[Attitudes and Expectations of Psychological and Medical Psychotherapists Towards Open Notes: Analysis of Qualitative Survey Responses]. / Einstellungen und Erwartungen von psychologischen und ärztlichen Psychotherapeut*innen gegenüber Open Notes: Analyse qualitativer Survey-Antworten.

OBJECTIVE: This study explores attitudes and expectations of psychotherapists (PT) towards the introduction of digital patient access to clinical notes ("Open Notes"; ON)), including the advantages and disadvantages in psychotherapeutic practice. METHODS: As part of the PEPPPSY study, an online survey was conducted. Free text responses (n = 107) were qualitatively analysed using thematic analysis. RESULTS: 129 psychological and medical PT took part in the survey. PT saw advantages such as transparency and patient-centred documentation, but feared disadvantages for the therapeutic relationship and an increased workload through the implementation of ON. Concerns were raised about data security and negative effects on treatment. Recommendations for implementation include patient-specific access adaptations and guided access. CONCLUSION: PT are ambivalent about ON. Further research and guidelines for the use of ON in psychotherapy are needed.

Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study.

BACKGROUND: Over the past few years, online record access (ORA) has been established through secure patient portals in various countries, allowing patients to access their health data, including clinical notes ("open notes"). Previous research indicates that ORA in mental health, particularly among patients with severe mental illness (SMI), has been rarely offered. Little is known about the expectations and motivations of patients with SMI when reading what their clinicians share via ORA. OBJECTIVE: The aim of this study is to explore the reasons why patients with SMI consider or reject ORA and whether sociodemographic characteristics may influence patient decisions. METHODS: ORA was offered to randomly selected patients at 3 university outpatient clinics in Brandenburg, Germany, which exclusively treat patients with SMI. Within the framework of a mixed methods evaluation, qualitative interviews were conducted with patients who chose to participate in ORA and those who declined, aiming to explore the underlying reasons for their decisions. The interviews were transcribed and analyzed using thematic analysis. Sociodemographic characteristics of patients were examined using descriptive statistics to identify predictors of acceptance or rejection of ORA. RESULTS: Out of 103 included patients, 58% (n=60) wished to read their clinical notes. The reasons varied, ranging from a desire to engage more actively in their treatment to critically monitoring it and using the accessible data for third-party purposes. Conversely, 42% (n=43) chose not to use ORA, voicing concerns about possibly harming the trustful relationship with their clinicians as well as potential personal distress or uncertainty arising from reading the notes. Practical barriers such as a lack of digital literacy or suspected difficult-to-understand medical language were also named as contributing factors. Correlation analysis revealed that the majority of patients with depressive disorder desired to read the clinical notes (P<.001), while individuals with psychotic disorders showed a higher tendency to decline ORA (P<.05). No significant group differences were observed for other patient groups or characteristics. CONCLUSIONS: The adoption of ORA is influenced by a wide range of motivational factors, while patients also present a similar variety of reasons for declining its use. The results emphasize the urgent need for knowledge and patient education regarding factors that may hinder the decision to use ORA, including its practical usage, its application possibilities, and concerns related to data privacy. Further research is needed to explore approaches for adequately preparing individuals with SMI to transition from their inherent interest to active engagement with ORA. TRIAL REGISTRATION: German Clinical Trial Register DRKS00030188; https://drks.de/search/en/trial/DRKS00030188.

Cooling-induced expansions of Afromontane forests in the Horn of Africa since the Last Glacial Maximum.

Understanding the changing plant ecosystems that existed in East Africa over the past millennia is crucial for identifying links between habitats and past human adaptation and dispersal across the region. In the Horn of Africa, this task is hampered by the scarcity of fossil botanical data. Here we present modelled past vegetation distributions in Ethiopia from the Last Glacial Maximum (LGM) to present at high spatial and temporal resolution. The simulations show that, contrary to long-standing hypotheses, the area covered by Afromontane forests during the Late Glacial was significantly larger than at present. The combined effect of low temperatures and the relative rainfall contribution sourced from the Congo Basin and Indian Ocean, emerges as the mechanism that controlled the migration of Afromontane forests to lower elevations. This process may have enabled the development of continuous forest corridors connecting populations that are currently isolated in mountainous areas over the African continent. Starting with the Holocene, the expansion of forests began to reverse. This decline intensified over the second half of the Holocene leading to a retreat of the forests to higher elevations where they are restricted today. The simulations are consistent with proxy data derived from regional pollen records and provide a key environmental and conceptual framework for human environmental adaptation research.

Honey-collecting in prehistoric West Africa from 3500 years ago.

Honey and other bee products were likely a sought-after foodstuff for much of human history, with direct chemical evidence for beeswax identified in prehistoric ceramic vessels from Europe, the Near East and Mediterranean North Africa, from the 7th millennium BC. Historical and ethnographic literature from across Africa suggests bee products, honey and larvae, had considerable importance both as a food source and in the making of honey-based drinks. Here, to investigate this, we carry out lipid residue analysis of 458 prehistoric pottery vessels from the Nok culture, Nigeria, West Africa, an area where early farmers and foragers co-existed. We report complex lipid distributions, comprising n-alkanes, n-alkanoic acids and fatty acyl wax esters, which provide direct chemical evidence of bee product exploitation and processing, likely including honey-collecting, in over one third of lipid-yielding Nok ceramic vessels. These findings highlight the probable importance of honey collecting in an early farming context, around 3500 years ago, in West Africa.

[Long-term outcome of disorder-specific group therapy for multisomatoform disorders: a 3-year follow-up study]. / Langzeitverlauf nach störungsorientierten Kurzgruppeninterventionen bei somatoformen Störungen mit multiplen Körperbeschwerden: Eine 3-Jahres-Katamnese

Little is known about the long-term effectiveness of disorder-specific group interventions for somatoform disorders. In total 128 patients with somatoform disorders who had participated in 2 different 8-week outpatient group programs (cognitive-behavioral therapy or progressive muscle relaxation) were questioned at baseline and at the end of treatment. On average, there was a follow-up after 6 months and after 3 -years (3-year follow-up response rate: 63.3%). Both interventions were combined for long-term analysis as there were no substantial differences. In 2.5% of cases a possible medical cause was found for complaints originally considered as somatoform. A short disorder-specific group intervention achieved small effect sizes (range: 0.14-0.40; ITT-sample range: 0.06-0.33) in the long term; about 30% of patients can be considered responders. Further efforts are needed to improve the treatment of patients with somatoform disorders.