Sabine Twork

Carl Gustav Carus-Institut, Pforzheim, Baden-Württemberg, Germany

Are you Sabine Twork?

Claim your profile

Publications (35)25.59 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In the last years there has been a growing interest in self assessment of Health-related quality of life (HRQOL). Studies show a reduced HRQOL in patients with Multiple Sclerosis (MS). A sample of n=3 157 members of the German Multiple Sclerosis Association (71.7% women, aged 48.2 years on average) was analyzed regarding the correlation between coping styles and HRQOL in MS patients. The findings show reduced HRQOL in MS patients in comparison to the general population in West Germany. MSQOL-54- and MSIS-29-sumscales and FKV-LIS-scales "depressive coping" and "minimizing importance" correlate significant: a depressive or trivializing coping style accompanies with reduced mental and physical HRQOL.
    PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 05/2011; 61(8):347-55. · 1.02 Impact Factor
  • M Menning, S Twork, J Kugler
    [Show abstract] [Hide abstract]
    ABSTRACT: Lack of treatment adherence is a significant issue in multiple sclerosis (MS). The aim of this project was to examine whether establishing an observational situation in the context of a non-interventional study could positively affect the treatment adherence, quality of life as well as patient satisfaction in 206 MS patients treated with Copaxone(®). Apart from 3 standardised, anonymous surveys no further measures were taken. Self-efficacy increased in the patients, which was also reflected in a decline in physician visits in the monitoring period. The number of consultations initiated by the patient decreased very much between the second and third patient surveys. In the quality of life area "health", there was a significant improvement. After 3 months there was a discontinuation rate of 10.4%; after 6 months 8.8%. Even though this was not a controlled study, these results could indicate that, on a short-term basis, patients can be motivated to adhere--probably as a result of the psychological aspects of the observational situation. However, long-term changes in behaviour can probably only be achieved through qualified training.
    Das Gesundheitswesen 05/2011; 73(5):e84-8. · 0.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Myasthenia gravis (MG) is a chronic neuromuscular disease. Advances in medical therapy have continuously increased the life expectancy of MG patients, without definitively curing the disease. To analyze life circumstances and quality of life (QoL), a large German MG cohort was investigated. In cooperation with the German Myasthenia Association, 2,150 patients with confirmed MG were asked to respond to a mailed questionnaire. The standardized questions related to demographic data, impairments, therapeutic course, use of complementary therapies, illness-related costs, and quality of life (SF-36). In total, 1,518 patients participated, yielding a response rate of 70.6%. The average age was 56.7 years, and the proportion of females 58.6%. Despite receiving recommended therapy, many patients still suffered from MG-related impairments. In particular, mobility and mental well-being were reduced; moreover, quality of life was markedly reduced. Stepwise linear regression analysis revealed illness stability, impairments, mental conditions, comorbid diseases, and employment to be determinants of QoL. Results indicate that despite prolonged life expectancy among MG patients, health-related quality of life is low. This outcome resulted mainly from impaired mobility and depression. Physical and mental well-being might be improved by additional therapy options. Additionally, health care resources could be used more efficiently in these patients.
    Health and Quality of Life Outcomes 11/2010; 8:129. · 2.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Progression in disability as measured by increase in the Expanded Disability Status Scale (EDSS) is commonly used as outcome variable in clinical trials concerning multiple sclerosis (MS). In this study, we addressed the question, whether there is a linear relationship between disability status and health related quality of life (HRQOL) in MS. 7305 MS patients were sent a questionnaire containing a German version of the "Multiple Sclerosis Quality of Life (MSQOL)-54" and an assessment of self-reported disability status analogous to the EDSS. 3157 patients participated in the study. Patients were allocated to three groups according to disability status. Regarding the physical health composite and the mental health composite as well as most MSQOL-54 subscales, the differences between EDSS 4.5-6.5 and EDSS > or = 7 were clearly smaller than the differences between EDSS < or = 4 and EDSS 4.5-6.5. These results indicate a non-linear relationship between disability status and HRQOL in MS. The EDSS does not seem to be interval scaled as is commonly assumed. Consequently, absolute increase in EDSS does not seem to be a suitable outcome variable in MS studies.
