Impact of the emotional development approach on psychotropic medication in adults with intellectual and developmental disabilities: a retrospective clinical analysis.

BACKGROUND: Compared with the general population, adults with an intellectual developmental disorder (IDD) are more likely to develop mental health problems and to receive high levels of psychotropic medication, particularly antipsychotics. The emotional development (ED) approach may help to better understand the nature of challenging behaviour (CB) and tailor treatment and support accordingly. The aim of this retrospective study was to investigate the impact of the ED approach on the prescription of psychotropic medication during inpatient psychiatric treatment. METHODS: The clinical data of 1758 patients were analysed within a retrospective study design over a period of 12 years. ED level was assessed (1) for the first time (INITIAL-SEO), (2) during a previous hospital stay (PAST-SEO) or (3) not at all (NO-SEO). The effects of the ED assessment and the respective intervention during the current admission on the number of psychotropics and the number and dosage of antipsychotics were analysed for the total sample, including those with CB, autism spectrum disorders and psychosis. Group differences were analysed by a chi-square test and a one-factorial analysis of variance. For analysing the impact of the application of the ED approach on psychotropic medication, a covariance model was applied. Changes between the subsamples were analysed by t-tests for dependent samples. RESULTS: The ED approach had a significant impact on reducing the overall amount of psychotropic medication and the dosage of antipsychotics in all patients with IDD. These effects were mainly attributable to those showing CB. In patients with autism spectrum disorders, the developmental approach reduced the number of antipsychotics. No effects could be observed in patients with psychosis; in this subsample, both the number and dosage of antipsychotics increased. CONCLUSIONS: The application of the ED approach in the current hospital stay reduced the number of psychotropic drugs and the number and dosage of antipsychotics, especially in those patients with IDD and CB, but also in those with autism spectrum disorders.

Trauma treatment using Narrative Exposure Therapy adapted to persons with intellectual disabilities or severe chronic mental disorders - a randomised controlled pilot study with an embedded observational study.

BACKGROUND: Despite an increased likelihood of experiencing traumatic events and increased vulnerability, there are only few publications on trauma therapy for persons with intellectual disabilities (IDs). This pilot study for the first time investigates the feasibility and effectiveness of Narrative Exposure Therapy (NET) within this target group modified by Plain Language. METHODS: A group of n = 10 participants with ID dual diagnoses and another group of n = 5 participants with severe and chronic mental disorders were separately stratified and randomised, then forming together an intervention group (n = 7) and a waiting list control group (n = 8). All participants were treated with NET attuned to their communication abilities by using Plain Language. Primary outcome was the post-traumatic stress measured with the Post-Traumatic Symptom Scale-10 before and after the intervention. In addition, the Adverse Childhood Experience Index was used for diagnostic purposes. Data were analysed using t-test for repeated measures and analysis of covariance. RESULTS: Narrative Exposure Therapy and the randomised controlled trial study proved to be successfully conductible with participants with IDs in a congregated residential service. Although the corresponding effect size was high (partial eta square = 0.188), the between-group difference was not significant (P = 0.12). Analysis of the observational study resulted in a highly significant improvement for participants with IDs (P < 0.001; Hedges' g = 2.36) and in a significant improvement in participants with severe and chronic mental disorders (P < 0.013; Hedges' g = 1.52). Additionally, the participants with IDs show a significantly better reduction of symptom burden (P = 0.03; partial eta square = 0.327). CONCLUSIONS: The results provide a first evidence for a possible and successful implementation of NET modified in Plain Language for persons with IDs and complex mental health support needs. Completeness in responding to the items of Post-Traumatic Symptom Scale-10 and Adverse Childhood Experience Index indicates the suitability of these instruments for both groups of participants. Although the group difference in the randomised controlled trial failed to achieve statistical significance mainly due to the small sample size, the results of the embedded observational study are promising for the conduct of further studies with the modified NET.

Complementary, alternative, integrative and dietary therapies for children with Crohn's disease - A systematic review.

