Implementation of a Web-Based Work-Related Psychological Aftercare Program Into Clinical Routine: Results of a Longitudinal Observational Study.

BACKGROUND: As inpatient medical rehabilitation serves to promote work ability, vocational reintegration is a crucial outcome. However, previous Web-based trials on coping with work-related stress have been limited to Web-based recruitment of study participants. OBJECTIVE: The aim of our study was to evaluate the implementation of an empirically supported transdiagnostic psychodynamic Web-based aftercare program GSA (Gesund und Stressfrei am Arbeitsplatz [Healthy and stress-less at the workplace])-Online plus into the clinical routine of inpatient medical rehabilitation, to identify characteristics of patients who have received the recommendation for GSA-Online plus, and to determine helpfulness of the intervention and satisfaction of the participants as well as improvement in quality of life and mental health status of the regular users of GSA-Online plus. METHODS: GSA-Online plus was prescribed by physicians at termination of orthopedic psychosomatic inpatient rehabilitation. Participants' use of the program, work-related attitudes, distress, and quality of life were assessed on the Web. RESULTS: In 2 rehabilitation centers, 4.4% (112/2562) of rehabilitants got a recommendation for GSA-Online plus during inpatient rehabilitation. Compared with usual person aftercare, the Web-based aftercare program was rarely recommended by physicians. Recommendations were made more frequently in psychosomatic (69/1172, 5.9%) than orthopedic (43/1389, 3.1%) rehabilitation (χ21=11.845, P=.001, Cramér V=-0.068) and to younger patients (P=.004, d=0.28) with longer inpatient treatment duration (P<.001, r=-0.12) and extended sick leaves before inpatient medical rehabilitation (P=.004; Cramér V=0.072). Following recommendation, 77% (86/112) of rehabilitants participated in Web-based aftercare. Completers (50/86, 58%) reported statistically significant improvements between discharge of inpatient treatment and the end of the aftercare program for subjective work ability (P=.02, d=0.41), perceived stress (P=.01, d=-0.38), functioning (P=.002, d=-0.60), and life satisfaction (P=.008, d=0.42). CONCLUSIONS: Physicians' recommendations of Web-based aftercare are well accepted by patients who derive considerable benefits from participation. However, a low rate of prescription compared with other usual aftercare options points to barriers among physicians to prescribing Web-based aftercare.

[Physicians of Gladiators in the Ancient Rome]. / Gladiatorenärzte im antiken Rom.

Gladiators in ancient Rome were an integral part of the Roman world and were a unique phenomenon. Their bloody fight presumably originated from the cult of the dead. Later it was a feature of the self-portrayal of many Roman noblemen, especially during the election campaigns. Eventually it became an imperial privilege. Legally, gladiators were slaves. They were trained in specially equipped schools (ludus, plural: ludi). Also, special schools existed that trained fighters to compete in the arena against wild animals. Doctors at the ludi took care of the fighters: They prepared them for the fight or treated injuries. The gladiator cemeteries of Ephesus and York clearly demonstrate typical injury patterns. The most prominent and best-known gladiator physician is - due to his eminent self-portrayal - Galenus. Even though he looked after the gladiators of his hometown Pergamon only for a brief time. From ancient inscriptions we know the names of several other physicians who took care of gladiators. Especially these largely forgotten doctors are referenced in this article.

Breast Ultrasonography: Findings in Pediatric Patients.

