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Background
Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D.
Methods
The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method.
Results
The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2.
Conclusions
There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.
Background
Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D.
Methods
The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method.
Results
The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2.
Conclusions
There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.
Objectives
The objective of this study was to assess the objectivity, cross-cultural validity, and convergent validity of the Vestibular Activities and Participation (VAP) questionnaire among four countries, Germany, United States, Jordan, and Saudi Arabia.
Study Design and Setting
This was a cross-sectional study conducted in four specialized outpatient dizziness clinics in Germany, United States, Jordan, and Saudi Arabia.
Results
A total of 453 participants were included in the study. The Rasch analysis revealed two separate subscales. Subscale 1 items included focusing attention, lying down, standing, bending, lifting and carrying objects, and sports. Subscale 2 items included walking long distances, climbing, running, moving around within buildings other than home, using transportation, and driving. The Pearson product–moment correlation between the Dizziness Handicap Inventory and the summary score of the VAP subscale 1 was 0.66 and was 0.64 for subscale 2.
Conclusion
Owing to its shortness and intercultural adaptability, the new two-scale version of the VAP questionnaire lends itself to clinical practice and research across countries to estimate the effect of vertigo and dizziness on activity limitation and participation restrictions. Psychometrically sound summary scores can be calculated. More extended versions of the VAP can be used for comprehensive clinical assessment where summary scores are not needed or a more detailed documentation is warranted.
This paper deals with the preparation of the Small GEO mission and the accommodation of a GPS receiver as an experiment. The expected benefits of using the GPS receiver for Small GEO are explained. The feasibility of using GPS for position determination is investigated by simulation using a MosaicGNSS receiver, which was stimulated by a Spirent RF signal generator. A procedure, how to evaluate flight data on ground is outlined. Success criteria of the experiment and the minimal size of the downlink stream required and reserved for the receiver TM are presented.
Background
As clinical practice guidelines represent the most important evidence-based decision support tool, several strategies have been applied to improve their implementation into the primary health care system. This study aimed to evaluate the effect of intervention methods on the guideline adherence of primary care providers (PCPs).
Methods
The studies selected through a systematic search in Medline and Embase were categorised according to intervention schemes and outcome indicator categories. Harvest plots and forest plots were applied to integrate results.
Results
The 36 studies covered six intervention schemes, with single interventions being the most effective and distribution of materials the least. The harvest plot displayed 27 groups having no effect, 14 a moderate and 21 a strong effect on the outcome indicators in the categories of knowledge transfer, diagnostic behaviour, prescription, counselling and patient-level results. The forest plot revealed a moderate overall effect size of 0.22 [0.15, 0.29] where single interventions were more effective (0.27 [0.17, 0.38]) than multifaceted interventions (0.13 [0.06, 0.19]).
Discussion
Guideline implementation strategies are heterogeneous. Reducing the complexity of strategies and tailoring to the local conditions and PCPs’ needs may improve implementation and clinical practice.
Symptom frequency and severity in vestibular disorders often do not correlate well with patients' restrictions of activities of daily living and limitations of participation.
Due to the lack of appropriate patient reported outcome measures (PRO), the extent of limitations and restrictions is mostly unknown. The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification to evaluate all aspects of health and disability. An ICF-based measure, the Vestibular and Participation Measure (VAP), was recently proposed.
Also, an ICF Core Set for vertigo, dizziness and balance disorders was developed to describe what aspects of functioning should be measured. This study protocol describes the development and cross-cultural validation of a new measure, the VAP-extended (VAP-e), based on VAP and ICF Core Set on three continents.
To determine objectivity and cross-cultural validity of the VAP and to find potentially redundant items, Rasch models will be used. The VAP-e will be created by modifying or adding items from the Activities and Participation and Environmental Factors component of the ICF Core Set. Reliability, objectivity and responsiveness of the VAP-e will be tested.
Vertigo, dizziness and balance disorders have major impact on independence, employability, activities and participation. There are many measures for the assessment of the impact of vertigo, but no consensus exists on which aspects should be measured.
