Self-Perceived Interpersonal Problems Among Long-Term Unemployed Individuals, and Vocational Rehabilitation Programs (In)ability to Change Them.

OBJECTIVE: Self-perceived interpersonal problems can challenge one's access to the work market, making it harder to attain and keep a job while adding to the distress of being outside of the labor market. METHODS: In this study, we compared the self-perceived interpersonal problems among long-term unemployed individuals taking part in vocational rehabilitation programs (VRPs) (N = 220) with those of the general population. In addition, we examined whether their self-perceived interpersonal problems changed while taking part in the VRPs. RESULTS: We found that participants report significantly higher levels of self-perceived interpersonal problems as measured by the Inventory of Interpersonal Problems (IIP), especially with regard to feeling cold/distanced, socially inhibited, vindictive/self-centered, and non-assertive. The participants did not report a significant decrease in self-perceived interpersonal problems after being part of VRPs for one year. CONCLUSION: These results are relevant as they may inform interventions targeted this population aimed at increasing employability and/or individual well-being. Importantly, the findings may be viewed as a reflection of both social and individual processes. Long-term unemployed individuals' tendency to feel insufficiently engaged may reflect difficulty with keeping up with a job market in constant change.

En route to flourishing - a longitudinal mixed methods study of long-term unemployed citizens in an interdisciplinary rehabilitation program.

BACKGROUND: Interdisciplinary rehabilitation programmes (IRP) are used in municipality settings to assist unemployed citizens with complex health and/or life issues. Individually tailored IRP activities help people develop their personal working life skills and increase their chances of re-entering the work force. The aims of this paper were to describe citizens' wellbeing in terms of health aspects, explore the impact of stressful life events on wellbeing and obtain understanding of how IRP activities affect the participants' development towards future employment. METHODS: A mixed methods exploratory approach has been used. For data collection a quantitative longitudinal survey (baseline and 1-year follow-up) and qualitative interviews were conducted. Descriptive statistics were used for the analysis of survey data, while the data material from interviews was analysed using directed content analysis. Results were discussed with the theory of flourishing as a framework to develop understanding. RESULTS: At baseline, 146 respondents (71% females) filled in the survey and seven participants were interviewed. The analysis of survey data and interviews revealed five themes: (1) Stressful life events, (2) Positive emotions - how IRP-activities positively impacted wellbeing and physical capacity, (3) Appreciation of engagement, (4) Relationships, and (5) Meaning and optimal functioning. Results showed that IRP participants from the outset experienced high general pain intensity as well as distress, anxiety and depression. Life events relating both to physical health and work life were significant for their wellbeing. IRP activities supported participants' positive development towards future employment in ways that were specific to each individual. CONCLUSIONS: From this study it can be derived that participants' development took place around self-acceptance, acceptance by others, physical capacity, psychological resources and capacity to balance engagement to cultivate the best version of themselves. In future programmes, it may be emphasized that participants' interest may be an important driver for wellbeing and future employment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02641704, date of registration December 29, 2015.

The Clinical Effectiveness of Blended Cognitive Behavioral Therapy Compared With Face-to-Face Cognitive Behavioral Therapy for Adult Depression: Randomized Controlled Noninferiority Trial.