Children with diagnosed inflammatory bowel diseases such as Crohn's disease are faced with the daunting prospect of living with a chronic disease. Besides psychological stress, children are suffering from therapy side-effects; in particular, corticosteroid therapies are problematic in the growth phase. This highlights that there is a need for less aggressive alternative therapies for children as well as adolescents living with such chronic conditions. Elemental diets are widely used and accepted therapy options. Several pediatric Crohn's disease patients also use complementary, alternative and integrative therapies to reduce or avoid drug therapies. To survey such therapy options and their efficiency and safety, we performed a systematic literature search and screened databases (Cochrane Library, EMBASE, OvidSP, PubMed, CAMbase, CAM-QUEST, Anthromedics) from their inception to December 2019. In total, seven of 1439 studies fulfilled search criteria. Six RCTs and one retrospective controlled trial investigating elemental diets (Flexical, Elemental 028), semi-elemental diets (Pregomin), polymeric diets (Modulen IBD), whole protein based formulas, and ω-3 fatty acid supplementation were found. Data indicated that diet therapies were equal to or more effective than corticosteroid therapies when used to treat Crohn's disease. Regrettably, we could not identify controlled studies investigating complementary, alternative and integrative medicine approaches. Our review provides an updated overview of controlled studies investigating dietary therapies used in the treatment of pediatric Crohn's disease, and demonstrates that the current study situation does not reflect the actual use of complementary, alternative and integrative therapies. Therefore, clinical trials are necessary to estimate risks and benefits of such therapies. The review indicated that enteral diets and ω-3 fatty acid supplementation may be an effective alternative to corticosteroid treatments for children with Chron's disease.

Complementary and alternative medicine in the treatment of acute bronchitis in children: A systematic review.

OBJECTIVE: Our review summarizes published literature of complementary and alternative medicine (CAM) used for the treatment of acute bronchitis in children. BACKGROUND: Acute bronchitis is one of the most frequent pediatric diseases and has high prevalence for in- and outpatient care. Acute bronchitis is mainly a viral-caused infection, but a high and inappropriate use of antibiotics has been demonstrated in many countries. As CAM therapies might reduce the use of antibiotics and can complement conventional therapies in children, they could be an appropriate treatment option. METHODS: A systematic literature search was conducted using general and complementary and alternative medicine (CAM)-specific databases. A search term including 65 CAM-associated definitions was applied. RESULTS: Literature search revealed 309 articles, whereby 18 articles hit search criteria. These clinical trials were subgrouped into the categories herbal medicine, anthroposophic medicine and homeopathy. The most often studied approaches are herbal remedies, in particular the Pelargonium sidoides extract, EPs® 7630. Its efficacy was demonstrated in three placebo-controlled trials and two observational studies. Anthroposophic approaches (mainly ribwort-containing remedies) were investigated in two controlled trials and three observational studies. Two studies were found investigating the homeopathic remedies Monapax® and Droperteel®. CONCLUSION: Study results indicate a favorable effect of investigated CAM approaches. However, only three of 18 studies were randomized controlled trials (RCTs), so a reliable statement on effectiveness was not possible and further RCTs are indispensable.

An expert consensus-based guideline for the integrative anthroposophic treatment of acute gastroenteritis in children.

OBJECTIVES: Acute gastroenteritis is one of the major causes of hospital admission in childhood. The primary objective of the treatment is rehydration, but conventional drug therapies are limited. Therefore, several pediatricians supplement conventional treatment with complementary and alternative therapies. In the two German departments for pediatric integrative medicine, children suffering from an acute gastroenteritis are treated with supportive therapy based on anthroposophic medicine. However, up to now scientifically validated guidelines for these therapies are lacking. DESIGN: We consulted an expert pool of 50 physicians with expertise in anthroposophic medicine as well as pediatrics and invited them to participate in an online-based Delphi process. Results were analyzed by means of qualitative content analysis with two independent raters using MAXQDA. Using four rounds of questioning, a consensus-based guideline was developed. RESULTS: A strong consensus (>90%) or consensus (>75-90%) was achieved for 14 of 16 subsections. The guideline describes disease characteristics, the most useful diagnostics, drug as well as non-drug treatment recommendations and advises for a good physician-patient interaction. CONCLUSION: The guideline will help clinicians, as well as family doctors, in their daily routine and make anthroposophic medicine more tangible for parents and health insurance companies.