Purpose To analyze referral indications, imaging findings and diagnoses in breast sonography in a division of pediatric radiology. Materials and Methods Breast ultrasound examinations of 270 patients were analyzed for referral reasons, imaging findings and final diagnoses (152 females, 118 males). The mean age of the patients was 8.8 years (range, 6 days-18 years). Each breast was examined systematically in two orthogonal probe orientations. Pathological findings were documented on two orthogonal imaging planes. Color Doppler ultrasonography was used additionally. Images and clinical data were reviewed in all cases. Results The most frequent referral reasons in female patients were breast enlargement (104 patients), palpable mass (24 patients) and mastodynia (23 patients). The most frequent diagnoses were normal gland tissue (101 patients), cysts (9 patients), augmented adipose tissue (7 patients) and hemangiomas (7 patients). The most frequent referral reasons in male patients were breast enlargement (106 patients), palpable mass (13 patients) and mastodynia (9 patients). The most frequent diagnoses were gland tissue (79 patients), augmented adipose tissue (24 patients) and cysts (10 patients). Only 2 malignant masses were diagnosed: A Burkitt lymphoma and a relapsed ALL. Conclusion Fear of breast cancer and permanent damage to the breast leads to low-threshold medical consultations and referrals. Sensitive handling is required especially in adolescent patients. Most disorders arise due to the variability of breast development. Ultrasound serves as a means to exclude significant diseases of the breast.

Evaluation of a video-based Internet intervention as preparation for inpatient psychosomatic rehabilitation: study protocol for a randomized controlled trial.

BACKGROUND: Patients' treatment expectations are a key factor in psychotherapy. Several studies have linked higher expectations to better treatment success. Therefore, we want to evaluate the impact of a targeted video-based intervention on patients' expectations and the treatment success of inpatient rehabilitation. METHODS/DESIGN: All patients who will be referred to inpatient psychosomatic rehabilitation in three clinics will receive a study flyer with information about how to log in to the study platform together with the usual clinic information leaflet. Patients will receive the study information and informed consent upon login and will be randomized into the intervention or the control group. The intervention group (n = 394) will get access to our virtual online clinic, containing several videos about inpatient rehabilitation, until their admission to inpatient rehabilitation. The control group (n = 394) will receive no special treatment preparation. Questionnaires will be given at study inclusion (T0), two weeks before admission to (T1), and at the end of (T2) inpatient rehabilitation. The primary outcome is the outcome expectancy measured with the Credibility Expectancy Questionnaire at T1. Secondary outcomes include treatment motivation, mental health, work ability, depression, anxiety, and satisfaction with and usage of the Internet platform. DISCUSSION: We expect the intervention group to benefit from the additional preparation concerning their outcome expectancy. If successful, this approach could be used in the future to enhance the efficacy of inpatient rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02532881 . Registered on 25 August 2015.

[Was cannibalism practiced in ancient Gaul? Critognatus, the leader of the Celts, in the focus of Caesar's propaganda]. / Kannibalismus im alten Gallien? Der Keltenfürst Critognatus im Brennpunkt der Propaganda Caesars.

Critognatus, the leader of the Celts, is mentioned only once in the extant ancient literature, namely in Caesar's description of the siege of Alesia in BG VII 77.2-78.2. Here he is portrayed as a determined patriot who wants to encounter the Roman invader bravely and at the risk of all available means. Nevertheless, crafty Caesar succeeds in stamping him by propagandistic pinches to an evil monster and cannibal. On the one hand Caesar falls back on current Roman prejudices towards the Gauls. On the other hand, the endocannibalism practised among Celts to a certain extent as a cult action seems to have played a rôle. Caesar's propagandistic methods are transparent and at the same time so effective that the label of an ogre sticks to Critognatus until the present day. Caesar's portrayal aims above all at the justification of his Gallic War which he wages against uncivilized and inhuman opponents who are a menace to Rome and even to the culture itself.

[Therapy or torture: a treatment of gout misunderstood by Gregory of Tours]. / Therapie oder Tortur--Eine missverstandene Behandlung der Gicht bei Gregor von Tours.