The objective of this study was to develop international standards (ICF Core Sets) for patients with vertigo and dizziness to describe functioning. The development of the ICF Core Sets involved a formal decision-making and consensus process, integrating evidence from preparatory studies including qualitative interviews with patients, a systematic review of the literature, a survey with health professionals, and empirical data collection from patients.
Twenty-seven experts selected 100 second level categories for the comprehensive Core Set and 29 second level categories for the Brief Core Set. The largest number of categories was selected from the ICF component Activities and Participation (40). Twenty-five categories were selected from the component Body Functions, six from Body Structures, and 29 from Environmental Factors.
The ICF Core Set for vertigo is designed for physicians, nurses, therapists and other health professionals working in inpatient or ambulatory settings. ICF Core Sets create patient-relevant outcomes that can be used as evidence for the success of treatments.
Up to now the research and development in the field of building acoustics is based mainly on measurements. In consequence the development and optimization of a new building component is a very tedious and expensive task. A considerable reduction of these costs could be achieved, if the optimization relying on measurements would be replaced – at least to some extent – by a computational prediction model. For these models it is necessary to represent not only the component and the adjacent rooms but also the excitation in a suitable way. This paper gives an overview of models for the excitation generated by a standard tapping machine taking into account the interaction between the impacting steel cylinders of the tapping machine and the vibrating surface of the floor.
Coating is an important step for the protection of drugs and flavors in the pharmaceutical and food industry. This paper presents a method for the experimental investigation of the coating process of a single freestream-fluidized particle by an infrared camera. The coating is dispersed by a nozzle with ultrasonic fluid atomization, allowing constant droplet size at different spray rates. The temperature of the fluidized particle was measured online by an infrared camera. The application of the coating on the particle in a spray cycle and the subsequent solvent vaporization is linked to the temperature and hence monitored during the whole coating process. The cyclic coating process of a Wurster coater is hence reproduced. The temperature evolution for different coating amounts in a single spray cycle, for different particle sizes, materials and temperature levels is monitored. A micro-computed tomography image shows the result of the levitator coating, giving a homogeneous layer.
Meeting ecological and water quality standards in lotic ecosystems is often failed due to multiple stressors. However, disentangling stressor effects and identifying relevant stressor-effect-relationships in complex environmental settings remain major challenges. By combining state-of-the-art methods from ecotoxicology and aquatic ecosystem analysis, we aimed here to disentangle the effects of multiple chemical and non-chemical stressors along a longitudinal land use gradient in a third-order river in Germany. We distinguished and evaluated four dominant stressor categories along this gradient: (1) Hydromorphological alterations: Flow diversity and substrate diversity correlated with the EU-Water Framework Directive based indicators for the quality element macroinvertebrates, which deteriorated at the transition from near-natural reference sites to urban sites. (2) Elevated nutrient levels and eutrophication: Low to moderate nutrient concentrations together with complete canopy cover at the reference sites correlated with low densities of benthic algae (biofilms). We found no more systematic relation of algal density with nutrient concentrations at the downstream sites, suggesting that limiting concentrations are exceeded already at moderate nutrient concentrations and reduced shading by riparian vegetation. (3) Elevated organic matter levels: Wastewater treatment plants (WWTP) and stormwater drainage systems were the primary sources of bioavailable dissolved organic carbon. Consequently, planktonic bacterial production and especially extracellular enzyme activity increased downstream of those effluents showing local peaks. (4) Micropollutants and toxicity-related stress: WWTPs were the predominant source of toxic stress, resulting in a rapid increase of the toxicity for invertebrates and algae with only one order of magnitude below the acute toxic levels. This toxicity correlates negatively with the contribution of invertebrate species being sensitive towards pesticides (SPEARpesticides index), probably contributing to the loss of biodiversity recorded in response to WWTP effluents. Our longitudinal approach highlights the potential of coordinated community efforts in supplementing established monitoring methods to tackle the complex phenomenon of multiple stress.
