Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises - study protocol for a randomized controlled-trial.

BACKGROUND: Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine und mittlere Unternehmen - Gesundheitsoffensive; en: small and medium-sized enterprises - health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees. METHODS: The study is planned as a 2 × 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees' mental health. Further dependent variables are leaders´ depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers' point of view. DISCUSSION: Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders´ and also employees` mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives. TRIAL REGISTRATION: The KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (05.11.2020).

[Fibromyalgia syndrome: considerable pain reduction after moving to a "safe site"]. / Fibromyalgiesyndrom: erhebliche Schmerzreduktion nach Wohnungswechsel an einen "sicheren Ort".

A patient with long-term fibromyalgia syndrome and concomitant post-traumatic stress disorder is reported. The relocation to a so-called external safe site resulted within a very short time in a sustained remission of the fibromyalgia syndrome, due to psychotherapeutic interventions. This shows that-according to the clinical guidelines-a psychiatric examination and, if necessary, targeted therapy of the psychiatric comorbidity is indispensable in patients with fibromyalgia syndrome.

The relation between dyadic coping and relationship satisfaction in couples dealing with haematological cancer.

Couples' ability to cope with cancer is significantly associated with how satisfied they are with their relationship. However, little evidence specific to haemato-oncological patients exists. The objective of this study was to examine how dyadic coping (DC) affects relationship satisfaction among couples facing haematological cancer. Furthermore, we tested complex interactions between distress, disease-related and socio-demographic factors. In a multicentre study, 327 patients (haemato-oncological cancer; mean age: 57 years, 63% male) and their partners responded to surveys examining their relationship satisfaction, DC and distress. The Actor-Partner-Interdependence-Model (APIM) and moderator analyses were used to assess interactions between these concepts. In the APIM, positive DC was significantly related to greater levels of relationship satisfaction, and negative DC was related to lower levels of relationship satisfaction (all p < .001). The partners' distress was significantly related to lower levels of relationship satisfaction of the partners (p < .05). Furthermore, distress, age and relationship duration had significant moderating effects on the association between DC and relationship satisfaction (p < .05). Our results enable describing patient and partner as an interactional unit in which positive DC supports a satisfying relationship. They imply that strengthening positive DC in a couple facing haematological cancer can contribute to them having a well-functioning and sustaining relationship.

[Relatives in intensive care units: (Un)Satisfied needs]. / Angehörige auf der Intensivstation : (Un)Befriedigte Bedürfnisse.

BACKGROUND: Relatives of patients in intensive care units (ICU) have important supportive care needs which are often unrecognized and rarely satisfactorily met. OBJECTIVES: Description of stress factors and strains as well as supportive care needs, assessment of care needs, empirical evidence for care needs, satisfaction of care needs, options and efficacy of psychosocial support and communication recommendations for this special situation. MATERIAL AND METHODS: Evaluation of literature review articles, discussion of basic qualitative and quantitative research findings, meta-analyses and expert recommendations. RESULTS: Relatives of ICU patients report a number of cognitive, emotional, social and pragmatic support needs. Important needs, such as maintenance of hope and security as well as sincere and needs-adjusted communication often remain unrecognized and are rarely satisfactorily met. The weighting and prioritization of support needs are modulated by sociodemographic and cultural factors. Psychoeducative interventions reduce the psychosocial distress of family members. Communicative strategies of healthcare professionals reduce the risk of posttraumatic stress disorders for family members, reduce anxiety and depression and improve participative decision making. CONCLUSION: Healthcare professionals in ICUs should be sensitized to the specific characteristics of these special situations. For healthcare professionals it is equally important to improve self-awareness regarding their own defense mechanisms and to refine communicative competence on accessibility and adequately address the reality of subjective experiences of family members. Psychosocial support services should be recommended and utilization should be encouraged.

[Health Promotion for Long-Term Unemployed Persons]. / Gesundheitsförderung für Menschen in Langzeitarbeitslosigkeit.

A controlled trial to improve perceived health in a sample of long-term unemployed persons was conducted. As primary endpoint the SF12-questionnaire was used. The intervention was tailored to the specific needs of the long-term unemployed combining individual sessions based on motivational interviewing and group sessions designed with the participation of the participants. 365 participants were enrolled in the study. 287 or, respectively, 148 unemployed persons participated at the 3-months/12-months follow-up assessments. A positive effect of the intervention in the setting of long-term unemployed persons has been shown for perceived health, mental health and changes towards more physical activity and healthier nutrition.

