The crisis is over, long live the crisis: mental health in emerging adulthood during the course of the COVID-19 pandemic.

Introduction: As a multidimensional stressor, the COVID-19 pandemic posed a significant threat to mental health, with studies showing younger age groups to be particularly vulnerable. Thus, this study aimed to monitor mental health, potential risk/protective factors, and pandemic-related variables among young university students during the pandemic. Methods: Students of the University of Greifswald (M age = 23.0 years, 73.9% female) participated in five cross-sectional online surveys in December 2020 (N = 1,127), March 2021 (N = 760), June/July 2021 (N = 531), December 2021 (N = 1,226), and December 2022 (N = 814). Sociodemographic data, depression and anxiety severity, loneliness, quality of life, coping strategies, resilience, self-esteem, and emotion regulation were measured. First, results from December 2020 were compared to pre-pandemic normative data. Second, the time course during the pandemic was analyzed. Third, linear models were calculated to examine the influence of risk and protective factures on depression and anxiety severity. Results: Higher levels of depression, anxiety, and loneliness, as well as lower levels of self-esteem, physical and mental health, social relationships and well-being were found in December 2020 compared to pre-pandemic. Levels of depression and anxiety severity peaked in December 2022. Female sex, loneliness, and previous mental treatment showed associations with higher depression and anxiety severity, while higher self-esteem, resilience and use of reappraisal strategies appeared to act as protective factors. Discussion: The study indicates the pandemic's detrimental impact on students' mental health and quality of life. Identified risk and protective factors provide guidance for tailored prevention and treatment, as well as the design of measures for future pandemics and other crisis.

Physiological and neural synchrony in emotional and neutral stimulus processing: A study protocol.

Background: As psychotherapy involves at least two individuals, it is essential to include the interaction perspective research. During interaction, synchrony, i.e., the occurrence of simultaneous responses, can be observed at the physiological, neural, and behavioral level. Physiological responses include heart rate and electrodermal activity; neural markers can be measured using electroencephalogram. Emotionally arousing stimuli are allocated more attentional resources (motivated attention), which is reflected in physiological activation and brain potentials. Here we present a protocol for a pilot study implementing a new research methodology, and replication of the motivated attention to emotion effect in in dyads. There is evidence that higher synchrony is associated with more positive (therapeutic) relationships. Thus, the secondary outcome will be the association between physiological and neural synchrony and subjective ratings. Methods and design: Individuals (18-30 years) will participate in same-sex pairs in two experiments. In the first experiment (triadic interaction), both participants attentively watch unpleasant, neutral and pleasant pictures, and read/listen to standardized scripts (unpleasant, neutral, and pleasant, respectively) for the imagination task. In the second experiment, participants will read out three scripts (unpleasant, neutral, pleasant) to each other, followed by a joint imagination period. Stimuli will be presented in counterbalanced orders. After each picture and imagination, participants rate their subjective arousal and valence. In the beginning and in the end of the procedure, dyads rate their relationship, sympathy, and bonds (Working Alliance Inventory subscale). Heart rate, electrodermal activity and electroencephalogram will be continuously measured during both experiments using portable devices (EcgMove4 and EdaMove4, nine-channel B-Alert X-Series mobile-wireless EEG). Synchrony analyses will include the dual electroencephalography analysis pipeline, correlational analyses and Actor-Partner Interdependence Models. Discussion: The present study protocol provides an experimental approach to investigate interpersonal synchrony during emotion processing, allowing for the establishment of research methods in a pilot study, which can later be translated into real-life psychotherapy research. In the future, fundamental understanding of such mechanisms in dyadic interactions is essential in order to promote therapeutic relationships, and thus, treatment effectiveness and efficiency.

Monitoring and management of chronic kidney disease in ambulatory care - analysis of clinical and claims data from a population-based study.

