High intensity endurance training is associated with better quality of life, but not with improved cognitive functions in elderly marathon runners.

Impairment of cognitive functions in advanced age leads to a reduced quality of life and impaired ability to perform everyday tasks. The positive impact of physical exercise on the quality of life and well-being, also at a later age, is well established. However, the effect of endurance exercises, including long distance running and cycling, on cognitive function and mental health within the elderly population has still to be elucidated. To this end, elderly active marathoners (N = 50) aged over 60 years and non-athlete controls (N = 49) were followed for four years. Cognitive function was assessed using the CERAD test battery. In addition, the Short Form Health Survey (SF-36) was applied to assess self-reported physical, mental, and emotional health. Except for age, sex and education-corrected z-values of the test "Word list recall", with marathon runners showing a decline compared to an improvement in controls (p < 0.05), there was no statistically significant difference in time trend between groups. In contrast, concerning self-reported health, scores in all eight domains of the SF-36 remained stable over time and, in nearly all of them, marathon runners showed higher self-reported health than controls. The results indicated that extensive endurance exercise is associated with improved subjective health but does not lead to better scores in cognitive performance tests in elderly persons.

Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire.

BACKGROUND: In order to identify cancer patients with psychosocial needs during radiotherapy, a routine screening questionnaire is widely recommended in the literature. Several tools focusing mainly on psychological issues have been developed during the past decade. However, problems with their implementation into clinical routine have been repeatedly reported, due to a lack of practicability for clinicians and nurses. This study reports the compilation of a multidisciplinary screening questionnaire and an analysis of the effectiveness of its implementation into clinical routine at the Department of Radiotherapy, Medical University of Vienna. MATERIALS AND METHODS: The screening questionnaire is based on a compilation of several subscales from established and validated assessment tools. It focuses on comprehensive information with high a clinical relevance for all professions. In a pilot study, patients' acceptance was assessed qualitatively. Analysis of missing screening data in consecutively admitted patients reflects the effectiveness of implementation and representativity of the data. A validation analysis of the psychological subscales was performed using external criteria and its internal consistency was tested with Cronbachs' α. RESULTS: Qualitative patient acceptance of the screening questionnaire is good. The overall response rate in the screening procedure was 75 %. Missing patient screening data sets arose randomly-mainly due to organizational problems-and did not result in systematic errors. The psychological subscales identify highly distressed patients with a sensitivity of 89 and 78 %, and an internal consistency of 0.843 and 0.617. CONCLUSION: The multidisciplinary screening questionnaire compiled in this study has a high patient acceptance, provides reliable and representative data and identifies highly distressed patients with excellent sensitivity. Although requiring additional personnel resources, it can be implemented successfully in clinical routine with benefits for both the patient and the professional team.

Physical and psychosocial support requirements of 1,500 patients starting radiotherapy.

BACKGROUND: The need for psychosocial support in cancer patients is estimated in the literature at 14-50 %. At the Department of Radiation Oncology, Medical University of Vienna, approximately 3,000 patients are seen annually. Due to limited staff resources, highly distressed patients need to be selected for focused support. A multidisciplinary screening questionnaire covering physical, social and psychological problems and needs was successfully implemented in clinical routine. We present the results of a representative sample of 1,500 heterogeneous cancer patients before beginning radiotherapy. PATIENTS AND METHODS: The prevalence rates of physical, social and psychological problems and needs were evaluated. Independent risk factors for critical psychological distress were analyzed in a multivariate logistic regression model, in order to identify vulnerable subgroups for focused psychosocial support. RESULTS: Critical psychological distress was found in 22 % of the overall cohort, of whom only 26 % reported a need for psychological information. Clinically relevant pain was suffered by 31 %. Patients' most frequent complaints were weakness, sleeping difficulties and exhaustion. Consequently, 40 % were impaired in activities and 35 % reported a requirement for support in daily life. A need for further information was expressed by 37 % of patients. Significant risk factors for critical psychological distress included pain, functional status, support requirements and patient-reported symptoms. Differences in tumor type, metastases and sociodemographic variables had no impact on critical psychological distress. CONCLUSION: Approximately one third of all patients beginning radiotherapy have physical, social and psychological problems and should receive focused psychosocial support. Multivariate analysis reveals that patients with impaired "physical integrity" are at a significantly higher risk of experiencing critical psychological distress.