    Health and Quality of Life Outcomes 01/2010; 8:55. · 2.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Treadmill training is used in rehabilitation and is described as improving gait parameters of patients with Parkinson's disease. To assess the effectiveness of treadmill training in improving the gait function of patients with Parkinson's disease and the acceptability and safety of this type of therapy. We searched the Cochrane Movement Disorders Group Specialised Register (see Review Group details for more information) (last searched March 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to March 2009), and EMBASE (1980 to March 2009).We also handsearched relevant conference proceedings, searched trials and research registers, and checked reference lists (last searched March 2009). We contacted trialists, experts and researchers in the field and manufacturers of commercial devices. We included randomised controlled trials comparing treadmill training with no treadmill training in patients with Parkinson's disease. Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted the trialists for additional information. We analysed the results as standardised mean differences (SMDs) and mean differences (MDs) for continuous variables and relative risk differences (RD) for dichotomous variables. We included eight trials (203 participants) in this review. Treadmill training improved gait speed (SMD 0.50; 95% confidence interval (CI) 0.17 to 0.84; P = 0.003; I(2) = 0%) (fixed-effect model), stride length (SMD 0.42; 95% CI 0.00 to 0.84; P = 0.05; I(2) = 0%), walking distance (MD = 358 metres; 95% CI 289 to 426; P < 0.0001; I(2) = 30%), but cadence did not improve (MD 1.06; 95% CI -4.32 to 6.44; P = 0.70; I(2) = 0%) at the end of study. Treadmill training did not increase the risk of patients dropping out (RD -0.07; 95% CI -0.18 to 0.05; P = 0.26; I(2) = 51%) (random-effects model). Adverse events were not reported. Patients with Parkinson's disease who receive treadmill training are more likely to improve their impaired gait hypokinesia. However, the results must be interpreted with caution because there were variations between the trials in patient characteristics, the duration and amount of training, and types of treatment. Additionally, it is not known how long these improvements may last.
    Cochrane database of systematic reviews (Online) 01/2010; · 5.70 Impact Factor
  • Gesundheitswesen. 01/2010; 72.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients regard health care professionals as role models for leading a healthy lifestyle. Health care professionals' own behaviour and attitudes concerning healthy lifestyle have an influence in counselling patients. The aim of this study was to assess consumption of alcohol, cigarettes and illegal substances among physicians and medical students in two German states: Brandenburg and Saxony. Socio-demographic data and individual risk behaviour was collected by an anonymous self-administered questionnaire. Physicians were approached via mail and students were recruited during tutorials or lectures. 41.6% of physicians and 60.9% of medical students responded to the questionnaire; more than 50% of the respondents in both groups were females. The majority of respondents consumed alcohol at least once per week; median daily alcohol consumption ranged from 3.88 g/d (female medical students) to 12.6 g/d (male physicians). A significantly higher percentage of men (p < 0.05) reported hazardous or harmful drinking compared to women. A quarter of all participating physicians and one third of all students indicated unhealthy alcohol-drinking behaviour. The majority of physicians (85.7%) and medical students (78.5%) were non-smokers. Both groups contained significantly more female non-smokers (p < 0.05). Use of illegal substances was considerably lower in physicians (5.1%) than medical students (33.0%). Male students indicated a significantly (p < 0.001) higher level of illegal drug-use compared to female students. More than one third of the medical students and health care professionals showed problematic alcohol-drinking behaviour. Although the proportion of non-smokers in the investigated sample was higher than in the general population, when compared to the general population, medical students between 18-24 reported higher consumption of illegal substances.These results indicate that methods for educating and promoting healthy lifestyle, particularly with respect to excessive alcohol consumption, tobacco use and abuse of illegal drugs should be considered.
