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Biomedical subjects

P Herschbach

Publications and source records attributed to P Herschbach.

At least 19 recordsLinked to original sources
PubMed2006

[Transsexuals' life satisfaction after gender transformation operations].

BACKGROUND: More and more frequently, the registration of life satisfaction is being used to evaluate different medical treatments. So far, there have been only few such surveys on transsexuals (TS). Therefore, the aim of this study was to evaluate the general and the health-related life satisfaction of transsexuals after gender transformation operations. PATIENTS AND METHODS: Forty patients took part in this German cross-sectional study. The Questions on Life Satisfaction Module (FLZ) and free questions on different aspects of the new gender identity were used as measuring instruments. RESULTS: Of the TS studied, 85-95% were "very satisfied" or "satisfied" with the results of their gender transformation operation in respect to gender identity. The TS were significantly less satisfied (P>0.001) in overall "general life satisfaction" than the general population. In overall FLZ scores for "health-related life satisfaction", no differences were seen. CONCLUSION: These data indicate a discrepancy between subjective satisfaction with new gender identity and current life situation, and they identify problems with life satisfaction.

Adult↗
PubMed2006

[Quality of life and patient satisfaction after breast reconstruction].

BACKGROUND: Nowadays, the array of methods for reconstruction of the female breast following mastectomy is vast. In this study, we investigate and compare quality of life after breast reconstruction and satisfaction with the results of two commonly used techniques (autologous tissue vs. expander/implant). METHODS: Ninety-one consecutive patients who underwent breast reconstruction at a German clinic between 1996 and 2001 were included in the study. Patient satisfaction and quality of life were assessed retrospectively using self-evaluation questionnaires. RESULTS: Patients were generally more satisfied with the outcome of the operation when autologous tissue was used. This was significant in the following areas: breast size, form, definition of the lower breast fold, softness of the breast, and symmetry of the breasts. In both groups the quality of life following breast reconstruction at least 2 years after the operation was equal to that of healthy women of the same age group. CONCLUSION: Although patients were more satisfied with the results of autologous breast reconstruction, procedure choice did not affect quality of life.

Adult↗
PubMed2004

Psychological problems of cancer patients: a cancer distress screening with a cancer-specific questionnaire.

The purpose of this study was to assess the psychological distress of cancer patients in a disease-specific manner as well as the demographic and medical variables that have an impact on the distress. Psychological distress was assessed with the Questionnaire on Stress in Cancer Patients revised version, which has been developed and psychometrically evaluated in Germany. It consists of items about 23 cancer-specific stress situations, which have to be answered in terms of relevance and amount of distress. A heterogeneous sample of 1721 cancer in- and outpatients was assessed. For the total group, the most important distress is the fear of disease progression. We consider between 23.4% (ca. of the upper gastrointestinal tract) and 40.9% (breast cancer patients) as highly distressed. The most distressed diagnostic subgroups are patients with soft tissue tumours and breast cancer patients. There are no global (general) stress factors, as the relevant demographic and medical 'risk factors' varied between the diagnostic subgroups. Cancer-specific distress questionnaires give a more precise insight into patients' experience than general or psychiatric questionnaires. They are not only used in large screening studies but also in routine medicine, particularly when the objective is to identify patients to whom psycho-oncological support is to be given.

Adult↗
PubMed2004

[The quality-of-life questionnaire QLS-H: validation of the French language version of the questionnaire in patients with growth hormone deficiency and collection of reference data in the general population].