BACKGROUND: Although chronic kidney disease (CKD) is highly prevalent in the general population, little research has been conducted on CKD management in ambulatory care. Objective was to assess management and quality of care by evaluating CKD coding in ambulatory care, patient diagnosis awareness, frequency of monitoring and whether appropriate patients are referred to nephrology. METHODS: Clinical data from the population-based cohort Study of Health in Pomerania (SHIP-START) were matched with claims data of the Association of Statutory Health Insurance Physicians. Quality of care was evaluated according international and German recommendations. RESULTS: Data from 1778 participants (56% female, mean age 59 years) were analysed. 10% had eGFR < 60 ml/min/1.73m2 (mean age 74 years), 15% had albuminuria. 21% had CKD as defined by KDIGO. 20% of these were coded and 7% self-reported having CKD. Coding increased with GFR stage (G3a 20%, G3b 61%, G4 75%, G5 100%). Serum creatinine and urinary dip stick testing were billed in the majority of all participants regardless of renal function. Testing frequency partially surpassed recommendations. Nephrology consultation was billed in few cases with stage G3b-G4. CONCLUSION: CKD coding increased with stage and was performed reliably in stages ≥ G4, while CKD awareness was low. Adherence to monitoring and referral criteria varied, depending on the applicability of monitoring criteria. For assessing quality of care, consent on monitoring, patient education, referral criteria and coordination of care needs to be established, accounting for patient related factors, including age and comorbidity. TRIAL REGISTRATION: This study was prospectively registered as DRKS00009812 in the German Clinical Trials Register (DRKS).

Comorbid Depression and Diabetes Are Associated with Impaired Health-Related Quality of Life in Chronic Kidney Disease Patients.

Given the increasing prevalence of chronic kidney disease (CKD) and its impact on health care, it is important to better understand the multiple factors influencing health-related quality of life (HRQOL), particularly since they have been shown to affect CKD outcomes. Determinants of HRQOL as measured by the validated Kidney Disease Quality of Life questionnaire (KDQOL) and the Patient Health Questionnaire depression screener (PHQ-9) were assessed in a routine CKD patient sample, the Greifswald Approach to Individualized Medicine (GANI_MED) renal cohort (N = 160), including a wide range of self-reported data, sociodemographic and laboratory measures. Compared to the general population, CKD patients had lower HRQOL indices. Dialysis was associated with (1) low levels of physical functioning, (2) increased impairments by symptoms and problems, and (3) more effects and burden of kidney disease. HRQOL is seriously affected in CKD patients. However, impairments were found irrespective of eGFR decline and albuminuria. Rather, the comorbid conditions of depression and diabetes predicted a lower HRQOL (physical component score). Further studies should address whether recognizing and treating depression may not only improve HRQOL but also promote survival and lower hospitalization rates of CKD patients.

Establishment of Emotional Memories Is Mediated by Vagal Nerve Activation: Evidence from Noninvasive taVNS.

Emotional memories are better remembered than neutral ones, but the mechanisms leading to this memory bias are not well understood in humans yet. Based on animal research, it is suggested that the memory-enhancing effect of emotion is based on central noradrenergic release, which is triggered by afferent vagal nerve activation. To test the causal link between vagus nerve activation and emotional memory in humans, we applied continuous noninvasive transcutaneous auricular vagus nerve stimulation (taVNS) during exposure to emotional arousing and neutral scenes and tested subsequent, long-term recognition memory after 1 week. We found that taVNS, compared with sham, increased recollection-based memory performance for emotional, but not neutral, material. These findings were complemented by larger recollection-related brain potentials (parietal ERP Old/New effect) during retrieval of emotional scenes encoded under taVNS, compared with sham. Furthermore, brain potentials recorded during encoding also revealed that taVNS facilitated early attentional discrimination between emotional and neutral scenes. Extending animal research, our behavioral and neural findings confirm a modulatory influence of the vagus nerve in emotional memory formation in humans.SIGNIFICANCE STATEMENT Emotionally relevant information elicits stronger and more enduring memories than nonrelevant information. Animal research has shown that this memory-enhancing effect of emotion is related to the noradrenergic activation in the brain, which is triggered by afferent fibers of the vagus nerve (VN). In the current study, we show that noninvasive transcutaneous auricular VN stimulation enhances recollection-based memory formation specifically for emotionally relevant information as indicated by behavioral and electrophysiological indices. These human findings give novel insights into the mechanisms underlying the establishment of emotional episodic memories by confirming the causal link between the VN and memory formation which may help understand the neural mechanisms underlying disorders associated with altered memory functions and develop treatment options.

