[Burnout : Symptoms, diagnostics and treatment approaches]. / Burnout : Symptomatik, Diagnostik und Behandlungsansätze.

Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.

Childhood maltreatment in bariatric patients and its association with postoperative weight, depressive, and eating disorder symptoms.

PURPOSE: The present study aimed to compare prevalence rates of childhood maltreatment between patients with severe obesity undergoing bariatric surgery and patients without a surgical procedure. Second purpose was to calculate the association between childhood maltreatment and outcomes 6 and 12 months after a bariatric procedure. METHODS: Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and compared between 120 bariatric surgery patients and 346 non-surgery patients with severe obesity. For the bariatric surgery subgroup, linear mixed models with repeated measures were used to analyze the predictive value of childhood maltreatment on weight outcomes and psychopathology. Additionally, between- and within-group comparisons were calculated to compare patients with and without childhood maltreatment regarding BMI and weight loss (%TWL, %EWL), depression severity (BDI-II), eating disorder psychopathology (EDE-Q), and suicidal ideation (BSS), at baseline, 6- and 12-month assessment. RESULTS: Prevalence rates for childhood maltreatment, depression and suicidal ideation were significantly higher in non-surgery compared to bariatric surgery patients. Within the surgery group, no significant interaction effect between childhood maltreatment and time was found. Hence, childhood maltreatment did not impact the course of body weight, depression and eating disorder psychopathology from pre- to post-surgery. CONCLUSIONS: Significantly higher rates of childhood maltreatment were found within non-surgery patients with obesity in comparison to bariatric surgery patients. Childhood maltreatment did not predict poorer outcomes after surgery. Since history of childhood maltreatment may increase the risk for psychological disturbances, regular screening and, if necessary, psychological support should be offered to both groups. LEVEL OF EVIDENCE: Evidence obtained from well-designed cohort or case-control analytic studies, Level III. CLINICAL TRIAL REGISTRATION: Deutsches Register Klinischer Studien-German Clinical Trials Register: DRKS00003976.

[Tonsillectomy for MRSA eradication-a case report]. / Tonsillektomie zur MRSA­Sanierung ­ eine Kasuistik.

Herein is reported the case of a clinician in whom, after three unsuccessful attempts to eradicate a nasopharyngeal MRSA (methicillin resistent staphylococcus ausreus) colonization, tonsillectomy was performed with long-term success.

Factors associated with non-participation and dropout among cancer patients in a cluster-randomised controlled trial.

We investigated the impact of demographic and disease related factors on non-participation and dropout in a cluster-randomised behavioural trial in cancer patients with measurements taken between hospitalisation and 6 months thereafter. The percentages of non-participation and dropout were documented at each time point. Factors considered to be potentially related with non-participation and dropout were as follows: age, sex, marital status, education, income, employment status, tumour site and stage of disease. Of 1,338 eligible patients, 24% declined participation at baseline. Non-participation was higher in older patients (Odds Ratio [OR] 2.1, CI: 0.6-0.9) and those with advanced disease (OR 2.0, CI: 0.1-1.3). Dropout by 6 months was 25%. Dropout was more frequent with increased age (OR 2.8, CI: 0.8-1.2), advanced disease (OR 3.0, CI: 1.0-1.2), being married (OR 2.4, CI 0.7-1.1) and less frequent with university education (OR 0.4, CI -1.3 to -0.8) and middle income (OR 0.4, CI -0.9 to -0.7). When planning clinical trials, it is important to be aware of patient groups at high risk of non-participation or dropout, for example older patients or those with advanced disease. Trial designs should consider their special needs to increase their rate of participation.

[Prolonged grief disorder]. / Anhaltende Trauerstörung.

Grief is a natural response to the loss of a loved one and its intensity usually lessens over time. Approximately 10% of bereaved persons, however, experience persistent symptoms resulting in the development of a prolonged grief disorder (PGD). A PGD shows a distinct symptom cluster and is considered for inclusion as a diagnosis in the upcoming revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). It is distinct from other mental disorders but symptoms overlap, especially with major depression and posttraumatic stress disorder. In addition to diagnostic criteria and differential diagnosis, the following article also describes prevalence rates, comorbidities, risk factors as well as treatment options for PGD.

[Internet-based interventions in the treatment of mental disorders : Overview, quality criteria, perspectives]. / Internetbasierte Interventionen in der Behandlung psychischer Störungen : Überblick, Qualitätskriterien, Perspektiven.

BACKGROUND: Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available. OBJECTIVE: The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions. METHODS: A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications. RESULTS: Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders. DISCUSSION: When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.

[Considering housing arrangements in elderly life: factors influencing plans concerning future housing arrangements and preferences in a representative sample of 45+ year olds]. / Nachdenken über das Wohnen im Alter : Einflussfaktoren auf wohnbezogene Zukunftspläne und Wohnpräferenzen in einer repräsentativen Stichprobe ab 45-Jähriger.

