Objective: To analyze the change in health-related quality-of-life (HRQoL) in patients with Parkinson’s disease (PD) and to identify different classes of HRQoL decline. Methods: A longitudinal cohort study was performed to assess clinical parameters (unified PD rating scale, Beck Depression Inventory) and HRQoL data (EuroQol, Parkinson’s Disease Questionnaire [PDQ]-39) at baseline, 3, 6, 12, 24, and 36 months. A total of 145 patients with PD were consecutively recruited in the county of Northern Hessia, Germany, between January and June 2000. A latent growth mixture model was applied to analyse the heterogeneity in HRQoL trajectories. Results: We successfully applied latent mixture growth modeling in order to identify different classes of HRQoL trajectories in PD. Three growth models were developed and each resulted in a four-class model of distinct patterns using the generic EuroQol instruments’ outcomes (EuroQol-5 Dimensions and visual analogue scale) and the disease-specific PDQ- 39. The four classes were defined by individual trajectory characteristics. Classes one and two represented trajectories with moderate declines over 36 months, but with different initial intercepts. Class three consisted mainly of patients who passed away during the observation period and therefore had a large HRQoL decline. Class four was characterized by a low level of HRQoL at baseline and a significant subsequent decline. Conclusions: The findings provide a more elaborate understanding of the variability in HRQoL reduction in PD over time. The classification of different HRQoL subgroups may help to explain the response of PD patients to the natural history of the disease. Future research will enable the identification of HRQoL responder subgroups on different treatment regimens.

Background: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. Objectives: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. Methods: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/ hyperactivity disorder (FBBHKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Results Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. Conclusions: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

Background: There is a lack of the generic data comparing the influence of different diseases on health-related quality of life (HrQoL) in a representative sample of primary care patients. Methods: Patient data were collected in the DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment) study including 55,000 patients. Results: 3,109 patients (33.3% female) with myocardial infarction (MI), stroke or both were compared to patients with a wide range of other diagnoses. Stroke and MI patients revealed a lower HrQoL as compared to patients with other diagnoses. Stroke was associated with strongest quality of life reduction. Multivariate analysis revealed several different determining factors. Conclusions: The reduction of HrQoL of patients with MI and stroke is primarily determined by the CNS insult. These data provide further evidence that early diagnosis and treatment of cardiovascular risk factors is essential to reduce subsequent stroke.

No description available.

No description available.

Introduction: We investigated the health-related quality of life (HRQoL) of long-term prostate cancer patients who received leuprorelin acetate in microcapsules (LAM) for androgen-deprivation therapy (ADT). Methods: The observational study was carried out by 30 office-based German urologists in 536 prostate cancer (PCa) patients treated for ≥5 years with LAM and in 116 patients of an age-matched control group (CG). Data on HRQoL and health status was collected prospectively using validated questionnaires QLQ-C30, QLQ-PR25 and Karnofsky Index. Data on effectiveness (clinical response, prostate specific antigen [PSA], testosterone) and safety was collected retrospectively from patients’ health records. We used descriptive statistics to analyze the data. Results: The mean treatment duration was 8.6 years (range 4.5–19.8 years). General health status (QLQ-C30) was comparable for both groups. Differences were observed regarding physical – and role functioning. ADT patients rated single items slightly worse than CG. Karnofsky-Index showed comparable high values (median of 90%). QLQ-PR25 revealed more PCa-related symptoms for ADT patients. Within 6 months, median PSA level declined >90% and median testosterone levels declined below castration level from 4.0 to 0.2 ng/mL. Clinical response (European Organisation for Research and Treatment of Cancer criteria) was observed in at least 90% of ADT patients. Conclusions: Long-term ADT with LAM is a well-accepted, tolerated, effective, and low-burden treatment option for patients with advanced, hormone-sensitive PCa.

