Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic ...inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.
We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.
Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.
This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.
CRD42019123222 .
In response to the spread of the coronavirus, educational institutions have been closed and digital education has become a new teaching method to ensure the continuity of medical education. Since ...this format was a new form of learning for students at medical faculties in Germany, little is known about the perception of it and the factors that contribute to successful mastery. The current study aimed to analyze students' learning experiences during the first online semester and to identify associations between learners' characteristics and enjoyment, mastery experiences, as well as the perceived stress level.
In this cross-sectional study, students of a medical faculty from Germany answered an online questionnaire including information about perceptions towards digital education and learners' characteristics (study skills and dispositions). Data were analyzed using multivariate linear regression analysis.
In total, 383 students responded to the online survey. A majority of students felt at least somewhat worse about their studies compared to before the pandemic. Success of study tasks was related to preferences for cooperative learning (B = - 0.063, p < .001) and success of study organization was associated to the use of metacognitive learning strategies (B = 0.019, p = .04). Enjoyment of studying in times of digital education was positively related to the use of metacognitive strategies (B = 0.049, p = .04) and self-efficacy (B = 0.111, p = .02). The perceived stress was influenced by cognitive strategies (B = 0.401, p = .02) and test anxiety (B = 0.466, p < .001).
Although students perceive digital teaching as a good alternative for big courses, those with low self-efficacy beliefs and low self-regulation have problems in coping with the demands of this learning format and need further support.
HintergrundEine veränderte Sichtweise auf den Gesundheitsbegriff und Fortschritte in therapeutischen Möglichkeiten führten zu einem wachsenden Interesse am Konzept der Lebensqualität in der Medizin. ...Dies gilt auch für die Beurteilung des Wohlbefindens bei Kindern und Jugendlichen.Ziel der ArbeitDas Konstrukt der Lebensqualität wird definiert und dessen Relevanz für die medizinische Forschung beschrieben. Weiterhin werden Methoden zur Erfassung der Lebensqualität bei Kindern und Jugendlichen benannt sowie aktuelle Befunde zur gesundheitsbezogenen Lebensqualität bei Kindern aus Deutschland vorgestellt.MethodeStudienergebnisse aus repräsentativen Umfragen zur Kinder- und Jugendgesundheit in Deutschland bilden die Grundlage für die berichteten Ergebnisse zur Lebensqualität.ErgebnisseBisher mangelt es an einer einheitlichen Theorie zum Konzept der Lebensqualität. Einigkeit besteht darin, dass Lebensqualität subjektiv, situativ und multidimensional ist. Zur Erfassung der Lebensqualität liegt eine Vielzahl validierter Instrumente vor. Die gesundheitsbezogene Lebensqualität der Kinder und Jugendlichen in Deutschland ist überwiegend gut bis sehr gut. Kinder aus sozial benachteiligten Familien berichten von einem schlechteren Befinden, was sich im Zuge der Coronapandemie noch weiter verschärft hat. Fremd- und Selbsteinschätzungen der Lebensqualität weichen v. a. bei weniger sichtbaren Dimensionen voneinander ab.SchlussfolgerungenBedürfnisse von Kindern und Jugendlichen aus Familien mit einem niedrigen sozioökonomischen Status müssen stärker berücksichtigt werden. Bei der Erfassung der Lebensqualität sind stets die Sichtweisen der Eltern und Kinder zu berücksichtigen.
•Validating the structure of anxiety predictors by means of control-value theory.•Confirms the role of self-efficacy for goal attainment as suggested by the theory of self-regulation.•Longitudinal ...validation study integrating assumptions of both theories.•Model integrating assumptions from both theories fits the data best.
Control-value theory (CVT) specifies a sequence of variables assumed to predict achievement-related emotions, and related performance. Similarly, Schwarzer’s theory of self-regulation (TSR) suggests that self-efficacy influences all links in the above-mentioned sequence. A longitudinal validation that integrates assumptions from both theories remains pending. Hence, the current study used a longitudinal design to validate the structure of anxiety predictors, thereby examining whether self-efficacy is associated with each link of the chain. A total of 92 students completed questionnaires at different time points before and after an oral examination. Using structural equation modeling, five separate models were run with stepwise involvement of the direct effects of self-efficacy on the other variables. Findings supported the proposed structure of relationships with self-efficacy affecting all variables.
Purpose
We examined whether multi-disciplinary stepped psycho-social care decreases financial problems and improves return-to-work in cancer patients.
Methods
In a university hospital, wards were ...randomly allocated to either stepped or standard care. Stepped care comprised screening for financial problems, consultation between doctor and patient, and the provision of social service. Outcomes were financial problems at the time of discharge and return-to-work in patients < 65 years old half a year after baseline. The analysis employed mixed-effect multivariate regression modeling.
Results
Thirteen wards were randomized and 1012 patients participated (
n
= 570 in stepped care and
n
= 442 in standard care). Those who reported financial problems at baseline were less likely to have financial problems at discharge when they had received stepped care (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1, 0.7;
p
= 0.01). There was no evidence for an effect of stepped care on financial problems in patients without such problems at baseline (OR 1.1, CI 0.5, 2.6;
p
= 0.82). There were 399 patients < 65 years old who were not retired at baseline. In this group, there was no evidence for an effect of stepped care on being employed half a year after baseline (OR 0.7, CI 0.3, 2.0;
p
= 0.52).
Trial registration
NCT01859429
Conclusions
Financial problems can be avoided more effectively with multi-disciplinary stepped psycho-social care than with standard care in patients who have such problems.
