly high (co)morbidity and high psychosocial impairments, indicating a reduced health state in IBD patients.
© 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
Method: Longitudinal data of 8877 qualified nurses and nursing aids in Germany (n=1639), Finland (n=2335), Italy (n=2314), the Netherlands (n=952), Poland (n=1223) and Slovakia (n=414) from the NEXT study were available for analyses [3]. The questionnaire comprised sociodemographic and institutional factors, nine work-related factors as well as individual factors (overcommitment [4], positive and negative affectivity [5]) that may be associated with burnout. The subjective extent of burnout symptoms was assessed with the scale "personal burnout" (Copenhagen Burnout Inventory [6], [7] at baseline and at one-year follow-up. Uni- and multivariate linear regression analyses were applied to analyze four models of factor groups with increasing model complexity in comparison of the 6 countries.
Results: Differences in the reported extent of individual and work-related indicators and differences between the prediction models of the six countries were remarkable. Mean levels of burnout measures were lowest in Dutch nurses who also reported better social support, and lower levels of work-family conflict, individual overcommitment and negative affectivity. A model optimizing strategy (stepwise method) with four consecutive linear regression models was applied. Sociodemographic and institutional factors had no effects (R²corr:.004-.051). Individual factors showed substantial effects for five of the six countries (∆R²corr:.115-.251;MD=.172); in contrast to work-related factors (∆R²corr:-.008-.029;MD=.034). When the models were adjusted for burnout level in the first year, model-fit indices again slightly increased (∆R²corr:.075-.202;MD=.180). Models were best predictive for the German and least predictive for the Polish sample.
Discussion: Our results show individual factors to be important predictors for burnout scores of nurses one year later. These findings were supported by the literature of burnout research [8], [9], [10], [11]. However, problems of type III error also need to be considered [cf. [12], [13], [14], [15]. Further analyses should be extended to model specific interaction effects of individual and work-related factors. Such models will provide further evidence for predictor models as well as preventional and interventional concepts.
References
1. Hasselhorn HM, Tackenberg P, Müller BH. Intent to leave nursing in the European nursing profession. In: Hasselhorn HM, Tackenberg P, Müller BH, eds. Working conditions and intent to leave the profession among nursing staff in Europe. Stockholm: National Institute for Working Life and authors; 2003. p. 115-24.
2. Estryn-Behar M, Van der Heijden BI, Oginska H, et al. The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses. Med Care. 2007;45(10):939-50.
3. Hasselhorn HM, Müller BH, Tackenberg P, Kümmerling A, NEXT-Study-Group. NEXT Scientific Report. Wuppertal, Germany: 2005.
4. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, et al. The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med. 2004;58(8):1483-99.
5. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063-70.
6. Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress. 2005;19(3):192-207.
7. Borritz M, Kristensen T. Copenhagen Burnout Inventory: Normative data from a presentative Danish population on Personal Burnout and Results from the PUMA Study on Personal Burnout, Work Burnout, and Client Burnout. Copenhagen: National Institute of Occupational Health; 2001.
8. Halbesleben JRB, Buckley MR. Burnout in organizational life. Journal of Management. 2004;30(6):859-79.
9. Jansen PGM, Kerkstra A, bu-Saad HH, Van Der Zee J. The effects of job characteristics and individual characteristics on job satisfaction and burnout in community nursing. International Journal of Nursing Studies. 1996;33(4):407-21.
10. Burisch M. A longitudinal study of burnout: The relative importance of dispositions and experiences. Work & Stress. 2002;16(1):1-17.
11. Bakker AB, Schaufeli WB, Sixma HJ, Bosveld W, van Dierendonck D. Patient demands, lack of reciprocity, and burnout: A five-year longitudinal study among general practitioners. Journal of Organizational Behavior. 2000;21(4):425.
12. Kimball AW. Errors of the Third Kind in Statistical Consulting. Journal of the American Statistical Association. 1957;52(278):133-42.
13
Lu TH. International comparisons: they do help and are essential for avoiding type III error. Injury Prevention. 2001;7(4):270-1.
14.
Schwartz S, Carpenter KM. The right answer for the wrong question: consequences of type III error for public health research. Am J Public Health. 1999;89(8):1175-80.
15.