    BMC Health Services Research 12/2009; 9:219. · 1.77 Impact Factor
  • Aktuelle Neurologie 09/2009; 36(04):151-157. · 0.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As described in the Millennium Development Goals, malnutrition is one of the major obstacles to sustainable socioeconomic development and poverty reduction, especially in developing countries. These are first results from a cross- sectional study in Amppipal hospital (Gorkha District) which provides health care for about 200.000 inhabitants from Gorkha, Lamjung and Tanahun district. During first 5 months of data collection 950 children aged 0 to 15 years seek medical aid in Amppipal Hospital (57,75% male, 42,25% female children, missing percent= missing data). Data concerning Health Care provision during last attendance were available from 606 children. Reasons for present consultation: infectious diseases 51,2%, non-infectious diseases 21,40% , 14,5% injuries, perinatal conditions 1,2%, 5,0% other. Mostly they suffered from infectious diseases of the respiratory tract and gut (40,7% and 17.5% of all diagnosed infectious diseases). Reasons for seeking medical aid last time: 62,1% due to high fever, diarrhea or cough, 22,8% for immunization, 15% for other reasons. 29,1% of the 0 to 5 years and 18,9% of the 6- 15 years aged children suffered from a BMI below 3rd percentile. 48,8% of all children needed health care during the last 30 days and 48,8% between 1 month and 1 year ago. Providing meals during last illness by the mother: 0,4% more than usual, 24,0% about the same, 65,2% less than usual, 3,1% stopped food, 6,4% never gave food (exclusively breast feeding). The children mostly presented with infectious diseases and seek medical aid for similar health problems during the last year. A considerable number of children suffer from a serious low BMI. However, it is discussable, whether parents should be better informed about supporting prevention of infectious diseases and child`s reconvalescence by appropriate provision of fluid and food and if this can help to mitigate the vicious circle of malnutrition, morbidity and poverty.
    12th World Congress on Public Health World Health Organization; 04/2009
  • Source
    Sabine Twork, Joachim Kugler
    [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund: Obwohl Multiple Sklerose in Europa und Nord-Amerika die häufigste chronisch-entzündliche neurologische Erkrankung im jungen Erwachsenenalter ist, wurden populationsbezogene Studien zur Lebensqualität von Multiple-Sklerose-Betroffenen in Deutschland bisher vergleichsweise selten publiziert. Das Ziel der vorliegenden Studie bestand in der Erfassung der Lebensqualität und deren Einflussfaktoren aus der Sicht von Multiple-Sklerose-Betroffenen von vier Landesverbänden der Deutschen Multiple Sklerose Gesellschaft (DMSG). Methodik: Mittels schriftlicher Fragebogenerhebung wurde vom Lehrstuhl Gesundheitswissenschaften/Public Health der TU Dresden in Zusammenarbeit mit den DMSG-Landesverbänden Sachsen, Sachsen-Anhalt, Berlin und Nordrhein-Westfalen eine repräsentative Mitgliederbefragung durchgeführt. Zur Ermittlung von Prädiktoren für die Selbsteinschätzung der Lebensqualität wurden Regressionsanalysen angewandt. Ergebnis: Die verschiedenen Lebensqualitätsaspekte fielen in allen vier Landesverbänden recht niedrig aus. Als Ergebnis der multivariaten Analysen bestätigte sich der starke Einfluss krankheitsspezifischer (vor allem mobilitätseinschränkender), psychischer und finanzieller Faktoren auf das physische und psychische Wohlbefinden der Befragten. Ebenso bedeutend waren aber auch Versorgungs-und Zufriedenheitsaspekte der Teilnehmer. Schlussfolgerungen: Die Ergebnisse deuten auf wichtige Versorgungsaspekte bei der Betreuung von MS-Betroffenen hin, um deren Lebensqualität zu verbessern. Dabei sollten die interindividuell verschiedenen Erkrankungsabläufe, Symptomausprägungen und psychosozialen Folgen im Mittelpunkt stehen. Ein Ansatz zur Umsetzung wären Bemühungen im Rahmen der integrierten Versorgung. Background: Although, multiples sclerosis is a frequent neurological disease, population based studies concerning quality of life are quite rare in Germany. Aim of this study was to assess quality of life and its determinants in multiple sclerosis patients from four different federal groups of the German Multiple Sclerosis Association (GMSA). Methods: By means of a standardized questionnaire the Department of Public Health of the Technical University of Dresden in cooperation with the corresponding federal group of the GMSA conducted a representative survey. To evaluate determinants of quality of life, regression analysis was used. Results: The different areas of quality of life were quite low in all of the assessed patient groups. The regression analysis showed a strong influence of disease specific factors as well as psychological factors and those concerning finances, care and satisfaction on physical and mental well being. Conclusions: The results point to important aspects of care to improve quality of life of patients with multiple sclerosis. Therefore, the interindividual course of the disease, symptoms and psychosocial consequences should be in the center of care. A solution might be integrated care.
