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J Klewer

Publications and source records attributed to J Klewer.

18 recordsLinked to original sources
PubMed2002

[Health behaviour and health status of nursing staff--a review of the literature].

Presently around 1.1 million nurses are employed in the German health care system. Due to increased workload and staff reduction, studies on the health behaviour and health condition of nursing staff are increasingly important. Hence we reviewed the literature on health behaviour and health condition of nursing staff. Articles available in Medline and Embase from 1978 to 2000 were included, focussing on smoking, alcohol consumption, substance abuse, eating habits, body-mass index, dental health status, risk behaviour in traffic, workload, burnout syndrome, sports and recreation, job satisfaction, subjective health status, subjective complaints, vaccinations and quality of life. Health behaviour was divided in unhealthy and healthy behaviour. It became obvious that most of the studies focussed on investigation of unhealthy behaviour, such as smoking, alcohol consumption, substance abuse and poor eating habits. Health promotion was mainly seen as avoiding these unhealthy habits. Only in current studies definitions of health promoting behaviour were developed as a part of a comprehensive life-style.

Adult↗
PubMed2001

Assessment of HIV transmission risks in clinical situations in health care students from Germany, Lithuania and Namibia.

Due to the increasing global HIV prevalence, comprehensive knowledge about clinical HIV transmission risks in health care professionals is essential. Mainly medical and nursing students are at risk, because they are working close to infected patients. By using an anonymous questionnaire, the study analysed the assessments of German medical/dental students (n = 182), Lithuanian medical students (n = 176) and Namibian student nurses (n = 135) on the risk of getting HIV infected in different clinical situations. It became obvious that the Namibian student nurses overestimated the risk of HIV transmission in several situations (eg changing dirty linen, physical examination). In comparison, the Lithuanian students showed the most realistic assessments, while the German students also tended to overestimate the risks of HIV transmission. The results indicate that assessments on the risk of HIV transmission in clinical situations are influenced by the national prevalence and daily contacts with HIV patients. Education of health care students should consider this and focus more on epidemiological aspects and infection control procedures, to avoid endangering students and patients.

Adolescent↗
PubMed2001

Poor assessment of HIV epidemiology and occupational HIV transmission risk by medical students.

Due to the increasing global number of HIV-positive patients, the potential risk of acquiring infection with HIV during routine clinical care is on the increase. Assessments of the knowledge of medical students about occupational HIV transmission are therefore important. This study analysed the knowledge of 397 first year and 75 fifth year medical students about the epidemiology of HIV in Germany and their assessment of the risk of acquiring HIV in different clinical situations. Medical students overestimated the incidence and mortality of HIV in Germany, with fewer than 30% knowing the correct numbers. They also overestimated the risk of occupational HIV infection in several clinical settings, such as changing dirty linen or wound dressings. Few differences were found between first and fifth year medical students. For their later work as physicians medical students still need more information and counselling about the epidemiology of HIV, prevention of occupational HIV infections and care for patients with HIV/AIDS.

Germany↗
PubMed2001

[What do medical students know about cause and epidemiology of the Creutzfeldt-Jakob disease in Germany?].

Due to the increase of patients with the variant Creutzfeldt-Jakob disease (vCJD) in Great Britain and the first cases of autochthonous BSE cases in Germany, the study tried to investigate the knowledge of medical students about the epidemiology of CJD in Germany and how they assess the influence of different factors on the etiology of CJD. Altogether 63 first year medical students, 96 third year medical students and 50 nurses were included in an anonymous questionnaire survey. They were asked to estimate the annually incidence of CJD in Germany and to assess, by using analogue-scales, the influence of different factors on the risk of contracting CJD. For the medical students the median was 100 and for the nurses the median was 10 annual CJD cases. All participants, and especially the males, emphasised the influence of "risk behaviour" and "environmental factors" on the risk of contracting CJD, the factor "stress/ emotional strain" was seen as most unimportant. No significant differences between female and male participants in the knowledge about the incidence of CJD in Germany were found. It becomes obvious, that epidemiological knowledge about CJD in medical staff is associated with different and gender-specific views on the etiology. Medical education should consider this to avoid endangering medical staff and patients due to overprotection or insufficient precautions.

Adult↗
PubMed2001

Problems reported by elderly patients with multiple sclerosis.

