[Barriers for Migrants Regarding the Access to Medical Rehabilitation on Behalf of the German Pension Insurance]. / Barrieren für Migranten beim Zugang in die medizinische Rehabilitation der gesetzlichen Rentenversicherung.

OBJECTIVE: To identify barriers for migrants regarding the access to medical rehabilitation on behalf of the German Pension Insurance. METHODS: Focus groups with migrants (n=5, 42 participants) and experts (n=1, 14 participants) were conducted and examined by qualitative content analysis. RESULTS: We identified 4 categories of access barriers: 1. system-related, migrant-specific, 2. person-related, migrant-specific, 3. system-related, primarily not migrant-specific, and 4. person-related, primarily not migrant-specific barriers. Barriers in categories 3 and 4 are mostly class- or gender-specific. Due to associations between migration background, social status and gender roles, these barriers are often of specific importance to migrants as well. Taking such intersections of single categories of inequality (migration background, social status, gender) into account, access barriers can interact and form complexes of barriers. CONCLUSION: In order to explain and overcome the low utilization of medical rehabilitation by migrants, the interaction of migrant-, class- and gender-specific barriers in the system and in persons have to be considered.

[Functional impairments in large-scale brain projects in opioid addiction]. / Funktsional'nye narusheniya v krupnomasshtabnykh setyakh pokoya golovnogo mozga pri opioidnoi narkomanii.

OBJECTIVE: To assess the functional state of large-scale resting networks of the brain in patients with opioid intoxication. MATERIAL AND METHODS: Thirty-one male subjects, aged 27.4+5.1 years, were studied. Resting state functional MRI was performed in 12 patients with heroin intoxication aged 29.1+5.9 years. The control group consisted of 16 healthy volunteers without bad habits aged 26.2+4.2 years. RESULTS: In the group of opioids intoxication, there is a decrease in the functional activity of the salience network with the executive control network and the default mode network of the brain (p<0.05) compared to the control group. A positive correlation of functional connections is found between the anterior cingulate cortex and the medial prefrontal cortex (T=2.74; p=0.041), which is not recorded in the control group. The functional connections between the default mode network and executive control are more highly represented in opioid intoxication in comparison with the control group (medial prefrontal cortex - left posterior parietal cortex T=7.5; p=0.001; medial prefrontal cortex - right posterior parietal cortex T=3.71; p=0.014; posterior cingulate cortex - left posterior parietal cortex T=6.15; p=0.002; posterior cingulate cortex - right posterior parietal cortex T=3.25; p=0.023; posterior cingulate cortex - right dorsolateral prefrontal cortex T=2.83; p=0.037). CONCLUSION: The results indicate that functional connections in large-scale resting networks are disrupted during opioid intoxication, which indicates a disturbance of the normal functional architectonics of the brain.

[Low doses of quetiapine (Seroquel) as an impulsivity corrector in patients with bipolar affective disorder in remission]. / Nizkie dozy kvetiapina (Serokvelya) v kachestve korrektora impul'sivnosti u patsientov s bipolyarnym affektivnym rasstroistvom v remissii.

OBJECTIVE: To evaluate the effectiveness of low doses (25-75 mg/day) of quetiapine (Seroquel) in patients with bipolar affective disorders in a euthymic state with signs of impaired impulse control. MATERIAL AND METHODS: The main criteria for patients' selection were as follows: both sex, diagnoses of bipolar affective disorders, remission (euthymic state), adult age (from 18 to 60 years old), stable basic therapy. The duration of the study was 6 weeks, a dose of quetiapine (Seroquel) varied from 25 to 75 mg. The examinations were carried out with the Barratt scale, computerized Go-No-Go and Balloon tests. RESULTS: The study group included 32 patients (11 men and 21 women), mean age 31.2±9.7 years (minimum 18, maximum 60 years). The changes in Barratt total score (p=0.000014, Wilcoxon test, effect size 0.48) and Balloon total earnings (p=0.03, Wilcoxon test, effect size 0.22) were statistically significant and reflected clinically significant improvement. The changes of the indices of the Go-No-Go test were not significant. The data of fMRI showed an increase in the connectivity of the cortex of the central and parietal tegmentum of the left hemisphere with other areas of the brain, which correlated with the changes in psychometric and test parameters. CONCLUSION: The results of the study showed that add-on of the low doses of quetiapine (Seroquel) significantly decreases impaired impulse control in remitted patients with bipolar affective disorders both in self-evaluation and in risk-taking experimental test. The drop of high level of impulsivity can improve the quality and stability of remission and reduce behavioral risks due to impaired impulse control.