Myeloperoxidase levels predict executive function.

The main purpose of the study was to investigate whether baseline myeloperoxidase (MPO) levels are associated with executive cognitive function in individuals with high physical activity. Baseline serum MPO levels of 56 elderly marathon runners and 58 controls were assessed by ELISA. Standardized tests were applied to survey domain-specific cognitive functions. Changes in brain morphology were visualized by magnetic resonance imaging (MRI). High baseline serum MPO levels correlated with worse outcome in tests assessing executive cognitive function in athletes but not in the control group (NAI maze test p<0.05, Trail Making Test ratio p<0.01). In control participants, subcortical white matter hyperintensities were associated with higher scores on the Geriatric Depression Scale (p<0.05), whereas athletes seem to be protected from this effect. During strenuous exercising, MPO as well as its educts may be elevated due to increased oxygen intake and excretion of pro-inflammatory mediators inducing host tissue damage via oxidative stress. This outweighs the potential benefits of physical activity on cognitive function.

A meta-analysis for neurobehavioural effects due to electromagnetic field exposure emitted by GSM mobile phones.

BACKGROUND AND OBJECTIVE: Numerous studies have investigated the potential effects of electromagnetic fields (EMFs) emitted by GSM mobile phones ( approximately 900 MHz to approximately 1800 MHz) on cognitive functioning, but results have been equivocal. In order to try and clarify this issue, the current study carried out a meta-analysis on 19 experimental studies. DESIGN: Meta-analysis. METHODS: Nineteen studies were taken into consideration. Ten of them were included in the meta-analysis as they fulfilled several minimum requirements; for example, single-blind or double-blind experimental study design and documentation of means and standard deviation of the dependent variables. The meta-analysis compared exposed with non-exposed subjects assuming that there is a common population effect so that one single effect size could be calculated. When homogeneity for single effect sizes was not given, an own population effect for each study and a distribution of population effects was assumed. RESULTS: Attention measured by the subtraction task seems to be affected in regard to decreased reaction time. Working memory measured by the N-back test seems to be affected too: under condition 0-back target response time is lower under exposure, while under condition 2-back target response time increases. The number of errors under condition 2-back non-targets appears to be higher under exposure. CONCLUSION: Results of the meta-analysis suggest that EMFs may have a small impact on human attention and working memory.

Validation of the SWAP-200 for diagnosing psychostructural organization in personality disorders.

BACKGROUND: The aim of the study was to investigate the validity of the prototype-matching, empirically based 200-item Shedler-Westen Assessment Procedure (SWAP-200) and its clinical utility for describing underlying dimensions of psychostructural organization and functioning. SAMPLING AND METHODS: Patients (n = 306) from two psychoanalytic out-patient departments were included. Replicatory and exploratory factor analysis, correlation and discriminant validity statistics, and canonical correlation analysis were performed. RESULTS: Replicatory factor analysis failed to reproduce the identical original factorial structure. Standard factor analysis revealed an eight-factor solution displaying a dimensional description of psychostructural personality organization (high functioning - neurotic/inhibited - borderline/emotionally dysregulated - psychotic/dissocial). Discriminant validity exists across the sample owing to high/poor psychological functioning. Canonical correlation analysis does not support the replacement of the Structured Clinical Interview for DSM-IV, but provides relevant implications for refining DSM-IV axis II. CONCLUSIONS: Support is given for the SWAP instrument in describing dimensional higher-order personality organization and psychostructural functioning.

Lead exposure levels and duration of exposure absence predict neurobehavioral performance.

