[Service structure and cooperation in mental health care]. / Struktur und Kooperation in der Versorgung psychisch Kranker.

BACKGROUND: This study assesses exemplarily the regional structure of mental health services and the practice of cooperation of mental health service providers. The aim is to identify starting points for improving mental health care. METHOD: (1) Mapping of mental health services in four exemplary regions (urban/rural, East/West Germany) using the European Service Mapping Schedule. (2) Analysis of the practice of cooperation in mental health care using focus groups and a postal survey of psychiatrists and psychotherapists working in private practice. RESULTS: All surveyed regions have a well-developed and complex service system available. Cooperation in mental health care takes place in flexible networks rather than in fixed relationships. An explicit concept of cooperation does not exist. Time and resources promote cooperation. Psychiatrists and psychotherapists working in outpatient care mainly cooperate among themselves and rarely on an interdisciplinary basis. In particular psychotherapists are usually not part of cooperation networks. CONCLUSIONS: Improvements in mental health care are more likely to be achieved through improving cooperation rather than just developing additional services. Starting points for improvements include-beyond the increase of resources for cooperation - the training of medical students and psychiatrists in cooperation practice, reimbursement of cooperation and coordination and the implementation of systematic coordination of service networks.

Calcium rubidium nitrate: mode-coupling beta scaling without factorization.

The fast dynamics of viscous calcium rubidium nitrate is investigated by depolarized light scattering, neutron scattering, and dielectric loss. Fast beta relaxation evolves as in calcium potassium nitrate. The dynamic susceptibilities can be described by the asymptotic scaling law of mode-coupling theory with a shape parameter lambda=0.79; the temperature dependence of the amplitudes extrapolates to T(c) approximately equal 378 K. However, the frequencies of the minima of the three different spectroscopies never coincide, in conflict with the factorization prediction, indicating that the true asymptotic regime is unreachable.

Area characteristics and admission rates of people with schizophrenia and affective disorders in a German rural catchment area.

BACKGROUND: Studies in urban areas identified environmental risk factors for mental illness, but little research on this topic has been performed in rural areas. METHODS: Hospital admission rates were computed for 174 rural municipalities in the catchment area of the state psychiatric hospital in Günzburg in years 2006 to 2009 and combined with structural and socio-economic data. Relationships of overall and diagnosis-specific admission rates with municipality characteristics were analysed by means of negative binomial regression models. RESULTS: Admission rates of patients with a diagnosis of schizophrenia and affective disorder combined decrease with increasing population growth, population density, average income and green areas, while admission rates are positively correlated with commuter balance, income inequality, unemployment rates and traffic areas. Admission rates for schizophrenia are negatively related to population growth, average income and agricultural areas, but positively related to mobility index, income inequality and unemployment rate. Admission rates for affective disorders are negatively related to population growth, population density, average income and green areas, while higher admission rates are correlated with commuter balance, high income inequality, unemployment rate and traffic-related areas. CONCLUSIONS: Effects of wealth, economic inequality, population density and structural area characteristics influence psychiatric admission rates also in rural areas.

What promotes and inhibits cooperation in mental health care across disciplines, services and service sectors? A qualitative study.

AIMS: To explore the practice of cooperation in mental health care across services and identify conditions that promote and inhibit cooperation. METHODS: Focus groups with relevant service providers were conducted in four exemplary regions in Germany (rural/ urban and East/West). The discussions were content analysed. RESULTS: Seven central categories were deduced: (1) involved service providers, (2) comprehension, (3) reasons, (4) instruments for cooperation, (5) promoting and inhibiting conditions, (6) interdisciplinarity, and (7) regional and personal networks. Cooperation is practiced in networks, rather than defined relations. Who is involved in cooperation depends on patients/clients needs and may vary from case to case. Service providers do not have theoretical concepts of cooperation. Cooperation relies not only on personal contacts and knowledge between services but also on time, financial reimbursement and the social capital of the environment. In particular, cooperation with physicians was considered to be difficult by non-medical professionals. Physician's role models do not seem to include cooperation with other disciplines as a core task. CONCLUSIONS: To improve cooperation, regional and sustainable mental health networks have to be systematically implemented by providing leadership, time and reimbursement for network meetings. Interdisciplinary cooperation practice should be part of the curricula of medical students and residents in psychiatry.

[Oxygen-enhanced MRI of the lung: optimized calculation of difference images]. / Sauerstoff-MRT der Lunge: Optimierte Berechnung von Differenzbildern.

BACKGROUND: In oxygen-enhanced lung MRI, difference maps of acquisitions during inhalation of room air and pure oxygen are calculated to assess lung function. The purpose of this study was to analyze how the calculation of these difference maps depends on the delayed signal change after switching the gas supply. METHODS: Ten healthy volunteers were examined with an ECG and respiratory-triggered T1-weighting inversion recovery HASTE sequence with parallel imaging. Four blocks with 20 repetitions of up to 6 coronal slices were continuously acquired; in blocks 1 and 3 room air was supplied, in blocks 2 and 4 oxygen. Data were postprocessed, discarding between 0 and 19 repetitions after each change of gas supply before calculating the relative signal difference. RESULTS: The averaged relative signal difference increases from 9.4 to 17.4% when the number of discarded acquisitions increases; the ratio of signal difference and spatial standard deviation reaches a maximum at 5-8 discarded acquisitions. CONCLUSIONS: An optimized ratio of signal difference and statistical error is found if about 5-8 of 20 respiratory-triggered repetitions are discarded after each change of gas supply for the calculation of difference maps.