[Psychiatric comorbidities with tobacco-related disorders]. / Psychiatrische Komorbiditäten bei tabakbedingten Störungen.

The coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.

[Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency]. / Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit.

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

[Qualification offers in geropsychology. A baseline study]. / Qualifikationsmöglichkeiten im Fachgebiet Gerontopsychologie. Empirische Bestandsaufnahme.

BACKGROUND: The increased need for professional expertise in the domain of aging is accompanied by a lack of academic experts in geropsychology. MATERIALS AND METHODS: In order to analyze whether German universities, universities of applied science, and psychotherapy training institutions produce a sufficient number of graduates, two studies were conducted. RESULTS: A complete survey of all courses and modules (study 1) identified only 4 master courses (9.3 %) and no bachelor courses with a substantial focus on geropsychology. All gerontology courses hold a substantial focus on geropsychology; however, only 6 courses are available (5 master, 1 bachelor). In an online survey (study 2) 55 % of the N = 103 psychotherapy training institutions (58 % response rate) stated that they offer geropsychology classes, though only to an average extent of M = 12.7 lessons (≙ 2 % of the required theory lessons). CONCLUSION: There is urgent need to expand the number of graduates with academic education and clinical training in geropsychology and -psychotherapy.

[Smoking cessation in patients with COPD]. / Tabakentwöhnung bei COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Cigarette smoking is the main cause of COPD. Quitting smoking is thus the most effective treatment strategy and central in COPD prevention. A number of guidelines on prevention, diagnosis, therapy and rehabilitation of COPD have been published. To help implementing and standardizing smoking cessation in COPD a guideline was published 2008 in Germany focusing on this complex issue. The present guideline is an update of the 2008 guideline and has a high grade of evidence (S3 according to the AWMF; Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften). The guideline gives comprehensive and practical information on how to integrate smoking cessation as an central part of COPD therapy.

[German Network for Tobacco-Free Hospitals & Health-Care Services]. / Das Deutsche Netz Rauchfreier Krankenhäuser & Gesundheits-einrichtungen (DNRfK).

The DNRfK (German Network for Tobacco-Free Hospitals & Health-Care Services) is based on the Code of the ENSH-Global Network for Tobacco-Free Health-Care Services. To evaluate the project, a total survey of network members using an online questionnaire (78 items) was carried out (n=181; 67.4% response rate). At the time of the recording period, 17% achieved the silver level of certification, 43% the bronze level and 40% had not been certified. Various smoking cessation methods are offered (motivational interviewing, 47%; brief interventions, 45%; individual counselling, 45%). Smokers received pharmacological support in 63% of the hospitals. Smoking cessation services are mainly carried out by physicians (63%), nursing staff (51%) and psychologists (51%). Guideline-oriented smoking cessation is offered by 36% of participants (69% silver level, 33% bronze level, and 32% in clinics without certification). The Code has been widely accepted and, consequently, well implemented by members. The quality of the tobacco control measures and evidence-based smoking cessation treatments increases with duration of membership and certification level or is validated through this. Some deficiencies were found with respect to training-the-trainer qualifications and follow-up measurements.

Scattering cancellation of the magnetic dipole field from macroscopic spheres.

Based on the scattering cancellation technique we suggest a cloak that allows to conceal macroscopic objects, i.e. objects with an optical size comparable to wavelengths in the visible and whose scattering response is dominated by a magnetic dipole contribution. The key idea in our approach is to use a shell of polaritonic spheres around the object to be cloaked. These spheres exhibit an artificial magnetism. In a systematic investigation, where we progressively increase the complexity of the considered structure, we devise the requirements imposed on the shell and outline how it can be implemented with natural available materials.

Omalizumab versus 'usual care': results from a naturalistic longitudinal study in routine care.

BACKGROUND: It is unclear how far the superior efficacy of omalizumab, established in randomized controlled clinical trials of patients with severe allergic asthma (SAA), translates into routine practice and when compared to matched controls. METHODS: New-onset omalizumab-treated (OT) patients with SAA (n = 53) were compared to a matched control group of usual-care (UC) patients (n = 53). Treatment and procedures were naturalistic. Subsequent to a baseline assessment, patients were followed up over at least 6 months with at least two follow-up assessments. Primary clinical outcomes were the number of asthma attacks, persistence of asthma symptoms and degree of control [asthma control test (ACT), Global Initiative for Asthma]. Secondary outcome criteria were quality of life (Euro-Qol 5D) and number of medications. For each outcome we compared within-group effects from baseline to 6-month follow-up as well as between-group effects. RESULTS: OT patients showed significant improvements in number [effect size (ES) = 0.03] and frequency (ES = 0.04) of asthma attacks as well as asthma control (ES = 0.09), whereas controls revealed no significant improvements in these measures. Further improvements in the OT group were found for 'perceived control always' (ACT, p = 0.006), no impairment (ACT, p = 0.02), reduction of sickness days (p = 0.002) and number of medications needed (p = 0.001). CONCLUSIONS: Substantial beneficial effects of omalizumab, similar to those observed in controlled trials and after marketing studies, were confirmed, particularly with regard to the reduction of asthma attacks, persistence of symptoms, asthma control and reduction of concomitant asthma medications. This study provides a tougher test and generalizable evidence for the effectiveness of omalizumab in routine care.