An experimental study on oil-dispersion baths generated by the Jungebad apparatus.

BACKGROUND: Since the very early documentation of medical treatments, bathing is an essential part of almost all traditional medical systems. In this context the oil-dispersion bath, developed in the 1930s by Werner Junge has been developed from anthroposophic medicine. We aimed at analyzing the apparatus, which churns water and essential oils into an oil-water dispersion, by means of an experimental study. MATERIAL AND METHODS: Using three different oils (rheumatic oil, citrus oil and rosemary oil) oil volumetric flow rate and oil droplet size distribution were examined at three different water volumetric flow rates of 5, 10, and 15 l/min at a constant temperature of 40 °C. Additionally, for the rheumatic oil measurements are taken at three different temperatures, 35, 40, and 45 °C at a constant volumetric flow rate of 10 l/min. Finally results were compared with a manual oil dispersion process. RESULTS: Oil volumetric flow rate increases with increasing water volumetric flow rates. Oil flow rate increases with increasing water temperature. Droplet-size distribution shows an optimal fit with a log-normal distribution for a volumetric flow rate of 5 l/min in all oils applied with citrus and rosemary oil showing a larger mean diameter compared to the rheumatic oil. Comparing the oil droplet size distribution for a traditional oil bath, distributions behaved completely different in comparison to our distributions. Moreover it seemed not possible to create an oil-dispersion with repeatable droplet size distributions whereas the Jungebad apparatus created similar oil dispersions with predictable results, independent of the user. DISCUSSION: This is the first study to explore the mechanisms of creation of the oil-dispersion bath by means of an experimental set up. Based on these experimental results, a more fundamental theoretical approach should be carried out to complement our findings and to gain deeper insights in the hydrodynamic and droplets forming processes in the Jungebad apparatus.

Physiological and emotional effects of pentatonic live music played for preterm neonates and their mothers in the Newborn Intensive Care Unit: A randomized controlled trial.

OBJECTIVE: Despite attempts to increase calmness in the Newborn Intensive Care Unit (NICU), preterm neonates still experience stress. The question arises how to further promote the infants' wellbeing. Therefore, the immediate effects of pentatonic live music on preterm infants and their mothers were examined. DESIGN AND METHODS: In a two-centre randomized controlled trial with crossover design preterm infants were exposed sequentially to two conditions: live pentatonic harp music (LPHM) used in Anthroposophic Medicine or standard care. The order of the conditions was randomized within each subject. The primary outcome was change of the number of oxygen desaturations < 90%/h, whereas secondary outcomes were: heart rate, respiratory rate, oxygen saturation, heart rate variability (HRV), the perfusion index, pulse-transit-time and maternal anxiety and others not reported on in this article. RESULTS: 21 preterm infants were randomized (14 girls), mean gestational age at measurement 35 + 0 weeks (SD 1 week). The primary outcome parameter showed no significant changes. Regarding the secondary outcomes the comparison of the pre-post-differences between the conditions showed significant effects for the HRV parameters pNN50 (ΔpNN50 = 1.46%, z = -2.47, p = .001) and SDNN (ΔSDNN=-0.06 ms, z = -2.25, p = .002). The music intervention significantly increased the values of pNN50 (Mdn 1.2% vs. 2.6%, p = 0.04) and marginally those of SDNN (Mdn 31.7 ms vs. 36.4 ms, p = 0.05). No changes were found in the other parameters. CONCLUSIONS: While the use of music in the NICU had no effect on the number of oxygen desaturations, it increased two HRV parameters indicative of infants' parasympathetic tone.

Effectiveness of an Ayurveda treatment approach in knee osteoarthritis - a randomized controlled trial.