BACKGROUND: Providing care and support for the elderly is a future challenge. MATERIALS AND METHODS: Using regression analysis, a representative population-based sample (n = 1,445) was examined with respect to whether they had considered future housing and which variables influenced their thoughts and preferences. RESULTS: The majority of the sample reported thinking about housing in old age and preferred to stay at home in old age. Thoughts about future housing and housing preferences were predicted by different factors in the age groups analyzed. Thinking about future housing was positively associated with increasing age and depression. Other relevant predictors were gender, living with a partner, images of old age (especially negative ones), and anticipated subjective health. These variables also predicted housing preferences. CONCLUSIONS: Thoughts about future living arrangements are widespread, and their importance increases with age. The wishes reported do contrast to a certain extent with reality. Planning future care as well as developing consultation guidelines should address these issues while considering the reported influences.

[Peripartum depression and grief after pregnancy loss: special problem areas in obstetrics]. / Peripartale Depressionen und Trauer nach Schwangerschaftsverlusten : Besondere Problemfelder in der Geburtshilfe.

There is evidence that postpartum depression increases the risk of premature birth and developmental disabilities of the child. Risk factors include a history of depression, prenatal anxiety, lack of social support, intimate partner violence, low socioeconomic status and lack of a relationship. For women in high risk groups antenatal interventions could reveal positive effects to prevent postpartum depression. In the peripartum period routine screening is recommended to detect women at risk of developing depression. Furthermore, prenatal losses during pregnancy, specifically occurring during the first weeks of pregnancy may result in complicated grief disorders. Only very few controlled and randomized intervention studies for the treatment after prenatal loss have been conducted; however, aimed at specific high-risk groups these bereavement interventions demonstrated a high treatment efficacy.

Are self-managed online interventions for depression effective in improving behavioral activation? A secondary analysis of a cluster-randomized controlled trial.

BACKGROUND: Online interventions can effectively improve depressive symptoms. They often include behavioral activation (BA) techniques, but research on the effects on behavioral activation is scarce. This study aims to examine short- and long-term effects of online interventions on behavioral activation in routine care. METHODS: This study is a secondary analysis of a pragmatic cluster-randomized controlled trial (@ktiv) with a sample of N = 647 GP patients with mild to moderate depression. The intervention group (IG) received treatment-as-usual (TAU) and adjunct access to an online intervention; the control group (CG) received TAU. BA was assessed in terms of the frequency and enjoyment of pleasant activities at baseline, after six weeks and after six months. Intention-to-treat analyses were performed via multilevel mixed linear regression. RESULTS: The frequency of pleasant activities was significantly higher in the IG than in the CG six months after baseline (t(1406) = 2.25, p = .024). The enjoyment of pleasant activities was significantly higher in the IG than in the CG both six weeks (t(1405) = 2.11, p = .035) and six months after baseline (t(1405) = 3.44, p = .001). Initial depressive symptoms significantly moderated the treatment effect on the enjoyment but not the frequency of pleasant activities. LIMITATIONS: BA measures have not been validated in a clinical context. CONCLUSIONS: GP patients with mild to moderate depressive symptoms profited from access to an online adjunct intervention in terms of improved behavioral activation. The findings emphasize the usefulness of online interventions as supportive options in mental health care.

Evaluating 5 decades of atmospheric 85Kr measurements in the southern hemisphere to derive an input function for dating water and ice with implications for interhemispheric circulation and the global 85Kr emission inventory.

In July 2015, the currently only active monitoring station for atmospheric 85Kr measurements in the southern hemisphere went operational at the Commonwealth Scientific and Industrial Research Organization (CSIRO) in Adelaide, Australia. Here, this new data is presented and combined with measurements from historic monitoring stations, to generate a85Kr input function for the southern hemisphere which is crucial for the application of 85Kr as a dating tracer for water and ice. After a linear increase in atmospheric 85Kr concentrations between 1980 and 2005, concentrations stabilized yielding mean 85Kr activity concentration during the Adelaide monitoring period of 1.3 ± 0.15 Bq/m³ air with slight variations indicating seasonal effects. Data from three northern hemispheric monitoring stations Schauinsland, Freiburg and Jungfraujoch of the German Federal Office for Radiation Protection (BfS), located in Central Europe are used to calculate an interhemispheric exchange time of 1.25 ± 0.24 years, using a simple box model approach. Furthermore, it is investigated whether a southern hemispheric 85Kr input function can be calculated from the baseline of the northern hemispheric data set. A comparison between the calculated and the fitted input function shows that analytical techniques can just resolve the concentration differences, emphasising the need of southern hemispheric monitoring stations for 85Kr. Analysing the decay-corrected input function and taking the current detection limit of low-level counting and Atom Trap Trace Analysis of 0.05 Bq/m³ air, a maximum apparent 85Kr tracer age of 40 years can be determined in the southern hemisphere. Finally, the 85Kr measurements are used to derive global 85Kr emission rates which are found to be in good agreement with published emissions from nuclear reprocessing plants.