Multiple sclerosis (MS) is one of the most common organic neurological diseases of the central nervous system. Because of improved therapies, nurses are confronted with elderly MS patients, but little is known about the specific problems of these patients. This survey analyzed problems in elderly MS patients. Fifty-three MS patients (44 female, 9 male; average age 73 years, average course of MS 25.3 years) from the Berlin Section of the German Multiple Sclerosis Association were evaluated by using a standardized questionnaire, considering social situation, daily problems, disease course, and disabilities, and by using the expanded disability status scale (EDSS). Elderly MS patients reported impaired mobility and inability to use public transportation; about 96% presented EDSS scores above 6.0. Nearly 50% complained about spasticity and pain due to spasticity. More than 70% suffered from bladder dysfunction. Problems with sleep and fatigue were present in less than 20%, but interrupted sleep was common. Selfcare impairments were reported by 50%-75% of the patients, and most of them required professional help. Depressive moods and thoughts about committing suicide were mentioned by more than 30% of the patients. Elderly MS patients experience physical and psychosocial impairments. Healthcare professionals should consider increasing independence and avoiding nursing home admissions in the management of elderly MS patients.

Activities of Daily Living↗
PubMed2000

Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome.

Continuous positive airway pressure (CPAP) is an established treatment of obstructive sleep apnoea syndrome (OSAS). While it is known that CPAP reverses the pathological breathing pattern and improves daytime sleepiness, there are no sufficient data on the long-term influence of CPAP on quality of life in patients with OSAS. Thirty-nine patients with polysomnographically verified OSAS (apnoea/hypopnoea index (AHI): (mean+/-SD) 46.8+/-21.8 events x h(-1)) were prospectively studied. All patients answered three quality of life measures (Complaint List, Nottingham Health Profile Part 1 (NHP), and Verbal Analogue-Scale "quality of life") prior to the initiation of CPAP therapy. After a mean of 9 months they were re-evaluated by polysomnography, and completed the questionnaires once again. As expected, CPAP was effective in treating the sleep-related breathing disorder. AHI decreased significantly from (mean+/-SD) 46.8+/-21.8 events x h(-1) to 3.3+/-6.3 events x h(-1), and minimum oxygen saturation increased from 77.1+/-9.3% to 89.9+/-3.4%, while body mass index did not change significantly (31.3+/-5.4 versus 30.8+/-4.8 kg x m(-2)). During long-term treatment with CPAP the Complaint List revealed a significant improvement of the extent of subjective impairment due to physical and general complaints (26.4+/-9.9 versus 20.4+/-11.1), and NHP a significant improvement of emotional reactions (19.8+/-21.7 versus 11.1+/-14.0) and energy (50.8+/-36.6 versus 32.1+/-36.7), but not of pain, physical mobility, sleep, social isolation, and quality of life as assessed by the It is concluded that long-term continuous positive airway pressure therapy is effective in improving not only pathological breathing patterns but also parameters that estimate quality of life in patients with obstructive sleep apnoea syndrome.

Female↗
PubMed2000

[What do medical students know about the epidemiology of tetanus and tuberculosis in Germany?--A comparison of epidemiologic knowledge regarding a rare and a prevalent infectious disease].

A Comparison of Epidemiological Knowledge About a Rare and a Common Infectious Disease: Tetanus and tuberculosis are still worldwide health problems. Due to an increasing number of insufficiently vaccinated persons, mainly in adults, tetanus in Germany requires more and more medical attention. At the same time, due to global migration and an increasing number of immunocompromised patients, the probability of getting infected with tuberculosis is on the increase. For preventing infectious diseases it is necessary to analyse to what extent medical students are informed about the epidemiology of tetanus and tuberculosis in Germany. This knowledge is a mainstay for later differential diagnosis. After completing medical training it is expected that they are capable of diagnosing both diseases properly and that they are trained to inform the population about necessary vaccinations. The following study analysed the incidence estimation of medical students (n = 472) on tetanus and tuberculosis morbidity in Germany. It is obvious that medical students still have gaps in their knowledge about the epidemiology of tetanus and tuberculosis. They overestimated the incidence of tetanus cases per year around 10-1,000 times. In comparison, they underestimated the incidence of tuberculosis. The study shows a distorted assessment of importance of medical problems by the students of medicine. Medical education should consider this and focus more on epidemiology of infectious diseases including tetanus and tuberculosis.