Historiarum libri decem, a work written by St. Gregory, the bishop of Tours, is an important contemporary source for the study of the Merovingian times. In Book V 42 Gregory reports the story of Maurilio, the bishop of Cahors in the Southern Gaul, who was strongly suffering from gout. Maurilio treated the illness himself applying a hot iron to his foot and shank. This therapy is already mentioned in the Corpus Hippocraticum. It seems, however, that cauterization was not known to St. Gregory of Tours as a medical treatment of this particular illness. He simply saw in it a sanctifying practice in the sense of penitential mortification. Indeed, for Gregory this interpretation is an important part of his literary aim, as Maurilio is for him a brilliant example of a minister of the Church. Although Maurilio is well-known for his piety, knowledge, and uprightness in diocesan dealings, he voluntarily, as Gregory thinks, submits to ascetic self-castigation.

[The struggle of early Christians against Isis medica: breaks and continuity in traditions in the context of health and healing]. / Zum Kampf der frühen Christenheit gegen die Isis Medica--Bruch und Kontinuität von Traditionen im Ubergangsfeld von Heil und Heilung.

The study of health and healing gods may offer significant examples of how certain ideas survive, with hardly any substantial loss, across periods of great change. It is no surprise that, following centuries of struggle by early Christians against the worship of pagan gods, some originally heathen ideas and elements of thinking should have been in due course, if with prudence, adapted to Christian needs and sensibilities. A most remarkable instance of such practice is to be found, somewhat surprisingly, in the life of the bishop St. Cyril of Alexandria. He opposed rigorously the cult of Isis, above all in Egypt, but nevertheless adapted features of Isis to his conception of the Blessed Virgin Mary as 'Theotokos'. In this manner Isis, the goddess-mother, with her child Horus became--in a certain measure--a type of the Blessed Virgin Mother of God, accompanied by the Infant Jesus. The legendary arson perpetrated at the start of the 6th century A.D. against a temple in Cologne wherein a healing deity was worshipped should, it is argued here for the first time, be understood in the context of conflict between early Christianity and the cult of Isis. There is good reason to believe that the aforementioned temple set on fire by Gallus, later Bishop of Clermont, was in fact the shrine of Isis in Cologne.

[Jean Dominique Larrey and a paradoxical charity postage stamp]. / Jean Dominique Larrey und eine paradoxe Wohlfahrtsmarke.

A few years ago, the author had the lucky opportunity to acquire a charity stamp in an upright format showing the great French army surgeon Jean Dominique Larrey. This remarkable stamp, issued in 1964 for the benefit of the French Red Cross, is in itself a historical paradox which perhaps has not yet been noticed. In fact, it should have never been issued, since Larrey, to put it briefly, would have made the foundation of the Red Cross almost unnecessary: if Larrey's requirements concerning a prompt and extensive care of all wounded soldiers and persons involved in a battle had been put into practice only in Europe, there would have been no reason for an organization like the Red Cross. Henri Dunant, walking through the battlefield of Solferino in 1859, would have seen many corpses and all kinds of broken army material lying around. Seeing all that would probably have saddened him, but he would have hardly undertaken any humanitarian activity. The misery and chaos on the battlefield that moved the Swiss observer so much and prompted him to found the Red Cross would have simply not existed. Nevertheless, Jean Dominique Larrey would certainly feel greatly flattered if he could see his portrait applied to supporting the charity organization which carries out many of the ideas--once vigorously advanced by himself--up to the present day.

[Aspects of senile dementia in ancient Rome: literary fiction and factual reality]. / Aspekte der Altersdemenz im antiken Rom: Literarische Fiktion und faktische Lebenswirklichkeit.

Old people and their pecularities have been the object of writers since the beginning of Western literature. The aim of this study is to verify the social and juridical significance of senile dementia in ancient Rome. Among the few relevant sources the 10th satire of Juvenal attracts attention. It describes a demented patient who revises his succession in favour of a lady with bad reputation. Logically, we wonder whether such dispositions were possible and after all legally binding. Or did Juvenal exaggerate? A look at the Roman legislation shows: Since the Twelve Tablet Law there were instruments to control or to help demented people. This meant care in the sense of the today's curatorship or guardianship. These measures were supposed to prevent extravagancy or doing business and legal acts like marriages or last wills in the state of diminished responsibility. Nevertheless, it must be assumed that there was a considerable discrepancy between juridical theory and daily practice, because the position of the "pater familias" was virtually untouchable, the individual freedom of the full citizen was firmly underlined and the Roman civil law allowed only little executive interferences. Juvenal's bizarre example should not only be taken as good literary fiction. It might reflect the sad, but nevertheless probable reality of the people directly concerned. Apart from that it has to be said that senile dementia played only a minor role in Roman legislation. Mainly because there were considerably less very old people--and in particular people with senile dementia--than today.