OBJECTIVES: We investigated cognitive functions in currently lead exposed and formerly lead exposed men. The aim of the study was to verify the hypothesis that lead induced cognitive deficits are reversible. METHODS: Forty-seven lead exposed subjects with a mean blood level (PbB) of 30.8 microg/100 ml and 48 formerly exposed aged-matched subjects (PbB: 5.5 microg/100 ml) with the same socio-economic background were investigated. Both groups were matched on verbal intelligence. Cognitive functions were assessed by using the Modified Wisconsin Card Sorting Test, Block Design Test, Visual Recognition Test, Simple Reaction Time, Choice Reaction and Digit Symbol Substitution. Lead exposure was assessed by using current and cumulative measures. The sample was divided according to their exposure duration versus exposure absence into four groups for subsequent ANOVA models analyses. RESULTS: Currently exposed men performed significantly worse in the Wisconsin Test and Block Design Test. No differences were found in the Visual Recognition Test, Simple Reaction Time, Choice Reaction and Digit Symbol Substitution. Splitting the sample according to their exposure duration versus exposure absence resulted in better cognitive performance of subjects with shorter exposure duration and longer exposure absence in the Block Design Test and the Wisconsin Test. CONCLUSIONS: Our results provide further evidence that cognitive deficits induced by occupationally lead are most likely reversible.

[Predictors for patients' starting psychotherapy]. / Prädiktoren für die Inanspruchnahme einer Psychotherapie.

BACKGROUND: The aim of this study was to discover prognostic criteria for outpatients' making use of psychotherapy. Data from patients and therapists were collected. SUBJECTS AND METHODS: After initial psychoanalytic interviews, 92 patients at a university psychotherapy outpatient department were asked to complete narrative forms and standardized questionnaires (FMP) regarding their motivation to seek psychotherapy. In addition, the therapists contributed a Global Assessment of Functioning (GAF) and estimate of the initial therapeutic working alliance (iTAB) for each patient. In the follow-up, we investigated patients' actual use of psychotherapy. RESULTS: Sociodemographic variables, personality variables, and diagnoses had only minor prognostic relevance, whereas therapists' assessments of patient resources for therapeutic relationship and work proved to be of high predictive value. CONCLUSION: Positive assessment of a patient's ability for therapeutic working alliance in the initial diagnostic interview is shown to be an important prognostic factor of a patient's entering psychotherapy.

Affective state of women following a prenatal diagnosis: predictors of a negative psychological outcome.

OBJECTIVE: The benefits of prenatal diagnostic procedures are well documented. However, the investigation of psychological consequences related to these procedures has remained a surprisingly neglected area of research. The main aim of the present study was to investigate the potential relationship between psychological outcome and associated (socio-demographic, psychological and obstetric) variables in women attending a tertiary referral center for prenatal diagnosis and therapy for ultrasound scanning (due to the suspicion of a fetal malformation raised by the gynecologist in private practice), amniocentesis or chorionic villus sampling. METHODS: Affective state was assessed by means of standardized measures of anxiety and depression (State-Trait Anxiety Inventory; Mood Scale) in 77 consecutive, unselected women. A follow-up investigation, including an additional assessment of coping mechanisms, took place 6 months after the first contact. Given the considerable number of intervening and correlating factors, a path analysis was undertaken. RESULTS: We found that all women in our sample experienced acute distress, not only those with proven fetal malformations, genetic disorders or intrauterine fetal death, but also those with the diagnosis of a sonographic sign. At baseline (i.e. immediately after the diagnostic procedure), mood and anxiety scores in our sample were found to be comparable to those of patients with a major depressive episode. A high trait anxiety level, implementation of negative coping strategies and loss of the child during pregnancy were found to be predictive of a negative psychological outcome at follow-up. Socio-demographic variables did not have a significant predictive function for the psychological outcome. CONCLUSIONS: We assume that a considerable number of women undergoing prenatal diagnostic procedures experience psychological distress, which may be underestimated by workers in prenatal care. Establishment of interdisciplinary treatment settings, in which access to psychological support is facilitated, may be extremely beneficial for women following a prenatal diagnosis.