Adult↗
PubMed2000

[Vaccination status of medical and dental students].

Infectious diseases are still a worldwide health problem, and hence physicians are responsible for providing the population with sufficient vaccinations. Until now, however, comprehensive studies on vaccination behaviour in German medical/dental students, the future physicians/dentists, are lacking. The study analysed vaccinations of medical/dental students against tetanus, diphtheria, poliomyelitis, hepatitis A + B and tried to find possible influences on the vaccination behaviour. 126 medical and 99 dental students participated by working on an anonymous questionnaire related to sociodemographic data, smoking/drinking habits, drug abuse and vaccinations. The response rate was between 76 and 85%. Altogether, the investigated students were not sufficiently vaccinated. Nevertheless, they were better vaccinated than a normal reference sample. Except for a significantly better immunisation against hepatitis B in dental students, no differences between medical and dental students were found. In comparison to male students, female students presented better immunisation. On the other hand, students from the former West Germany, smoking students and students who are taking illegal drugs, were more insufficiently immunised than the other students. To optimise vaccinations in future physicians and dentists, medical/dental education should focus more on infectious diseases and knowledge about vaccinations. This would help to protect future physicians and dentists against preventable infectious diseases. Additionally, they are better skilled to prevent infectious diseases by providing the population with information and vaccinations.

Adult↗
PubMed1998

[Neglect of tuberculosis in medical education. How medical students perceive the incidence of tuberculosis in Germany].

BACKGROUND: Tuberculosis is still a health problem. Due to an increasing number of immunosuppressed patients the probability of getting infected with tuberculosis in the hospital rises up. SUBJECTS AND METHODS: For prevention of infections, medical students play a critical role: Firstly, because of bedside-teaching in the hospital, medical students are at risk of getting infected with tuberculosis. Secondly, immediately after university training, it is expected that they are capable to diagnose tuberculosis. The following study analysed the incidence-estimation of medical students (n = 278) of tuberculosis-morbidity and tuberculosis-mortality in Germany. RESULTS: It becomes obvious, that medical students still have gaps in their knowledge about tuberculosis. They underestimated the incidence of tuberculosis and they overestimated the mortality of tuberculosis. CONCLUSION: The study indicates a misperception of relevant health problems which may be due to the study situation at German Medical Schools. Medical students need more information and counselling about epidemiology of infectious diseases including tuberculosis.

Adult↗
PubMed1997

[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study].

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon. Patients were asked to rate quality of life on the Nottingham Health Profile and on a visual analogue scale. Multiple regression analysis (stepwise) identified two predictors for reducing overall quality of life (F-test: P = 0.007): number of operations (adjusted beta: -0.21) and age (adjusted beta: -0.17). Other factors showed no significant relationship with overall quality of life or with subscales of the Nottingham Health Profile. These findings indicate a dilemma between two therapeutic goals: good functional outcome, which often requires repeated operations, and quality of life, which suffers under prolonged surgical treatment.

Adult↗
PubMed1997

[The anxious patient during magnetic resonance tomography (MRI) examination. Health care economic aspects of patient education].

Due to the increasing debate of limiting costs in the public health system, the use of magnetic resonance imaging (MRI) has been under discussion for several times. Diagnostic imaging by means of MRI is an expensive but informative and safe method. Instead of looking on cost-benefit analysis, it is shown how the efficiency of MRI can be increased by improving patient information about this imaging method. Because of the technical conditions, up to 40% of the patients show anxiety-related-reactions. These reactions include slight discomfort up to claustrophobic reactions and panic attacks. Therefore, correct and complete informing of patients prior to MRI examinations by the physicians is very important. The given information should include technical aspects about MRI and in addition, the physician has a chance to evaluate the patients' disposition to anxiety-related-reactions. To prepare risk patients for successful MRI technics like music, prone positioning, sedatives and relaxation exercises are available. By taking patients' anxiety into consideration and using the techniques mentioned above, unnecessary costs for unsuccessful or repeated MRI examinations can be avoided and the overall costs for clinical diagnostics will be reduced.

Anxiety↗
PubMed1996

[Assessing the risk of HIV infection in the clinic and daily environment by medical students].

