@article{StroblMuellerThorandetal.2014, author = {Strobl, R. and M{\"u}ller, Martin and Thorand, B. and Linkohr, B. and Autenrieth, C. S. and Peters, A. and Grill, E.}, title = {Men benefit more from midlife leisure-time physical activity than women regarding the development of late-life disability--results of the KORA-Age study}, series = {science direct}, journal = {science direct}, editor = {Elsevier,}, year = {2014}, abstract = {Objective Encouraging physical activity is an important public health measure to reduce disability prevalence in the aged. The aims of this study were to determine the association between midlife physical activity and late-life disability and to investigate gender-specific differences. Method This data originates from the KORA-Age cohort, a follow-up in 2008 of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases)/KORA (Cooperative Health Research in the Region of Augsburg) S1-S4 surveys (1984-2001) situated in Augsburg, a city in Southern Germany. We applied a multivariable hurdle model to investigate the association of physical activity and disability. Results We analysed 3333 persons with a mean follow-up of 18 ± 5.5 years. Using hurdle models, moderate activity and high activity had a protective effect on the occurrence of disability (OR (odds ratio) = 0.80 and 0.73), but not on severity (i.e. number of limitations). We observed a strong gender-specific difference in this association, with men benefitting more from exercise. Conclusion Elevated physical activity reduces the risk of becoming disabled and postpones the onset of disability by several years, but we could not show an effect on the severity of disability. In addition, men seem to benefit more from leisure-time physical activity than women}, language = {en} } @inproceedings{SchutterNeubergerPreisner2014, author = {Schutter, Sabina and Neuberger, Franz and Preisner, Klaus}, title = {"Single mothers as vanguards of emancipation or drivers of poverty. A detailed decomposition of family type related incomes from 1992 to 2014"}, series = {Social Stratification and Social Mobility, ISA RC 28 Summer Meeting, Columbia University New York.}, booktitle = {Social Stratification and Social Mobility, ISA RC 28 Summer Meeting, Columbia University New York.}, year = {2014}, language = {en} } @article{SchaefflerMuellerHuppertetal.2014, author = {Schaeffler, F. and M{\"u}ller, Martin and Huppert, D. and Brandt, T. and Tiffe, T. and Grill, E.}, title = {Consequences of visual height intolerance for quality of life: a qualitative study.}, series = {Quality of life research}, journal = {Quality of life research}, editor = {Springer Link,}, year = {2014}, abstract = {Purpose Visual height intolerance (vHI) occurs when a trigger causes the apprehension of losing balance and falling. Depending on the severity of vHI, an avoidance behavior may develop in about 50 \% of the thus afflicted, and it can have considerable impact on their daily life and interpersonal interactions. It seems obvious that such experiences may be impairing and distressing, but this has not yet been examined systematically. Objective of this study was to examine the consequences of vHI for quality of life. Methods A qualitative, phenomenological exploratory approach was chosen. Individual face-to-face interviews were conducted with individuals who had reported in a previous study that they were susceptible to vHI. The interview transcripts were segregated into distinct meaning units, which were used to create a coding guideline with meta- and subcodes. Meaning units were then systematically extracted and assigned to the appropriate codes. Weights and links were used to assign priorities for interpretation. Results Eighteen participants were interviewed (mean age 53, range 30-73; 11 females). Data analysis resulted in 29 meta-codes and 115 subcodes. Responses indicated that vHI can be very disabling and has a relevant impact on quality of life and daily activities of the affected persons, including their family life and behavior towards partner, children and friends. Conclusion Relevant topics for further quantitative studies were identified, for example, strategies of compensation and the influence of vHI on family life. Other quantitative studies should determine whether comorbidities and the typologies found in this study have consequences for individual therapeutic approaches.}, language = {en} } @article{RoehrigStroblMuelleretal.2014, author = {Roehrig, N. and Strobl, R. and M{\"u}ller, Martin and Perz, S. and Kaab, S. and Martens, E. and Peters, A. and Linkohr, B. and Grill, E.}, title = {Directed acyclic graphs helped to identify confounding in the association of disability and electrocardiographic findings: results from the KORA-Age study}, series = {Journal of clinical epidemiology}, journal = {Journal of clinical epidemiology}, editor = {PlumX Metrics,}, year = {2014}, abstract = {Objectives To examine the association between electrocardiographic (ECG) findings and disability status in older adults. Study Design and Setting KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older. Results A total of 534 (51.5\%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P < 0.05). In models controlled for age and sex, these effects remained constant except for QT prolongation. In the models adjusted for the minimal sufficient adjustment set (consisting of the variables sex, physical activity, age, obesity, diabetes, education, heart diseases, income, lung diseases, and stroke) identified by a directed acyclic graph (DAG), no significant association could be shown. Conclusion Associations between specific ECG findings and disability were found in unadjusted analysis and logistic models adjusted for age and sex. However, when adjusting for other possible confounders identified by the DAG, all these associations were no longer significant. It is important to adequately identify confounding in such settings.