Erratum: Six Nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations - ERRATUM.

[This corrects the article DOI: 10.1192/bji.2022.16.].

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations.

This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted.

Suicide in Older Prisoners in Germany.

As in many countries, the numbers of older prisoners are rising in Germany, but scientific information on this group is scarce. For the current study, a survey was used that included all prison suicides in Germany between the years of 2000 and 2013. Suicide rates of the elderly prisoners exceeded the suicide rates of the general population and the same age group. We observed a continuous decrease in the suicide rate of elderly prisoners. When compared to the younger suicide victims in prison, significantly more elderly suicide victims were: female, of German nationality, remand prisoners, or serving a life sentence. In Germany, elderly prisoners are a vulnerable subpopulation of the prison population. Higher suicide rates than in the same age group in the general population indicate unmet needs regarding mental disorders and their specific treatment.

Prison suicide in female detainees in Germany 2000-2013.

Specific risk factors for suicide among female prisoners were examined using an exhaustive sample of all suicides in German prisons between 2000 and 2013. The rate of prison suicide was lower among female (53,5/100,000) than among male prisoners (101/100,000). Differences between the genders regarding the various risk factors for prison suicide are few. Significant differences were observed only for bullying among men and higher percentages of drug withdrawal syndrome among women. Factors specific to the prison setting that contribute to suicide risk in incarcerated women should be examined.

Paraphilias.

PURPOSE OF REVIEW: The concept of paraphilia still carries an 'unwanted burden' of sexual norms because the pathologization of some sexual practices as paraphilic disorders is still based on the assumption that normal sexuality should be genitally organized with the aim of reproduction. The aim of this review is to give an impression of the ongoing discussion about the changes introduced with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the results of recent research in this area. RECENT FINDINGS: The release of DSM-5 in the spring of 2013 introduced a distinction between paraphilias and paraphilic disorders, implying a destigmatization of consenting adults engaging in unusual sexual behaviour. According to DSM-5 diagnostic criteria, paedophilic disorder is the only paraphilic disorder without an 'in remission' and an 'in a controlled environment' specifier. Today, antiandrogen treatment is offered to sex offenders in many countries as an additional treatment strategy alongside psychotherapy. SUMMARY: The introduction of DSM-5 offers the possibility to distinguish between paraphilia and paraphilic disorders. The aetiology of paraphilias is still unknown. Paraphilias are much more common in men than in women, but the reasons for this difference remain unknown. So far there is no clear consent on the best therapeutic approach for a paraphilic disorder.

Prison suicides in Germany from 2000 to 2011.

In many countries, suicide is the most frequent cause of prison deaths; moreover, the respective national penal suicide rates are consistently several times higher than the suicide rates in the general population. To assess the situation in German prisons, an assessment of all suicides in German prisons by means of a survey was carried out for the time from 2000 to 2011. The mean rate per year of prison suicides in Germany from 2000 to 2011 was 105.8 per 100,000 male inmates and 54.7 per 100,000 female inmates. Male prisoner suicide rates significantly declined during the period under investigation; no significant trend was evident for female prisoners in pre-trial detention but a noteworthy increase was apparent in the suicide rate of female sentenced prisoners. A significant positive relationship can be demonstrated between occupation density and the suicide rate for both men and women. These results should be taken as a challenge for further research on the reasons for the unexpected increase of suicide rate in female sentenced prisoners and as well on the effect of population density on prison suicide rate.

Prison psychiatry.

PURPOSE OF REVIEW: Prison psychiatry is a secluded area of the psychiatric care system, which in fact often provides treatment for those who do not have access to community-based healthcare systems. The aim of this review is to give an impression of the special challenges of psychiatric work behind bars and to emphasize current trends in prison psychiatry. RECENT FINDINGS: In prisoners, mental disorders are more common than in the general population. There is evidence that prison suicide rates do not reflect general population suicide rates, suggesting that variation in prison suicide rates possibly also reflects differences in the provision of psychiatric care. Good transitional preparation preceding release seems to be necessary to reduce the risk of poor health outcome, but is hard to achieve. Up to now, there is no clear decision on whether it is useful or possible to treat adult prisoners with attention-deficit/hyperactivity disorder with stimulants. SUMMARY: Prison psychiatry has to deal with a disproportionate burden of psychiatric disease in prisoners. Adequate psychiatric treatment options may reduce suicide behind bars. Further research should focus on the special needs of individuals who are out of reach of the conventional community-based health system.

