Determinanten eines vorzeitigen Therapieabbruchs: Über den Einfluss psychosozialer und soziodemographischer Faktoren, externer Ereignisse sowie subjektiver Schlafqualität während der stationären qualifizierten Entzugsbehandlung bei Patienten mit Alkohol- und Drogenabhängigkeit auf den Therapieerfolg

Introduction Addiction is a chronic disease that affects millions of individuals worldwide. Qualified detoxification treatment is the first step in inpatient substance abuse treatment. Premature treatment discontinuation is a common complication with negative impact on the long-term course of the disease. Regular treatment completion is therefore a key success criterion of detoxification treatment. The aim of the present doctoral thesis was to determine the influence of socio-demographic environment, international sports events and sleep quality on qualified detoxification treatment outcome. Method Data on the patient’s social environment and medical anamnesis were collected from 832 patients and analysed with respect to the prediction of regular, respectively irregular treatment outcome. The second study aimed to evaluate a potential effect of international sports events on qualified detoxification outcome. Four periods were defined to determine admission and unplanned discharge rates prior to, during and after the European Football Championship. The aim of the third study was to evaluate sleep quality during qualified detoxification treatment and whether bad sleep might serve as a predictor of premature treatment drop-out. Results The drop-out rate in the first study was 37%. A stable social network in terms of family, employment and education and a lower dependency severity positively predicted treatment outcome, whereas an unstable social environment, younger age, male sex and a high number of previous drop-outs were predictive for a premature treatment drop-out. In the second study, the admission rate of male patients increased significantly after the European Football Championship had ended. The drop-out rate measured 26% respectively 30%. In the third study, at admission, impaired sleep was observed in 70% of the patients. Sleep quality at admission predicted the change of sleep quality during qualified detoxification treatment. But sleep quality was not a predictor for unplanned treatment drop-out. With only 7% the drop-out rate was remarkably low. Discussion With the present work, clinical knowledge about predictors of premature treatment drop-out could be expanded. The results indicate that predominantly socially stable patients benefit from the currently established treatment setting. Our results suggest that sports events such as the European Football Championship can trigger unplanned treatment drop-out in male patients. Social and political measures could improve public awareness. In the light of the prevalence of sleep disturbances during detoxification, detoxification treatment should be enriched with individual evaluation of sleep quality and insomnia-specific treatment.Sucht ist eine chronische Erkrankung, die Millionen von Menschen weltweit betrifft. Die Entgiftung ist der erste Schritt in der stationären Alkohol- und Drogentherapie. Der vorzeitige Behandlungsabbruch ist eine häufige Komplikation, die den langfristigen Verlauf der Krankheit negativ beeinflusst. Im Rahmen der vorliegenden Publikationsdissertation wurden anhand von drei Studien potentielle Determinanten eines vorzeitigen Therapieabbruchs untersucht. Methodik Während der Aufnahmeuntersuchung wurden soziodemographische und medizinische Variablen von 832 Suchtpatienten erhoben und nach signifikanten Assoziationen hinsichtlich eines irregulären bzw. regulären Behandlungsabschlusses gesucht. In der zweiten Studie wurde der Einfluss der Fußball-Europameisterschaft 2012 auf die Behandlungstreue untersucht. Dabei wurden vier zu vergleichende Perioden definiert und die Aufnahmen zur qualifizierten Entzugstherapie sowie die vorzeitigen Entlassungen gegenübergestellt. In der dritten Studie wurde unter Verwendung des Pittsburgh Sleep Quality Index (PSQI) untersucht, welchen Einfluss die subjektive Schlafqualität während der qualifizierten Entzugsbehandlung auf den Behandlungsabschluss hat und ob schlechter Schlaf als Prädiktor eines vorzeitigen Therapieabbruchs herangezogen werden kann. Ergebnisse 37% der Patienten brachen die Behandlung in der ersten Studie vorzeitig ab. Weibliches Geschlecht, Partnerschaft, Berufstätigkeit und gute Bildung waren prädiktiv für einen regulären Behandlungsabschluss, während jüngeres Alter, männliches Geschlecht, eine hohe Anzahl vorhergehender Therapieabbrüche sowie Delinquenz als Prädiktoren für einen irregulären Behandlungsabschluss identifiziert werden konnten. Die Abbruchquote der zweiten Studie lag bei 26% bzw. 30%. Bei den männlichen Patienten war nach der Europameisterschaft ein signifikanter Anstieg der Aufnahmen zu beobachten. Die Abbruchquote in der dritten Studie betrug nur 7%. Die Prävalenz von Schlafstörungen (PSQI-Wert > 5) betrug 70%. Die Schlafqualität bei der Aufnahme war prädiktiv für die Schlafqualität bei der Entlassung. Die Schlafqualität während des Entzuges jedoch war nicht prädiktiv für einen irregulären Behandlungsabschluss. Diskussion Anhand der vorliegenden Arbeit konnten die klinischen Kenntnisse über Determinanten eines vorzeitigen Therapieabbruchs erweitert werden. Die Ergebnisse deuten darauf hin, dass vorwiegend sozial stabile Patienten vom derzeitig etablierten Behandlungssetting profitieren. Unsere Untersuchungen legen weiterhin nahe, dass Sportgroßereignisse für männliche Patienten ein Auslöser für einen Therapieabbruch sein können, hier könnten gesellschaftspolitische Maßnahmen zu einer Verbesserung führen. In Anbetracht der Prävalenz von Schlafstörungen während des Entzuges erscheint es sinnvoll, das stationäre Behandlungskonzept um Maßnahmen zur Behandlung von Schlafstörungen zu erweitern

