Initial motivation for psychotherapy and institutional fate of psychotherapeutic outpatients

Erster Gegenstand dieses Artikels ist die Entwicklung und Validierung eines Systems zur Kategorisierung von initialer Therapiemotivation. Auf Basis einer Inhaltsanalyse der Antworttexte von 202 Patienten zweier österreichischer Therapieambulanzen auf die offene Frage, was sie zur Therapie motiviere, wird ein über Definitionen, Ankerbeispiele und Kodierregeln dokumentiertes, interraterreliables System von 16 Motivkategorien vorgelegt. Im Vergleich zu bisherigen Untersuchungen fällt auf, dass häufig ein relativ unspezifischer Wunsch nach Gespräch und Unterstützung zur Therapie motiviert – ein Motiv, das von einer von vorneherein an Problemen oder Zielen orientierten Forschungslogik offenbar ausgeblendet wird.Es lassen sich Zusammenhänge zwischen den Therapiemotiven der Patienten und ihrem »institutionellen Schicksal« beobachten: etwa erhalten Personen, die von eigenen Entwicklungsmöglichkeiten, von Selbsterkenntnis oder davon, ihre Lebensfreude wiederzuerlangen, motiviert sind, häufiger Gruppen-, Paar- und Familientherapie. Bei 8 Patientinnen führt die Erstvorstellung nicht zum Beginn einer Therapie. Diese sind überdurchschnittlich alt und geben v.a. Fremdanraten, Depression und Leidensdruck als Motive an. Wir identifizieren sie als Problempatienten des Therapiesystems, die – von Ärzten oder Familienangehörigen »überwiesen« – mit wenig Reflexionsmotivation bzw. -kapazität die therapeutischen Ambulanzen anlaufen, um dort trotz hohen Leidensdrucks überzufällig häufig wieder weggeschickt zu werden.Patients’ motivation is one of the most decisive factors for successful psychotherapy. Motivation, however, not only amounts to a quantitative entity, but the kind of this motivation is essential. Thus, our basic research aim was to develop an instrument for representing the specific quality of a patient’s therapy motivation in a clear and reliable way. Before their first interview at two Austrian therapeutic out-patient centres, we asked 202 prospective patients to respond to an open question regarding their motivation to seek psychotherapy. Based on a content analysis of their written answers, we suggest a system of 16 motif categories. The system is well documented through definitions, anchor examples, and coding rules and can easily be adopted for further research. We find that frequently patients simply wish to talk to someone and be supported – a rather unspecific motif category that previous research logic, oriented on patients’ problems and goals as it was, obviously has been hiding.Patients’ motives, as categorized by our instrument, correlate with indication to therapy. Those who are motivated by their own potential, by insight or who want to regain their love of live more often are referred to group, couple, or family therapy. On the other hand, 8 patients, all of them women, are not considered for therapy at all. They are significantly older than average and, when asked for their motivation to seek therapy, answered in ways that were rated as recommendation by others, depression, and suffering. We identify them as »problem children« of the therapy system: referred by their doctors or their relatives, they show up at the ambulance with little motivation or capacity for self-reflection – and are sent away despite of their subjective suffering

Economic growth and the incidence of occupational injuries: a long time analysis among Austrian employees between 1955 and 2004

OBJECTIVES: The aim of this paper was to analyze the impact of economic growth measured by real gross domestic product (GDP) on the incidence of occupational injuries in Austria. METHODS: The relationship between GDP and the occupational injury rate of the wage-earning population between 1955 and 2004 was analyzed using an error correction model. The sample size increased from 1.568,371 persons in 1955 to 2.656,952 in 2004. Occupational injuries were divided into fatal and non-fatal injuries. RESULTS: Occupational injuries (fatal and non-fatal) decreased from 8.59% to 4.08%: non-fatal injuries decreased from 8.56% to 4.07%; fatal injuries decreased from 0.03% to 0.01%. Austrian GDP increased from EUR 37.7 billion to EUR 202.8 billion (base year 1995). Statistical analysis clearly shows that a growing economy is associated with declining injury rates (fatal and non-fatal). Two mechanisms are discussed. Firstly, rising GDP is accompanied by greater investment in safer technologies and occupational safety measures. Secondly, booming economies are associated with a reduced risk of unemployment, which is already known to be a risk factor for occupational injuries. CONCLUSIONS: Economic development appears to have an impact on the incidence of occupational injuries in Austria. Health policy should emphasize the necessity for safety at work particularly in phases of economic slowdown. (author's abstract