[Stress Management Interventions at the Workplace Improve Perceived Stress Reactivity of Men at Higher Risk]. / Prävention stressbedingter Gesundheitsschäden in einem Industriebetrieb bei Männern mit erhöhtem Risiko.

A randomised controlled trial was conducted in a metal working plant. The primary endpoint was perceived stress reactivity (Stress Reactivity Scale, SRS). 174 participants were randomly assigned to a stress-management intervention (SMI) (IG) or a waiting control group (CG). N=174 participants (171 male) were recruited at t0, 154 (89%) were still taking part after one year (t1), 131 (76%) after 2 years. The SRS score decreased in both groups. The conducted SMI proved to be effective over both a 1- and a 2-year period.

["Fit4You"--A Programme for Prevention and Reduction of Overweight in Apprentices in the Workplace Setting]. / "Fit4U"--ein Präventionsprogramm zur Vermeidung und Verminderung von Übergewicht bei Auszubildenden im Betrieb.

The effect of health promotion at the worksite for overweight adolescents is not known. This 2-year intervention study examined the effect of a multimodal programme including nutrition counselling, sport, and life-skill training on medical and psychological outcomes. The body mass index increased slightly less in the intervention group. Semistructured interviews at the end showed that participants are highly interested in health promotion at the worksite.

[Health coaching as a part of integration into the job market--evaluation of a qualification concept]. / Gesundheits-Coaching in der Arbeitsmarktintegration--Evaluation eines Qualifizierungskonzepts.

OBJECTIVES: The aim of this study is to develop, implement and evaluate an education programme enabling the pedagogic staff of employment promotion agencies to integrate health promotion approaches und activities in vocational training programmes. METHODS: The evaluation of the education programme is based on Kirkpatrick's 4 levels training evaluation model. Besides the participants' verbal end of session feedback, a standardised questionnaire was used at the end of the education programme and after 3 months practical experience. Process evaluation included the implementation level of the methods learned. RESULTS: From a total of 71 participants, 56 completed the first and 31 the second questionnaire (return rate 79% and 44%, respectively). The participants' mean age was 42 years, 80% were female. Only 22% of them integrated health topics systematically into their daily work. A 3-day basic training followed by case conferences during practical work was developed to transfer knowledge and practical competence in person-to-person talks and group activities (so called FIT-counselling and FIT-group). For 96% of participants, their expectations regarding the education programme were met completely or predominantly. 91% indicated a rise in motivation to work as health coach. When rating the training material, 96% judged it helpful for implementation/transfer. Many participants marked the education programme as being too short and wished more time for the topic of "mental health" and exchange of experiences. The follow-up after 3 months on-the-job training revealed that 84 and 97%, respectively, found FIT-counselling and FIT-groups helpful for their daily work. In all employment promotion agencies FIT-counselling and FIT-groups were implemented. CONCLUSION: Our results affirm the need for and prove the acceptance of education programmes enabling the pedagogic staff of job-training programmes to deliver health coaching. Periodic case conferences take into account the participants' request for more exchange of experiences, facilitate implementation and contribute to quality and sustainability. Further development of the education programme is ongoing.

[Aspects of post-tramatic stress disorder after a traffic acident]. / Aspekte posttraumatischer Symptombildung nach einem Autoverkehrsunfall.

Post-traumatic stress disorder (PTSD) occurs most frequently in the general population after traffic accidents and affects up to 15 % of those involved. Mental and physical comorbidity, preliminary damage or injury can herald the development of PTSD, but the scope of social support after the accident plays a crucial role in whether and to what extent potential PTSD develops. Against this background, preventive and injury reduction aspects of the interaction between insurance companies and their customers are conceivable, which could also positively affect health economic and aspects of job or customer satisfaction.

Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial.