Prognos (R) in the diagnosis of amalgam hypersensitivity - A diagnostic case-control study

Objective: We aimed to investigate whether the Prognos (R) device might be a useful tool in the diagnosis of disorders suspected to be due to dental amalgam fillings. Participants and Methods: A diagnostic case-control study was performed in 27 patients who complained about health problems attributed to amalgam ( cases), 27 healthy volunteers with amalgam fillings ( controls I), and 27 healthy amalgam-free volunteers ( controls II). All participants were tested before and after application of 300 mg DMPS (2.3-dimercapto-1-propanesulfonic acid) with Prognos, a diagnostic device for the energetic measurement of Traditional Chinese Medicine meridians. In addition, mercury was measured in blood, urine, and saliva, and a lymphocyte transformation test (LTT) was performed. Results: Diagnoses derived from the first and second Prognos testing did not agree above chance (Cohen's Kappa = -0.11, 95% confidence interval -0.33 to 0.10; p = 0.30). Agreement for secondary outcome measures was poor, too. Prognos measurements did not differ between cases and controls. Correlations with measurements in urine, blood and saliva were low. Conclusion: In this study Prognos could not be shown to be a useful tool in the diagnosis of disorders suspected to be due to dental amalgam fillings

Die Rolle der Zielnähe und der investierten Anstrengung für den erwarteten Wert einer Handlung