Item and source memory for emotional associates is mediated by different retrieval processes.

Recent event-related potential (ERP) data showed that neutral objects encoded in emotional background pictures were better remembered than objects encoded in neutral contexts, when recognition memory was tested one week later. In the present study, we investigated whether this long-term memory advantage for items is also associated with correct memory for contextual source details. Furthermore, we were interested in the possibly dissociable contribution of familiarity and recollection processes (using a Remember/Know procedure). The results revealed that item memory performance was mainly driven by the subjective experience of familiarity, irrespective of whether the objects were previously encoded in emotional or neutral contexts. Correct source memory for the associated background picture, however, was driven by recollection and enhanced when the content was emotional. In ERPs, correctly recognized old objects evoked frontal ERP Old/New effects (300-500 ms), irrespective of context category. As in our previous study (Ventura-Bort et al., 2016b), retrieval for objects from emotional contexts was associated with larger parietal Old/New differences (600-800 ms), indicating stronger involvement of recollection. Thus, the results suggest a stronger contribution of recollection-based retrieval to item and contextual background source memory for neutral information associated with an emotional event.

Enhanced spontaneous retrieval of cues from emotional events: An ERP study.

Recent evidence points to enhanced episodic memory retrieval not only for emotional items but also for neutral information encoded in emotional contexts. However, prior research only tested instructed explicit recognition, and hence here we investigated whether memory retrieval is also heightened for cues from emotional contexts when retrieval is not explicitly probed. During the first session of a two-session experiment, neutral objects were presented on different background scenes varying in emotional and neutral contents. One week later, objects were presented again (with no background) intermixed with novel objects. In both sessions, participants were instructed to attentively watch the stimuli (free viewing procedure), and during the second session, ERPs were also collected to measure the ERP Old/New effect, an electrophysiological correlate of episodic memory retrieval. Analyses were performed using cluster-based permutation tests in order to identify reliable spatio-temporal ERP differences. Based on this approach, old relative to new objects, were associated with larger ERP positivity in an early (364-744 ms) and late time window (760-1148 ms) over distinct central electrode clusters. Interestingly, significant late ERP Old/New differences were only observed for objects previously encoded with emotional, but not neutral scenes (504 to 1144 ms). Because these ERP differences were observed in a non-instructed retrieval context, our results indicate that long-term, spontaneous retrieval for neutral objects, is particularly heightened if encoded within emotionally salient contextual information. These findings may assist in understanding mechanisms underlying spontaneous retrieval of emotional associates and the utility of ERPs to study maladaptive involuntary memories in trauma- and stress-related disorders.

Chronic stress and emotion: Differential effects on attentional processing and recognition memory.

Previous research indicates that acute stress around the time of learning facilitates attention and memory for emotionally salient information. Despite accumulating evidence for these acute stress effects, less is known about the role of chronic stress. In the present study, we therefore tested emotional and neutral scene processing and later recognition memory in female participants using hair cortisol concentrations as a biological marker for chronic stress. Event-related potentials recorded during picture viewing indicated enhanced late positive potentials (LPPs) for emotional, relative to neutral contents. These brain potentials varied as a function of long-term hair cortisol levels: hair-cortisol levels were positively related to overall LPP amplitudes. Results from recognition memory testing one week after encoding revealed better memory for emotional relative to neutral scenes. Hair-cortisol levels, however, were related to poorer memory accuracy. Taken together, our results indicate that chronic stress enhanced attentional processing during encoding of new stimuli and impaired later recognition memory. Results are discussed with regard to putatively opposite effects of chronic stress on certain brain regions (e.g., amygdala and hippocampus).

[Mandatory Surgical Subinternship in the Final Year of Medical School - a Stepping Stone to Becoming a Surgeon?] / Chirurgisches Pflichttertial im Praktischen Jahr ­ das Sprungbrett in die chirurgische Weiterbildung?