Research on the role of learning strategies and self-efficacy for mathematics performance in higher education is sparse, especially if cognitive and metacognitive strategies are considered. In ...response, the current study investigated the associations between these variables with a sample of 206 university students in the context of a two-semester math course. Self-efficacy measured after one semester (t2) was positively related to both cognitive and metacognitive strategy use at the beginning (t1) and the end of the math course (t3). The use of either strategy was stable from t1 to t3. Once the variance overlap between the learning strategies was controlled for, metacognitive strategy use at t1 was positively and at t3 negatively associated with performance in the math course exam at t4. Greater levels of self-efficacy at t2 also predicted a better exam performance. Future longitudinal research is warranted to demonstrate the causal role of self-efficacy as a mediator between learning strategy use on math performance. In terms of implications, interventions may help to foster the students' awareness for an integrated use of cognitive and metacognitive strategies.
•Cognitive strategy use after two semesters predicted a better math grade.•Early metacognitive strategy use enhanced the math grade, late use reduced it.•Once added, self-efficacy absorbed the positive effect of late cognitive strategies.•Self-efficacy was positively related to both cognitive and metacognitive strategies.•There was an indirect effect of cognitive strategies on grade through self-efficacy.
About 2000 children and adolescents under the age of 18 are diagnosed with cancer each year in Germany. Because of current medical treatment methods, a high survival rate can be reached for many ...types of the disease. Nevertheless, patients face a number of long-term effects related to the treatment. As a result, physical and psychological consequences have increasingly become the focus of research in recent years. Social dimensions of health have received little attention in health services research in oncology so far. Yet, there are no robust results that allow an estimation of whether and to what extent the disease and treatment impair the participation of children and adolescents and which factors mediate this effect. Social participation is of great importance especially because interactions with peers and experiences in different areas of life are essential for the development of children and adolescents.
Data are collected in a longitudinal, prospective, observational multicenter study. For this purpose, all patients and their parents who are being treated for cancer in one of the participating clinics throughout Germany will be interviewed within the first month after diagnosis (t1), after completion of intensive treatment (t2) and half a year after the end of intensive treatment (t3) using standardized questionnaires. Analysis will be done by descriptive and multivariate methods.
The results can be used to identify children and adolescents in high-risk situations at an early stage in order to be able to initiate interventions tailored to the needs. Such tailored interventions will finally reduce the risk of impairments in the participation of children and adolescents and increase quality of life.
ClinicalTrials.gov: NCT04101123.
Purpose
Patients with head and neck cancer experience multiple complaints during treatment which also affect quality of life. The present study assessed predictors of temporal changes in quality of ...life over a 6-month period among patients treated for head and neck cancer.
Methods
Patients completed questionnaires at the beginning (t1) and end (t2) of their hospital stay and 3 (t3) and 6 months (t4) thereafter. Quality of life was evaluated using EORTC QLQ-C30 and QLQ-H&N35. Descriptive statistics were computed across measurement points for different domains of quality of life; predictors were identified using general linear models.
Results
Eighty-three patients (mean age: 58, SD = 11, 20.5% female) participated. Quality of life decreased during treatment and slowly recovered thereafter. From t1 to t4, there were adverse changes that patients consider to be relevant in physical and role functioning, fatigue, dyspnea, insomnia, loss of appetite, financial difficulties, problems with senses and teeth, limited mouth opening, mouth dryness, social eating, coughing, and sticky saliva. Temporal changes in global quality of life between t1 and t2 were predicted by tumor stage (
B
= − 5.6,
p
= 0.04) and well-being (
B
= 0.8,
p
= 0.04); radiotherapy was a predictor of temporal changes in physical functioning (
B
= − 12.5,
p
= 0.03).
Conclusions
Quality of life decreases during treatment, half a year after hospital stay there are still restrictions in some areas. A special focus should be given on head and neck cancer patient’s quality of life in the aftercare.
Control beliefs have been found to influence adaption to a cancer diagnosis. This study explored interrelationships among education, control beliefs, and health-related quality of life (HRQoL) in ...patients with breast, prostate, colorectal, and lung cancer and tested weather control beliefs act as mediators. Six hundred and five patients with breast (n = 205), prostate (n = 205), colorectal (n = 124), and lung (n = 71) cancer from two German cancer registries answered standardized questionnaires. Response rate was 54%. HRQoL was assessed with the EORTC QLQ-C30 core questionnaire and control beliefs (internal, external, and fatalistic) were evaluated using the IPC-questionnaire. Education was measured on a scale ranging from 1 to 8. Data were analyzed using multiple mediation models. There was a positive correlation between education and HRQoL. Internal beliefs were positive and external beliefs were negative correlated with HRQoL. Internal control beliefs mediated the relationship between education and global health-related quality of life (.299, CI .122, .531), physical functioning (.272, CI .110, .486), emotional functioning (.325, CI .120, .578), and pain (-.288, CI - .558, - .094). External and fatalistic control beliefs did not act as mediators.
Summary
Although a number of studies have addressed the interplay of achievement goals, cognitions, and emotions in academic settings, it remains largely unknown how the two latter change when ...students become aware that a performance goal was (un)accomplished. The current study used questionnaires assessing test‐related cognitions (perceived importance, interest, and attributions) and emotions before, during, and after an oral examination in order to investigate how students cope with a blocked academic goal. Students with blocked/unachieved goals devalued the importance of the examination, reported a decline in interest, and attributed the result more to external than internal reasons. Students who achieved their goal attributed the result equally to external and internal reasons and reported more gain‐related and less loss‐related emotions than unsuccessful students. The results indicate that students apply a goal disengagement strategy in order to cope with an unachieved goal as indicated by changes in cognitive and emotional processes alike.
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