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Eine Kurzform der Skala zur Generalisierten Selbstwirksamkeit (GSW-6): Entwicklung, psychometrische Merkmale und Validität in einer interkulturellen nicht-klinischen Stichprobe und in einer Stichprobe von Herzinsuffizienz-Risikopatienten
No full textObjective: General self-efficacy has been found to be an influential variable related to the adaptation to stress and chronic illness, with the General Self-Efficacy (GSE) Scale by Jerusalem and Schwarzer being a reliable and valid instrument to assess this disposition. The aim of this study was to construct and test a short form of this scale to allow for a more economical assessment of the construct.Methods: The item characteristics of the original scale were assessed using an intercultural non-clinical sample (n =19,719). Six items with the highest coefficient of variation and good discrimination along the range of the trait were selected to build a short form of the instrument (GSE-6). Subsequently, the psychometric properties and the concurrent and predictive validity of the GSE-6 were tested in a longitudinal design with three measurements using a sample of patients with risk factors for heart failure (n =1,460).Results: Cronbach's alpha for the GSE-6 was between .79 and .88. We found negative associations with symptoms of depression (-.35 and -.45), anxiety (-.35), and vital exhaustion (-.38) and positive associations with social support (.30), and mental health (.36). In addition, the GSE-6 score was positively associated with active problem-focused coping (.26) and distraction/self-encouragement (.25) and negatively associated with depressive coping (-.34). The baseline GSE-6 score predicted mental health and physical health after 28 months, even after controlling for the respective baseline score. The relative stability over twelve and 28 months was r =.50 and r =.60, respectively, while the mean self-efficacy score did not change over time.Conclusions: The six item short form of the GSE scale is a reliable and valid instrument that is useful for the economical assessment of general self-efficacy in large multivariate studies and for screening purposes.Hintergrund: Die generalisierte Selbstwirksamkeit hat sich als einflussreiche Variable im Zusammenhang mit der Anpassung an stressreiche Situationen und chronische Erkrankungen gezeigt. Die Skala Generalisierte Selbstwirksamkeit (GSW) von Jerusalem und Schwarzer ist ein reliables und valides Instrument zur Erhebung dieser Disposition. Ziel der vorliegenden Studie war die Entwicklung und Prüfung einer Kurzform dieser Skala, um eine ökonomischere Erfassung des Konstrukts zu ermöglichen.Methoden: Die Itemmerkmale der Original-Skala wurden anhand der Daten einer interkulturellen, nicht-klinischen Stichprobe (n =19.719) bestimmt. Sechs Items mit dem höchsten Variationskoeffizienten und guter Diskrimination über den Merkmalsbereich wurden ausgewählt, um aus ihnen eine Kurzform des Instruments zusammenzustellen (GSW-6). Anschließend wurden psychometrische Merkmale und die konkurrente und prädiktive Validität der GSW-6 in einem Längsschnittdesign mit drei Messzeitpunkten an einer Stichprobe von Patienten mit Risikofaktoren für eine Herzinsuffizienz geprüft (n =1.460).Ergebnisse: Cronbachs alpha für die GSW-6 lag zwischen .79 und .88. Wir fanden negative