The QLS-H(c) (Questions on Life Satisfaction- Hypopituitarism) is new a quality of life (QoL) self-administered questionnaire addressing the complaints of adult patients with growth hormone deficiency. The French version of the QLS-H(c) (16 items) has been psychometrically evaluated during a randomized, open label study comparing two strategies of growth hormone (GH) replacement therapy. Seventy-three patients were included and received an 8-month GH replacement therapy. QoL was explored at baseline, 4 and 8 months using the QLS-H(c) questionnaire and the Nottingham Health Profile (NHP) reference scale. Acceptance of the QLS-H(c) was excellent as 92% of the questionnaires were suitable for analysis. All the items demonstrated good selectivity. The homogeneity of the questionnaire was confirmed (Cronbach's alpha, 0.87). The external validity construct was assessed and confirmed using the NHP scores. Sensitivity to change was confirmed. Following an 8-month replacement therapy, the perception of the QoL assessed with the QLS-H(c) questionnaire was significantly improved, irrespective to the treatment strategy. Finally, redundant items of the questionnaire were removed. As a result, the final version of the QLS-H(c) contained 9 items. In a parallel study, reference data of the QLS-H(c) (9 items) were collected from a representative sample of 989 subjects from the French population. With these reference ranges, algorithms to calculate Z scores adjusted for age and gender were developed as a measure for the deviation of patients' scores from those of the general population, and also to evaluate changes along time. In summary, the French version of the quality of life QLS-H(c) questionnaire is a relevant, validated investigational tool for the evaluation and follow-up of an adult patient with growth hormone deficiency.

Adult↗
PubMed2003

Questions on life satisfaction (FLZM) in inflammatory bowel disease.

BACKGROUND AND AIMS: When assessing quality of care the outcome in terms of quality of life (QOL) is of major significance. This study examined QOL in IBD outpatients and the contribution of individual expectations and various other factors including disease activity. PATIENTS AND METHODS: The study included 306 outpatients with Crohn's disease and 109 with ulcerative colitis (UC). General and health-related QOL was quantified using the instrument Questions on Life Satisfaction(Modules). Disease activity was assessed by a questionnaire. Data were compared with a normal population sample. RESULTS: Life satisfaction scores on general items and on health-related items were significantly lower than in a control sample (60.5+/-37.3 and 74.4+/-41.5, respectively) among both CD patients (54.3+/-33.2, 59.1+/-38.8) and UC patients (45.4+/-34.0, 52.1+/-40.7). Scores were significantly related to severity of disease activity. IBD patients attributed particular importance to health-related issues. CONCLUSION: Both health-related and general life satisfaction is compromised in IBD outpatients, and health-related topics have major impact. Not surprisingly, inflammatory activity compromises QOL, which underlines the importance of anti-inflammatory strategies. The importance attributed to health-related features is higher in IBD patients than in the normal population.

Adult↗
PubMed2003

[Fear of progression in patients with cancer, diabetes mellitus and chronic arthritis].

Fear of an increasing disease progression (fear of progression) is among the main psychological stresses in patients with cancer, diabetes mellitus (type 1 and type 2) and chronic arthritis. The questions the study seeks to answer are: (1) Which are the main fears of these patients?, (2) How and in which circumstances in life do they occur?, (3) Which are the triggers of the fear? To answer these questions, a sample of 65 patients were researched through interviews. The results indicate that the predominant fears of cancer patients are the fear of dying and the unpredictability of the progression of the disease. Patients with chronic arthritis most frequently fear being physically dependent on someone else. The most common anxiety of diabetes patients are long-term complications. For all three groups of patients job-related fears cause a high amount of distress. These results contribute to the development of a standardised fear of progression questionnaire.

Activities of Daily Living↗
PubMed2003

A novel quality of life instrument for deep brain stimulation in movement disorders.

OBJECTIVE: To develop a short instrument to examine quality of life (QoL) which specifically addresses patients with movement disorders treated by deep brain stimulation (DBS). DESIGN: The instrument was developed within an existing concept of a modular questionnaire (questions on life satisfaction: "general life satisfaction" QLS(M)-A, and "satisfaction with health" QLS(M)-G), in which each item is weighted according to its relative importance to the individual. METHODS: Items were generated by interviews with 20 DBS patients, followed by item reduction and scale generation, factor analysis to determine relevant and final questionnaire items, estimation of reliability, and validation based on the medical outcome study 36 item short form health survey (SF-36) and the EuroQol (EQ-5D) (data from 152 patients with Parkinson's disease, essential tremor, or idiopathic torsion dystonia, including 75 patients with DBS). RESULTS: Initial questionnaires were reduced to 12 items for a "movement disorder module" (QLS(M)-MD), and five items for a "deep brain stimulation module" (QLS(M)-DBS). Psychometric analysis revealed Cronbach's alpha values of of 0.87 and 0.73, and satisfactory correlation coefficients for convergent validity with SF-36 and EQ-5D. CONCLUSIONS: QLS(M)-MD and QLS(M)-DBS can evaluate quality of life aspects of DBS in movement disorders. Psychometric evaluation showed the questionnaires to be reliable, valid, and well accepted by the patients.