[Internet therapy. Opportunities and boundaries]. / Internettherapie. Möglichkeiten und Grenzen.

Internet therapy is directed toward people whose access to the usual treatment structures is limited. Further, Internet therapy is aimed at patients with circumscribed psychiatric disorders or symptoms. Compared to usual face-to-face treatment the duration of the Internet therapy programs evaluated were rather short, and frequently only small populations were examined. The studies presented demonstrate that Internet-based therapy of specific disorders is suitable for a significant reduction of symptoms. As follow-up data of longer duration are not available, no concluding statement relating to sustained symptom reduction can be made. Further, it remains unclear whether efficacy of the Internet therapy programs examined is comparable to usual treatment, since only two studies compare Internet therapy with face-to-face treatment.

Predicting suicidal ideation by interpersonal variables, hopelessness and depression in real-time. An ecological momentary assessment study in psychiatric inpatients with depression.

OBJECTIVE: To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time. METHODS: This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%). RESULTS: Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI. CONCLUSIONS: This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

Serotonergic genes modulate amygdala activity in major depression.

Serotonergic genes have been implicated in the pathogenesis of depression probably via their influence on neural activity during emotion processing. This study used an imaging genomics approach to investigate amygdala activity in major depression as a function of common functional polymorphisms in the serotonin transporter gene (5-HTTLPR) and the serotonin receptor 1A gene (5-HT(1A)-1019C/G). In 27 medicated patients with major depression, amygdala responses to happy, sad and angry faces were assessed using functional magnetic resonance imaging at 3 Tesla. Patients were genotyped for the 5-HT(1A)-1019C/G and the 5-HTTLPR polymorphism, including the newly described 5-HTT-rs25531 single nucleotide polymorphism. Risk allele carriers for either gene showed significantly increased bilateral amygdala activation in response to emotional stimuli, implicating an additive effect of both genotypes. Our data suggest that the genetic susceptibility for major depression might be transported via dysfunctional neural activity in brain regions critical for emotion processing.

Functional anatomy of visuo-spatial working memory during mental rotation is influenced by sex, menstrual cycle, and sex steroid hormones.

Recent observations indicate that sex and level of steroid hormones may influence cortical networks associated with specific cognitive functions, in particular visuo-spatial abilities. The present study probed the influence of sex, menstrual cycle, and sex steroid hormones on 3D mental rotation and brain function using 3-T fMRI. Twelve healthy women and 12 men were investigated. Menstrual cycle and hormone levels were assessed. The early follicular and midluteal phase of the menstrual cycle were chosen to examine short-term cyclical changes. Parietal and frontal areas were activated during mental rotation in both sexes. Significant differences between men and women were revealed in both phases of menstrual cycle. In men we observed a significant correlation of activation levels with testosterone levels in the left parietal lobe (BA 40). In women, a cycle-dependent correlation pattern was observed for testosterone: brain activation correlated with this male hormone only during the early follicular phase. In both cycle phases females' brain activation was significantly correlated with estradiol in frontal and parietal areas. Our study provides evidence that fMRI-related activity during performance of cognitive tasks varies across sex and phases of the menstrual cycle. The variation might be partly explained by better task performance in men, but our results indicate that further explanations like basic neuronal or neurovascular effects modulated by steroid hormones must be considered. Both estradiol and testosterone levels may influence fMRI signals of cognitive tasks, which should affect selection of subjects for future fMRI studies.

A novel solid-state NMR method for the investigation of trivalent lanthanide sorption on amorphous silica at low surface loadings.

The modelling of radionuclide transport in the subsurface depends on a comprehensive understanding of their interactions with mineral surfaces. Spectroscopic techniques provide important insight into these processes directly, but at high concentrations are sometimes hindered by safety concerns and limited solubilities of many radionuclides, especially the actinides. Here we use Eu(iii) as a surrogate for trivalent actinide species, and study Eu(iii) sorption on the silica surface at pH 5 where sorption is fairly limited. We have applied a novel, surface selective solid-state nuclear magnetic resonance (NMR) technique to provide information about Eu binding at the silica surface at estimated surface loadings ranging from 0.1 to 3 nmol m(-2) (<0.1% surface loading). The NMR results show that inner sphere Eu(iii) complexes are evenly distributed across the silica surface at all concentrations, but that at the highest surface loadings there are indications that precipitates may form. These results illustrate that this NMR technique may be applied in solubility-limited systems to differentiate between adsorption and precipitation to better understand the interactions of radionuclides at solid surfaces.