    Heilberufe 01/2009; 61:13-21.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To perform a systematic review about the effect of using clinical pathways on length of stay (LOS), hospital costs and patient outcomes. To provide a framework for local healthcare organisations considering the effectiveness of clinical pathways as a patient management strategy. As participants, we considered hospitalized children and adults of every age and indication whose treatment involved the management strategy "clinical pathways". We include only randomised controlled trials (RCT) and controlled clinical trials (CCT), not restricted by language or country of publication. Single measures of continuous and dichotomous study outcomes were extracted from each study. Separate analyses were done in order to compare effects of clinical pathways on length of stay (LOS), hospital costs and patient outcomes. A random effects meta-analysis was performed with untransformed and log transformed outcomes. In total 17 trials met inclusion criteria, representing 4,070 patients. The quality of the included studies was moderate and studies reporting economic data can be described by a very limited scope of evaluation. In general, the majority of studies reporting economic data (LOS and hospital costs) showed a positive impact. Out of 16 reporting effects on LOS, 12 found significant shortening. Furthermore, in a subgroup-analysis, clinical pathways for invasive procedures showed a stronger LOS reduction (weighted mean difference (WMD) -2.5 days versus -0.8 days)).There was no evidence of differences in readmission to hospitals or in-hospital complications. The overall Odds Ratio (OR) for re-admission was 1.1 (95% CI: 0.57 to 2.08) and for in-hospital complications, the overall OR was 0.7 (95% CI: 0.49 to 1.0). Six studies examined costs, and four showed significantly lower costs for the pathway group. However, heterogeneity between studies reporting on LOS and cost effects was substantial. As a result of the relatively small number of studies meeting inclusion criteria, this evidence base is not conclusive enough to provide a replicable framework for all pathway strategies. Considering the clinical areas for implementation, clinical pathways seem to be effective especially for invasive care. When implementing clinical pathways, the decision makers need to consider the benefits and costs under different circumstances (e.g. market forces).
    BMC Health Services Research 01/2009; 8:265. · 1.77 Impact Factor
  • Sabine Twork, Joachim Kugler
    Heilberufe 01/2009; 61:13-21.
  • Heilberufe 01/2009; 61:98-103.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Das Internet gewinnt sowohl für die Kommunikation zwischen Arzt und Patient als auch für die Suffizienz des Therapieprozesses eine immer größere Bedeutung. Patientenseiten im Internet können für die Durchsetzung solcher Konzepte wie Shared decision making und Empowerment entscheidend beitragen. Hierzu sind Qualitätsparameter auf der Grundlage bereits evaluierter Modellprojekte zu entwickeln, die eine hohe Qualität der Patienteninformation sicherstellen. Basierend auf Literaturangaben wurde ein zehnstufiges Scoringsystem entwickelt, mit dem zehn Homepages für Betroffene von Multipler Sklerose analysiert wurden. Die Analyse zeigt, wie wichtig es ist, bestimmte Qualitätsparameter und Qualitätszertifikate zur Grundlage für das Erstellen dieser Seiten zu machen und in den Mittelpunkt der allgemeinen Aufmerksamkeit zu stellen, damit sich Patienten daran zunehmend orientieren können. Over the last years, the importance of the internet concerning patient information and communication has increased. This tendency is especially seen among patients with multiple sclerosis (MS). However, in spite of its popularity the internet lacks of regulations with respect to quality and sufficiency for the medical communication process. There is a need for an evaluation of the quality of websites and for the development of quality tools. From the literature, a score consisting of 10 items was derived. Analysis of 10 internet sites of patient organizations from Germany revealed only a moderate quality of websites for patients with multiple sclerosis. The implementation of a mandatory certification for patient websites or of a general seal of quality should be discussed.