}, language = {en} } @article{ProdingerShawStammetal.2014, author = {Prodinger, Birgit and Shaw, L. and Stamm, T. and Rudman, D. L.}, title = {Enacting occupation-based practice: Exploring the disjuncture between everyday life of mothers with rheumatoid arthritis (RA) and institutional processes}, series = {British Journal of Occupational Therapy}, volume = {77}, journal = {British Journal of Occupational Therapy}, number = {10}, pages = {491 -- 498}, year = {2014}, abstract = {Introduction: Occupation-based approaches are a hallmark of excellence in occupational therapy practice. This article focuses on the disjuncture between how women with rheumatoid arthritis go about their daily lives, that is to say their occupations, and what is addressed during routine visits at a specialized rheumatology outpatient clinic. Method: Institutional ethnography was employed as a method of inquiry to identify the occupations and related issues that were or were not accounted for in health records and addressed within institutional processes. Interviews and participant observations were conducted with seven women with rheumatoid arthritis who were mothers. Hospital records were analysed as texts mediating between the women's daily lives and the rheumatology outpatient clinic. Findings: The analysis revealed that despite the diversity in the ways that the women managed their daily lives, the things that they did were viewed, understood, and addressed only within the boundaries of the standardizing relations that ruled practice in this clinical setting. Institutional processes grounded in biomedical concepts such as functional status or disease activity, as well as clinical assessments that depict these concepts, both shape and limit opportunities for occupational therapists to advance and enact occupation-based practice. Conclusion: In this setting, the complexity of the participants' daily lives and the occupations they engage in remain unaddressed.}, language = {en} } @article{ProdingerShawRudmanetal.2014, author = {Prodinger, Birgit and Shaw, L. and Rudman, D. L. and Stamm, T.}, title = {Negotiating disability in everyday life: Ethnographical accounts of women with rheumatoid arthritis}, series = {Disability and Rehabilitation}, volume = {36}, journal = {Disability and Rehabilitation}, number = {6}, pages = {497 -- 503}, year = {2014}, abstract = {Purpose: Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled. Methods: An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context. Results: The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants' lives and shapes their everyday doing. Conclusion: This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria. Implications for Rehabilitation Maximising full participation for people with rheumatoid arthritis is important. This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives. This requires also understanding how knowledge about disability is passed on from previous generations.}, language = {en} } @article{MuellerStroblJahnetal.2014, author = {M{\"u}ller, Martin and Strobl, R. and Jahn, K. and Linkohr, B. and Peters, A. and Grill, E.}, title = {Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study}, series = {European journal of public health}, journal = {European journal of public health}, editor = {Oxford Academic,}, year = {2014}, abstract = {Background: Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Methods: Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Results: Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95\% confidence intervals 1.40-1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5\% (6.6 to 15.1) in men and 9.0\% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Conclusions: Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability.}, language = {en} } @article{MuellerStroblJahnetal.2014, author = {M{\"u}ller, Martin and Strobl, R. and Jahn, K. and Linkohr, B. and Ladwig, K.H. and Mielk, A. and Grill, E.