Basic Civil Engineering notes on Transportation Engineering & Modes of Transport
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1. Public Health – Dresden Medical School
Complementary care seeking behavior
in patients with Myasthenia gravis
J. Klewer 1, L. Wondzinski 1, A. Friedrich 1,
R. Amman 2, D. Pöhlau 3, J. Kugler 1
1 Public Health, Dresden Medical School, Dresden , Germany
2 German Myasthenia Association, Bremen, Germany
3 Dept. of Neurology, Kamillus-Hospital, Asbach, Germany
2. Public Health – Dresden Medical School
Myasthenia gravis
Incidence:
2-20 per 1 Mio. residents
Prevalence:
50-100 per 1 Mio. residents
Autoimmune disease caused by antibodies
Defect in neuromuscular transmission with
muscle weakness and fatigue
3. Public Health – Dresden Medical School
Myasthenia gravis - Symptoms
Age at onset: 20-40 years
In 60-80% of the patients associated with thymomas
Often: initial weakness of ocular muscles (ptosis, diplopia)
Facial muscle weakness; speech, chewing and swallowing
difficulties
The patterns of muscle involvement varies between
individuals; heterogeneous progress of the muscle
weakness (limb weakness, respiratory muscle weakness)
4. Public Health – Dresden Medical School
- Spontaneous remission rate in 20% of the patients.
- In the past: 30% of the patients died within 3 years.
- Today: Around 5% of the patients deteriorate and die (mainly
due to wrong therapies)
- With therapy: Normal life expectancy & fit for work !
Myasthenia gravis – Therapy und Prognosis
- Immunosuppression (i.e. Prednisolone, Azathioprine)
- Anticholinesterase treatment (i.e. Pyridostigmine)
- Thymectomy (Thymoma)
5. Public Health – Dresden Medical School
Study aims
Studies evaluating medical care and quality of life
in German Myasthenia gravis patients are still lacking:
? Demographical data of German M.g. patients ?
? M.g. related complaints and disabilities ?
? Therapeutical course ? By whom ?
? Financial burdens due to M.g. ? In detail ?
? Inasmuch M.g. patients seek for CAM ?
? Relations between request for CAM and subjective
quality of life ?
??
6. Public Health – Dresden Medical School
Questionnaire-based study in collaboration with the
“German Myasthenia Association”, the self-help
organization for M.g. patients in Germany.
2150 M.g. patients living in Germany and suffering
from confirmed M.g. were asked to work on a mailed
anonymous questionnaire.
A cover letter and pre-paid envelope to return the
questionnaire have been included.
Methods
Response rate 70,6% (n = 1518)
7. Public Health – Dresden Medical School
Methods
Self-completed questionnaire:
Demographical data data
Physical complaints/ disabilities
Therapeutical course
M.g. related financial burden
Use of CAM
Quality of life (SF –36, Analogue-scale)
8. Public Health – Dresden Medical School
Sample
Sample (n = 1518)
Age 56.7 years [3-94 years]
Gender f = 60.7% m = 39.3%
Marital status
single = 13.1%
married = 66.3%
divorced = 7.1%
widowed = 10.6%
Household – net income Median: 1600 USD [70-50.000 USD]
Health insurance statutory health insurance = 87%
Years since M.g. onset 12.9 years [0-68 years ]
Years since diagnosis of M.g. 10.2 years [0-53 years ]
9. Public Health – Dresden Medical School
Patients seeking for CAM
Spent money for non-medical practitioners
Reported treatment by non-medical
practitioners
Spent money for CAM
Admitted use of CAM
10. Public Health – Dresden Medical School
Samples - Differences
No CAM
(n = 1055)
CAM
(n = 463)
Statistical
difference
Age 57.3 years 55.3 years p = .030
Gender f = 55.5% m = 45.5% f = 73.2% m = 27.8% p = .000
Marital status
single = 12.4%
married = 70.2%
divorced = 5.9%
widowed = 10.3%
single = 15.3%
married = 60.9%
divorced = 10.3%
widowed = 11.8%
p = .005
M.g. onset 11.9 years ago 15.3 years ago p = .000
Diagnosis of M.g. 9.5 years ago 11.8 years ago p = .000
Age (diagnosis) 47.9 years ago 43.5 years ago p = .000
No differences: Place of residency (small/ big towns), Net income,
Secondary school qualification
11. Public Health – Dresden Medical School
Symptoms – Differences *
No CAM
(n = 1055)
CAM
(n = 463)
Statistical
difference
Muscle weakness (during/
after physical strain)
75.9% 82.5% p = .011
Arm/ hand weakness 71.3% 76.7% p = .024
Walking difficulties 70.3% 75,2% n.s.