Rose G. Sick Individuals and Sick Populations. International Journal of Epidemiology. 1985;14(1):32-8.
Methods: Survey data of 1018 IBD patients (65 % female, 58 % CD patients, mean age 42 yrs, disease duration: 13 yrs) on perceived daily stress, mental strains associated with the disease (e.g. anxiety and depression: HADS [5]) and utilization of health care services were analyzed. Scale construction was based on item response theory. Scale properties were investigated with factor analysis, reliability analyses and model-fit statistics (Rasch modelling with Winsteps 3.68®).
Results: A unidimensional scale with good properties (Cronbach's α: .73; person reliability: .76) was constructed with three items on perceived stress (frequency of stress, impairment by stress, suffering from stress and extraordinary strains). Three groups (low, moderate, high perceived stress) were identified, which differed substantially in reported anxiety (d = 1.2) and depression (d = 0.9), in an objective disease activity score (GIBDI) and further symptoms. In addition, the three groups differ concerning preferences for and utilization of various (esp. psychosocial) health services.
Conclusions: IBD patients report multiple psychosocial impairments [1]. The scale for perceived stress seems to be able to identify IBD patients with severe psychosocial impairments and a high demand for psychosocial attendance, if confirmed in independent samples. To inhance secondary prevention of impairments of chronic disease and allowing for the optimizing of health care services [6] we propose to integrate this indicator for psychosocial impairments into the diagnostic process.
Outline
References
1. Hoffmann JC, Preiss JC, Autschbach F, et al. [Clinical practice guideline on diagnosis and treatment of Crohn's disease]. Z Gastro. 2008;46:1094-146.
2. Hoffmann C, Zeitz M, Bischoff SC, et al. [Diagnosis and therapy of ulcerative colitis: results of an evidence based consensus conference by the German society of Digestive and Metabolic Diseases and the competence network on inflammatory bowel disease]. Z Gastro. 2004;42:979-83.
3. Hardt J, Muche-Borowski C, Conrad S, Balzer K, Bokemeyer B, Raspe H. [Inflammatory bowel diseases as multi-focal disorders: results from a multi-regional survey on bodily and psychosocial problems in IBD patients]. Z Gastro. 2010;48:381-91.
4. Hardt J, Balzer K, Muche-Borowski C, Raspe H. [Examination of a short scale on perceived stress in patients with inflammatory bowel disease]. Zbl Arbmed. 2010;60:318-319.
5.
Herrmann C, Buss U, Snaith RP. [HADS-D Hospital Anxiety and Depression Scale - German Version. A Questionnaire for measuring anxiety and depression in somatic medicine]. Bern: Huber; 1995.
6.
Raspe H, Conrad S, Muche-Borowski C.[Evidence-based and consented pathways for patients with inflammatory bowel diseases (IBD)]. Z Gastroenterol. 2009;47(6):541-62.
Methoden: Der Pretest des CAPI-Instruments wurde an einer Stichprobe von 200 Personen durchgeführt. Das umfangreiche Befragungsinstrument umfasst u.a. 6 Skalen des COPSOQ, der die individuelle Bewertung von Arbeitsbedingungen (z.B. quantitative Arbeitsanforderungen, soziale Unterstützung, Führungsqualität) mit validierten Skalen basierend auf likertskalierten Items erfragt. Für die Items der COPSOQ-Skalen wurden deskriptive Statistiken, Schwierigkeitsindizes, Trennschärfekoeffizienten und interne Konsistenzen (Cronbach's alpha) berechnet sowie Verteilungsannahmen geprüft. Zur Analyse der Konstruktvalidität wurde die Dimensionalität der Skalen geprüft. Nach Interkorrelationsanalysen der Skalen wurden die Item-Werte z-transformiert und mit einer Hauptkomponentenanalyse (Varimax-Rotation) die Faktorenstruktur der verwendeten COPSOQ-Skalen geprüft.