}, title = {Impact of vertigo and dizziness on self-perceived participation and autonomy in older adults: Results from the KORA-Age study}, series = {Quality of life research}, journal = {Quality of life research}, editor = {Springer Link,}, year = {2014}, abstract = {Purpose The impact of vertigo and dizziness on healthy ageing, and especially on participation, is not fully understood. The objective of this study was to investigate the association of vertigo and dizziness with self-perceived participation and autonomy in older non-institutionalised individuals, adjusted for the presence of other health conditions. Specifically, we wanted to investigate the different effects of vertigo and dizziness on specific components of participation, i.e. restrictions in indoor and outdoor autonomy, family role, social life and relationships, and work and education. Methods Data originate from the second wave of the German KORA-Age cohort study collected in 2012. Participation and autonomy was investigated with the Impact on Participation and Autonomy Questionnaire. We used robust regression to analyse the association of vertigo and dizziness with self-perceived participation and autonomy adjusted for covariates. Results A total of 822 participants (49.6 \% female) had a mean age of 78.1 years (SD 6.39). Participation and autonomy were significantly lower in participants with vertigo and dizziness across all domains. Adjusted for age, sex, and chronic conditions, vertigo and dizziness were significantly associated with participation restrictions in all domains except social life and relationships. Conclusion The results of our study indicate that vertigo and dizziness contribute to restrictions in participation and autonomy in individuals of older age. Recognising vertigo and dizziness as independent contributors to loss of autonomy and decreased chances for independent living may create new options for patient care and population health, such as the designing of complex interventions to maintain participation and autonomy.}, language = {en} } @article{GrillStruppMuelleretal.2014, author = {Grill, E. and Strupp, M. and M{\"u}ller, Martin and Jahn, K.}, title = {Health services utilization of patients with vertigo in primary care: a retrospective cohort study}, series = {Journal of neurology}, journal = {Journal of neurology}, editor = {Springer Link,}, year = {2014}, abstract = {Vertigo and dizziness count among the most frequent symptoms in outpatient practices. Although most vestibular disorders are manageable, they are often under- and misdiagnosed in primary care. This may result in prolonged absence from work, increased resource use and, potentially, in chronification. Reliable information on health services utilization of patients with vertigo in primary care is scarce. Retrospective cohort study in patients referred to a tertiary care balance clinic. Included patients had a confirmed diagnosis of benign paroxysmal positional vertigo (BPPV), Meni{\`e}re's disease (MD), vestibular paroxysmia (VP), bilateral vestibulopathy (BVP), vestibular migraine (VM), or psychogenic vertigo (PSY). All previous diagnostic and therapeutic measures prior to the first visit to the clinic were recorded. 2,374 patients were included (19.7 \% BPPV, 12.7 \% MD, 5.8 \% VP, 7.2 \% BVP, 14.1 \% VM, 40.6 \% PSY), 61.3 \% with more than two consultations. Most frequent diagnostic measures were magnetic resonance imaging (MRI, 76.2 \%, 71 \% in BPPV) and electrocardiography (53.5 \%). Most frequent therapies were medication (61.0 \%) and physical therapy (41.3 \%). 37.3 \% had received homoeopathic medication (39 \% in BPPV), and 25.9 \% were treated with betahistine (20 \% in BPPV). Patients had undergone on average 3.2 (median 3.0, maximum 6) diagnostic measures, had received 1.8 (median 2.0, maximum 8) therapies and 1.8 (median 1.0, maximum 17) different drugs. Diagnostic subgroups differed significantly regarding number of diagnostic measures, therapies and drugs. The results emphasize the need for establishing systematic training to improve oto-neurological skills in primary care services not specialized on the treatment of dizzy patients.}, language = {en} } @article{FischerBartoszekMuelleretal.2014, author = {Fischer, U. and Bartoszek, G. and M{\"u}ller, Martin and Strobl, R. and Meyer, G. and Grill, E.}, title = {Patients' view on health-related aspects of functioning and disability of joint contractures: a qualitative interview study based on the International Classification of Functioning, Disability and Health}, series = {Disability and Rehabilitation}, journal = {Disability and Rehabilitation}, editor = {Taylor and Francis online,}, year = {2014}, abstract = {Purpose: The aim of this study was to identify health-relevant aspects of functioning and disability of persons aged 65 years or older with joint contractures, to link the findings to corresponding ICF categories and to describe the patients' perspective. Methods: We conducted 43 qualitative, semi-structured, face-to-face interviews with affected persons in two different locations (Witten, Munich) and in three different settings. Data were analyzed using the "meaning condensation procedure" and then linked to ICF categories. Results: From all interviews a total of 2499 single meaning-concepts were extracted which were linked to 324 different ICF categories. The participants in all settings mainly reported problems related to "Mobility of a single joint (b710)", "Sensation of pain (b280)" and problems related to "Walking (d450)". Almost all participants reported "Products and technology for personal indoor and outdoor mobility and transportation (e120)" as a relevant environmental factor. Conclusions: From the patients' perspective, joint contractures have an impact on multifaceted aspects of functioning and disability, mainly body functions, environmental factors and activities and participation. The results of this study will contribute to the development of a standard instrument for measuring functioning, disability and health-relevant aspects for patients with joint contractures. Implications for Rehabilitation Joint contractures are a major cause for the development of disability in older people. Patients' perspectives and their personal experiences have to be considered when assessing the impact of joint contractures. The International Classification of Functioning, Disability and Health (ICF) is an appropriate framework for describing the patients' multifaceted experience of joint contractures.