Trauma and grief 2-7 years after termination of pregnancy because of fetal anomalies--a pilot study.

The aim of the study was to obtain information on the long-term posttraumatic stress response and grief several years after termination of pregnancy due to fetal malformation. We investigated 83 women who had undergone termination of pregnancy between 1995 and 1999 and compared them with 60 women 14 days after termination of pregnancy and 65 women after the spontaneous delivery of a full-term healthy child. Women 2-7 years after termination of pregnancy were expected to show a significantly lower degree of traumatic experience and grief than women 14 days after termination of pregnancy. Contrary to the hypothesis, however, the results showed no significant intergroup differences with respect to the degree of traumatic experience. With the exception of one subscale (fear of loss), this also applied to the grief reported by the women. However, both groups differed significantly in their posttraumatic stress response from women who had given spontaneous birth to a full-term healthy child. The results indicate that termination of pregnancy is to be seen as an emotionally traumatic major life event which leads to severe posttraumatic stress response and intense grief reactions that are still detectable some years later.

Basal growth hormone levels are positively correlated with high-density lipoprotein cholesterol levels in women.

Previous studies in patients with either a deficiency or an excess of growth hormone (GH) yielded contradictory results on the regulation of lipoprotein metabolism by GH. In a cross-sectional study of 563 male and 126 female participants of the Prospective Cardiovascular Münster (PROCAM) Study, we determined biometric and demographic data, serum levels of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein (apo)A-I, A-II, and B, and unstimulated GH levels. The median of basal GH levels was higher in women than in men. Moreover, 44.2% of men but only 8.7% of women had basal GH levels less than the detection limit of 0.05 microgram/L. The relationship between basal GH and lipoprotein metabolism was investigated by univariate and multivariate regression analysis of data from 315 men and 126 women with detectable basal GH levels. In men, GH correlated positively with HDL cholesterol and negatively with body mass index (BMI), age, and triglycerides. After multivariate analysis, the correlation with triglycerides remained independent of age and BMI. Among women, GH correlated positively with the use of hormonal contraception, HDL cholesterol, apoA-I, and apoA-II, and negatively with BMI, age, menopause, triglycerides, and apoB. With multivariate analysis, the positive correlations of GH with HDL cholesterol and apoA-I in women were independent of age. BMI, menopause, and oral contraception. We conclude that GH contributes to the regulation of HDL cholesterol levels. Moreover, in women the well-known effects of exogenous estrogen or estrogen loss on HDL metabolism may be partially mediated via GH.

Basal growth hormone levels in women are positively correlated with high-density lipoprotein cholesterol and apolipoprotein A-I independently of insulin-like growth factor 1 or insulin.

Previous studies in growth hormone (GH)-deficient or acromegalic patients yielded contradictory results on the effect of GH on lipoprotein metabolism. In a cross-sectional study, we analyzed the relationships between unstimulated GH, insulin-like growth factor 1 (IGF1), insulin, and lipoprotein metabolism in 44 non-obese young women. On univariate analysis, basal serum levels of GH correlated positively with triglycerides, high-density lipoprotein (HDL) cholesterol, apolipoprotein A-I (apoA-I) and apoA-II and negatively with lipoprotein lipase (LPL) activity. These associations remained significant on multivariate analyses that, in addition to GH, took into account the effects of insulin or C-peptide, as well as the effects of total, protein-bound, or free IGF1. In most cases, the relationships of these lipid parameters with insulin/C-peptide and IGF1 and its free or protein-bound subfractions were opposite of those with GH and not significant. Thus, GH appears to regulate the metabolism of HDL and triglycerides independently of IGF1 and insulin.

Serum levels of anticardiolipin antibodies are pathologically increased after active immunization of patients with recurrent spontaneous abortion.

Although the pathophysiological mechanisms leading to recurrent spontaneous abortion are still not fully understood, treatment schemes based on immunological principles have been advocated in recent years claiming that the production of the so-called blocking factor is being specifically stimulated. We investigated, retrospectively, whether active immunization can affect the production of immunoglobulin (Ig)G and IgM anticardiolipin antibodies. In a group of untreated recurrent spontaneous abortion patients (n = 9), the range of variation of cardiolipin antibodies, during consecutive controls taken at the same time interval as after immunization, was not statistically significant. In contrast to this, significant increases of both IgG and IgM antibodies occurred after active immunization with paternal leucocytes in 10 of 15, and in 6 of 15 cases, respectively. The mean basal and posttransfusion levels were: 7.26 +/- 2.53 and 30.15 +/- 23 U/mL for IgG and 2.26 +/- 1.2 and 6.82 +/- 5.6 U/mL for IgM, respectively. We conclude that active immunization with human lymphocytes leads to the production of antibodies against cardiolipin. This effect is exerted on both IgM and IgG antibodies.