BACKGROUND: Internet-based cognitive behavioral therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (FtF) consultations in a blended format may produce a new treatment format (B-CBT) with multiple benefits from both traditional CBT and iCBT, such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. OBJECTIVE: The primary aim of this study is to compare directly the clinical effectiveness of B-CBT with FtF-CBT for adult major depressive disorder. METHODS: A 2-arm randomized controlled noninferiority trial compared B-CBT for adult depression with treatment as usual (TAU). The trial was researcher blinded (unblinded for participants and clinicians). B-CBT comprised 6 sessions of FtF-CBT alternated with 6-8 web-based CBT self-help modules. TAU comprised 12 sessions of FtF-CBT. All participants were aged 18 or older and met the diagnostic criteria for major depressive disorder and were recruited via a national iCBT clinic. The primary outcome was change in depression severity on the 9-item Patient Health Questionnaire (PHQ-9). Secondary analyses included client satisfaction (8-item Client Satisfaction Questionnaire [CSQ-8]), patient expectancy (Credibility and Expectancy Questionnaire [CEQ]), and working (Working Alliance Inventory [WAI] and Technical Alliance Inventory [TAI]). The primary outcome was analyzed by a mixed effects model including all available data from baseline, weekly measures, 3-, 6, and 12-month follow-up. RESULTS: A total of 76 individuals were randomized, with 38 allocated to each treatment group. Age ranged from 18 to 71 years (SD 13.96) with 56 (74%) females. Attrition rate was 20% (n=15), which was less in the FtF-CBT group (n=6, 16%) than in the B-CBT group (n=9, 24%). As many as 53 (70%) completed 9 or more sessions almost equally distributed between the groups (nFtF-CBT=27, 71%; nB-CBT=26, 68%). PHQ-9 reduced 11.38 points in the FtF-CBT group and 8.10 in the B-CBT group. At 6 months, the mean difference was a mere 0.17 points. The primary analyses confirmed large and significant within-group reductions in both groups (FtF-CBT: ß=-.03; standard error [SE] 0.00; P<.001 and B-CBT: ß=-.02; SE 0.00; P<.001). A small but significant interaction effect was observed between groups (ß=.01; SE 0.00; P=.03). Employment status influenced the outcome differently between groups, where the B-CBT group was seen to profit more from not being full-time employed than the FtF group. CONCLUSIONS: With large within-group effects in both treatment arms, the study demonstrated feasibility of B-CBT in Denmark. At 6 months' follow-up, there appeared to be no difference between the 2 treatment formats, with a small but nonsignificant difference at 12 months. The study seems to demonstrate that B-CBT is capable of producing treatment effects that are close to FtF-CBT and that completion rates and satisfaction rates were comparable between groups. However, the study was limited by small sample size and should be interpreted with caution. TRIAL REGISTRATION: ClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/ct2/show/NCT02796573. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-016-1140-y.

Workplace Social Capital as Buffer for Emotional Demands and Perceived Stress in Symphony Orchestras: A Danish Cross-Sectional Survey.

INTRODUCTION: High workplace social capital (WSC) is associated with improved occupational health in the common occupational areas. However, little is known on WSC and its effect on the emotional demands and stress seen in the work of classical symphonic musicians. AIM: To investigate whether WSC moderates the associations between emotional demands and stress in the professional musicians working in Danish symphony orchestras. METHODS: This cross-sectional study builds on existing data collected on a sample of 341 Danish classical symphonic musicians. An interaction model based on multiple regression with bias corrected boot-strapping was used to assess the moderating effect of low, medium and high levels of WSC on the association between emotional demands and perceived stress. RESULTS: WSC had a significant moderating effect on the association between emotional demands and perceived stress: b = -0.01, t(212) = -2.40, p = 0.018. At low levels of WSC the effect of emotional demands on stress was strongest, declining at higher levels of WSC in a dose response pattern: low-WSC, b = 0.23, t(212) 3.20, p = 0.002, medium-WSC, b = 0.11, t(212) = 2.40, p = 0.017, and high-WSC, b = 0.04, t(212) = 0.75, p = 0.455. CONCLUSION: The study indicates a buffering effect of WSC on the association between emotional demands and stress in the work of orchestra musicians. Thus, enhancement of WSC could be a potential stress-preventing strategy in symphony orchestras and should be investigated in future studies on musicians' mental health.

Effects of testosterone therapy on constructs related to aggression in transgender men: A systematic review.

BACKGROUND: Transgender men are assigned female sex at birth, but identify as men. The anabolic and androgenic sex hormone testosterone has been positively associated with aggression. Therefore, transgender men are warned of increasing aggression when initiating testosterone therapy. AIM: To explore the literature regarding the effects of testosterone therapy on aggression-related constructs in transgender men. METHODS: Following PRISMA-guidelines, PsycINFO, MEDLINE®, EMBASE, and PubMed® were searched in November 2019. Risk of bias was analyzed using the Newcastle-Ottawa-Scale, and result-synthesis was grouped by aggression-outcome. RESULTS: Seven prospective cohort studies investigating aggression-dimensions pre- and post-testosterone therapy, reporting on data from 664 transgender men, were eligible. The studies had moderate to high risk of bias due to non-randomization, lack of appropriate control groups, and reliance on self-report. The behavioral tendency to react aggressively increased in three studies out of four (at three months follow-up), whereas only one study out of five found angry emotions to increase (at seven months follow-up). In contrast, one out of three studies reported a decrease in hostility after initiation of testosterone therapy. The remaining studies found no change in aggressive behavior, anger or hostility during hormone therapy. DISCUSSION AND CONCLUSION: Four out of seven studies reported an increase in aggression-related constructs, while one study reported a decrease. In all studies reporting changes, the follow-up period was less than 12 months, indicating that gender-affirming testosterone therapy could have a short-term impact on aggression-related constructs. However, the available studies carried a risk of bias, which indicates a need for further research.