Zusammenhänge mit depressiven Symptomen (-.35 und -.45), Angstsymptomen (-.35), und vitaler Erschöpfung (-.38) sowie positive Zusammenhänge mit sozialer Unterstützung (.30) und psychischer Gesundheit (.36). Weiterhin hing der GSW-6-Score positiv mit aktivem problemorientiertem Coping (.26) und Ablenkung/Selbstaufbau (.25) sowie negativ mit depressiver Krankheitsverarbeitung (-.34) zusammen. Der GSW-6-Ausgangswert konnte die psychische und körperliche Gesundheit nach 28 Monaten, auch nach Kontrolle des jeweiligen Ausgangswertes, vorhersagen. Die relative Stabilität über zwölf bzw. 28 Monate betrug r =.50 und r =.60, während sich der mittlere Selbstwirksamkeitsscore im Zeitverlauf nicht änderte.Schlussfolgerungen: Die aus sechs Items bestehende Kurzform der GSW-Skala ist ein reliables und valides Instrument, das zur ökonomischen Erfassung der generalisierten Selbstwirksamkeit in großen multivariaten Studien und zum Einsatz als Screeninginstrument geeignet ist
Prognostic impact of diastolic dysfunction in systolic heart failure—A cross‐project analysis from the German Competence Network Heart Failure
No full textThe β-blocker uptitration in elderly with heart failure regarding biomarker levels: CIBIS-ELD substudy
No full textDiagnostics and therapy of heart failure in elderly patients
No full textDer Schwerpunkt dieser Arbeit ist die Diagnose und Therapie der
Herzinsuffizienz beim älteren Patienten. In einer multizentrischen
randomisierten Studie mit 883 Patienten konnte ich deutliche Unterschiede in
der klinischen Wirksamkeit der untersuchten Betablocker zeigen: Bisoprolol
führte zu einer stärkeren Herzfrequenzsenkung und mehr unerwünschten
Ereignissen durch Bradykardie. Carvedilol führte zu einer klinisch relevanten
Reduktion der FEV1 und mehr pulmonalen Nebenwirkungen. Für Patienten mit einer
niedrigen Ruheherzfrequenz sollte Carvedilol bevorzugt werden; für Patienten
mit einer COPD Bisoprolol. Dass nur ein Drittel der älteren Patienten die
Zieldosis erreichten, bestätigt die Ergebnisse großer Surveys. Mit der selbst-
eingeschätzten Gesundheit kann der behandelnde Arzt zu Therapiebeginn
einschätzen, wie wahrscheinlich unerwünschte Ereignisse auftreten.
Herzinsuffiziente Patienten mit schlechter selbst-eingeschätzter Gesundheit
waren doppelt so häufig von einer verschlechterten Symptomatik bedroht und
wurden fünfmal so häufig hospitalisiert. Die einfache Frage „Wie würden Sie
Ihren Gesundheitszustand im Allgemeinen beschreiben?“ sollte in die
Routinebetreuung herzinsuffizienter Patienten aufgenommen werden. Anti-
Troponin I hingegen scheint kein sinnvoller Marker zur Diagnose und
Verlaufskontrolle der Herzinsuffizienz zu sein. Im Gegensatz zu NT-proBNP und
Troponin I gab es keine signifikanten Unterschiede zwischen verschiedenen
Herzinsuffizienzschweregraden von 138 Patienten und 300 gesunden Kontrollen.
Zur Routinediagnostik herzinsuffizienter Patienten sollte jedoch die
Spirometrie gehören. Bei knapp einem Drittel der untersuchten Patienten
konnten wir eine bisher unbekannte COPD diagnostizieren. Die COPD führte zu
einer relevanten Einschränkung der Belastbarkeit im 6-Minuten-Gehtest. Für
herzinsuffiziente Patienten mit erhaltener Ejektionsfraktion ist das
kombinierte Kraft- und Ausdauertraining eine hocheffektive Therapie. Dies
konnten wir erstmals in einer randomisierten, kontrollierten Studie zeigen.