[Check up 35: what benefits do general practitioners in Brandenburg see?]. / Die Gesundheitsuntersuchung: Welchen Nutzen sehen Brandenburger Hausärzte?

INTRODUCTION: The so-called "Check up 35" is a structured preventive examination to be conducted by primary care providers. Recent interviews have shown that expectations with regard to this examination vary among physicians; some of them expressed doubt that the consultation is useful at all. The aim of this study was to representatively examine Brandenburg's family physicians' attitudes towards this "Check up". METHODS: 50% of the family physicians listed in the data base of the Association of SHI Physicians were randomly selected to receive a mail questionnaire (n=748). Participation in the study was voluntary, the questionnaires were evaluated anonymously. The physicians were asked about both content and assumed benefit of consultations. RESULTS: The questionnaire was answered by 37% of the physicians (n=274). In 2008, 40 "Check ups" were conducted every three months. 96% of the physicians amended the standard programme with additional preventive examinations - most frequently serum creatinine measurements. In most of the respectively rated categories, they appreciate the usefulness of the examination. In contrast, they take a rather sceptical attitude towards the en bloc standard programme. DISCUSSION: The study shows that many family physicians are very critical of the "Check up 35"; in particular, this applies to the range of scheduled examinations. There are considerable variations in the individual shaping of the consultation process among the physicians. They use the "Check up" as a tool for individual prevention instead of limiting it to the reduced standardised screening as intended.

Operationalizing multimorbidity and autonomy for health services research in aging populations--the OMAHA study.

BACKGROUND: As part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older. METHODS/DESIGN: OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%). DISCUSSION: The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.

Innovative strategy for implementing chronic heart failure guidelines among family physicians in different healthcare settings in Berlin.

AIMS: The aim of this study was to improve drug therapy for chronic heart failure (CHF) patients. METHODS AND RESULTS: This prospective interventional pilot study was performed with cross-sectional comparative analysis before and after the intervention. Usual pharmacotherapy was observed for 8 months in two different outpatient healthcare settings in Berlin [11 family physicians from individual GP (IGP) practices and 12 working in a medical care centre (MCC)]. Medical care centres provide a novel structure for outpatient care and have recently been introduced in Germany. The subsequent intervention entailed implementation of heart failure guidelines via a computer-based reminder system, followed by renewed cross-sectional observation of prescription behaviour for 1 year. Family physicians recruited patients, assessed CHF severity according to the NYHA class, and referred patients for echocardiography. The study included 190 patients in the baseline phase and 209 in the intervention phase. Longitudinal follow-up was performed in 172 cases. Echocardiography was ordered by 94.6% of MCC-physicians and 79.9% of IGP's. Undermedication was observed in both settings. Guideline-based beta-blocker therapy was prescribed for 46.3% of patients (44.8% of IGPs and 48.5% of MCC-GPs). Prescription improved by 12.3% after the intervention. There were marked deficiencies in the prescription of aldosterone antagonists (35%) for severe heart failure, which improved to 44.2% after the intervention. CONCLUSION: The problem of inadequate implementation of evidence-based therapy for CHF was partially overcome by using the reminder system, which provided participating physicians with short guideline recommendations during the intervention phase.

[Are there any differences in guideline adherence to pharmacotherapy of heart failure between individual GP practices and Medical Care Centres (MCCs)?]. / Leitliniengerechte Pharmakotherapie bei herzinsuffizienten Patienten--Gibt es Unterschiede der Behandlung durch Hausärzte in Einzelpraxen und in Medizinischen Versorgungszentren?