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.
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.
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
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.
Symptom frequency and severity in vestibular disorders often do not correlate well with patients' restrictions of activities of daily living and limitations of participation. Due to the lack of appropriate patient reported outcome measures (PRO), the extent of limitations and restrictions is mostly unknown.
The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification to evaluate all aspects of health and disability. An ICF-based measure, the Vestibular and Participation Measure (VAP), was recently proposed. Also, an ICF Core Set for vertigo, dizziness and balance disorders was developed to describe what aspects of functioning should be measured.
This study protocol describes the development and cross-cultural validation of a new measure, the VAP-extended (VAP-e), based on VAP and ICF Core Set on three continents. To determine objectivity and cross-cultural validity of the VAP and to find potentially redundant items, Rasch models will be used. The VAP-e will be created by modifying or adding items from the Activities and Participation and Environmental Factors component of the ICF Core Set.
Reliability, objectivity and responsiveness of the VAP-e will be tested.
In order to set up guidelines for the design of light-weighted ceilings for timber constructions to be used by engineers in practice, investigations based on both measurements and numerical models have been carried out [1, 2, 3].
The setup and the calibration of the numerical model of the structure are outlined briefly.
A semi-analytical approach for the prediction of radiated sound is presented, which is based on Integral Transform Methods. The method can be applied in the post processing of a Finite Element computation.
Thus as a first step the structure, consisting of a timber slab, a floating floor and a suspended ceiling, is built up in a Finite Element model, where the material properties of wood and the characteristics of the system are considered.
The model is parameterized in order to enable computations with varying geometry and material parameters and calibrated with the help of measurements using model updating techniques.
The velocity pattern resulting out of the FEM computation is transformed from the spatial into the wavenumber domain and from the time into the frequency domain using Fourier Transform Methods. Applying this velocity pattern as a boundary condition to the Helmholtz Equation, which results out of the Fourier Transform of the wave equation, the wavenumbers, which fulfil the radiation condition, can be selected and the pressure field in the adjacent acoustic fluid can be computed.
Due to the properties of the Fourier-Transform the radiated sound power can be calculated efficiently in the transformed domain out of pressure and velocity.
In a second part of the contribution the model for the air cushion in the suspended ceiling is discussed, where a FSI-model for the acoustic fluid and the structure is compared against engineering approaches using simplifications concerning mass distribution and transfer impedances between the individual nodes at the interface
Background
A multitude of different rehabilitation interventions and other specific health care services are offered for individuals with disorders of consciousness in long-term care settings. To investigate the association of those services and patient-relevant outcomes, a specific instrument to document the utilization of those services is needed. The purpose of this study was to develop such a questionnaire administered to caregivers in epidemiological studies or patient registries in Germany.
Methods
The development process of the RECAPDOC questionnaire was carried out in three steps. Step 1 consisted of a systematic literature review and an online-based expert survey to define the general content. Step 2 was an expert interview to evaluate the preliminary content of the questionnaire. Step 3 was a pretest including cognitive interviews with caregivers. After each step, the results were combined into a new version of the questionnaire.
Results
The first version of the questionnaire included items on utilization of medical care, medical aids, nursing and therapeutic care. The results of the expert interview led to the integration of five new items and the modification of six other items. The pretest led to some minor modifications of the questionnaire since it was rated as feasible and acceptable. The final questionnaire consisted of 29 items covering the domains “living situation”, “social insurance status”, “utilisation of home health care”, “domestic services”, “outpatient health care”, “specific diagnostic measures”, “adaptive technologies”, “medical aids” and “utilization of therapies”. Also the experience of family support and multidisciplinary collaboration of health professionals is covered.
Conclusions
The developed questionnaire is a first step to make the situation of patients with disorders of consciousness in the long-term care setting accessible for evaluation in epidemiological studies and in the context of patient registries. However, further reliability and validity studies are needed.