Die Therapie erhöhte nicht nur die maximale Sauerstoffaufnahme und die
Lebensqualität, sie war außerdem spezifisch und verbesserte die diastolische
Funktion und das atriale Remodelling.The main focus of this work is the diagnosis and treatment of heart failure in
older patients. In a multi-centre randomized study with 883 patients I was
able to show a clear difference in the clinical effectiveness of the beta-
blockers being studied: Bisoprolol led to a stronger decrease in heart and
more adverse events through bradycardia. Carvedilol led to a clinically
relevant reduction in the FEV1 and more pulmonary adverse events. For patients
with a low resting heart rate carvedilol should be preferred; and for patients
with COPD bisoprolol. Only a third of our patients achieved the target dose,
which supports the results of large surveys. Assessment of self-rated health
at the start of therapy can help the treating physician to predict the
likelihood of adverse events. Heart failure patients with low self rated
health were twice as likely to experience worsening of symptoms and were
hospitalized five times more often. The simple question of, “How would you
describe your health in general?” should be included in the routine care of
heart failure patients. Anti-troponin I, however, did not seem to be a helpful
biomarker for the diagnosis and treatment of heart failure. In contrast to NT-
pro BNP and Troponin I, there was no significant difference in blood levels
between 138 heart failure patients and 300 healthy controls. However,
spirometry should be included in the routine diagnosis of heart failure
patients. In almost a third of the evaluated patients we were able to detect a
previously undiagnosed COPD. The presence of COPD led to a relevant limitation
in 6-minute-walk test distance. For heart failure patients with preserved
ejection fraction, combined strength and endurance training is a highly
effective therapy. We were able to show this for the first time in a
randomized controlled trial. The therapy not only increased maximum oxygen
uptake and quality of life, but was found to be a specific therapy and
improved diastolic function and atrial remodelling
Effects of long‐term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction
No full textBackground The long-term effects of exercise training (ET) in diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF) are unknown. The present study compared the long-term effects of ET on exercise capacity, diastolic function, and quality of life (QoL) in patients with DD vs. HFpEF. Methods A total of n=43 patients with asymptomatic DD (n=19) or HFpEF [DD and New York Heart Association (NYHA) ≥II, n=24] and left ventricular ejection fraction ≥50% performed a combined endurance/resistance training over 6months (2–3/week) on top of usual care. Cardiopulmonary exercise testing, echocardiography, and QoL were obtained at baseline and follow-up. Results Patients were 62±8 years old (37% female). In the HFpEF group, 67% of patients were in NYHA class II (33% in NYHA III). Exercise capacity (peak oxygen consumption, peak VO2) differed at baseline (DD 29.2±8.7mL/min/kg vs. HFpEF 17.8±4.6 mL/min/kg; P=0.004). After 6months, peak VO2 increased significantly (P<0.044) to 19.7±5.8 mL/min/kg in the HFpEF group and also in the DD group (to 32.8±8.5mL/min/kg; P<0.002) with no overall difference between the groups (P=0.217). E/e′ ratio (left ventricular filling index) decreased from 12.2±3.5 to 10.1±3.0 (P<0.002) in patients with HFpEFand also in patients with DD (10.7±3.1 vs. 9.5±2.3; P=0.03; difference between groups P=0.210). In contrast, left atrial volume index decreased in the HFpEF group (P<0.001) but remained stable within the DD group (difference between groups P=0.015). After 6 months, physical QoL (Minnesota living with heart failure Questionnaire, 36-item short form health survey), general health perception, and 9-item patient health questionnaire score only improved in HFpEF (P<0.05). In contrast, vitality improved in both groups (difference between groups P=0.708). Conclusion A structured 6 months ET programme effectively improves exercise capacity and diastolic function in patients with DD and overt HFpEF. Therefore, controlled lifestylemodification with physical activity is effective both in DD and HFpEF
Vitamin D deficiency in patients with diastolic dysfunction or heart failure with preserved ejection fraction
No full textAims
Vitamin D deficiency is prevalent in heart failure (HF), but its relevance in early stages of heart failure with preserved ejection fraction (HFpEF) is unknown. We tested the association of 25-hydroxyvitamin D [25(OH)D] serum levels with mortality, hospitalizations, cardiovascular risk factors, and echocardiographic parameters in patients with asymptomatic diastolic dysfunction (DD) or newly diagnosed HFpEF.