Ergebnisse: Es zeigten sich Decken- und Bodeneffekte für Items in drei der sechs Skalen (soziale Unterstützung, Entwicklungsmöglichkeiten, Einfluss bei der Arbeit). Die Werte aller Items der 6 Skalen waren nicht normalverteilt, Schiefe (Median = -0.14; Range: -1.45 – 1.03) und Kurtosis (Median = -0.62; Range: -1.39 – 1.64) variierten stark. Die Schwierigkeitsindizes für die 6 Skalen variierten von 25-77, die Trennschärfekoeffizienten von 0.57-0.86 (alle signifikant) und Cronbach's alpha von 0.63-0.88. In der Hauptkomponentenanalyse bestätigte sich die angenommene 6-Faktoren-Lösung mit den höchsten Faktorladungen der Items auf dem jeweiligen Skalenfaktor (MW = .760, Range: .518-.864).
Diskussion: Die psychometrische Qualität der COPSOQ-Skalen im CAPI wurde insgesamt als gut bewertet. Die bekannten Decken- und Bodeneffekt bestätigten sich. Schwierigkeitsindizes und Trennschärfekoeffizienten zeigten akzeptable Werte und die faktorielle Struktur konnte bestätigt werden. Die COPSOQ-Skalen scheinen damit für die Verwendung im CAPI ausreichend validiert und werden in der deutschen Version [6] vergleichbar mit Referenzpopulationen eingesetzt.
Gliederung
Literatur
1. du Prel JB, Hardt J, Rauch A, Rose U, Schröder H, Steinwede J, Swart E, Trappmann M, Müller BH, Hasselhorn HM, Peter R, the lidA Study Group. A prospective longitudinal investigation of work-related health determinants of an aging workforce in Germany – the lidA Study. Longitudinal and Life Course Studies. 2010;1(3 Suppl):281.
2. Lienert G, Raatz U. Testaufbau und Testanalyse. Weinheim: Beltz Psychologie Verl.-Union; 1998.
3. Bühner M. Einführung in die Test- und Fragebogenkonstruktion. 3rd ed. München, Boston: Pearson Studium; 2010
4. Streiner D, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford; New York: Oxford University Press; 2008.
5.
Pejtersen JH, Kristensen TS, Borg V, Björner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24.
6.
Methoden zur Erfassung psychischer Belastungen – Erprobung eines Messinstrumentes (COPSOQ). Schriftenreihe der Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA), Fb 1058. Berlin: BAuA; 2005.
Inflammatory bowel diseases (IBD: Crohn‘s disease, ulcerative colitis) are chronic relapsing diseases. Manifestations of the disease affect predominantly the bowel, but also extraintestinal organ systems (e.g. skin, eyes, joints, liver). The prevalence of IBD in Germany is 320.000 patients [1, 2]. We previously reported data on the substantial psychosocial impairments of IBD patients from a German survey [3], which seem to constitute a high psychosocial / mental burden of this chronic disease. Recent studies showed associations of exposure to stress and acute episodes of active disease [1,2]. A secondary analysis of IBD survey data investigates associations of perceived daily
stress (without theoretical definition) with disease symptoms, indicators of mental health and health care utilization [4]. A short scale of perceived stress with three items was constructed and analyzed as a potential indicator for psychosocial impairments (construct/criterion validity).
Methods: Survey data of 1018 IBD patients (65 % female, 58 % CD patients, mean age 42 yrs, disease duration: 13 yrs) on perceived daily stress, mental strains associated with the disease (e.g. anxiety and depression: HADS [5]) and utilization of health care services were analyzed. Scale
construction was based on item response theory. Scale properties were investigated with factor analysis, reliability analyses and model-fit statistics (Rasch modelling with Winsteps 3.68®).
Results: A unidimensional scale with good properties (Cronbach's α: .73; person reliability: .76) was constructed with three items on perceived stress (frequency of stress, impairment by stress, suffering from stress and extraordinary strains). Three groups (low, moderate, high perceived stress) were identified, which differed substantially in reported anxiety (d = 1.2) and depression (d = 0.9), in an
objective disease activity score (GIBDI) and further symptoms. In addition, the three groups differ concerning preferences for and utilization of various (esp. psychosocial) health services.
Conclusions: IBD patients report multiple psychosocial impairments [1]. The scale for perceived stress seems to be able to identify IBD patients with severe psychosocial impairments and a high demand for psychosocial attendance, if confirmed in independent samples. To inhance secondary prevention of impairments of chronic disease and allowing for the optimizing of health care services [6] we propose to integrate this indicator for psychosocial impairments into the diagnostic process.
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