BACKGROUND: Multisomatoform disorder is characterised by severe and disabling bodily symptoms, and pain is one of the most common and impairing of these. Furthermore, these bodily symptoms cannot be explained by an underlying organic disorder. Patients with multisomatoform disorder are commonly found at all levels of healthcare and are typically difficult to treat for physicians as well as for mental health specialists. AIMS: To test whether brief psychodynamic interpersonal therapy (PIT) effectively improves the physical quality of life in patients who have had multisomatoform disorder for at least 2 years. METHOD: We recruited 211 patients (from six German academic outpatient centres) who met the criteria for multisomatoform disorder for a randomised, controlled, 12-week, parallelgroup trial from 1 July 2006 to 1 January 2009 (International Standard Randomised Controlled Trial Number ISRCTN23215121). We randomly assigned the patients to receive either 12 weekly sessions of PIT (n = 107) or three sessions of enhanced medical care (EMC, n = 104). The physical component summary of the Short Form Health Survey (SF-36) was the pre-specified primary outcome at a 9-month follow-up. RESULTS: Psychodynamic interpersonal therapy improved patients' physical quality of life at follow-up better than EMC (mean improvement in SF-36 score: PIT 5.3, EMC 2.2), with a small to medium between-group effect size (d = 0.42, 95% CI 0.15-0.69, P = 0.001). We also observed a significant improvement in somatisation but not in depression, health anxiety or healthcare utilisation. CONCLUSIONS: This trial documents the long-term efficacy of brief PIT for improving the physical quality of life in patients with multiple, difficult-to-treat, medically unexplained symptoms.

[Prevalence of mental disorders in multimodal therapy of chronic back pain]. / Prävalenz psychischer Störungen in der multimodalen Therapie des chronifizierten Rückenschmerzes.

Because of its biopsychosocial factors chronic back pain is often resistant to unimodal therapy regimes. Multimodal pain programs are a promising therapy option in the management of chronic pain as they focus on functional restoration. The aim of the study was to evaluate the prevalence of psychopathology in patients with chronic back pain. The study included 127 patients suffering from chronic back pain in multimodal inpatient pain therapy who were assessed by a psychologist. A retrospective analysis was performed focusing on the psychological diagnoses. Further factors investigated were age, gender, numeric rating scale (NRS) pain intensity at the beginning and end of the program, hospital anxiety and depression scale (HADS), further psychological treatment recommendations and migration background. Fisher's exact test was performed to calculate the significance in the different subgroups. The results showed that there was a high prevalence of depression, anxiety disorders and adjustment disorders in patients with chronic back pain. In this cohort the prevalence of depression and anxiety disorders was significantly higher than the estimated prevalence of the normal German population.

[Etiopathogenetic aspects of somatoform disorders]. / Ätiopathogenetische Aspekte somatoformer Störungen.

The etiopathology of somatoform disorders can only be understood against the background of an integrated biopsychosocial model. Cultural and historical influences must be taken into account as well as contemporary settings of scientific or medical priorities. In this context the emphasis on neurobiological findings can be interpreted as the non-accidental struggle for legitimacy of both patients and physicians. Altogether the available data on factors influencing the formation and maintenance of somatoform symptoms has to be described as both diverse and unspecific and thus points to a challenging research program in the coming years.

[Default mode network of the brain. Neurobiology and clinical significance]. / "Default-mode"-Netzwerk des Gehirns. Neurobiologie und klinische Bedeutung.

The resting state of the human brain is intrinsically organized by the so-called default mode network (DMN) which comprises cortical midline structure as well as lateral parietal and temporal areas. The activity of this system increases during self-oriented thinking, e.g. during a resting state but decreases during externally oriented attention and specific cognitive tasks. This review article provides a historical and methodological outline of the DMN model and describes its functional anatomy and putative functions. Based on the empirical literature the clinical implications of alterations of the DMN architecture and its role in various mental disorders are discussed.

[Health promotion for long-term unemployed. Effects on motivation for a healthy lifestyle]. / Gesundheitskompetenztraining für Menschen in Langzeitarbeitslosigkeit. Auswirkungen auf die Motivation zu einem gesünderen Lebensstil.