OBJECTIVE: Ayurveda is commonly used in South Asia to treat knee osteoarthritis (OA). We aimed to evaluate the effectiveness of Ayurvedic treatment compared to conventional conservative care in patients with knee OA. METHOD: According to American College of Rheumatology (ACR) criteria knee OA patients were included in a multicenter randomized, controlled, open-label trial and treated in 2 hospital clinics and 2 private outpatient clinics in Germany. Participants received either a multi-modal Ayurvedic treatment or multi-modal conventional care with 15 treatments over 12 weeks respectively. Primary outcome was the change on the Western Ontario and McMaster University Osteoarthritis (WOMAC) Index after 12 weeks. Secondary outcomes included WOMAC subscales; the pain disability index and a pain experience scale, numeric rating scales for pain and sleep quality, quality-of-life and mood, rescue medication use, and safety issues. RESULTS: One hundred fifty-one participants (Ayurveda n = 77, conventional care n = 74) were included. Changes of the WOMAC Index from baseline to 12 weeks were more pronounced in the Ayurveda group (mean difference 61.0 [95%CI: 52.4;69.6]) than in the conventional group (32.0 [95%CI: 21.4;42.6]) resulting in a significant between-group difference (p < 0.001) and a clinically relevant effect size (Cohen's d 0.68 [95% CI:0.35;1.01]). Similar trends were observed for all secondary outcomes at week 12. Effects were sustained at follow-ups after 6 and 12 months. CONCLUSION: Results suggest that Ayurvedic treatment is beneficial in reducing knee OA symptoms. Further studies should be conducted to confirm the magnitude of the effect and to clarify the role of different treatment components and non-specific effects. REGISTRATION: at clinicaltrials.gov (NCT01225133; initial release 10/06/2010).

ß-Catenin acts in a position-independent regeneration response in the simple eumetazoan Hydra.

Wnt/ß-Catenin signaling plays crucial roles in regenerative processes in eumetazoans. It also acts in regeneration and axial patterning in the simple freshwater polyp Hydra, whose morphallactic regenerative capacity is unparalleled in the animal kingdom. Previous studies have identified ß-catenin as an early response gene activated within the first 30min in Hydra head regeneration. Here, we have studied the role of ß-Catenin in more detail. First, we show that nuclear ß-Catenin signaling is required for head and foot regeneration. Loss of nuclear ß-Catenin function blocks head and foot regeneration. Transgenic Hydra tissue, in which ß-Catenin is over-expressed, regenerates more heads and feet. In addition, we have identified a set of putative ß-Catenin target genes by transcriptional profiling, and these genes exhibit distinct expression patterns in the hypostome, in the tentacles, or in an apical gradient in the body column. All of them are transcriptionally up-regulated in the tips of early head and foot regenerates. In foot regenerates, this is a transient response, and expression starts to disappear after 12-36h. ChIP experiments using an anti-HydraTcf antibody show Tcf binding at promoters of these targets. We propose that gene regulatory ß-Catenin activity in the pre-patterning phase is generally required as an early regeneration response. When regenerates are blocked with iCRT14, initial local transcriptional activation of ß-catenin and the target genes occurs, and all these genes remain upregulated at the site of both head and foot regeneration for the following 2-3 days. This indicates that the initial regulatory network is followed by position-specific programs that inactivate fractions of this network in order to proceed to differentiation of head or foot structures. brachyury1 (hybra1) has previously been described as early response gene in head and foot regeneration. The HyBra1 protein, however, appears in head regenerating tips not earlier than about twelve hours after decapitation, and HyBra1 translation does not occur in iCRT14-treated regenerates. Foot regenerates never show detectable levels of HyBra1 protein at all. These results suggest that translational control mechanisms may play a decisive role in the head- and foot-specific differentiation phase, and HyBra1 is an excellent candidate for such a key regulator of head specification.

The Questionnaire D-RECT German: Adaptation and testtheoretical properties of an instrument for evaluation of the learning climate in medical specialist training.