    Heilberufe 01/2009; 61:98-103.
  • PiD - Psychotherapie im Dialog 12/2008; 9(4):387-391.
  • PiD - Psychotherapie im Dialog 12/2008; 9(4):392-396.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Less is known about reasons for seeking medical aid for children and parental supportive behaviour in rural Nepal. These are first results from a cross-sectional study in the Amppipal hospital (Gorkha district) which provides health care for about 200.000 inhabitants from the Gorkha, Lamjung and Tanahun district. During that period 101 children aged 0 to 15 years presented there. Data concerning health care provision at the last attendance were available from 90 children averagely aged 4.0 years (56.7% male, 34.4% female children; missing percent = missing data). Reasons for seeking medical aid: 61.1% due to high fever, diarrhoea or cough, 6.7% for immunisation, 31.1% for other reasons. Time after recognising child's illness until care: 92.2% within 24 hours, 1.1% more than 24 hours. Providing fluids during last illness by the mother: 52.2% more than usual, 31.1% less than usual, 6.7% gave nothing to drink. Providing meals during last illness by the mother: 18.9% more than usual, 2.2 about the same, 37.8% less than usual, 23.3 stopped providing food, 1.1% never gave food (exclusively breast feeding). The children presented with typical health problems for that age, mostly with infectious diseases of the gut and respiratory tract accompanied by fever. However, it is discussable whether parents should be better informed about supporting child's reconvalescence by appropriate provision of food and fluid.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE AND METHODS: A complete vaccination status against infectious diseases is important for protecting health care professionals as well as patients. A survey based on a written questionnaire was conducted to record the actual vaccination status against diphtheria, hepatitis A und B, mumps, measles, poliomyelitis, rubella and tetanus. 642 general practitioners (family physicians and surgeons), 298 medical students and 962 nursing students from areas of eastern Germany completed the questionnaire. RESULTS AND CONCLUSIONS: There was no complete vaccination status against those diseases covered by the survey. Physicians had a good immunisation rate against tetanus (96.2%) and diphtheria (91.8%). The number of physicians without immunisation against measles (42.9%), HA (29.3%) and HB (12.7%) was unsatisfactory. Less than 50% of nursing students and medical students could show a complete vaccination status against MMR. In both student groups there were also gaps for vaccines against tetanus, diphtheria, HA and HB. Complete vaccination status was found to be in the range of 74-81% for tetanus, 51-66% for diphtheria, 47-63% for HA and 62-73% for HB. Furthermore, there is a need for actions to raise the immunisation rates and for improving the health protection for all persons involved (professionals and patients) in the health care system.
    Das Gesundheitswesen 08/2008; 70(7):408-14. · 0.62 Impact Factor
  • Aktuelle Neurologie - AKTUEL NEUROL. 01/2008; 35(2):70-80.
  • Das Gesundheitswesen. 01/2008; 70:408-414.

Publication Stats

126 Citations
25.59 Total Impact Points

Institutions

  • 2009–2011
    • Carl Gustav Carus-Institut
      Pforzheim, Baden-Württemberg, Germany
  • 2007–2010
    • Technische Universität Dresden
      • Institut für Medizinische Informatik und Biometrie
      Dresden, Saxony, Germany
  • 2007–2008
    • Hospital Dresden-Friedrichstadt
      Dresden, Saxony, Germany