}, language = {en} } @article{DuerSteinerFialkaMoseretal.2014, author = {D{\"u}r, M. and Steiner, G. and Fialka-Moser, V. and Kautzky-Willer, A. and Dejaco, C. and Prodinger, Birgit and Stoffer, M. A. and Binder, A. and Smolen, J. and Stamm, T.A.}, title = {Development of a new occupational balance-questionnaire: incorporating the perspectives of patients and healthy people in the design of a self-reported occupational balance outcome instrument}, series = {Health and Quality of Life Outcomes}, volume = {12}, journal = {Health and Quality of Life Outcomes}, pages = {45}, year = {2014}, abstract = {Background Self-reported outcome instruments in health research have become increasingly important over the last decades. Occupational therapy interventions often focus on occupational balance. However, instruments to measure occupational balance are scarce. The aim of the study was therefore to develop a generic self-reported outcome instrument to assess occupational balance based on the experiences of patients and healthy people including an examination of its psychometric properties. Methods We conducted a qualitative analysis of the life stories of 90 people with and without chronic autoimmune diseases to identify components of occupational balance. Based on these components, the Occupational Balance-Questionnaire (OB-Quest) was developed. Construct validity and internal consistency of the OB-Quest were examined in quantitative data. We used Rasch analyses to determine overall fit of the items to the Rasch model, person separation index and potential differential item functioning. Dimensionality testing was conducted by the use of t-tests and Cronbach's alpha. Results The following components emerged from the qualitative analyses: challenging and relaxing activities, activities with acknowledgement by the individual and by the sociocultural context, impact of health condition on activities, involvement in stressful activities and fewer stressing activities, rest and sleep, variety of activities, adaptation of activities according to changed living conditions and activities intended to care for oneself and for others. Based on these, the seven items of the questionnaire (OB-Quest) were developed. 251 people (132 with rheumatoid arthritis, 43 with systematic lupus erythematous and 76 healthy) filled in the OB-Quest. Dimensionality testing indicated multidimensionality of the questionnaire (t = 0.58, and 1.66 after item reduction, non-significant). The item on the component rest and sleep showed differential item functioning (health condition and age). Person separation index was 0.51. Cronbach's alpha changed from 0.38 to 0.57 after deleting two items. Conclusions This questionnaire includes new items addressing components of occupational balance meaningful to patients and healthy people which have not been measured so far. The reduction of two items of the OB-Quest showed improved internal consistency. The multidimensionality of the questionnaire indicates the need for a summary of several components into subscales.}, language = {en} } @article{CarrierProdinger2014, author = {Carrier, A. and Prodinger, Birgit}, title = {Visions of possibility: Using institutional ethnography as a theory and method for understanding contexts and their ruling relations}, series = {Occupational Therapy Now}, volume = {16}, journal = {Occupational Therapy Now}, number = {2}, pages = {18 -- 21}, year = {2014}, language = {en} } @article{BayerstadlerBenstetterHeumannetal.2014, author = {Bayerstadler, Andreas and Benstetter, Franz and Heumann, Christian and Winter, Fabian}, title = {A predictive modeling approach to increasing the economic effectiveness of disease management programs}, series = {Health Care Management Science}, volume = {17}, journal = {Health Care Management Science}, pages = {284 -- 301}, year = {2014}, abstract = {Predictive Modeling (PM) techniques are gaining importance in the worldwide health insurance business. Modern PM methods are used for customer relationship management, risk evaluation or medical management. This article illustrates a PM approach that enables the economic potential of (cost-)effective disease management programs (DMPs) to be fully exploited by optimized candidate selection as an example of successful data-driven business management. The approach is based on a Generalized Linear Model (GLM) that is easy to apply for health insurance companies. By means of a small portfolio from an emerging country, we show that our GLM approach is stable compared to more sophisticated regression techniques in spite of the difficult data environment. Additionally, we demonstrate for this example of a setting that our model can compete with the expensive solutions offered by professional PM vendors and outperforms non-predictive standard approaches for DMP selection commonly used in the market.}, language = {en} }