Optical properties of a fabricated self-assembled bottom-up bulk metamaterial.

We investigate the optical properties of a true three-dimensional metamaterial that was fabricated using a self-assembly bottom-up technology. The metamaterial consists of closely packed spherical clusters being formed by a large number of non-touching gold nanoparticles. After presenting experimental results, we apply a generalized Mie theory to analyze its spectral response revealing that it is dominated by a magnetic dipole contribution. By using an effective medium theory we show that the fabricated metamaterial exhibits a dispersive effective permeability, i.e. artificial magnetism. Although this metamaterial is not yet left-handed it might serve as a starting point for achieving bulk metamaterials by using bottom-up approaches.

[Smoking cessation in patients with COPD: the status of routine care in Germany]. / Tabakentwöhnung bei COPD-Patienten und -Patientinnen: Zur Versorgungssituation in Deutschland.

Almost every second heavy-smoker (> 20 Cig./day) develops a COPD after long-term tobacco use. Cigarette smoking is not only the leading cause of COPD, but also the most important predictor for an unfavourable prognosis. Inversely, quitting smoking can enhance the disease course as well as the lung function of patients suffering from COPD more effectively than any other treatment. Currently, a wide range of evidence-based psychological and pharmacological smoking cessation treatments exists including disease-specific therapy approaches. However, professional smoking cessation treatments are used only rarely in health-care routine. This fact is due to persisting deficits in the German health-care system: With the exception of pharmacological therapy approaches and some telephone or online counselling programmes, smoking cessation treatments are not generally available. In the future, one should keep a sharp eye on the permanent motivation of COPD patients to quit smoking totally and to establish disease-specific smoking cessation programmes in routine care.

Pharmaceutical care services for asthma patients: a controlled intervention study.

As asthma is associated with an enormous social, psychological, and economic burden, various patient education programs have been developed to improve outcomes, including quality of life. The authors evaluated the effectiveness of community pharmacy-based interventions on lung function, health-related quality of life, and self-management in asthma patients in a 12-month controlled intervention study in 26 intervention and 22 control pharmacies. Pharmacies opted whether to take part as intervention or control pharmacies. According to this, patients (ages 18-65) with mild to severe asthma attending the pharmacies were allocated to the intervention (n = 161) or control group (n = 81), respectively. Intervention patients were educated on their disease, pharmacotherapy, and self-management; inhalation technique was assessed and, if necessary, corrected. Pharmaceutical care led to significantly improved inhalation technique. Asthma-specific quality of life and the mental health summary score of the SF-36 improved significantly in the intervention group. At 12 months, the intervention group showed significant improvements with regard to evening peak flow, self-efficacy, and knowledge.

Controlled and uncontrolled allergic asthma in routine respiratory specialist care - a clinical-epidemiological study in Germany.

BACKGROUND: Studies in the last decade showed high rates of poorly treated and poorly controlled asthma in the community. Extending these findings we describe the more recent situation in specialist respiratory care as the most frequent source of treatment provision using comprehensive clinical and patient assessments and exploring predictors for poor control. METHODS: This is a German cross-sectional, clinical epidemiological study in a nationally representative stratified treatment prevalence sample of N = 572 outpatients diagnosed with allergic asthma (AA; females 58.2%, aged 47.5 ± 16.3 (16-81 years). Treating physicians completed standardized clinical assessments (lung function, laboratory, clinical findings, severity, illness and treatment history, asthma control [GINA]), supplemented by patients' self-report measures (EQ5-D, AQLQ, ACT) and mental health module (CIDI-SF). RESULTS: A total of 65.4% of patients were rated (GINA) as controlled, 30.3% partially controlled, and 4.4% uncontrolled; the patient-rated ACT showed lower rates of control (19.9% controlled, 44.2% partial, 35.8% uncontrolled, kappa: 0.2). Consistent with findings of clinical measures, controlled asthma was highest among patients with pre-treatment stage I severity (83.6%) and decreased by pre-treatment severity (stage IV patients: 29.3%). Poorer control was associated with pre-treatment severity, nocturnal attacks, diminished adherence and comorbid anxiety/depression. Patients received complex multiple drug and non-drug interventions, largely consistent with guidelines. Degree of asthma control was associated with improved and even normalized quality of life findings. CONCLUSION: In this representative sample of longterm treated AA patients in specialist respiratory care we find better control rates and better adherence to guidelines as previous studies. Despite remarkable differences in clinician- vs patient-rated control ratings even the initially most severe stage IV patients (12.9% of patients) showed remarkable control rates and close to normal quality of life. Intensified treatment (e.g. omalizumab) was associated with improved control. Poorer control was associated with higher initial severity, diminished adherence, comorbid anxiety/depression and old age. LIMITATION: Findings apply to AA patients in respiratory specialist care sector which is likely to treat the more severely affected patients. Thus, findings cannot be generalized to the general population, other treatment settings or asthma types.