Low Vitamin D Levels Do Not Predict Hyperglycemia in Elderly Endurance Athletes (but in Controls).

BACKGROUND AND AIM:Recent studies revealed a link between hypovitaminosis D3 and the risk for hyperglycemia. Further mechanistic and interventional investigations suggested a common reason for both conditions rather than a causal relationship. Exposure to sunlight is the most relevant source of vitamin D3 (25(OH)D), whereas adipose tissue is able to store relevant amounts of the lipophilic vitamin. Since running/bicycling leads to increased out-door time and alters physiological response mechanisms, it can be hypothesized that the correlation between hypovitaminosis D3 and hyperglycemia might be disturbed in outdoor athletes. METHODS:47 elderly marathoners/bicyclists and 47 age/sex matched controls were studied in a longitudinal setting at baseline and after three years. HbA1c as a surrogate for (pre-)diabetic states was quantified via HPLC, 25(OH)D levels were measured by means of chemiluminescent assays. Physical performance was assessed by ergometry. RESULTS:When adjusted for seasonal variations, 25(OH)D was significantly higher in athletes than in controls. 25(OH)D levels inversely correlated with triglycerides in both groups, whereas only in controls an association between high BMI or low physical performance with hypovitaminosis D3 had been found. Likewise, the presence of hypovitaminosis D3 at baseline successfully predicted hyperglycemia at the follow up examinations within the control group (AUC = 0.85, 95% CI [0.74, 0.96], p < .001, statistically independent from BMI), but not in athletes. CONCLUSION:Our data suggest that mechanisms of HbA1c elevation might differ between athletes and controls. Thus, intense physical activity must be taken into account as a potential pre-analytic confounder when it is aimed to predict metabolic risk by vitamin D3 levels

A combination of routine blood analytes predicts fitness decrement in elderly endurance athletes.

Endurance sports are enjoying greater popularity, particularly among new target groups such as the elderly. Predictors of future physical capacities providing a basis for training adaptations are in high demand. We therefore aimed to estimate the future physical performance of elderly marathoners (runners/bicyclists) using a set of easily accessible standard laboratory parameters. To this end, 47 elderly marathon athletes underwent physical examinations including bicycle ergometry and a blood draw at baseline and after a three-year follow-up period. In order to compile a statistical model containing baseline laboratory results allowing prediction of follow-up ergometry performance, the cohort was subgrouped into a model training (n = 25) and a test sample (n = 22). The model containing significant predictors in univariate analysis (alanine aminotransferase, urea, folic acid, myeloperoxidase and total cholesterol) presented with high statistical significance and excellent goodness of fit (R2 = 0.789, ROC-AUC = 0.951±0.050) in the model training sample and was validated in the test sample (ROC-AUC = 0.786±0.098). Our results suggest that standard laboratory parameters could be particularly useful for predicting future physical capacity in elderly marathoners. It hence merits further research whether these conclusions can be translated to other disciplines or age groups

Partial correlation of 25(OH)D and ergometry performance among controls, but not in athletes.

<p>*residuals (ergometry performance/date of blood withdrawal) are plotted versus residuals (25(OH)D/date of blood withdrawal)</p

Characterization of the APSOEM study cohort.

<p>Characterization of the APSOEM study cohort.</p

Training intensity and 25(OH)D.

<p>Relationship between weekly amount of physical exercise (as a surrogate for outdoor activities) and 25(OH)D levels among athletes.</p