[Euripides and Heraclitus on the attitude towards the corpse--an unrecognized fragment of Heraclitus in Electra, v. 289]. / Euripides und Heraklit uber den Umgang mit den Körpern Verstorbener--Ein unerkanntes Heraklitfragment in der Elektra, V. 289.

Among the fragments of Heraclitus preserved to our times there is one saying that corpses ought to be disposed of more urgently than excrements Diels/Kranz 22 B 96. This sentence of an aphoristic nature, as frequently in the case of Heraclitus' scripts, allows many different interpretations. Even in antiquity these words led to vitriolic reactions and perplexed other writers. It is why they have been frequently quoted. Nevertheless, it has been overlooked until now that Euripides, the youngest of the three great Attic tragedians, had inserted them into one of his dramas. In his Electra it is the title figure who uses them while reporting the slaughter of Agamemnon. The quotation bears witness to Euripides' erudition as of one of the earliest men known to have possessed a private library. He must, therefore, have had access to many treatises on various subjects, among them to the work by Heraclitus. The Electra is a kind of homage to the obscure thinker from Ephesus. From this fact, and from the plot of this particular play, we may gain some insight into an ambivalent attitude of the ancient Greeks towards the corpse that certainly influenced ideas about human anatomy in particular and medical knowledge in general. A characteristic feature of the malefactors, namely Aigisthos and Clytaimestra, is the deliberate dishonouring of their victims corpse. By contrast, the noble characters Orestes and Electra never violate the corpse of their arch-enemy Aigisthos, but see to it that he is properly buried. Burial was, particularly in Athens, so essential that in the well-known Arginusai trial the failure to bury the fallen soldiers resulted in capital punishment for the accused. Nevertheless, it is likely that Euripides, following Heraclitus, did not reject the anatomical examination of corpses for scientific purposes, as he was not only in this regard a supporter of science and progress. Perhaps Plato's notion of the human body as the tomb of the soul is foreshadowed here. This notion may have helped demythologize the corpse. Anyway, it is striking to observe the beginnings of the so-called Hippocratic medicine on the coast of Asia Minor and the near islands. It is exactly this part of the world where the pre-Socratics had made their first attempts at reasoning about the nature of being and made the transition from mythos to logos a few generations earlier. That intellectual climate was certainly good for nourishing scientific ideas of paramount importance. Heraclitus was without doubt one of the deepest-thinking pre-Socratics. The acceptance of his results by many critical thinkers of the time, such as Euripides, helped them attain their due recognition.

[Wishes for recovery on bronze--comments on a coin in honour of L. Aelius Caesar]. / Ein eherner Genesungswunsch--Anmerkungen zu einer Münze des L. Aelius Caesar.

L. Aelius Caesar is a little known co-regent of Hadrian who, having already been taken ill, was elected Princeps as Hadrian's successor and died soon afterwards. The city of Mytilene in Lesbos dedicated a bronze coin for him while he was still alive. The reverse of the coin shows the arrival of Asclepios in the shape of a snake. It is certainly a reference to the mythic translation of the cult of Asclepios to Rome in the third century B. C. which introduced the worship of the healing god on the Tiber Island. The community of Mytilene that struck the coin wanted to wish the ruler, whose illness was generally known, a good recovery or even to encourage him to convalesce at the famous ancient spa of Mytilene. At the same time they wanted to make a request on their own behalf. They wanted to gain the favour of the putative successor to the ruling Princeps in order to keep or regain certain liberties for their city which have been reduced by Vespasian in his centralization of the Roman Empire.