AIM: Boor et al developed and validated the questionnaire D-RECT (Dutch Residency Educational Climate Test ) to measure the clinical learning environment within the medical specialist training. In this study, a German version of this questionnaire (D-RECT German) is analyzed regarding testtheoretical properties. PROBLEM: Are the results of Boor et al replicable as a proof for validity of the questionnaire D-RECT? MATERIAL & METHODS: The study was performed as online survey using the questionnaire D-RECT German (50 items in 11 subscales). To determine item characteristics and internal consistency (Cronbach's α), item- and reliability analyses were performed. Furthermore, a confirmatory factor analysis was performed using a model for maximum-likelihood estimation to evaluate validity. RESULTS: This replication study on the psychometric properties of the D-RECT with 255 residents at 17 German hospitals revealed heterogeneous discriminatory power for all items and an internal consistency of Cronbach's α between 0.57 and 0.85. Within the confirmatory factor analysis, 6 items showed standardized regression coeffizients <0.5, two of them in the subscale "Attendings role". Furthermore, strong interdependencies (>0.7) were found between the subscales "Supervision", "Coaching" and "Attendings role". CONCLUSION: The present replication study with the D-RECT German showed structural differences with respect to factorial validity underpinning the need of further validation studies.

[Language barriers in the care for pediatric immigrant patients -- results of a pilotstudy among pediatricians in Germany]. / Sprachbarrieren in der Betreuung von Patienten mitMigrationshintergrund ­ Ergebnisse einer Pilotstudiezu den Erfahrungen von Kinder- und Jugendärzten

BACKGROUND: In 2010, 19.3% of German inhabitants were either first or second generation immigrants. Language barriers can potentially impair quality of care of this heterogenous group of patients. It has not yet been studied how pediatricians practicing in Germany experience and cope with language barriers. METHODS: We conducted a written survey among participants of the 105th annual meeting of the German Society of Pediatrics in 2009. The questionnaire was newly developed and consisted of 39 items and 3 open questions. Frequency distribution and cross tables were used for descriptive analysis of categorical data. RESULTS: 229 participants returned the questionnaire (40% in inpatient care, 33% in private practice, 26% in public outpatient services). 75% of participants are confronted with language barriers regularly. The most widespread strategy to overcome barriers is using bilingual colleagues, employees or patient family members as interpreters. The opportunity to access professional interpreters depends on the care setting (22% [inpatient care] vs. 5% [private practice] vs. 28% [public outpatient service]). 91% claim that the expenditure of time to organize professional interpreting services is high. CONCLUSION: The results of the pilot project suggest that the possibilities to overcome language barriers largely depend on the care setting. A high amount of organizational work and vague financing currently limit the use of professional interpreting services. However, health politics and science increasingly demand their use.

Identification of maternal characteristics associated with the use of epidural analgesia.

The present survey aims to identify predictors associated with the use of epidural analgesia (EA). Therefore, from October 2007 to June 2008, a survey was conducted in 193 pregnant women (mean age 31.7 years (SD 4.9); 64.8% primipara) attending a German general hospital with a specialisation in integrative medicine. Questionnaires, including Antonovsky's sense of coherence (SOC) were delivered antepartum. Delivery data were recorded within the hospital quality management programme. The adjusted odds ratio (OR) for EA use was significantly greater than one for women who had previously used EA (adjusted OR =4.1; CI: 1.03-16.31) and for the desire for a delivery without pain (adjusted OR =3.05; CI: 1.36-6.83). The likelihood of EA use decreased in multipara (adjusted OR =0.05; CI: 0.01-0.22). SOC was not found to be an independent predictor for EA use. However, women with high SOC more often preferred a delivery without EA (p for trend =0.037). In conclusion, first time labour, the desire for a delivery without pain and previous use of EA are independent predictors for the use of EA in labour. Further studies should clarify the predictive role of SOC in pregnancy.

Adverse drug reactions in a complementary medicine hospital: a prospective, intensified surveillance study.

Background. Anthroposophic medicine is one of the widely used approaches of complementary and alternative medicine. However, few prospective studies have generated safety data on its use. Objectives. We aimed to assess adverse drug reactions (ADRs) caused by anthroposophical medicines (AMEDs) in the anthroposophical Community Hospital Havelhoehe, GERMANY. Study Design and Methods. Between May and November 2007, patients of six medical wards were prospectively assessed for ADRs. Suspected ADRs occurring during hospitalization were documented and classified in terms of organ manifestation (WHO SOC-code), causality (according to the Uppsala Monitoring Centre WHO criteria), and severity. Only those ADRs with a severity of grade 2 and higher according to the CTCAE classification system are described here. Results. Of the 3,813 patients hospitalized, 174 patients (4.6%) experienced 211 ADRs (CTCAE grade 2/3 n = 191, 90.5%, CTCAE grade 4/5 n = 20, 9.5%) of which 57 ADRs (27.0%) were serious. The median age of patients with ADRs (62.1% females) was 72.0 (IQR: 61.0; 80.0). Six patients (0.2%) experienced six ADRs (2.8% of ADRs) caused by eight suspected AMEDs, all of which were mild reactions (grade 2). Conclusion. Our data show that ADRs caused by AMEDs occur rarely and are limited to mild symptoms.