Mental movements: How long-distance walking influences reflection processes among middle-age and older adults.

By providing a distinctive room for reflection, long-distance walks can help people similar to professional counselling. To understand reflection processes' influence on mental health, a framework focusing on personal transformations, specifically through the concept of liminality, can be used. Through nine semi-structured interviews with middle-aged and older long-distance walkers, this study answers the following question: How do middle-aged and older adults experience long-distance walking, and how do their experiences influence their reflective process? Four themes emerged during the analysis: (1) overcoming strain and achieving a sense of capability; (2) simplicity in obligations and having the time to pursue emotionally difficult experiences; (3) solitariness and reflection on oneself; and (4) calmness and embracing thoughts. These findings illustrate how going on long-distance walks may be similar to entering a liminal, or transformational, space. The findings show how long-distance walks can be helpful, or perhaps even therapeutic, in situations where personal transformation is required.

Adolescents need more sleep: Rethinking the preventive options of school environments.

Sleep problems in adolescence have both somatic and psychological consequences for health. Most adolescents spend a considerable amount of time in school, but there is little published research on how the school environment affects adolescent health and well-being. This commentary explores whether using a nap room in the middle of the school day can reduce perceived stress and fatigue in high school students and improve their sleep quality. We show that a short nap of 10 minutes can prevent stress-related problems. A method of improving adolescent health might be the reorganization of the school environment.

Physical exercise in the treatment of alcohol use disorder (AUD) patients affects their drinking habits: A randomized controlled trial.

AIM: The aim of this study is to compare the effect of exercise training on physical capacity and alcohol consumption in alcohol use disorder (AUD) patients. METHODS: One hundred and five AUD patients were randomly assigned to treatment as usual combined with running and brisk walking for 30-45 min twice a week, either in small supervised groups (GR) or individually (IND), or to a control group with no running (C). Assessments were made after 6 and 12 months of training. RESULTS: Training volume was estimated as 36 min per training bout at an intensity of 78% of HRmax with no differences between GR and IND ( p>.05). A highly significant reduction in training frequency was seen in both training groups after the first month ( p<.0001). Only IND increased VO2max, by 5.7% ( p<.05), while no differences were seen between GR, IND and C. Alcohol intake decreased from 219 to 41 units per 30 days as the average for the entire sample with no significant difference of drinking outcomes between groups ( p<.0001). CONCLUSIONS: We saw an effect on drinking habits after running in both groups. However, no additional effect was seen when compared with the control group. A drop in the training frequency during the intervention might have resulted in an insignificant training stimulus.

The effects of practicing target-shooting sport on the severity of inattentive, hyperactive, and impulsive symptoms in children: a non-randomised controlled open-label study in Denmark.

Purpose: Target-shooting sport requires mental effort and concentration. Training may reduce inattentiveness and distractibility. There is little knowledge if children with symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from practicing target-shooting sport. Materials and methods: Our study aims to investigate this in a non-randomised controlled open-label study of 128 children, 10-14 years of age, with ADHD-symptoms. The intervention-group (n = 64) practiced target-shooting in local shooting associations once a week for 6 months. The control group (n = 64) received treatment as usual. Primary outcome: teacher-rated ADHD-RS-IV-total score. Secondary outcomes: (a) parent-rated ADHD-RS-IV-total score; (b) teacher- and parent-rated Strengths-and-Difficulties-Questionnaire (SDQ); (c) self-rated quality of life (KIDSCREEN-27-total score); and (d) four objective measurements of ADHD-symptoms using the QbTest™. The data were collected at baseline and after 6 months. Results: When estimating the marginal effect of the intervention on our primary outcome, the teacher-rated ADHD-RS-IV, we found no significant effect (mean change between groups (contrast)=2.23; p = 0.193). However, we did find significant beneficial effects on four of the eight secondary outcomes, including the parent-rated ADHD-RS-IV-total score (contrast = 4.76; p = 0.024), the parent-rated SDQ-total score (contrast = 2.09; p = 0.027), and on the QbTest™ measurements of the Reaction Time Variation (RTVar) (contrast = 36.96; p = 0.013), and of Omission Errors (contrast = 7.57; p = 0.019). Conclusions: Despite the negative result on the primary outcome, the robust findings on these secondary outcomes in this open-label study indicate proof of concept that practicing target-shooting sport may have some beneficial effects on the severity of ADHD-symptoms in children. No adverse events were reported. Randomised trials of this non-pharmacological intervention are needed.