Swallowing difficulties 43.9% 51.0% p = .045
Chewing difficulties 37.1% 49.3% p = .000
Problems with defecation 39.1% 45.2% n.s.
Ptosis 38.7% 45.5% p = .037
* Multiple answers possible
12. Public Health – Dresden Medical School
Symptoms – Differences *
No CAM
(n = 1055)
CAM
(n = 463)
Statistical
difference
Diplopia 35.1% 47.7% p = .000
Head drooping 29.4% 40.9% p = .000
Speech difficulties 29.7% 39.4% p = .039
Reduced facial expression 26.4% 36.8% p = .000
Difficulties to urinate 27.2% 27.7% n.s.
Sexual problems 20.9% 24.1% n.s.
Muscle weakness (without
strain)
19.4% 20.7% n.s.
* Multiple answers possible
13. Public Health – Dresden Medical School
Therapists *
* Multiple answers possible
No CAM
(n = 1055)
CAM
(n = 463)
Statistical
difference
Neurologist (medical practice) 62.2% 60.3% n.s.
General practitioner/
Family doctor
49.5% 52.7% n.s.
Hospital doctors 38.9% 38.7% n.s.
Physician (medical practice) 16.4% 16.8% n.s.
Physiotherapists 8.2% 17.7% p = .000
Non-medical practitioner - 13.8% -
No differences: Annual visits at the doctor
14. Public Health – Dresden Medical School
No CAM
(n = 1055)
CAM
(n = 463)
Statistical
difference
Anticholinesterase
treatment
95.8% 94.9% n.s.
Azathioprine 78.7% 78.3% n.s.
Steroids 65.8% 65.2% n.s.
Thymectomy 56.4% 62.2% n.s.
Immunglobulines 18.7% 23.1% n.s.
Plasmapheresis/
Immunoadsorption
16.5% 15.5% n.s.
Therapies *
* Multiple answers possible
15. Public Health – Dresden Medical School
No CAM
(n = 1055)
CAM
(n = 463)
Statistical
difference
non 22.7% 10.4%
p = .000
up to 25 USD/ month 35.3% 17.8%
up to 50 USD/ month 20.7% 25.8%
up to 250 USD/ month 17.2% 34.4%
Up to 500 USD/ month 3.4% 8.7%
More than 500 USD/ month 0.8% 2.9%
Amount of money spent due to Myasthenia gravis
No correlation between net income
and amount of money spent !
16. Public Health – Dresden Medical School
No CAM
(n = 1055)
CAM
(n = 463)
OTC-drugs 10 USD (2-175 $) 10 USD (3-200 $)
pain killer 5 USD (1-200 $) 7,5 USD (2-100 $)
homeopathic/
alternative drugs
-- 15 USD (5-500 $)
physiotherapy/
occupational therapy
20 USD (3-250 $) 20 USD (5-300 $)
alternative treatments -- 42 USD (5-400 $)
Taxi/ Transportation 30 USD (3-350 $) 30 USD (3-300$)
Actual illness related amount of money spent per month*
* Multiple answers possible
17. Public Health – Dresden Medical School
Used CAM methods
vitamins = 38.7% specific diets = 10.6%%
homeopathy = 32.8% electromagnetism = 6.6%
antioxidant substances = 28.7%
acupuncture = 28.7% (magic) crystals = 4.5%
heavy metal detoxification = 9.9%
18. Public Health – Dresden Medical School
Quality of life (Analogue-scale)
CAM No CAM
0
10
20
30
40
50
60
70
80
90
100
**
healthy
references
19. Public Health – Dresden Medical School
Quality of life (SF-36)
physical physical bodily general vitality social emotional mental
0
10
20
30
40
50
60
70
80
90
100
No CAM CAM
**
**
**
** **
***
**
***
functioning functioning
role role
health
pain health
20. Public Health – Dresden Medical School
Conclusions
The investigated M.g. patients seeking for CAM
included more females and suffered significantly
longer from M.g. !
Especially increased disabilities and reduced quality of life
were associated with use of CAM !
Successful managed care in M.g. patients depends not only
on evidence-based therapies but also on additional
measures improving quality of life !
Patients seeking for CAM require intensified attention to
improve their physical situation and quality of life !