Methods and results
We measured 25(OH)D serum levels in outpatients with risk factors for DD or history of HF derived from the DIAST-CHF study. Participants were comprehensively phenotyped including physical examination, echocardiography, and 6 min walk test and were followed up to 5 years. Quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. We included 787 patients with available 25(OH)D levels. Median 25(OH)D levels were 13.1 ng/mL, mean E/e′ medial was 13.2, and mean left ventricular ejection fraction was 59.1%. Only 9% (n = 73) showed a left ventricular ejection fraction <50%. Fifteen per cent (n = 119) of the recruited participants had symptomatic HFpEF. At baseline, participants with 25(OH)D levels in the lowest tertile (≤10.9 ng/L; n = 263) were older, more often symptomatic (oedema and fatigue, all P ≤ 0.002) and had worse cardiac [higher N-terminal pro-brain natriuretic peptide (NT-proBNP) and left atrial volume index, both P ≤ 0.023], renal (lower glomerular filtration rate, P = 0.012), metabolic (higher uric acid levels, P < 0.001), and functional (reduced exercise capacity, 6 min walk distance, and SF-36 physical functioning score, all P < 0.001) parameters. Increased NT-proBNP, uric acid, and left atrial volume index and decreased SF-36 physical functioning scores were independently associated with lower 25(OH)D levels. There was a higher risk for lower 25(OH)D levels in association with HF, DD, and atrial fibrillation (all P ≤ 0.004), which remained significant after adjusting for age. Lower 25(OH)D levels (per 10 ng/mL decrease) tended to be associated with higher 5 year mortality, P = 0.05, hazard ratio (HR) 1.55 [1.00; 2.42]. Furthermore, lower 25(OH)D levels (per 10 ng/mL decrease) were related to an increased rate of cardiovascular hospitalizations, P = 0.023, HR = 1.74 [1.08; 2.80], and remained significant after adjusting for age, P = 0.046, HR = 1.63 [1.01; 2.64], baseline NT-proBNP, P = 0.048, HR = 1.62 [1.01; 2.61], and other selected baseline characteristics and co-morbidities, P = 0.043, HR = 3.60 [1.04; 12.43].
Conclusions
Lower 25(OH)D levels were associated with reduced functional capacity in patients with DD or HFpEF and were significantly predictive for an increased rate of cardiovascular hospitalizations, also after adjusting for age, NT-proBNP, and selected baseline characteristics and co-morbidities
Outcome assessment using estimation of left ventricular filling pressure in asymptomatic patients at risk for heart failure with preserved ejection fraction
No full text
The diagnostic and prognostic value of galectin‐3 in patients at risk for heart failure with preserved ejection fraction: results from the DIAST‐CHF study
No full textAbstract Aims Galectin‐3 (Gal‐3) predicts long‐term outcome among patients with heart failure (HF) with preserved ejection fraction (HFpEF). The ability of Gal‐3 to diagnose and predict incident HFpEF in a cohort at risk for HFpEF is of particular interest. We aimed to determine the association between Gal‐3 and clinical manifestations of HFpEF, the relationship between Gal‐3 and all‐cause mortality, or the composite of cardiovascular hospitalization and death. Methods and results The observational Diast‐CHF study included patients aged 50 to 85 years with ≥1 risk factor for HF (e.g. hypertension, diabetes mellitus, and atherosclerotic disease) or previously suspected HF. Patients were followed for 10 years. The association between Gal‐3, evidence of diastolic dysfunction, and Framingham criteria for HF was examined. All deaths and hospitalizations were adjudicated as cardiovascular or non‐cardiovascular. The analysis population was composed of 1386 subjects (67 years old, 50.9% female). The area under the receiver operating characteristic curve to diagnose HFpEF was 0.71. At a cut‐off value of 13.57 ng/mL, sensitivity was 0.61 and specificity was 0.73 for Gal‐3, and the diagnostic power to detect HFpEF was superior to N‐terminal pro‐brain natriuretic peptide (area under the receiver operating characteristic curve 0.59, P \u0026gt; 0.001). Baseline Gal‐3 was associated with risk factors for HF (P \u0026lt; 0.001). Higher levels of Gal‐3 predicted incident HFpEF (P \u0026lt; 0.05), adjusted all‐cause mortality (P \u0026lt; 0.001), and the adjusted composite of cardiovascular hospitalization and death (P \u0026lt; 0.001), both independent from N‐terminal pro‐brain natriuretic peptide. Conclusions Gal‐3 differentiated patients with HFpEF from an overall cohort of well‐characterized patients with risk factors for HFpEF. Independent of other factors, baseline Gal‐3 levels were associated with a higher risk for incident HFpEF, mortality, or the composite of cardiovascular hospitalization and death over 10 year follow‐up. In conjunction with clinical parameters, Gal‐3 adds a statistically significant value for the diagnosis of HFpEF within this study, yet the clinical relevance remains debatable.Bundesministerium für Bildung und Forschung http://dx.doi.org/10.13039/50110000234
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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