Thiolated polyacrylic acid-modified iron oxide nanoparticles for in vitro labeling and MRI of stem cells.

PURPOSE: The purpose of this study was to develop and characterize new surface-modified iron oxide nanoparticles demonstrating the efficiency to be internalized by human endothelial progenitor cells (EPCs) from umbilical cord blood. METHODS: Iron oxide nanoparticles were coated with polyacrylic acid-cysteine (PAA-Cys) by either in situ precipitation or postsynthesis. The nanoparticles were characterized by X-ray powder diffraction. EPCs were labeled with PAA-Cys-modified iron oxide nanoparticles or with uncoated nanoparticles. The relaxivity of uncoated and coated iron oxide nanoparticles as well as EPCs labeled with PAA-Cys-modified iron oxide were determined. RESULTS: Addition of PAA-Cys increased the particle size from 10.4 to 144 and 197 nm, respectively. The X-ray powder diffraction pattern revealed that the particles consist of Fe(3)O(4) with a spinal structure. Postsynthesis coated particles showed a cellular uptake of 85% and 15.26 pg iron/cell. For both types of particles the relaxivity ratio was at least 2-fold higher than that of the gold standard Resovist(®). CONCLUSION: The PAA-Cys coated iron oxide nanoparticles are a promising tool for labeling living cells such as stem cells for diagnostic and therapeutic application in cell-based therapies due to their high relaxivities and their easy uptake by cells.

Validation of the self regulation questionnaire as a measure of health in quality of life research.

OBJECTIVES: Several epidemiological studies address psychosomatic self regulation as a measure of quality of life aspects. However, although widely used in studies with a focus on complementary cancer treatment, and recognized to be associated with better survival of cancer patients, it is unclear what the self regulation questionnaire exactly measures. DESIGN AND SETTING: In a sample of 444 individuals (27% healthy, 33% cancer, 40% other internal diseases), we performed reliability and exploratory factor analyses, and correlated the 16-item instrument with external measures such as the Hospital Anxiety and Depression Scale, the Herdecke Quality of Life questionnaire, and autonomic regulation questionnaire. RESULTS: The 16-item pool had a very good internal consistency (Cronbach's alpha = 0.948) and satisfying/good (r subsetrt = 0.796) test-retest reliability after 3 months. Exploratory factor analysis indicated 2 sub-constructs: (1) Ability to change behaviour in order to reach goals, and (2) Achieve satisfaction and well-being. Both sub-scales correlated well with quality of life aspects, particularly with Initiative Power/Interest, Social Interactions, Mental Balance, and negatively with anxiety and depression. CONCLUSIONS: The Self Regulation Questionnaire (SRQ) was found to be a valid and reliable tool which measures unique psychosomatic abilities. Self regulation deals with competence and autonomy and can be regarded as a problem solving capacity in terms of an active adaptation to stressful situations to restore well-being. The tool is an interesting option to be used particularly in complementary medicine research with a focus on behavioural modification.

Validation of the brief multidimensional life satisfaction scale in patients with chronic diseases.