BACKGROUND: Chronic heart failure is one of the most important cardiovascular diseases. Patients with this common disease are primarily treated by general practitioners (GPs). Previous research showed deficits in drug therapy. Ambulatory care in Germany is changing; new structures for medical care (Medical Care Centres) have been registered since 2003. It was of interest to evaluate medical procedures of these new structures and compare them to the one applied in traditional single practices. Aim of this study was to investigate compliance with guidelines regarding drug therapy of chronic heart failure performed by GPs working in two different outpatient settings. METHODS: A prospective observational study was conducted. Over a period of eight months medical pharmacotherapy in individual practices and a Medical Care Centre (MCC) was compared. To ensure comparability in both settings GPs treating randomly selected patients were asked to recruit patients with heart failure, encode their NYHA class and conduct echocardiography to verify the diagnosis. RESULTS: 241 heart failure patients were enrolled by general practitioners (137 in individual practices and 104 in MCCs). GPs working in MCCs performed more diagnostic echocardiographies than physicians in individual practices. ACE inhibitors/sartans, beta blockers and diuretics were prescribed less often than recommended in the guideline. DISCUSSION: The hypothesis of insufficient adherence to guideline recommendations for pharmacotherapy of ambulatory heart failure patients was confirmed. However, the prescribing behaviour for pharmacotherapy of heart failure among the physicians in Berlin was better than among their European colleagues. There were only minor differences in drug prescription between the 11 GPs from single practices and the 12 GPs working in an MCC.

Low-density lipoprotein receptor variants are associated with spontaneous and treatment-induced recovery from hepatitis C virus infection.

Low-density lipoprotein receptor (LDLR) is involved in the entry of hepatitis C virus (HCV) in host cells. We investigated whether three single-nucleotide alterations within LDLR might be associated with the course of hepatitis C infection and response to antiviral therapy. We enrolled 651 individuals with chronic HCV infection who had received interferon-based combination therapy, 174 individuals with self-limited HCV infection, and 516 healthy controls. LDLR c.1171G>A, c.1413G>A, and c.*52G>A genotyping was performed by real-time PCR-based assays. HCV genotype 1-infected individuals who were homozygous for 3'UTR c.*52G were at increased risk for virologic non-response to antiviral therapy compared to virologic responders (66.3% vs. 51.0%, p=0.001). Furthermore, compared to healthy controls, self-limited HCV genotype 1 infection was significantly associated with c.1171A (15.1% vs. 6.6%, p=0.006) and negatively associated with c.1413G>A heterozygosity (33.0% vs. 46.1%, p=0.023). The data indicate that LDLR alterations are correlated with response to interferon-based combination therapy and with self-limitation of HCV 1 infection.

Perception of stress and quality of life in overweight and obese people--implications for preventive consultancies in primary care.

BACKGROUND: The increasing prevalence of obesity requires especially primary health care providers to act. General Practitioners (GP) in particular have the opportunity to motivate patients in early risk stages to follow weight reduction programmes before manifestation of associated diseases. In order to conduct preventive consultancies it is necessary to explore the individual physical and mental health status of patients. Aim of this study was to examine quality of life and perceived level of stress in overweight and obese patients treated in primary care. MATERIAL/METHODS: 123 patients, following a health Check up realized by their GP, rated self- reported questionnaires regarding quality of life and perceived level of stress (SF-12, PSS). Following descriptive analysis, differences in dependent variables related to BMI, sex and age were tested using ANOVA and regression analysis (SPSSv15.0). RESULTS: Restrictions in all parameters of mental health for overweight and obese patients in primary care were shown. Especially patients with a BMI above 30 kg/m2 reported a decreased level of quality of life. CONCLUSIONS: Health care providers should be aware of cumulative restrictions in mental health of their overweight patients. The findings provide essential implications for all health care professionals in primary care doing preventive consultancies with obese clients.

Effects of mindfulness-based stress reduction on quality of life in nursing home residents: a feasibility study.