"I don't need a flat tummy; I just want to run fast" - self-understanding and bodily identity of women in competitive and recreational sports.

BACKGROUND: Women who exercise intensively, whether competitive or recreational, devote a lot of time and energy into exercise, which requires high levels of ambition and motivation. The aim of the study is to investigate the self-understanding and bodily identity of different (competitive vs recreational) forms of exercise, and to investigate the role of important others (parents, siblings and social relations) for this self-understanding. METHODS: A qualitative study using semi-structured interviews. An interactional psychodynamic framework informed the development of the interview questions focusing on the influence of their family, peers, and the meaning of exercise for their identity. Participants were recruited via local training centers and via the Danish Athletic Sports Association. A total of twenty highly physically active female athletes were interviewed, ten of whom participated in competitions ("competitve athletes") and ten of whom did not ("recreational athletes"). RESULTS: Self-related and social similarities and differences between competitive athletes and recreational athletes were found. Recreational athletes had supportive but not ambitious parents and used sport to reinforce their bodily self-efficacy and identity, while competitive athletes had highly engaged parents, especially fathers, and competed to externalize their identities as athletes. Correspondingly, the meaning of exercise was the activity itself, for recreational athletes, while competition was the means to the end of achievement, for competitive athletes. CONCLUSION: All athletes are affected and triggered by their biography and their environment. The biographical tradition of sport culture must be recognized as important for the engagement in different forms of physical activity in health and competition settings. If research can make the conflicts and relations of the self visible in sports culture, this could strengthen the recognition that the overall bodily well-being of athletes is important for women's health.

Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study.

BACKGROUND: Internet-based cognitive behavioral therapy (iCBT) is a promising new treatment method for depression and anxiety. However, it is important to determine whether its results can be replicated in routine care before its implementation on a large scale. Although many studies have demonstrated the efficacy of iCBT under controlled conditions, only a few studies have investigated its effectiveness in routine care. Furthermore, several effects of iCBT such as treatment effects in routine care are unclear. OBJECTIVE: This study aimed to evaluate the clinical effectiveness of iCBT for depression and anxiety in routine secondary care. METHODS: n a retrospective cohort study, we analysed patients treated for depression or anxiety in a dedicated iCBT clinic in secondary care in Denmark. Patients were examined before treatment and weekly thereafter by using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales for the diagnoses of depression and anxiety, respectively. Primary analyses were conducted using a linear mixed-effects model with random slope and intercept. Secondary analyses were conducted using baseline characteristics as predictors (gender, age, highest level of education, occupational status, marital status, psychotropic medication use, consumption of alcohol, and leisure drugs). Additionally, logistic regression analyses were used to predict noncompletion of treatment. RESULTS: A total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P<.001, d=1.0) and anxiety (beta=-3.78, SE 0.43, P<.001, d=1.1). High baseline severity of the primary disorder was associated with high treatment gains (r=-0.31 for depression; r=-0.41 for anxiety). In patients with anxiety, high baseline severity also predicted a high risk of noncompletion (odds ratio=1.08, CI=1.01-1.16, P=.03). An increase in the baseline severity of the comorbid disorder slightly increased the risk of noncompletion for both disorders (depression: odds ratio=1.03, CI=1.01-1.06, P=.02; anxiety: odds ratio=1.08, CI=1.01-1.16, P=.03). CONCLUSIONS: iCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and noncompletion. However, all predictor effects were statistically weak.

The influence of participation in target-shooting sport for children with inattentive, hyperactive and impulsive symptoms - A controlled study of best practice.