OBJECTIVE: We intended to determine the reliability of a brief life satisfaction scale in a sample of patients with chronic diseases, and to analyze its external validity. METHODS: Reliability and factor analysis of the 8-item "Brief Multidimensional Life Satisfaction Scale" (BMLSS) were performed according to standard procedures. The test sample contained 979 individuals (mean age 54+/-11 years). Forty-two percent had cancer, 22% chronic pain conditions, 10% depressive disorders, 6% other chronic diseases, and 20% were healthy. RESULTS: Reliability analysis of the 8-item pool revealed a good internal consistency coefficient (Cronbach's alpha=.869), and a single-factor structure which explains 53% of variance. The BMLSS sum scores significantly differed with respect to the underlying disease, family status, duration of disease, and age. The highest scores were found in healthy individuals, and the lowest in patients with chronic pain conditions and depressive disorders. In cancer patients, the BMLSS correlated negatively with Depression/Anxiety (HADS), Fatigue (CFS-D), and positively with SF-12's mental health and to a weaker content also with physical health. Stepwise regression analyses revealed that life satisfaction can be predicted best by (the absence of) depression, but also by Conscious Living (AKU), which is an active cognitive-behavioral style in terms of adaptive coping. CONCLUSIONS: The evaluation of the BMLSS revealed that the instrument has good psychometric properties and can be regarded as a brief, reliable and valid measure of LS in patients with chronic diseases. The instrument can be an important additive to existing health-related quality of life questionnaires, since it captures dimensions that contribute to quality of life but are not health related.

Adaptation of the Herdecke Quality of Life questionnaire towards quality of life of cancer patients.

Although instruments for the measurement of quality of life (QoL) do exist for cancer patients, factors like sleepiness or digestion are only marginally addressed. We intended to adapt the Herdecke Quality of Life (HLQ) towards these aspects in a multi-centre cross-sectional validation study. A group of 293 subjects [79% female, age: 55.9 +/- 13.4 years; 146 cancer patients, 28 patients with rheumatic diseases and a healthy control group (n = 119)]. Structural relations between the items were detected by factor and reliability analyses. For external validation, correlations with the hospital anxiety and depression scale (HADS), self-regulation score (SRS) and the Marburger short questionnaire on chronotypology (MQC) were performed, and test-retest reliability was calculated. Factor analysis found three sub-scales: physical abilities (PA) (Cronbach's alpha = 0.90), sleep quality (SQ) (Cronbach's alpha = 0.89) and digestive well-being (DWB) (Cronbach's alpha = 0.80). Sleep quality correlated well with HADS-anxiety (r =-0.52), PA with HADS-depression (r =-0.49). We found moderate correlations of PA and SQ with SRS, while the HLQ scales did not correlate with the MQC. Analysis of test-retest reliability resulted in values of r = 0.757 for PA, r = 0.715 for SQ and r = 0.603 for DWB. The HLQ-cancer suits to measure unique features of cancer-related QoL aspects. In future studies it has to be tested in larger samples of cancer patients.

Functionality or aesthetics? A pilot study of music therapy in the treatment of multiple sclerosis patients.

INTRODUCTION: Neuro-degenerative diseases are, and will remain, an enormous public health problem. Interventions that could delay disease onset even modestly will have a major public health impact. The aim of this study is to see which components of the illness are responsive to change when treated with music therapy in contrast to a group of patients receiving standard medical treatment alone. MATERIAL AND METHODS: Twenty multiple sclerosis patients (14 female, 6 male) were involved in the study, their ages ranging from 29 to 47 years. Ten participants formed the therapy group, and 10 the matched control group matched by age, gender and the standard neurological classification scheme Expanded Disability Status Scale (EDSS). Exclusion criteria were pregnancy and mental disorders requiring medication. Patients in the therapy group received three blocks of music therapy in single sessions over the course of the one-year project (8-10 sessions, respectively). Measurements were taken before therapy began (U1), and subsequently every three months (U2-U4) and within a 6-month follow-up without music therapy (U5) after the last consultation. Test battery included indicators of clinical depression and anxiety (Beck Depression Inventory and Hospital Anxiety and Depression Scale), a self-acceptance scale (SESA) and a life quality assessment (Hamburg Quality of Life Questionnaire in Multiple Sclerosis). In addition, data were collected on cognitive (MSFC) and functional (EDSS) parameters. RESULTS: There was no significant difference between the music-therapy treatment group and the control group. However, the effect size statistics comparing both groups show a medium effect size on the scales measuring self-esteem (d, 0.5423), depression HAD-D (d, 0.63) and anxiety HAD-A (d, 0.63). Significant improvements were found for the therapy group over time (U1-U4) in the scale values of self-esteem, depression and anxiety. In the follow-up, scale values for fatigue, anxiety and self-esteem worsen within the group treated with music therapy. DISCUSSION: A therapeutic concept for multiple sclerosis, which includes music therapy, brings an improvement in mood, fatigue and self-acceptance. When music therapy is removed, then scale scores worsen and this appears to intimate that music therapy has an influence.