The potential risks of obtaining an HIV infection during the clinical routine becomes recently more and more a subject for discussion. The assessment of HIV transmission in the hospital by medical students seems to be important, because medical students are doing practical nursing training, medical clerkships and courses in the hospital, are in a developing process to their later social role as a physician and because of their age, they belong to the group with the highest statistical risk of getting HIV infected. The following study analysed the view of medical students to get HIV infected in typical clinical routine situations and non-clinical situations. 316 medical student in the first year (average age: 22 years, female = 171, male = 145) estimated the risk of getting HIV infected for 18 different clinical and non-clinical situations. The survey was done in 1991 and 1993. It becomes obvious, that medical students still have gaps in their knowledge about HIV transmission. Over 10% of them estimated non-clinical situations like mosquito- and animal-bites or clinical situations like changing dirty linen or physical examination as situations with a high risk of getting HIV infected. The study shows, that medical students need more informations and counselling about HIV related aspects for their later work as a physician.

Adolescent↗
PubMed1996

[Modification of cardiopulmonary performance parameters in patients with obstructive sleep apnea treated with nCPAP therapy].

nCPAP influences cardiopulmonary hemodynamic function in patients with obstructive sleep apnea (OSA). It is known that systolic function of the right and left ventricle, systemic and pulmonary hypertension, arterial blood gases and lung function during the day may improve under this treatment. We prospectively followed 30 patients with severe OSA and determined diastolic left ventricular function (Doppler echocardiography), cardiovascular efficiency (steady state exercise stress testing); and individual assessment of performance (standardized psychometric questionnaire) before, and 2 weeks and 6 months after initiation of nCPAP treatment. The following results could be obtained (first value after 2 weeks, second value after 6 months): Doppler echocardiography: E/A rose by 9.3% (p < 0.05) and another 0.5% (n.s.). E/A integral increased by 13.8% (p < 0.01) and another 3.5% (n.s.). Deceleration period decreased by 22.7% (p < 0.01) and another 3.1% (n.s.). Steady state exercise stress testing: Maximum performance rose by 10% (p < 0.05) and another 17.5% (p < 0.01). Heart rate ratio 100 W/rest dropped by 13.5% (p < 0.001) and another 6.5% (p < 0.01), systolic blood pressure ratio 100 W/rest by 0.8% (n.s.) and another 14.9% (p < 0.001). Diastolic blood pressure ratio 100 W/rest did not change significantly. Questionnaire: Assessment of well-being increased by 44.5% (p < 0.05) and another 16.9% (n.s.). After an initial drop of 0.8% (n.s.), quality of life increased by 14.9% (p < 0.05). Assessment of performance rose by 21.7% (p < 0.05) and another 4.1% (n.s.). nCPAP therapy in patients with OSA improves diastolic function of the left ventricle, cardiovascular performance and individual assessment of performance.

Adult↗
PubMedDate not supplied

[Vaccination status of medical students in munich - results of a questionnaire survey].

BACKGROUND: Vaccinations, e. g., against hepatitis B, are recommended for health care workers in order to minimize the risk of occupational infections. While medical students come into contact with patients early in their medical education, sufficient vaccination is not routinely checked during their training. Hence, we wanted to assess the prevalence of medical students (fourth year) not sufficiently vaccinated against occupationally relevant infectious diseases (hepatitis A and B, measles, mumps, German measles, poliomyelitis) at the two medical schools in Munich. METHODS: One hundred and forty nine students of the medical school at the Ludwig-Maximilians-University and 89 students of the medical school at the Technical University completed a standardized questionnaire on demographic data, vaccination status and personal attitude towards vaccinations. RESULTS: Nine percent of the students at the Ludwig-Maximilans-University and one percent of the medical students at the Technical University reported not to have been vaccinated against hepatitis B. The relative frequency of students not vaccinated against hepatitis A was higher and did not differ between the medical schools (LMU: 35.9 %, TU: 40.5 %; 95 % Confidence Interval for the difference: -17.7-+ 8.5 %). The prevalence of vaccination especially against German measles among women was unsatisfactory. Individual vaccination status of the students seemed to be related to their personal attitude towards vaccinations. CONCLUSION: In order to increase the prevalence of hepatitis B vaccination among medical students they should be informed more intensively about the free of charge vaccination early during their education, e. g., before the beginning of their medical training.

Adult↗