BACKGROUND: Practising target-shooting sport requires focused attention and motoric steadiness. A previous non-controlled pilot study suggests that children with impairing symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from participating in target-shooting sport in local shooting associations, as rated by parents and teachers. This study aims at examining if, and to which extent, target-shooting sport reduces parent- and teacher-reported severity of inattentiveness, hyperactivity, and impulsivity in children with attention difficulties, and if, and to which extend, target-shooting sport improves the children's wellbeing and quality of life. METHODS: A mixed method approach is applied. A non-blinded, waiting list controlled study is combined with a case study, consisting of interviews and observations. The intervention consists of children practising target-shooting sport, by attending a local shooting association, once a week for six months, during regular school hours. Data from questionnaires (ADHD-RS, SDQ, Kidscreen-27), as well as a computerized continued performance test (Qb test), measure the children's activity and attention. The study includes 50 children in an intervention group and 50 children in a waiting list control group. The Qb test collects data from at least 20 children from the intervention group and at least 20 children from the waiting list control group. Data from the questionnaires and Qb-test is collected at baseline, and six months post intervention. In addition, a case study is carried out, consisting of interviews of at least five children from the intervention group, their parents, teachers and shooting instructors. Observations are carried out, when children are in school and while they are attending the local shooting association. The case study adds to an in-depth understanding of children's participation in target-shooting sports. DISCUSSION: At present, little is known about the effects and influence of practising target-shooting sport for children experiencing difficulties with inattentiveness, hyperactivity and impulsivity. This study is expected to contribute to an understanding of the influence of participating in target-shooting sports on inattentive, hyperactive and impulsive symptoms, and the effects on the children's psychological wellbeing and quality of life. TRIAL REGISTRATION: Current Controlled Trials NCT02898532 . Retrospectively registered 14 September 2016.

Exercising alcohol patients don't lack motivation but struggle with structures, emotions and social context - a qualitative dropout study.

BACKGROUND: Exercise is an important component of a healthy lifestyle, the development of which is a relapse prevention strategy for those with alcohol use disorder. However, it is a challenge to create exercise interventions with a persistent behavioural change. The aim of this qualitative study was to investigate perceived barriers to participation in an exercise intervention among alcohol use disorder patients, who dropped out of the intervention program. Furthermore, this study aims to propose possibilities for a better practice of future intervention studies based on the participants' experiences and suggestions. METHODS: Qualitative interviews with 17 patients who dropped out from an exercise intervention in an outpatient treatment centre about their experiences and reasons for dropping out. Social cognitive theory informed the development of the interview guides and systematic text condensation was used for analysis. RESULTS: Analysis revealed three central themes: 1) Structural barriers described as the type of exercise and the timing of the intervention, 2) Social barriers described as need for accountability and unsupportive relations, and 3) Emotional barriers described as fear, guilt and shame, and negative affect of the intervention on long term. CONCLUSIONS: Future exercise interventions should include socio-psychological support during the first weeks, begin shortly after treatment initiation instead of concurrently, and focus on garnering social support for participants in both the intervention context and among their existing network in order to best reduce barriers to participation. TRIAL REGISTRATION: This study was retrospectively registered at Current Controlled Trials ISRCTN74889852 on 11 July 2013.

Exercise based interventions for alcohol use disorder: A comment on motivational aspects of participation.

Exercise based treatment for alcohol use disorders have shown an impact on mental health (e.g., depression or anxiety), and alcohol outcomes (e.g., craving or abstinence). However, there is a lack of information on the role of motivational aspects of participation in the process of designing exercise interventions for alcohol use disorder. This study aims to examine: (1) whether motivational aspects are taken into account when the type and delivery method of exercise interventions are chosen; (2) whether motivational aspects are taken into account post intervention; and (3) whether there are different traditions regarding payment for participants. A systematic search was conducted to identify eligible studies in order to investigate the impact of motivational aspects including payment for participation. Twelve samples including ten to 620 participants were investigated. Participants were predominantly male and in their 40s, ranging from 20 to 69 years. Aerobic exercise (running, walking, fitness) either in a group or individual condition is the most frequently used exercise form. Two studies included ball games or cycling, while only one study offered the opportunity to choose between a wide range of sports. Motivational aspects are mentioned explicitly in half of the studies, mostly with regard to adherence to participation and social integration as the reason for using a group condition. Achievement is mentioned in two studies but not explicitly with regard to planning the intervention design. Five studies include payment for participation in exercise. Findings of the present study identify that motivational aspects for participation are rarely involved in the planning of an exercise intervention. With regard to the specific psychosocial vulnerability of an alcohol use disorder population, this should be an important aspect of further research studies.