In human neuroscientific research, there has been an increasing interest in how the brain computes the value of an anticipated outcome. However, evidence is still missing about which valuation related brain regions are modulated by the proximity to an expected goal and the previously invested effort to reach a goal. The aim of this dissertation is to investigate the effects of goal proximity and invested effort on valuation related regions in the human brain. We addressed this question in two fMRI studies by integrating a commonly used reward anticipation task in differential versions of a Multitrial Reward Schedule Paradigm. In both experiments, subjects had to perform consecutive reward anticipation tasks under two different reward contingencies: in the delayed condition, participants received a monetary reward only after successful completion of multiple consecutive trials. In the immediate condition, money was earned after every successful trial. In the first study, we could demonstrate that the rostral cingulate zone of the posterior medial frontal cortex signals action value contingent to goal proximity, thereby replicating neurophysiological findings about goal proximity signals in a homologous region in non-human primates. The findings of the second study imply that brain regions associated with general cognitive control processes are modulated by previous effort investment. Furthermore, we found the posterior lateral prefrontal cortex and the orbitofrontal cortex to be involved in coding for the effort-based context of a situation. In sum, these results extend the role of the human rostral cingulate zone in outcome evaluation to the continuous updating of action values over a course of action steps based on the proximity to the expected reward. Furthermore, we tentatively suggest that previous effort investment invokes processes under the control of the executive system, and that posterior lateral prefrontal cortex and the orbitofrontal cortex are involved in an effort-based context representation that can be used for outcome evaluation that is dependent on the characteristics of the current situation.Derzeit besteht im Bereich der Neurowissenschaften ein großes Interesse daran aufzuklären, auf welche Weise verschiedene Variablen die Wertigkeit eines erwarteten Handlungsziels beeinflussen bzw. welche Hirnregionen an der Repräsentation der Wertigkeit eines Handlungsziels beteiligt sind. Die meisten Untersuchungen beziehen sich dabei auf Einflussgrößen wie die erwartete Belohnungshöhe, die Wahrscheinlichkeit, mit der ein bestimmtes Ereignis eintritt, oder die Dauer bis zum Erhalt einer Belohnung. Bisher liegen jedoch kaum Untersuchungen vor bezüglich zweier anderer Variablen, die ebenfalls den erwarteten Wert eines Handlungsergebnisses beeinflussen. Das sind (a) die Nähe zu dem erwarteten Ziel und (b) die bisher investierte Anstrengung, um ein Ziel zu erreichen. Das Ziel der vorliegenden Dissertation ist zu untersuchen, wie die Nähe zum Ziel und die bisher investierte Anstrengung Gehirnregionen beeinflussen, die mit der Repräsentation von Wertigkeit im Zusammenhang stehen. Dazu führten wir zwei fMRT-Studien durch, in denen wir eine klassische Belohnungs-Antizipationsaufgabe in unterschiedliche Versionen eines „Multitrial Reward Schedule“ Paradigmas integriert haben. Das bedeutet, dass die Probanden Belohnungs-Antizipationsaufgaben unter zwei unterschiedlichen Belohnungskontingenzen bearbeiteten: In der verzögerten Bedingung erhielten die Probanden einen Geldbetrag nach der erfolgreichen Bearbeitung von mehreren aufeinanderfolgenden Aufgaben, in der direkten Bedingung dagegen nach jeder korrekt ausgeführten Aufgabe. In der ersten Studie konnte eine sukzessiv ansteigende Aktivität in Abhängigkeit zur Zielnähe in der rostralen cingulären Zone identifiziert werden. Das deutet darauf hin, dass dieses Areal den Wert einer Handlung in Abhängigkeit zur Nähe zum Ziel kodiert. Die Ergebnisse der zweiten Studie zeigten, dass die bisher investierte Anstrengung kortikale Regionen moduliert, die klassischerweise mit kognitiven Kontrollfunktionen in Zusammenhang gebracht werden. Außerdem repräsentierten der posteriore laterale präfrontale Cortex und der orbitofrontale Cortex den motivationalen Kontext eines Trials anhand des Risikos des Verlustes von bisher investierter Anstrengung. Insgesamt weisen diese Befunde darauf hin, dass die rostrale cinguläre Zone eine entscheidende Rolle spielt für die Kontrolle sequenzieller Handlungsstufen, die auf eine verzögerte Belohnung ausgerichtet sind. Diese Kontrollfunktion scheint auf der kontinuierlichen Aktualisierung des Wertes einer Handlungsstufe zu basieren, der von der aktuellen Zielnähe bestimmt wird. Die Befunde der zweiten Studie lassen darauf schließen, dass sich die bisher investierte Anstrengung zur Erreichung eines Handlungsziels auf die Bereitstellung von allgemeinen kognitiven Ressourcen auswirkt. Das Risiko des Verlustes von bisher investierter Anstrengung kann außerdem ein kontextuelles Merkmal der Situation darstellen, das als Bezugsrahmen für die Evaluation des erwarteten Wertes dienen kann

A retrospective study on 195 horses with contaminated and infected synovial cavities

This study analyzes the clinical aspects of contaminated and infected synovial cavities in horses and evaluates their prognosis after treatment. The medical records of 195 affected horses referred between June 1999 and July 2004 were reviewed. Twenty-six horses were euthanized or returned home without further treatment. Therapeutic strategies for the remaining 169 horses were not different from those reported in other recent studies, except that lavage was performed predominantly without endoscopic visualization. Follow-up was obtained by questionnaire for 150 of 169 treated horses. The outcome was considered successful (survival without residual lameness) in 109 of 150 horses (72.7%). Iatrogenic synovial infection, the presence of radiographic signs on admission and the use of regional antibiotic perfusion were significantly related with non-successful outcome. Overall, the outcome in the present study appeared to be slightly less favorable compared to other recent reports, although it certainly improved for horses with deep nail puncture wounds

Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) - Design and Protocol of a Randomised Controlled Multi-Centre Trial

Background: We report on the study design and protocol of a randomised controlled trial (Acupuncture in Seasonal Allergic Rhinitis, ACUSAR) that investigates the efficacy of acupuncture in the treatment of seasonal allergic rhinitis (SAR). Objective: To investigate whether acupuncture is non-inferior or superior to (a) penetrating sham acupuncture and (b) rescue medication in the treatment of SAR. Design: 3-armed, randomised controlled multi-centre trial with a total follow-up time of 16 weeks in the 1st year and 8 weeks in the 2nd year. Setting: 41 physicians in 37 out-patient units in Germany specialised in acupuncture treatment. Patients: 400 seasonal allergic rhinitis patients with clinical symptoms and test-positive (skin-prick test and/or specific IgE) to both birch and grass pollen. Interventions: Patients will be randomised in a 2:1:1 ratio to one of three groups: (a) semi-standardised acupuncture plus rescue medication (cetirizine); (b) penetrating sham acupuncture at non-acupuncture points plus rescue medication; or (c) rescue medication alone for 8 weeks (standard treatment group). Acupuncture and sham acupuncture will consist of 12 treatments per patient over 8 weeks. Main Outcome Measures: Average means of the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the Rescue Medication Score (RMS) between weeks 6 and 8 in the first year, adjusted for baseline values. Outlook: The results of this trial available in 2011 will have a major impact on the decision of whether acupuncture should be considered as a therapeutic option in the treatment of SAR