BACKGROUND: The final year is an important time for a medical student as this is when medical knowledge is transformed into medical responsibilities. The field of surgery is firmly anchored in the educational structure as it is mandatory during the practical year of a medical student. The purpose of this paper is to identify factors that influence medical students to choose surgery after the final year of medical school. MATERIALS AND METHODS: An online survey conducted by the AG DGOU 2012 provided complete data sets from a total of 9079 participants. 184 of these had already completed their PJ compulsory sub-internship (tertiary) surgery. These were divided into four groups for analysis: decision to specialise in surgery prior to the PJ compulsory tertiary ("yes, before", JV), during the PJ compulsory ("yes, during", JW), decision against before the PJ compulsory ("no, before", NV) or during the compulsory ("no, during", NW). The total of 38 survey items were summarised for overall assessment, taking into account the decision on subject specialisation. RESULTS: 57.9% of the respondents were positive regarding the overall impression of the surgical internship during their final year. The respondents of the JW group were especially positive, having made the decision to become a surgeon, based on their internship experience during the final year in comparison to the NW group (decision against surgery). We find significant differences in all analysed items: integration into team JW/NW (p ≤ 0.003), acquisition of expertise (p ≤ 0.014), teachers (p ≤ 0.025), quality and structure of teaching (p ≤ 0.043) and overall satisfaction with the required tertial (p ≤ 0.037). CONCLUSION: In comparison to other specialities, in the field of surgery there is the option of recruiting directly within the framework of the compulsory internship. The results reveal unsatisfactory structures from a student perspective. The lack of medical care/support, the insufficient inclusion in therapeutic considerations, the lack of professional knowledge and lack of contact with the teachers are just a few key points that negatively impact the overall outcome of students' satisfaction with the compulsory tertiary education. The results of the present study should serve as motivation and contribute to the restructuring of the compulsory core of the Practical Year, which the Master Plan 2020 will entail.

Effects of Transcutaneous Vagus Nerve Stimulation (tVNS) on the P300 and Alpha-Amylase Level: A Pilot Study.

Recent research suggests that the P3b may be closely related to the activation of the locus coeruleus-norepinephrine (LC-NE) system. To further study the potential association, we applied a novel technique, the non-invasive transcutaneous vagus nerve stimulation (tVNS), which is speculated to increase noradrenaline levels. Using a within-subject cross-over design, 20 healthy participants received continuous tVNS and sham stimulation on two consecutive days (stimulation counterbalanced across participants) while performing a visual oddball task. During stimulation, oval non-targets (standard), normal-head (easy) and rotated-head (difficult) targets, as well as novel stimuli (scenes) were presented. As an indirect marker of noradrenergic activation we also collected salivary alpha-amylase (sAA) before and after stimulation. Results showed larger P3b amplitudes for target, relative to standard stimuli, irrespective of stimulation condition. Exploratory post hoc analyses, however, revealed that, in comparison to standard stimuli, easy (but not difficult) targets produced larger P3b (but not P3a) amplitudes during active tVNS, compared to sham stimulation. For sAA levels, although main analyses did not show differential effects of stimulation, direct testing revealed that tVNS (but not sham stimulation) increased sAA levels after stimulation. Additionally, larger differences between tVNS and sham stimulation in P3b magnitudes for easy targets were associated with larger increase in sAA levels after tVNS, but not after sham stimulation. Despite preliminary evidence for a modulatory influence of tVNS on the P3b, which may be partly mediated by activation of the noradrenergic system, additional research in this field is clearly warranted. Future studies need to clarify whether tVNS also facilitates other processes, such as learning and memory, and whether tVNS can be used as therapeutic tool.

[Quality and Satisfaction with the Surgical Medical Clerkship from a Student Perspective]. / Qualität und Zufriedenheit mit der chirurgischen Famulatur aus studentischer Sicht.