Blended CBT versus face-to-face CBT: a randomised non-inferiority trial.

BACKGROUND: Internet based cognitive behavioural therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (ftf) consultations in a blended format (B-CBT) may produce a new treatment format with multiple benefits from both traditional CBT and iCBT such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. The primary aim of the present study is to compare directly the clinical effectiveness of B-CBT with face-to-face CBT for adult major depressive disorder. METHODS/DESIGN: The study is designed as a two arm randomised controlled non-inferiority trial comparing blended CBT for adult depression with treatment as usual (TAU). In the blended condition six sessions of ftf CBT is alternated with six to eight online modules (NoDep). TAU is defined as 12 sessions of ftf CBT. The primary outcome is symptomatic change of depressive symptoms on the patient-health questionnaire (PHQ-9). Additionally, the study will include an economic evaluation. All participants must be 18 years of age or older and meet the diagnostic criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental disorders 4th edition. Participants are randomised on an individual level by a researcher not involved in the project. The primary outcome is analysed by regressing the three-month follow-up PHQ-9 data on the baseline PHQ-9 score and a treatment group indicator using ancova. A sample size of 130 in two balanced groups will yield a power of at least 80% to detect standardised mean differences above 0.5 on a normally distributed variable. DISCUSSION: This study design will compare B-CBT and ftf CBT in a concise and direct manner with only a minimal of the variance explained by differences in therapeutic content. On the other hand, while situated in routine care, ecological validity is somewhat compromised by the controlled manner in which the study is conducted. TRIAL REGISTRATION: ClinicalTrials.gov NCT02796573 . Registered June 1st 2016. Currently recruiting participants.

Effects of exercise and group counselling on body composition and VO2max in overweight women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is often associated with an increased waist circumference and with lower cardio-respiratory fitness as a consequence of obesity, which may be improved by physical activity. OBJECTIVE: To investigate the effect of high-intensity aerobic training combined with group counselling sessions on anthropometry and cardio-respiratory fitness in women with PCOS. DESIGN: Seventeen sedentary, overweight women with PCOS were randomized in a cross-over design to 16 weeks of intervention: eight weeks high-intensity aerobic exercise was followed by eight weeks of group counselling (n = 8) or vice versa (n = 9). Fourteen of the women completed the tests. MAIN OUTCOME MEASURES: Waist circumference, body mass index and maximal aerobic capacity (VO(2max) ) were measured at baseline, cross-over and post-intervention. RESULTS: There was a decrease in waist circumference (119.9 vs. 106.5 cm) and body mass index (34.9 vs. 34.4 kg/m(2) ) and an increase in VO(2max) (2554.9 vs. 2807.9 mL/min) during the intervention period (t = 16 weeks, n = 14), all p < 0.05. Weight loss tended to be highest in the group which started with group counselling (2.9 vs. 0.6 kg, t = 16 weeks, n = 14, p = 0.055). CONCLUSION: Exercise in groups followed by counselling or vice versa had beneficial effects on waist circumference, weight, and VO(2max) in women with PCOS. Future studies should examine possible beneficial effects of combined group counselling and exercise on weight loss and adherence to exercise protocols among women with PCOS.

Pain among professional orchestral musicians: a case study in body culture and health psychology.

BACKGROUND: Professional musicians experience high rates of musculoskeletal pain, but only few studies have investigated how this pain is accepted by musicians. AIM: To investigate the culture of pain and to explore how professional musicians experience and cope with pain. METHODS: Ten semi-structured in-depth interviews were conducted; 8 with musicians and 2 with professional elite athletes. In addition, a concert and two rehearsals were observed. The audiotaped interviews were transcribed verbatim. Configurational analysis was used to interpret the material as a whole. RESULTS: Musicians often experience pain as a consequence of prolonged repetitive work early in their career. Such pain is compounded by the lack of breaks during concerts and rehearsals. Orchestras seldom give opportunities for adjustments required for individual instruments, breaks, or action to prevent pain. Musicians' strong sense of coherence and the experience of pain as integral to their identity have encouraged musicians to develop flexible coping strategies. Ignoring pain and potential damage is an accepted concomitant to striving for perfection. A musician does not focus on pain but on the music. CONCLUSION: For the musician, pain has a significance beyond being something that can simply be removed by a practitioner. Pain tells both an individual story and a cultural story that is crying out to be heard.