Among the long-term unemployed ill health is often a hindrance to successful reintegration in the job market. In a quasi-experimental controlled study we examined the effects of a health promotion intervention program tailored to the specific needs of the long-term unemployed combining individual sessions based on motivational interviewing and participatory group sessions including physical activity. Over a period of 3 months the participants of the intervention group (n = 179) showed more improvement compared to the control group (n = 108) in terms of motivation for lifestyle changes towards more physical activity and healthier nutrition. Participants of the intervention group developed an intention to act significantly more often (active lifestyle: odds ratio 4.44; 95% CI: 2.00-9.83; healthy nutrition: odds ratio 3.94; 95% CI: 1.55-10.00) and actually implemented a behavior change significantly more often (active lifestyle: odds ratio 2.77; 95% CI: 1.35-5.71; healthy nutrition: odds ratio 4.34; 95% CI: 1.92-9.78). In terms of smoking and alcohol consumption no significant intervention effects were detected. The results of the study show the effectiveness of the described health promotion program regarding a lifestyle change towards more healthy nutrition and more physical activity.

[Assessment of the capability of performance of patients with psychic and psychosomatic diseases--a diagnostic model]. / Begutachtung der Leistungsfähigkeit bei Personen mit psychischen und psychosomatischen Störungen--ein diagnostisches Modell.

The limited availability of appropriate methods and criteria makes the assessment of capability by psychic and psychosomatic disorders difficult. This article displays and discusses the standards relating to content and method in capability assessments. The underlying diagnostic model of assessment capability has been conceptualised and tested empirically by a multicentric and interdisciplinary work-group. Different diagnostic levels of the manual are outlined as well as the procedures of operationalisation of the diagnostic categories. Furthermore, first results of empirical analysis are described and important conditions of the application of the diagnostic model are discussed.

Design and Development of a Tunable Ferroelectric Microwave Surface Mounted Device.

Based on a Ba(1-x)SrxTiO3 ferroelectric thin film, a discrete tunable surface mounted device (SMD) capacitor has been developed for microwave frequency applications. The proposed SMD topology has the particular advantage of inherent decoupling between the RF signal and the dc biasing voltage, necessary to tune the ferroelectric permittivity. The design and technological development of the SMD component is presented, and the synthesis of the ferroelectric thin film is summarized. Material characterization shows convenient tunability, while low dielectric losses at 10 MHz. The integration of the SMD tunable capacitor into a Planar Inverted-F Antenna has been done in order to evaluate the agility and tunability performance of the antenna.

Psychiatric comorbidity in patients with spasmodic dysphonia: a controlled study.

OBJECTIVES: To study the prevalence of psychiatric comorbidity assessed by a structured clinical interview in patients with spasmodic dysphonia (SD) compared with patients suffering from vocal fold paralysis (VFP). METHODS: In 48 patients with SD and 27 patients with VFP, overall psychiatric comorbidity was studied prospectively using the Structured Clinical Interview for DSM-IV Axis I disorders. Physical disability and psychometric variables were assessed with standardised self-rating questionnaires. RESULTS: 41.7% of SD subjects and 19.5% of the control group met DSM-IV clinical criteria for current psychiatric comorbidity (p<0.05). Significant predictors of psychiatric comorbidity in SD were severity of voice impairment and subjective assessment of "satisfaction with health". As a limitation, the severity of voice impairment in patients with SD was nearly twice as high, and their illness had lasted nearly twice as long. CONCLUSIONS: We found a high prevalence of psychiatric comorbidity in patients with SD. The significant correlation between current psychiatric comorbidity and the extent of voice pathology may point to an especially strong interaction between somatic and psychiatric complaints in SD.

Domain wall motion in Pb(Zr0.20Ti0.80)O3 epitaxial thin films.

Two Pb(Zr0.20Ti0.80)O3 samples of different thickness and domain configuration have been studied. The c-domain sample was found to have a higher coercive field E c and higher dielectric losses than the other which presents approximately 60% of c-domains and 40% of a-domains as observed by piezo force microscopy (PFM) characterization. Hyperbolic law measurements reveal that the higher coercive field is due to domain wall pinning in deeper defects and hence a higher field E th is required for unpinning. The dissipation factors due to domain wall motion, however, are similar in both samples since the domain wall density is low and there is almost no interaction between domain walls. The higher dielectric losses in the c-domain oriented sample are a result of a greater contribution from the lattice and seem to be due to strain from the substrate, which is not relieved in a thin sample. PFM and dielectric characterization are complementary methods which provide a better understanding of the domain wall motion.