[Idiopathic abdominal pain in children: results, deficits and perspectives of empirical research]. / Idiopathischer Bauchschmerz im Kindesalter. Ergebnisse, Defizite und Perspektiven empirischer Forschung.

Recurrent abdominal pain (RAP) is one of the most common pain syndromes in childhood, with prevalence rates ranging from 10 to 20% in all school-age children. In nearly 50% the complaints persist over many years of their life-span to adolescence or adulthood. Although the empirical findings have increased in the last decade, our knowledge about the etiology, pathogenesis, and pathophysiology is still very limited. Current approaches suggest that we understand recurrent pain syndromes as a complex and multidimensional disturbance (biopsychosocial paradigm). In this respect there is strong evidence for the major importance of psychosocial causes (daily hassles, specific life events), psychopathological factors (anxiety, depression, somatization disorder), and social environmental influences (mother's psychopathology, social modelling, reinforcement) in the pathogenesis of functional abdominal pain. The noticeable correlation with other pain syndromes and functional disturbances indicates that recurrent pain may possibly be a manifestation of a basic somatization disorder. The unfavourable long-term prognosis supports the need for early and specific interventions. Psychological treatment requires a medical examination to exclude organic origins. Some of these invasive diagnostic procedures can be very difficult, expensive and distressing for the child. Behavioural medicine is based upon having an extensive family history and symptom analysis. The psychological interventions applied in clinical practice include prophylaxis, reduction of pain symptoms and environmental modification. In recent years there has been an increasing trend to create more complex and multidimensional behavioural treatment programs for children. Although preliminary data on the use of these behavioural medicine programs have shown some promise, further investigations are needed to examine the applicability and effectiveness of specific interventions in the treatment of abdominal pain symptoms.

[Illness specific data collection on quality of life of patients with asthma and chronic obstructive bronchitis]. / Krankheitsspezifische Erhebungsverfahren zur Lebensqualität bei Patienten mit Asthma und chronisch-obstruktiver Bronchitis.

Resource allocation in health care and rehabilitation has been increasingly influenced by medical outcome studies. In recent years, the importance of health-related quality of life (HRQOL) in the evaluation of medical care and intervention practice has been widely acknowledged. In particular for chronic diseases like asthma or COPD the multi-dimensional concept of quality of life (QOL) has adopted the role of an essential outcome parameter. Instruments used to measure QOL can be categorised as one of two types: a) generic instruments which assess overall QOL and b) disease-specific questionnaires which focus on specific aspects related to a particular disease. Over the last two decades more than 1,000 QOL-instruments have been developed, including nearly 20 disease-specific inventories for patients with chronical lung diseases. In clinical practice, both generic and specific questionnaires are used to assess quality of life in patients with asthma and COPD. Disease-specific QOL-instruments are considered to be more sensitive in establishing the specific restrictions related to asthma or COPD and in detecting possible improvements in QOL after treatment. To exemplify its properties, limitations, and special methodological issues, we chose two of the most widely used and well-validated disease-specific quality of life inventories: the "St. George Hospital Respiratory Questionnaire (SGRQ)" and the "Fragebogen zur Lebensqualität bei Asthma (FLA)". The FLA, representing the German revision of the "Living with Asthma Questionnaire (LAQ)" (Hyland et al., 1991), has been one of the first questionnaires available for measuring disease specific quality of life (QOL) in adults with asthma. The FLA contains 40 items in three dimensions ("physical symptoms", "functional status", "psychological distress"). The SGRQ (Jones et al., 1991) is a standardized questionnaire for measuring health related restrictions and quality of life in patients with chronical lung disease. In contrast to LAQ/FLA the SGRQ can be used both for patients with asthma and COPD. It includes 76 items, divided in three subscales ("symptoms", "activity", and "impacts") permitting to calculate different summary scores as well as a total score. Both questionnaires appear to be reliable, valid and efficient for the assessment of QOL in patients with asthma or COPD, and may facilitate decision making in the treatment process. On the other hand there are some unsolved methodological problems requiring further investigations and improvements in this research area.