[Pilot study for the development of a questionnaire for the measuring of the patients' attitude towards spirituality and religiosity and their coping with disease(SpREUK)]. / Pilotstudie zur Entwicklung eines Fragebogens zur Erfassung der spirituellen und religiosen Einstellung und des Umgangs mit Krankheit (SpREUK).

OBJECTIVE: Life-threatening diseases are the standard situations which confront patients with spirituality and religiosity. Although both are wellknown factors in disease coping, their measurability and operationability remains a basic problem due to the variety of different meanings and interpretations of these terms. In this paper we describe the development of a questionnaire for the measuring of the patients' attitudes towards spirituality and religiosity and their disease coping (SpREUK). MATERIAL AND METHODS: For a first evaluation, 129 patients with a mean age of 54 years (SD 14.3) completed the questionnaire. 67% of them were women. 76% had a Christian denomination, 19% no denomination, and only 4% reported other religious traditions. 45% of the patients suffered from cancer, 18% from multiple sclerosis, 22% from other chronic diseases, and 15% from acute diseases. The questionnaire comprises 29 five-stage likert-scaled items. Apart from a descriptive analysis of the single items, reliability (Cronbach's alpha) and validity analysis (factor analysis) of the questionnaire was performed. RESULTS: Factor analysis resulted in four dimensions: (1) 'Search for meaningful support', (2) 'Guidance, control and message of disease', (A) 'Support in relations with the external through spirituality/religiosity', and (B) 'Stabilization of the inner condition through spirituality/religiosity'. The reliability of the four scales of the SpREUK questionnaire is high: Cronbach's alpha 0.82, 0.62, 0.89, resp. 0.74. Women had significantly higher SpREUK scores for scales 1 and 2 than male patients. Non-denominational patients had significantly lower scores in all four scales than those with a Christian denomination. The scores did not correlate with disease or duration of disease; however, there might be a positive correlation between age and the score of scale 2. DISCUSSION: The impact of spirituality and religiosity on the course of disease, coping skills, and health-related quality of life is broadly discussed not only in complementary medicine. With the SpREUK questionnaire we present a reliable and valid instrument to measure the patients' search for meaningful support through spirituality/religiosity in terms of disease coping and health restoration. Further evaluation of this instrument is planned with a focus on hospitals which are affiliated with a specific denomination, as a reasonable extension of quality management and concept development.

[The use of methylphenidate in children: analysis of prescription usage based in routine data of the statutory health insurance bodies concerning drug prescriptions]. / Der Einsatz von Methylphenidat im Kindesalter: Analyse des Verordnungsverhaltens auf der Basis von Routinedaten der gesetzlichen Krankenkassen zu Arzneimittelverordungen.

UNLABELLED: In Germany only few data is available on the use of stimulants in the treatment of Attention Deficit/Hyperactivity Disorder. For the first time a full survey of health insurance data was carried out on methylphenidate prescriptions from 2000 to 2001 in an East German District. 783 patients of the total cohort received at least one prescription for methylphenidate. In our sample, the treatment prevalence more than doubled in the observation period from 0.6 % to 1.4 % in children aged between 5 and 15 years, this age group representing the largest treatment group. Younger children, adolescents and adults were only rarely treated. The treatment was undertaken predominantly by paediatricians, general practitioners and neurologists/psychiatrists/child psychiatrists. Prescriptions were issued by one, or by not more than two doctors. CONCLUSION: In Mecklenburg-Vorpommern the prevalence of stimulant treatment has clearly increased. Since diagnosis-related data is not available it is not possible to assess the indications for treatment. Further studies should serve to evaluate the correspondence between diagnosis and therapy in relation to stimulant medication.