Activities of Daily Living↗
PubMed2003

Quality of life (QoL) as predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy.

BACKGROUND: The prognosis for patients with malignant astrocytoma or brain metastases is often fatal despite intensive therapy. Therefore we wished to elucidate whether the quality of life (QoL) is a determinant of overall survival (OAS). PATIENTS AND METHODS: From 1997 to 2000 153 patients with brain tumours were screened; 39 patients (26%) refused to participate and further 47 patients were excluded (cerebral impairment 14%, amaurosis/ language problems 3%, Karnofsky performance score < 50% 7%, death 8%, non-compliance 7%). Thus, 57 patients were analysed (33 with primary brain tumours, 24 with brain metastases). With the FACT-G questionnaire cancer-specific aspects of health-related QoL were assessed. RESULTS: Patients with metastases showed a lower QoL in the physical sphere than patients with astrocytoma, but there were no significant differences in OAS. Median survival of patients with good QoL was 31.3 months versus 14.2 months in patients with bad QoL. Only the two variables 'living with a spouse' and FACT-G sum score had a statistically significant influence on survival (p = 0.033 and p = 0.003) modelled by the Cox-PH regression. Patients who did not live with a spouse had shorter survival times than the other patients. CONCLUSION: Health-related QoL can serve to identify a patient group with higher risks of death.

Adult↗
PubMed2003

Coping of cancer patients during and after radiotherapy--a follow-up of 2 years.

AIM: We wanted to understand coping strategies specific to different phases up to two years after radiotherapy, to identify patients who are at higher risk of mood disturbances and to characterise the association between coping strategies and psychosocial adaptation. PATIENTS AND METHODS: From 1997 to 2001, 2,169 patients with different diagnoses were screened (27.8% refused to participate). Data of 276 patients from the beginning of radiotherapy (ti1) and 5 follow-up investigations (ti6/2 years) could be analysed. With the FKV (Freiburg Questionnaire Coping with Disease) cancer-specific coping aspects were assessed. The association between coping styles and psychosocial adaptation was evaluated using the Questionnaire on Stress in Cancer Patients (QSC) and the questionnaire on Functional Assessment of Cancer Treatment (FACT-G). RESULTS: 'Active problem-orientated' coping and 'distractions' are the most important coping strategies. Only 'active problem-orientated' and 'depressive' coping showed a significant decrease. We observed higher means on the scales of the FKV in women. Marital status (single, married, divorced/widowed) had a significant influence on active problem-orientated coping and spirituality. Age, children, education, T/M status and curative/ palliative intention of treatment had no influence on coping styles. Breast cancer patients and lymphoma patients demonstrated the highest use of coping strategies after radiotherapy with a significant decrease of 'active problem-orientated coping'. Depressive coping and minimizing importance at ti1 were associated with high psychosocial distress and low quality of life (QoL) at ti6. CONCLUSION: The correlation of coping mechanisms at the beginning of radiotherapy with low QoL and high psychosocial stress at 2 years could help to identify patients at risk for low psychosocial adaptation. Psycho-oncologically trained teams of physicians would best correspond to this profile of needs and would contribute significantly to an ameliorated adaptation of patients to cancer which could lead to higher life satisfaction.

Adaptation, Psychological↗
PubMed2001

[Disease specific stress of tumor patients at the beginning of radiotherapy. Effects on psychosocial support requirement].