PREFACE: The surgical medical clerkship is of special importance, as the student is given the opportunity to get in touch with medical colleagues and patients for the first time, and the interest in a certain field of specialisation can be consolidated. The present study will clarify how students perceived their medical clerkship in the field of surgery. METHODS: A nationwide online survey carried out in 2012 was able to recruit 9079 participants, and contained questions about the completed curricular internships. The present evaluation contains the data of those respondents who had completed at least four weeks of internship in surgery. The following main groups were of particular interest: overall assessment, satisfaction, structure and quality of teaching, of the teachers, and the acquisition of practical skills, which were divided into 35 items. Statistical evaluation was carried out using SPSS 22.0 (IBM Corp., Armonk, USA). In addition to the descriptive statistics, the Chi² test was performed for frequencies, and univariate ANOVAs with the sub-subject factor group (satisfied, neutral, dissatisfied) were performed for the individual items. RESULTS: Overall, the data of 526 participants could be analysed. The female proportion of students was 56.7%; the average age at the time of the survey was 25 years. In all evaluated items, there were significant differences between the groups satisfied and dissatisfied. The participants of the survey who were satisfied with the overall qualification (p = 0.000), reported that they benefited with regard to the technical and didactic quality of teaching (p = 0.000), the acquisition of practical competences (p = 0.000), as well as the didactic and professional quality of teaching (p = 0.000). DISCUSSION: Little is published about the internships for students, including the medical clerkship "Famulatur". However, this information seems to be important, as the students can freely choose the subject in which the Famulatur can be completed. Thus, in this early phase of training, it is possible to recruit young academics for the department by optimising existing structures and improving the range of courses.

Event-related potentials of emotional and neutral memories: The role of encoding position and delayed testing.

Previous research found that memory is not only better for emotional information but also for neutral information that has been encoded in the context of an emotional event. In the present ERP study, we investigated two factors that may influence memory for neutral and emotional items: temporal proximity between emotional and neutral items during encoding, and retention interval (immediate vs. delayed). Forty-nine female participants incidentally encoded 36 unpleasant and 108 neutral pictures (36 neutral pictures preceded an unpleasant picture, 36 followed an unpleasant picture, and 36 neutral pictures were preceded and followed by neutral pictures) and participated in a recognition memory task either immediately (N = 24) or 1 week (N = 25) after encoding. Results showed better memory for emotional pictures relative to neutral pictures. In accordance, enhanced centroparietal old/new differences (500-900 ms) during recognition were observed for unpleasant compared to neutral pictures, most pronounced for the 1-week interval. Picture position effects, however, were only subtle. During encoding, late positive potentials for neutral pictures were slightly lower for neutral pictures following unpleasant ones, but only at trend level. To summarize, we could replicate and extend previous ERP findings showing that emotionally arousing events are better recollected than neutral events, particularly when memory is tested after longer retention intervals. Picture position during encoding, however, had only small effects on elaborative processing and no effects on memory retrieval.

[Young Academics in Neuropsychological Disciplines: Factors Affecting Career Aspiration in Psychiatry, Neurology and Psychosomatic Medicine]. / Nachwuchs in der Nervenheilkunde: berufswunschprägende Faktoren in Psychiatrie, Neurologie und Psychosomatik.

OBJECTIVE: Students with specialization preferences in psychiatry, neurology, or psychosomatic medicine were retrospectively compared with regard to aspects of motivation to choose medicine as their field of study. METHODS: To identify early predictors of specialization preferences, a nationwide online survey was conducted with 9079 medical students. The statements of those with a preference for neurology, psychiatry, or psychosomatic medicine were evaluated using analysis of variance (ANOVA). RESULTS: Prospective neurologists were motivated by scientific interest variables and less by the aspects of life management. On the other hand, students with preferences for one of the psychological disciplines reported comparatively higher degrees of desire to actively provide help and of the importance of their own medical history. There were no significant differences between future psychiatrists and psychosomatic professionals. CONCLUSION: The reported motives point to thematic orientations that might be useful in the subject-specific acquisition of young academics.

[Nursing Internship Internal Medicine: Evaluation and Influences on the Attitude towards the Specialization]. / Pflegepraktikum Innere Medizin: Evaluation und Einflüsse auf die Einstellung zum Fach.

Background German medical students have to perform a nursery internship of three month duration. While this internship is widely discussed, there is a lack of student evaluation data. Objectives Here, for the first time, student evaluation of a nursery internship in internal medicine (IM) is investigated. Moreover, the question was raised, whether the early experience during this internship may influence students' attitude towards the specialty. Methods In a nation-wide online-survey, 767 German medical students (mean age 22.8 years; 58 % female) evaluated a nursery internship on an IM ward concerning integration in medical teams, teachers, structure and quality of teaching, and satisfaction. Multivariate comparisons were conducted following the question, whether students could imagine choosing IM for a clinical elective after this nursery internship. Results 71 % of the students felt well integrated in the medical team, most was learned from the nurses, and most students indicated having acquired nursing skills. Only 19 % evaluated the structure of the internship as good, and 40 % indicated that they reached the learning goals. Students who could imagine performing an IM clinical elective (52 %) gave best evaluations on all items. Conclusions A successful nursery internship can promote students' interest in the specialty of internal medicine. But, there is a strong need for improvement in structure and content, including the, to date missing, definition of learning targets, regarding this first practical experience in medical studies.