Acupuncture randomized trials (ART) in patients with chronic low back pain and osteoarthritis of the knee - Design and protocols

Background: We report on the study design and protocols of two randomized controlled trials (Acupuncture Randomized Trials = ART) that investigate the efficacy of acupuncture in the treatment of chronic low back pain and osteoarthritis of the knee, respectively. Objective: To investigate whether acupuncture is more efficacious than (a) no treatment or (b) minimal acupuncture in the treatment of low back pain and osteoarthritis. Design: Two randomized, controlled, multicenter trials with three treatment arms and a total follow-up time of 52 weeks. Setting: 30 practitioners and outpatient units in Germany specialized in acupuncture treatment. Patients: 300 patients will be included in each study. In the low back pain trial, patients will be included according to clinical diagnosis. In the osteoarthritis pain trial, patients will be included according to the American College of Rheumatology criteria. Interventions: Patients are randomly assigned to receive either (1) semi-standardized acupuncture (150 patients), (2) minimal acupuncture at non-acupuncture points (75 patients), or (3) no treatment for two months followed by semi-standardized acupuncture (75 patients, waiting list control). Acupuncture treatment consists of 12 sessions per patient over a period of 8 weeks. Main Outcome Measure: The main outcome measure is the difference between baseline and the end of the 8-week treatment period in the following parameters: pain intensity as measured by a visual analogue scale (VAS; 0-100 mm) in the low back pain trial and by the Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC) in the osteoarthritis trial. Outlook: The results of these two studies (available in 2004) will provide health care providers and policy makers with the information needed to make scientifically sound assessments of acupuncture therapy

Coronectomy of deeply impacted lower third molar : incidence of outcomes and complications after one year follow-up

Objectives: The purpose of present study was to assess the surgical management of impacted third molar with proximity to the inferior alveolar nerve and complications associated with coronectomy in a series of patients undergoing third molar surgery. Material and Methods: The position of the mandibular canal in relation to the mandibular third molar region and mandibular foramen in the front part of the mandible (i.e., third molar in close proximity to the inferior alveolar nerve [IAN] or not) was identified on panoramic radiographs of patients scheduled for third molar extraction. Results: Close proximity to the IAN was observed in 64 patients (35 females, 29 males) with an impacted mandibular third molar. Coronectomy was performed in these patients. The most common complication was tooth migration away from the mandibular canal (n = 14), followed by root exposure (n = 5). Re-operation to remove the root was performed in cases with periapical infection and root exposure. Conclusions: The results indicate that coronectomy can be considered a reasonable and safe treatment alternative for patients who demonstrate elevated risk for injury to the inferior alveolar nerve with removal of the third molars. Coronectomy did not increase the incidence of damage to the inferior alveolar nerve and would be safer than complete extraction in situations in which the root of the mandibular third molar overlaps or is in close proximity to the mandibular canal

Socially Necessary Impact/Time: Notes on the Acceleration of Academic Labor, Metrics and the Transnational Association of Capitals

This article constitutes a contribution to the critique of the political economy of contemporary higher education. Its notes form, intended to open "windows" on the thorny issue of metrics permeating academia on both the local/national and global levels, facilitates a conceptualization of the academic law of value as a mechanism responsible for regulating the tempo and speed of academic labor in a higher education system subsumed under capital. First, it begins with a presentation of the Marxist approach to acceleration and measure. Second, it presents the academic law of value as a socially necessary impact/time. Third, it conceptualizes a figure of capital that operates in the contemporary global higher education system. Fourth, it describes the conditions of operation of merchant capital within higher education and explores the close links of global university rankings, metadata providers, and the academic publishing industry. As a fifth and final point, the analysis turns to Central Eastern Europe and the case study of Poland to demonstrate that, to function properly, the academic law of value needs to be imposed by political means, that is, through policy reforms that establish and legitimize the sets of parameters and criteria for the evaluation of academic labor. In conclusion, the argument suggests that the domination of merchant capital over academic labor, resulting in the latter's ongoing and uncontrolled acceleration, cannot be overcome without addressing not so much the issue of private property but, first and foremost, the politically and socially defined metrics

foresight for crisis prevention

As part of their efforts to professionalize crisis and conflict prevention, foreign policy-makers are investing more in foresight, early warning or prediction. Different approaches and their products are suited for different purposes, based on distinct strengths and weaknesses. This policy paper provides an overview of the most common methods used in the context of preventing violent conflict and governance breakdown, and offers guidance on what to look out for when thinking about and planning for the future of crisis prevention