PURPOSE: Radiotherapy brings a tumor patient into a special life situation in which different variables play a role of often unknown importance. The goal of this study was to investigate disease specific stress of tumor patients at the beginning of radiotherapy with established psychodiagnostic questionnaires and to evaluate the effect on psychosocial support requirement in order to reduce stress and to improve quality of life and compliance during radiotherapeutical treatment. PATIENTS AND METHODS: 732 patients were screened, of whom 446 (60.9%) fulfilled the criteria for inclusion (refusals 21.0%, low karnorsky performance status 6.6%, management problems 3.4%, language barriers 3.0%, cognitive restrictions 2.6%, death 2.5%). Disease specific aspects of stress in the questionnaire (Fragebogen zur Belastung von Krebspatienten, FBK), life situation (LS) and self-defined care requirements (BB) (Figure 1) were self-rated by patients with different tumor types before radiotherapy. Medical and sociodemographic data were also documented. We investigated 446 patients (262 male, 184 female; median age 60.0 years) with different diagnoses (Table 1). RESULTS: Stress was observed mainly due to reduction of efficiency, anxiety and pain on the subscales (Figure 2). Women had a significant higher stress on subscales of pain (p = 0.016) and anxiety (p = 0.009) (Table 2), patients younger than 45 years in the subscale information (p = 0.002) and patients older than 45 and younger than 60 years in the subscale anxiety (p = 0.002) and the total score (p = 0.003) (Table 3). Patients with mamma carcinoma had the highest the stress (Table 4). The maximum percentages of patients under high stress were found for the subscales of efficiency (43%) and anxiety (40%). The support requirement was characterized by the need of more medical information and dialogue with the doctor. We saw a significant correlation of high stress and high care requirement (Tables 5 and 6). CONCLUSIONS: Psychosocial support should be founded on psychosocial stress diagnostic and self-defined care requirement.

Adult↗
PubMed2001

Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency.

BACKGROUND: Adults with growth hormone (GH) deficiency (GHD) may experience physical and psychological disturbances, which can affect their quality of life (QOL). OBJECTIVES: To develop and validate a disease-specific module from the previously published QOL measure Questions on Life Satisfaction Modules (QLS(M)): the QLS(M)-H that specifically addressed the needs of patients with hypopituitarism. A second aim was for the questionnaire to be applicable across different cultural backgrounds in order to evaluate the efficacy of therapy in large, international clinical trials, thus providing additional clinical endpoints for these studies. DESIGN: A preliminary German language version of the QLS(M)-H was developed from 26 semi-structured interviews of adults with GHD. The questionnaire was then independently translated into five other languages and applied in open, non-controlled, multicentre, longitudinal studies to patient (n=717) and normative populations (n=2700). METHODS: A revised, nine-item version of the questionnaire was developed, based on previously defined criteria, and was evaluated for reliability and validity. Sensitivity to detect changes after GH replacement was also assessed. RESULTS: The 16 items of the preliminary questionnaire were reduced to nine items on the basis of the correlation of items/factors from initial patient interviews. Psychometric analysis revealed the reliability of the nine-item scale. The Cronbach's alpha scores ranged from 0.81 to 0.89 and the test-retest correlations ranged from 0.76 to 0.88, all of which indicate reliability over time. Mean scores increased significantly during GH replacement therapy, with observed changes greater than those seen with the non-specific modules of the QLS(M), indicating the sensitivity of the scale. CONCLUSIONS: The QLS(M)-H questionnaire is concise, easy to complete, and can be effectively applied across different cultural backgrounds. Psychometric evaluation of the questionnaire reveals that it is a valid, reliable and sensitive tool useful for assessing impaired life satisfaction in adult patients with GHD and also for monitoring the efficacy of GH therapy.

Adult↗
PubMed1998

[Quality of life after complex tibial reconstruction].

58 patients following Gustilo IIIB open tibial fractures, treated by serial debridements, osteosynthesis and microvascular free tissue transfer were investigated after an average of 6 years. Assessment of life satisfaction was done by means of a proven valid and reliable test instrument (FLZ-"Fragen zur Lebenszufriedenheit"). Further specific questions on treatment satisfaction, aesthetic result, occupation and income were added to this questionnaire. Significant discrepancies of the items recreational activities, income, occupation and partnership, productivity, mobility and pain were evaluated in comparison to available data of healthy west german population. The calculated global index of life satisfaction and health differed significantly from the established index of west german population. Although specific aspects like aesthetic result, donor site morbidity, pain and even function were critically judged, 91% of the patients were satisfied with the long term result of the treatment. None of the patients thought that an initial amputation probably might have been a better solution. The postrehabilitation employment rate was 64%. Limb salvage of Gustilo IIIB fractures by means of a multidisciplinary treatment protocol is able to afford useful and satisfying long time results. However, an impairment of quality of life, at least in specific items has to be considered.