Cognitive functioning and emotion processing in breast cancer survivors and controls: An ERP pilot study.

Diagnosis and treatment of breast cancer is a very emotionally aversive and stressful life event, which can lead to impaired cognitive functioning and mental health. Breast cancer survivors responding with repressive emotion regulation strategies often show less adaptive coping and adverse outcomes. We investigated cognitive functioning and neural correlates of emotion processing using ERPs. Self-report measures of depression, anxiety, and fatigue, as well as hair cortisol as an index of chronic stress, were assessed. Twenty breast cancer survivors (BCS) and 31 carefully matched healthy controls participated in the study. After neuropsychological testing and subjective assessments, participants viewed 30 neutral, 30 unpleasant, and 30 pleasant pictures, and ERPs were recorded. Recognition memory was tested 1 week later. BCS reported stronger complaints about cognitive impairments and more symptoms of depression, anxiety, and fatigue. Moreover, they showed elevated hair cortisol levels. Except for verbal memory, cognitive functioning was predominantly in the normative range. Recognition memory performance was decreased in cancer survivors, especially for emotional contents. In ERPs, survivors showed smaller late positive potential amplitudes for unpleasant pictures relative to controls in a later time window, which may indicate less elaborative processing of this material. Taken together, we found cognitive impairments in BCS in verbal memory, impaired emotional picture memory accuracy, and reduced neural activity when breast cancer survivors were confronted with unpleasant materials. Further studies and larger sample sizes, however, are needed to evaluate the relationship between altered emotion processing and reduced memory in BCS in order to develop new treatment strategies.

New learning following reactivation in the human brain: targeting emotional memories through rapid serial visual presentation.

Once reactivated, previously consolidated memories destabilize and have to be reconsolidated to persist, a process that might be altered non-invasively by interfering learning immediately after reactivation. Here, we investigated the influence of interference on brain correlates of reactivated episodic memories for emotional and neutral scenes using event-related potentials (ERPs). To selectively target emotional memories we applied a new reactivation method: rapid serial visual presentation (RSVP). RSVP leads to enhanced implicit processing (pop out) of the most salient memories making them vulnerable to disruption. In line, interference after reactivation of previously encoded pictures disrupted recollection particularly for emotional events. Furthermore, memory impairments were reflected in a reduced centro-parietal ERP old/new difference during retrieval of emotional pictures. These results provide neural evidence that emotional episodic memories in humans can be selectively altered through behavioral interference after reactivation, a finding with further clinical implications for the treatment of anxiety disorders.

Effects of pre-encoding stress on brain correlates associated with the long-term memory for emotional scenes.

Recent animal and human research indicates that stress around the time of encoding enhances long-term memory for emotionally arousing events but neural evidence remains unclear. In the present study we used the ERP old/new effect to investigate brain dynamics underlying the long-term effects of acute pre-encoding stress on memory for emotional and neutral scenes. Participants were exposed either to the Socially Evaluated Cold Pressure Test (SECPT) or a warm water control procedure before viewing 30 unpleasant, 30 neutral and 30 pleasant pictures. Two weeks after encoding, recognition memory was tested using 90 old and 90 new pictures. Emotional pictures were better recognized than neutral pictures in both groups and related to an enhanced centro-parietal ERP old/new difference (400-800 ms) during recognition, which suggests better recollection. Most interestingly, pre-encoding stress exposure specifically increased the ERP old/new-effect for emotional (unpleasant) pictures, but not for neutral pictures. These enhanced ERP/old new differences for emotional (unpleasant) scenes were particularly pronounced for those participants who reported high levels of stress during the SECPT. The results suggest that acute pre-encoding stress specifically strengthens brain signals of emotional memories, substantiating a facilitating role of stress on memory for emotional scenes.