BACKGROUND: With demographic change, the number of elderly people is increasing. The aging process and associated stress diminishes their quality of life. Mindfulness-based stress reduction (MBSR) has been claimed to reduce stress and alleviate suffering. It might be a useful approach to improve the condition in the elderly. PATIENTS AND METHODS: To examine feasibility and potential effects of MBSR on nursing home residents in Germany, a non-randomized feasibility study was conducted including 22 participants; 15 of them participated in an 8-week MBSR course, 7 served as untreated comparison group. Health-related quality of life (SF-12), depressive symptoms (GDS-12R), cognitive impairment (MMST), activities of daily living (Barthel Index), satisfaction with life, physical pain and major complaints were assessed pre- and post-intervention. RESULTS: 9 out of 15 course participants completed the course (60%). They showed a significant increase in the SF-12 physical health score (p = 0.017). Depressive symptoms (GDS-12R) significantly declined within the meditation group (p = 0.04) and as compared to the untreated group (p = 0.011). In the comparison group, a significant decrease in major complaints (p = 0.011) and an increase in the SF-12 mental health score were found. The meditation group yielded positive changes in the SF-12 mental health score, in satisfaction with life and in pain intensity. CONCLUSIONS: In view of the setting, the completion rate of 60% appears to be acceptable. Significant results suggest that MBSR may help improve health-related quality of life and reduce symptoms of depression. Yet, as participants did not meet the requirement to practice independently, feasibility of conducting MBSR with elderly who live in a nursing home has to be questioned.

Mind/body techniques for physiological and psychological stress reduction: stress management via Tai Chi training - a pilot study.

BACKGROUND: Stress can affect health. There is a growing need for the evaluation and application of professional stress management options, i.e, stress reduction. Mind/body medicine serves this goal, e.g, by integrating self-care techniques into medicine and health care. Tai Chi (TC) can be classified as such a mind/body technique, potentially reducing stress and affecting physical as well as mental health parameters, which, however, has to be examined further. MATERIAL/METHODS: We conducted a prospective, longitudinal pilot study over 18 weeks for the evaluation of subjective and objective clinical effects of a Yang style TC intervention in young adults (beginners) by measuring physiological (blood pressure, heart rate, saliva cortisol) and psychological (SF-36, perceived stress, significant events) parameters, i.e, direct or indirect indicators of stress and stress reduction, in a non-randomised/-controlled, yet non-selected cohort (n=21) by pre-to-post comparison and in follow-up. SF-36 values were also compared with the age-adjusted norm population, serving as an external control. Additionally, we measured diurnal cortisol profiles in a cross-sectional sub-study (n=2+2, pre-to-post), providing an internal random control sub-sample. RESULTS: Only nine participants completed all measurements. Even so, we found significant (p<0.05) reductions of saliva cortisol (post and follow-up), which seems to be an indicator of general stress reduction. A significant decrease in perceived mental stress (post) proved even highly significant (p<0.01) in the follow-up, whereas physical stress perception declined to a much lesser degree. Significant improvements were also detected for the SF-36 dimensions general health perception, social functioning, vitality, and mental health/psychological well-being. Thus, the summarized mental health measures all clearly improved, pointing towards a predominantly psychological impact of TC. CONCLUSIONS: Subjective health increased, stress decreased (objectively and subjectively) during TC practice. Future studies should confirm this observation by rigorous methodology and by further combining physical and psychological measurements with basic research, thereby also gaining knowledge of autoregulation and molecular physiology that possibly underlies mind/body medicine.

[Pilot study of breathing therapy in groups for patients with bronchial asthma]. / Pilotuntersuchung zu atemtherapeutischem Gruppenunterricht bei Patienten mit Asthma bronchiale.

BACKGROUND: The present study examines the efficacy of breathing and body therapy (according to the organization of breathing therapists, BVA) on bronchial asthma. This psychophysical therapy procedure has never before been studied for its efficacy on asthma, much in contrast to breathing exercises, which have been extensively examined. PATIENTS AND METHODS: This uncontrolled observational study is of preliminary character. It examines the influence of psychophysical breathing and body exercises practiced in short-term intervention groups on quality of life (SF-36) as well as subjective discomfort (discomfort diary) in patients with bronchial asthma. As there are no prior studies on the breathing and body therapy (BVA) method, it was hypothesized, based on experience, that it would improve ventilation, lower anxiety, and perhaps even allow for a reduction of medication. RESULTS: An anti-obstructive effect could not be addressed here, as the study only included patients who were free of clinically relevant obstructions through conventional treatment. However, a tendency for an anxiety-relieving effect could be observed in the SF-36. Subjective reports of respiratory discomfort, obtained through assessment of the patients' diaries, did not show any tendencies or even significant changes over the course of the therapy. CONCLUSION: The suggested anxiety-relieving effect of breathing therapy should be examined in future studies with more patients and stricter inclusion criteria.