[Lower Saxony/Bremen Scientific Rehabilitation Research Group]. / Rehabilitationswissenschaftlicher Forschungsverbund Niedersachsen/Bremen (RFNB).

The Network for Rehabilitation Research Niedersachsen/Bremen (RFNB) combines the competencies of different disciplines and regional agents/institutions in the field of rehabilitation, hence creating a network of interdisciplinary rehabilitation research to support the further development of research methodology, to initiate studies whose results can be fed back to practice and be used for education and further qualification. The current research projects of the RFNB are focussing on outcome parameters such as prediction, optimization of interventions and costs in successful rehabilitation.

["Questionnaire on Quality of Life in Asthma"--studies of the dimensionality and references for evaluation]. / Der "Fragebogen zur Lebensqualität bei Asthma" (FLA)--Untersuchungen zur Dimensionalität und Hinweise zur Auswertung.

The FLA, representing the German revision of the LWAQ (Hyland et al., 1991), is one of the few available questionnaires for measuring the disease-specific quality of life (QOL) in adults suffering from asthma. The present study aimes at analysing the structure and reliability of the FLA and also at improving its feasibility. Therefore, the inventory has been analysed in terms of its dimensional structure, internal reliability, and homogeneity. To facilitate the interpretation of the test outcomes and to obtain more differentiated predictors, the 40 items of the FLA were--according to theoretical considerations--categorised into three dimensions ("Physical Symptoms", "Psychological Distress" and "Functional Status"). In this study the FLA was applied with a sample of 136 hospitalised asthma patients of varying severity (63 male, 73 female, meanage; 49.5 years) in the North German "Allergie- und Asthmaklinik Wilhelm Gronemeyer, Bad Lippspringe, to evaluate the reliability of the total scale and its dimensions. The findings of the item analysis with regard to selectivity and item difficulty yielding satisfying results are presented in multiple tables. Furthermore, recommendations for the transformation of original values into summary scores and evaluation procedures were developed to improve the strength of evidence in the data. The summary scores, which can be computed for both total scale and the three dimensions, facilitate intra- and interindividual comparison of the patients' quality of life and point to special deficits in different QOL domains requiring specific therapeutic interventions. Finally, the FLA's range of application, its limitations, developmental perspectives and proposals for improvement are discussed.

[In-patient asthma education and self-management training in clinical practice--a national survey in Germany]. / Zur Praxis der stationären Asthmaschulung in der Bundesrepublik Deutschland - eine bundesweite Bestandsaufnahme.

BACKGROUND: According to international guidelines patient education is a key component of modern asthma-management. Especially in rehabilitation, patient training is considered essential for long-term treatment success. Based on growing empirical evidence for clinical efficacy of asthma self-management training, standardized education programs as well as guidelines and recommendations for quality management in health care practice have been developed. AIM: Due to the lack of evidence [empirical data] on compliance to these recommendations we conducted a nation-wide survey including in-patient pneumological clinics in Germany. METHODS: Exploiting address registers of national asthma organizations (i. e. Deutsche Atemwegsliga) we identified 75 clinics that offer education programs on a regular basis, 65 of which participated in this study (drop-out-rate: 12 %). These institutions were asked to complete a questionnaire in order to assess various aspects of their education practice. RESULTS: Although 91 % of clinics reported to adhere to guidelines and recommendations for patient education, merely 50 % supplied standardized and evaluated education and self-management training programs. A rather small proportion (19 %) was found to fully adhere to protocol (maximum treatment integrity, no mixing of different education schemes). Furthermore, substantial variance between clinics was observed in actual performance of asthma education, the major indicators being: indication criteria and eligibility of patients; education contents; group size, duration and frequency of sessions; extent and intensity; didactical methods; number and qualification of trainers; measures of quality management, and settings. Accordingly, a consistent standard of patient education in rehabilitation practice has not yet been achieved. CONCLUSION: While substantial advances in the proposition of patient education and self-management trainings in in-patient health care remain unquestioned, there are some deficits in actually performing such programs in clinical practice. Results also show that another question needs to be addressed: qualifying trainers. Less than half of trainers participating in this study reported to have absolved a train-the-trainer-course.