The catheter and its use from Hippocrates to Galen.

PURPOSE: We comprehensively reviewed the history and use of the bladder catheter in Western medicine from 500 BC to 200 AD. MATERIALS AND METHODS: Greek and Latin texts were key word searched to identify descriptions of contemporary instruments and their uses. RESULTS: The catheter and its use were mentioned by about 10 ancient authors in more than a total of 20 texts dating to the end of the second century AD. The authors include Hippocrates, Celsus, Soranus, Rufus, Aretaeus and Galen. They described the use of the instrument in reference to contemporary anatomy and physiology, and indications and contraindications in regard to certain conditions, such as urinary retention, bladder stones and intravesical blood clots. Technical details and particularities of use were also reviewed, as were pharmacological considerations and underlying physical principles. CONCLUSIONS: Knowledge of the urinary catheter, and its usefulness and risks in ancient medicine can be dated from the 5th century BC. Our study of European texts documents its broad use. Because catheterization was perceived as a practical measure, it generated little scientific controversy.

The catheter and its use in late antiquity and the early middle ages.

PURPOSE: Based on Greek and Latin sources the use of the urinary catheter in Western medicine between 200 and 1000 CE was reviewed. MATERIALS AND METHODS: Computerized databank searches permitted the identification and analysis of ancient and early medieval texts that include material on the catheter. RESULTS: Ten medical authors mentioned the catheter and its use. In the Byzantine world they include the encyclopedists Oribasius, Aetius and Paul of Aegina. The best known Latin author is Caelius Aurelianus. These writers often put together summaries of earlier works. Innovation or independent research was not easily found at a time during which neither anatomical autopsy nor experimentation was widely practiced. CONCLUSIONS: Old texts contain numerous instructions on how to skillfully use the catheter. As a technical achievement, it was independent of philosophical trends. Its primary indications, namely urinary retention, bladder stones and the administration of cures, changed little with time. As one of the oldest and most important instruments at the disposal of physicians, the history of the catheter should be known to every urologist.

[A lead seal of the "Germanos' Health Service" as an early forerunner of the health insurance card in ancient Byzantium]. / Ein Bleisiegel der "Diakonie des Germanos" als früher Vorläufer eines Krankenversicherungsausweises im alten Byzanz".

The aim of this study is to present a Byzantine lead seal from the 6th century A. D. in the light of other comparable finds and to explain its function. According to the Greek inscription it was issued by the so-called "Germanos' Health Service". Its beneficiaries carried it probably around the neck or wrist. This charitable institution, settled in Constantinople, supported people in need. Feeding of the poor and free access to the baths certainly belonged to the standard services of the "Germanos' Health Service". Several reasons favour the assumption that medical help was also included in the range of benefits offered to people to whom it would have otherwise been out of reach. Contrary to the modern Health Insurance there was no legal claim to the medical care. It was rather a voluntary charitable supply that is to be seen in the context of Christian love and of personal striving for the salvation of the soul through good deeds. Therefore, the seal of the "Germanos' Health Service" belongs at least indirectly among the forerunners of the modern Health Insurance Card which ought to give access to participation in the blessing of good health.

[Defense of Ovid: annotations on Metamorphoses IV 119-123)]. / Eine lanze für Ovid - Anmerkungen zu 'Metamorphosen' IV 119-124.

