Guidelines for the sociomedical assessment of performance in patients suffering from inflammatory bowel disease

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemization of the sociomedical assessment of performance in inflammatory bowel disease (Crohn's disease, ulcerative colitis) were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent -- e. g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of inflammatory bowel disease and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.     

Organisation of a proposed Cochrane Diet and Nutrition Field

The Cochrane Collaboration helps people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. In all, 51 Cochrane Review Groups are responsible for preparing and maintaining the reviews. Most of these Review Groups are problem-based. However, there are a number of areas or dimensions of health care, such as the setting of care (eg primary care) or the type of patient/consumer (eg older persons), that cannot be usefully conceptualised as 'health problems'. In order to reflect the interests of these dimensions, or 'fields', of health care more effectively, the Cochrane Collaboration created another type of entity: Cochrane Fields or Networks. The core functions of these Fields are described. It is proposed that a new Cochrane Subfield for Diet and Nutrition should be set up to attract a cadre of new reviewers in order to ensure the proper representation of diet and nutrition expertise in the relevant Collaborative Review Groups. The methodological pitfalls of the use of nonrandomised studies will be a key issue for the new Subfield, since the focus of the Cochrane Collaboration's programme of searching databases, journals and conference proceedings has been on the identification of reports of randomised controlled trials (RCTs). Some of these sources will be need to be searched again for non-RCT studies. The financial considerations of establishing of a Cochrane Subfield for Diet and Nutrition are discussed.     

A Comparison of Self-Selectivity Corrections in Economic Evaluations and Outcomes Research

OBJECTIVE: Two alternative selectivity correction methods have been widely applied in the health economics literature: the sample selection model (SSM) and the multipart model (MPM). The difference between these two approaches results from their initial assumptions about the distribution of error terms. Because the distributional assumptions cannot be theoretically verified, the usefulness of the methods can only be evaluated by real world comparison. This article reviews and empirically tests the two alternative selectivity correction methods to give a reality-based evaluation. METHODS: Using a randomized sample of patients as the "gold standard," the SSM and MPM are applied to a nonrandomized sample of patients with an identical set of dependent and independent variables. By comparing the actual estimates of the two methods, we evaluate the robustness of the two approaches. RESULTS: The results show that neither method is empirically robust in replicating the results of the randomized trial. There is no consistent pattern in the coefficients from either selectivity-correction method for replicating the coefficients in the randomized sample. CONCLUSIONS: Researchers should be cautious in applying these correction methods, and any conclusions based on these approaches may need to be qualified.     

Prevalence of physical activity among the working population and correlation with work-related factors: results from the first German National Health Survey

This paper investigates levels of engagement in physical activity (PA) among the total German working population and for specific subgroups. The first national health survey for the Federal Republic of Germany was conducted from October 1997 to March 1999. The following study is based on a representative net sample of 3,323 employed persons aged 18 to 69. Bivariate methods and multiple logistic regression analyses were used to investigate the relationship between PA and workplace and occupational factors in addition to social and lifestyle-specific correlates. Four out of 10 gainfully employed persons (39.2%) do not engage in sport. Those with physically strenuous jobs and frequent overtime work are significantly less likely to engage in leisure-time PA. Non-manual workers, and younger, unmarried workers are particularly likely to have an active lifestyle. Our study population did not correspond to the popular image of the recreational athlete as an abstinent, "ascetic" individual: The subgroups of non-smokers and teetotalers contained significantly fewer athletes than the corresponding reference groups. The present paper is the first to publish representative data on PA in the working population since German reunification in 1990. The data show that workers with a high risk of morbidity are those least likely to engage in leisure-time PA (manual workers with below-average educational qualifications from lower socioeconomic groups). The significant accumulation of socially depriving living conditions and lifestyle deficits among inactive subjects shows that one-off preventive measures intended to motivate sporting activity are likely to be ineffective in these subgroups of the population. We therefore advocate continuous exercise programs near the workplace involving exercise training suited to the particular occupation, dietary advice, relaxation techniques and occupational medical care.     

The extended columellar strut-tip graft

The extended columellar strut-tip graft is a structural unit used in endonasal rhinoplasty that combines the attributes of the columellar strut and the tip graft. It is used to provide projection and contour to the nasal tip. Our goal with this study was to evaluate a 15-year experience with 155 patients who underwent rhinoplasty with the extended columellar strut-tip graft. Of these, 110 underwent secondary rhinoplasty, and 45 underwent primary rhinoplasty. There were 6 patients in the secondary rhinoplasty group who experienced complications: in 3, the graft became visible postoperatively, and 3 patients had graft placement asymmetry. These 6 patients underwent surgery in the initial years of graft development. One patient with graft edge visibility and 1 patient with graft asymmetry underwent revision surgery with satisfactory results. The extended columella strut-tip graft is a reliable method to provide nasal tip projection and contour. The successful use of the graft requires precise diagnosis and surgical technique.     

Impact of malpractice reforms on the supply of physician services

Context  Proponents of restrictions on malpractice lawsuits claim that tort reform will improve access to medical care. Objective  To estimate the effects of changes in state malpractice law on the supply of physicians. Design  Differences-in-differences regression analysis that matched data on the number of physicians in each state between 1985 and 2001 from the American Medical Association’s Physician Masterfile with data on state tort laws and state demographic, political, population, and health care market characteristics. Main Outcome Measure  Effect on physician supply of "direct" malpractice reforms that reduce the size of awards (eg, caps on damages). Results  The adoption of "direct" malpractice reforms led to greater growth in the overall supply of physicians. Three years after adoption, direct reforms increased physician supply by 3.3%, controlling for fixed differences across states, population, states’ health care market and political characteristics, and other differences in malpractice law. Direct reforms had a larger effect on the supply of nongroup vs group physicians, on the supply of most (but not all) specialties with high malpractice insurance premiums, on states with high levels of managed care, and on supply through retirements and entries than through the propensity of physicians to move between states. Direct reforms had similar effects on less experienced and more experienced physicians. Conclusion  Tort reform increased physician supply. Further research is needed to determine whether reform-induced increases in physician supply benefited patients.      

Addressing the psychosocial and communication challenges posed by radiological/nuclear terrorism: key developments since NCRP Report No. 138

One of the most innovative aspects of NCRP Report No. 138 (Management of Terrorist Incidents Involving Radioactive Material) was the high priority it accorded to psychosocial and communication issues. While previous discussions of radiological and nuclear terrorism had occasionally referred to these topics, NCRP Report No. 138 was the first report of its kind to recognize the profound challenges posed by these issues and to place them at the heart of preparedness and response efforts. In the years since the report's release, a host of important developments have taken place in relation to psychosocial and communication issues. This paper reviews key changes and advances in five broad areas: (1) training exercises, (2) policy and guidance development, (3) findings on hospital and clinician needs, (4) survey research on public perceptions of radiological terrorism, and (5) risk communication for radiological and nuclear terrorism situations. The article concludes with a discussion of continuing psychosocial and communication challenges, including critical areas needing further attention as the nation moves to meet the threat of terrorism involving radioactive materials.