Adolescent↗
PubMed1997

Psychometric properties of the Questionnaire on Stress in Patients with Diabetes--Revised (QSD-R).

This study reports the psychometric properties of a 45-item diabetes-specific questionnaire, the Questionnaire on Stress in Patients with Diabetes--Revised (QSD-R), a modified and shortened version of the QSD (G. Duran, P. Herschbach, S. Waadt, A. Zettler, & F. Strian, 1995). The QSD-R was filled out by 1,930 individuals with insulin-dependent diabetes mellitus and noninsulin-dependent diabetes mellitus. Eight consistent scales were identified (values of Cronbach's alpha: .69-.81). The test-retest reliability for the total score after a 5-week interval was rtt = .63. The results provide evidence for the reliability and validity of this instrument.

Adolescent↗
PubMed1996

[Comparison of the quality of life after subtotal and total gastrectomy for stomach carcinoma].

OBJECTIVE: To compare quality of life after subtotal gastrectomy (STG) and total gastrectomy of various types, in view of the fact that, with T1 and T2 gastric carcinoma of intestinal type in the distal third of the stomach, subtotal gastrectomy is similar to total gastrectomy regarding the extent of lymphadenectomy and prognosis. PATIENTS AND METHODS: Quality of life was measured by standardised questionnaires given to 36 patients after subtotal gastrectomy (22 men, 14 women; mean age 63 [27-79] years): general physical complaints (GPC); contentment with life (CL); psychosocial stress (PSS). The results were compared with those previously obtained in 58 patients with total gastrectomy (46 men, 12 women; mean age 63.4 [36-74] years) and oesophagojejunostomy (OJS) (n = 29) or oesophagojejunoplication and pouch (OJPP) (n = 29). RESULTS: Weight loss of patients after OJPP was not significantly different from that of patients after STG, but it was significantly higher after OJS (13.5 +/- 8.6 kg; P < 0.0006). Patients with STG had significantly more general complaints (P < 0.05) and greater discontent with life (P < 0.05) than those with OJPP. Specific analysis of gastric complaints showed greatest dissatisfaction with gastrointestinal functions in patients after STG (P < 0.0004), less also after OJS compared with OJPP (P < 0.01). CONCLUSIONS: Subtotal gastrectomy for gastric carcinoma has no advantages over total gastrectomy with oesophagojejunoplication and pouch as regards weight loss, gastrointestinal complaints, psychosocial stress and general contentment. The poor quality of life seems to have its functional correlate in increased intestino-oesophageal reflux with incompetent cardia and after Billroth II reconstruction.

Adult↗
PubMed1995

Coping with fear of long-term complications in diabetes mellitus: a model clinical program.

Preliminary results are reported on the efficacy of a behaviorally oriented group therapy (n = 17) intended to improve coping with fear of long-term complications in patients with diabetes mellitus. Treatment consisted of exposure in imagination, relaxation training and analysis of dysfunctional health beliefs. Pre-, posttreatment and 3-month follow-up measure showed significant improvements regarding fear, acceptance of chronic disease and work. The usefulness of such a treatment program and the necessarity for further research is discussed.

Adaptation, Psychological↗
PubMed1995

Assessing daily problems with diabetes: a subject-oriented approach to compliance.

The reliability, construct validity, and discriminant validity of a new self-report questionnaire, the Questionnaire on Stress in Diabetic Patients, were assessed in a sample of 617 patients with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus. The 90-item inventory is designed to assess psychosocial stress associated with problems in daily living with diabetes. One of the intended uses is to identify psychosocial factors hampering patient compliance with the necessary treatment regimen. Values of Cronbach alpha ranged from 0.63 to 0.88. The results provide initial evidence for the reliability and validity of the instrument.

Activities of Daily Living↗