The description of Pyramus' suicide in the Metamorphoses has been commented on by many scholars. There has been particular criticism of the comparison between the unfortunate lover's wound, squirting out blood, and a burst water-main. This has been supposed to show yet again how Ovid, in spite of his undoubtedly great talent, is capable of ruining a story by exaggeration. Nevertheless, a medical look at his wording leads to quite a different judgement. In his simile of the burst water-main Ovid obviously had in mind the haemorrhage from a damaged femoral artery, which can shoot blood to a considerable distance, sometimes over several yards. Only in this way can the fruits of the mulberry tree, hanging high over the wounded Pyramus, be moistened with blood and painted dark. This is, after all, the metamorphosis which justifies the inclusion of the story in the whole corpus. As it is possible for a person fatally wounded in this way to survive for some hours, the poet has to guarantee that Pyramus dies within minutes of turning his sword against himself. Only so can Thisbe, returning quickly, confess her love for Pyramus in such a heartfelt way and follow him at once. The haemorrhage from a femoral artery my indeed kill a person within a few minutes. Therefore Ovid's description is neither gruesome nor tasteless but simply natural and dramatically conclusive. The comparison with the water-main is one which would easily have occurred to the poet. From Ovid' point of view and that of his contemporaries, who had no knowledge of the circulation of the blood, no better comparison can be imagined than that between the blood vessels of the human body and urban water-pipes, a technical achievement of which the Romans were particularly proud.

Roman emperors suffering from apoplexy: the medical and historical significance of classical literary sources.

According to various Greek and Latin texts, several Roman emperors died of "apoplexy". This paper presents a systematic collection and evaluation of these sources. The contents of the texts are compared with contemporary knowledge as well as present-day perspectives. In retrospect, few of the "royal cases" can be classified as cerebrovascular disorders.

[A drill-bow in Horace, Odes 3.6.7]. / Ein Bogenbohrer bei Horaz, Carmina 3, 26, 7.

With the short poem Odes 3.26 Horaces says--ostensibly--farewell to the subject of love. A symbol of his retreat is the order given to his followers: they ought to lay in the Temple of Venus the three objects which he has used in his night escapades struggling for the girls' love: lucida funalia (torches), vectis (jemmies), and arcus. The last words has been puzzling the scholars for centuries. Many took offence at the transmitted text and offered conjectures of their own. Some, however, defended arcus using different arguemtns, for instance that arcus refers to bows and arrows as weapons of the lascivious night-reveller. Also the author of this article retains arcus in the text. The context and grammatical construction let assume that also this noun denotes a tool of a burglar, preferably a drill driven by a fiddle-bow. Such instruments were use by carpenters, joiners, and surgeons. Apart from this, gigantic drill-bows were known among military machines. These were frequently applied in sieges. Horace might have seen descriptions and drawings of them in military handbooks which he presumably read in order to prepare himself for his short and rather inglorious career as an officer in the army of Caesar's murderers. For Romans without military experience who suddenly obtained a high rank at war this was a typical way of making good their shortcomings. The parallel between the siege of a town and the attack upon the beloved girl's house must be regarded as a poetic exaggeration; the reader should be amused by an impracticable idea. Furthermore, a possible connection between Horace's poem and the Heracles of Euripides is pointed out here for the first time. In Heracles 942-6 the hero, driven insane by Lyssa's work, asks for his bow, his arrows and siege instruments to take Mycenae, the fortress of his tormentor Eurystheus. In fact he brakes into his own bedroom and kills his spouse and his son.

[A report of St. Bonaventura in the mirror of the history of neurology]. / Ein bericht des heiligen Bonaventura im spiegel der neurologiegeschichte.

Ancient and medieval literature contain few case reports of specific syndromes. But there is no lack of such accounts in theological literature, with its long tradition of gathering and documenting individual case studies involving miracle cures--a practice which stretches from the ancient sanctuaries of Asclepius to today's places of pilgrimage. Among the many miracles attributed to St. Francis, complied around 1260 by his biographer, St. Bonaventura, is the case of a young monk afflicted by a sudden hemiplegia accompanied by aphasia and mental confusion. According to legend, he was miraculously and completely healed by the appearance of St. Francis. The report can be interpreted from a number of different approaches: medical, theological, literary or even autobiographical. Neurologists may treat this "case history" as an early description of a "prolonged ischaemic neurological deficit" (PRIND).