The Importance of the Outdoor Environment for the Recovery of Psychiatric Patients: A Scoping Review.

(1) Background: Research has shown that patients with mental health diagnoses experience less anxiety and depressive symptoms and higher levels of 'well-being' when they spend time in natural environments as part of their treatment. It has been suggested that there is a relationship between the outdoor settings and the recovery of psychiatric patients. Recovery describes an individual process, which can vary from person to person. (2) Methods: This scoping review examined the relationship between the physical environment and the recovery of psychiatric patients. Systematic searches in three online databases, namely Medline, Embase, and PsycINFO, were performed using a selection of psychiatric, environmental, and recovery terms and included both quantitative and qualitative studies. In general, 'well-being' serves as an overarching indicator when it comes to research on how outdoor settings can affect mental health. Well-being was expressed in terms of mood, social relations, and autonomy. (3) Results: A total of 8138 records were screened, 85 studies were included for full-text reading, and five articles were included in the final analysis. The review showed in general that outdoor settings, more specifically gardening, contact with nature, and a safe environment can be related to the well-being of patients on psychiatric wards. (4) Conclusions: The five reviews allow us to conclude that outdoor settings can be seen as a comprehensive resource for mental health.

Therapeutic Environments in Drug Treatment: From Stigmatising Spaces to Enabling Places. A Theory-Based Qualitative Analysis.

Investigating therapeutic environments for young drug users is needed to avoid a high dropout rate due to a potential stigmatising effect of the structure of the space. In this article, we draw from three semi-structured interviews with young drug users. The interviews focused broadly on their experiences being on drug treatment and on how they experienced counselling and treatment in different spaces. The findings show that therapeutic spaces that were viewed as clinical and sterile were experienced as stigmatising, which discouraged young drug users from engaging in treatment and therapeutic processes. In contrast, therapeutic places with a homely atmosphere reduced the experience of stigmatisation, facilitated participation in treatment and helped users to relax and feel part of a community. In the analysis, we show how enabling therapeutic places with a homely atmosphere can be produced through materials, activities, and sensory processes.

Parked on the verge: vocational rehabilitation of long-term unemployed citizens - a mixed methods study.

BACKGROUND: Vocational rehabilitation programs (VRP) developing and improving work ability are used in Denmark to assist long-term unemployed citizens with complex problems. The aims of this study were to (1) describe VRP-participants in relation to general health, well-being, work ability and self-efficacy at baseline and one-year follow-up, (2) obtain an understanding of VRP-participants' personal development towards improving work ability, and (3) explore VRP-participants' hopes and thoughts about their future. METHODS: In a mixed methods approach, data from a longitudinal survey and semi-structured interviews were collected. In the quantitative longitudinal survey, all participants completed paper questionnaires at baseline and one-year follow-up. For the qualitative semi-structured interviews, VRP participants were recruited with a maximum variation sampling strategy through VRP coordinators and personal contact. Data were analysed by descriptive statistics and systematic text condensation. Following analysis, data were merged and presented in combination according to identified themes. RESULTS: At baseline and one-year follow-up 146 (response rate 34%) and 74 participants (response rate 52%) respectively, responded to the questionnaire. Seven participants were interviewed. The analysis revealed four themes: 1) Individual explanations of life situation and health; 2) Finding the path; 3) Work as giving meaning to life; 4) Hope for the future. Despite self-reported scores indicating poor general health, lack of well-being, low work ability and low self-efficacy, VRP-activities seemed to have assisted participants in finding meaning in life. VRP-components that may be drivers of successful recovery processes were identified. CONCLUSIONS: VRP-participants experienced life situations that include multifactorial burdens, and low levels of general health, well-being, work ability, and self-efficacy at baseline and 1 year later. From the outset, most did not have a clear goal of employment, but over time, new goals were set as realistic opportunities for re-developing their work ability were explored. Successful core components of VRP were individually tailored programs and support, development of new relationships, and accommodated flexible internships and jobs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02641704 , date of registration December 29, 2015.