Auf der Grundlage der DETECT-Studie wird die querschnittliche Assoziation depressiver Störungen mit einem weiten Spektrum körperlicher Erkrankungen in einer bundesweit repräsentativen Stichprobe von 51.000 Patienten aus der primärärztlichen Versorgung in Deutschland sowie der Zusammenhang mit gesundheitsbezogener Lebensqualität und Arbeitsunfähigkeit untersucht. Das Vorliegen einer Depression wurde über den Depression Screening Questionnaire (DSQ) mit seinem ICD-10 Algorithmus ermittelt. Bei einer Gesamt-Querschnittsprävalenz depressiver Störungen von 7,5 % ergaben sich erhöhte Depressionsraten und signifikante Assoziationen für nahezu alle untersuchten Krankheitsgruppen. (1) Ko- und Multimorbidität somatischer als auch somatischer mit depressiven Störungen sind die Regel: „Reine“ (nicht komorbide) Depressionen sind ebenso wie reine somatische Erkrankungen die Ausnahme. (2) Das Depressionsrisiko steigt stetig mit der Anzahl komorbider Krankheiten. (3) Besonders ausgeprägte Assoziationen ergaben sich für schwergradige Herzinsuffizienzen (OR: 5,8), diabetische Folgekomplikationen (OR: 1,7–2,0), koronare Herzerkrankungen (KHK) (OR: 1,7), zerebrale Insulte (OR: 2,5) sowie muskuloskelettäre Erkrankungen (OR: 1,5). Demgegenüber waren z. B. die Raten bei Hyperlipidämie (OR: 1,1) nur leicht erhöht. (4) Komorbide Depression und steigende Multimorbidität waren mit stetig zunehmenden Arbeitsunfähigkeits- raten und absinkender gesundheitsbezogener Lebensqualität assoziiert. Angesichts der quantitativen Bedeutung der Depression sowie des mit Multimorbidität drastisch ansteigenden Depressionsrisikos und der damit verbundenen hohen direkten und indirekten Krankheitslast für das Gesundheitssystem und die Gesellschaft ist das hohe Ausmaß der Unterschätzung von Depression in der Routineversorgung besorgniserregend. / As part of the DETECT study, a nationwide representative clinical-epidemiological study, the frequency and associated problems of comorbid depression with a wide range of somatic illnesses were studied in N = 51,000 primary care patients. Further the association with health related quality of life and disability is examined. Depression was assessed with the Depression Screening Questionnaire (DSQ) with an ICD-10 algorithm. Results: (1) 7.5 % of all primary care patients met criteria for ICD-10 depressive disorders. (2) Depression risk was increased whenever any somatic disorder was present and increased in a dose-response relationship by number of comorbid conditions. (3) Elevation of depression risk was fairly independent of type of diagnosis, although associations with coronary heart disease (OR: 1.7), diabetic complications (OR: 1.7– 2.0), stroke (OR: 2.5) and pain-related chronic disorders (OR: 1.5) were particularly pronounced. Moderate associations were found for hyperlipidaemia (OR: 1.1). (4) Associated with the increasing number of comorbid conditions, patients with comorbid depression had increasingly more disability days and lower health related quality of life. It is concluded that the degree to which the frequency and the deleterious effects of comorbid depression is underestimated and unrecognized is alarming. The use of comorbidity indices might improve recognition.

Background: Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. Objectives: The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. Methods: The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/ hyperactivity disorder (FBBHKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Results Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. Conclusions: The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

Objective: To analyze the change in health-related quality-of-life (HRQoL) in patients with Parkinson’s disease (PD) and to identify different classes of HRQoL decline. Methods: A longitudinal cohort study was performed to assess clinical parameters (unified PD rating scale, Beck Depression Inventory) and HRQoL data (EuroQol, Parkinson’s Disease Questionnaire [PDQ]-39) at baseline, 3, 6, 12, 24, and 36 months. A total of 145 patients with PD were consecutively recruited in the county of Northern Hessia, Germany, between January and June 2000. A latent growth mixture model was applied to analyse the heterogeneity in HRQoL trajectories. Results: We successfully applied latent mixture growth modeling in order to identify different classes of HRQoL trajectories in PD. Three growth models were developed and each resulted in a four-class model of distinct patterns using the generic EuroQol instruments’ outcomes (EuroQol-5 Dimensions and visual analogue scale) and the disease-specific PDQ- 39. The four classes were defined by individual trajectory characteristics. Classes one and two represented trajectories with moderate declines over 36 months, but with different initial intercepts. Class three consisted mainly of patients who passed away during the observation period and therefore had a large HRQoL decline. Class four was characterized by a low level of HRQoL at baseline and a significant subsequent decline. Conclusions: The findings provide a more elaborate understanding of the variability in HRQoL reduction in PD over time. The classification of different HRQoL subgroups may help to explain the response of PD patients to the natural history of the disease. Future research will enable the identification of HRQoL responder subgroups on different treatment regimens.

No description available.