What are disease perceptions and subjective treatment goals of insulin treated diabetic patients?

BACKGROUND: Despite increasing importance of patient self-management, little is known about their own perceptions and treatment goals. OBJECTIVES: The aim of this explorative study was to examine what diabetic patients perceive as most concerning and what their own treatment goals are. METHODS: A 23-item anonymous questionnaire was distributed among type 1 diabetic patients treated with and without an insulin pump and insulin treated type 2 diabetic patients in the outpatient clinic of a University Hospital. 86% of the questionnaires were returned (n = 124). RESULTS: In open-ended questions, patients in all three groups together felt mostly restricted by their loss of freedom (24%), the dietary restrictions (17%) and the need to measure blood glucose (17%). Patients treated with an insulin pump worried more about hypoglycaemia and less about dietary restrictions. In closed-ended questions, patients were mostly concerned about hypoglycaemia and developing complications. However, the main treatment goal of both groups together was long-term good blood glucose control (63%). Further patient goals were the prevention of complications (27%) and the preservation of a good quality of life. Quality of life was a more important goal for type 1 diabetic patients (29%) than for type 2 diabetic patients (0%). Patients thought that blood glucose control was more important for their physicians (main treatment goal for 86%) than for themselves. CONCLUSION: Insulin treated patients with diabetes spontaneously express concerns about their actual quality of life and daily hassles and mention long-term worries after explicit questioning. For their main treatment goals they choose mainly long-term goals. According to the patients, physicians tend to overestimate blood glucose control

On the structure of the set of bifurcation points of periodic solutions for multiparameter Hamiltonian systems

This paper deals with periodic solutions of the Hamilton equation with many parameters. Theorems on global bifurcation of solutions with periods $2\pi/j,$ $j\in\mathbb{N},$ from a stationary point are proved. The Hessian matrix of the Hamiltonian at the stationary point can be singular. However, it is assumed that the local topological degree of the gradient of the Hamiltonian at the stationary point is nonzero. It is shown that (global) bifurcation points of solutions with given periods can be identified with zeros of appropriate continuous functions on the space of parameters. Explicit formulae for such functions are given in the case when the Hessian matrix of the Hamiltonian at the stationary point is block-diagonal. Symmetry breaking results concerning bifurcation of solutions with different minimal periods are obtained. A geometric description of the set of bifurcation points is given. Examples of constructive application of the theorems proved to analytical and numerical investigation and visualization of the set of all bifurcation points in given domain are provided. This paper is based on a part of the author's thesis [W. Radzki, ``Branching points of periodic solutions of autonomous Hamiltonian systems'' (Polish), PhD thesis, Nicolaus Copernicus University, Faculty of Mathematics and Computer Science, Toru\'{n}, 2005].Comment: 35 pages, 4 figures, PDFLaTe

Neural and behavioral traces of error awareness

Monitoring for errors and behavioral adjustments after errors are essential for daily life. A question that has not been addressed systematically yet, is whether consciously perceived errors lead to different behavioral adjustments compared to unperceived errors. Our goal was to develop a task that would enable us to study different commonly observed neural correlates of error processing and post-error adjustments in their relation to error awareness and accuracy confidence in a single experiment. We assessed performance in a new number judgement error awareness task in 70 participants. We used multiple, robust, single-trial EEG regressions to investigate the link between neural correlates of error processing (e.g., error-related negativity (ERN) and error positivity (Pe)) and error awareness. We found that only aware errors had a slowing effect on reaction times in consecutive trials, but this slowing was not accompanied by post-error increases in accuracy. On a neural level, error awareness and confidence had a modulating effect on both the ERN and Pe, whereby the Pe was most predictive of participants’ error awareness. Additionally, we found partial support for a mediating role of error awareness on the coupling between the ERN and behavioral adjustments in the following trial. Our results corroborate previous findings that show both an ERN/Pe and a post-error behavioral adaptation modulation by error awareness. This suggests that conscious error perception can support meta-control processes balancing the recruitment of proactive and reactive control. Furthermore, this study strengthens the role of the Pe as a robust neural index of error awareness

eCute: Difference is good

This paper provides an overview of ongoing research on cultural and emotional learning, thereby utilizing engaging roleplay with synthetic characters. The paper explains the underlying learning objectives and provides an overview of how we intend to achieve them. This includes a technical framework integrating affective AI characters and innovative interaction technologies. The framework will be used to realize a virtual learning environment hosting the synthetic characters. Finally a brief description of an evaluation approach for the anticipated learning objectives is given

Dopamine transporter (DAT1) and dopamine receptor D4 (DRD4) genotypes differentially impact on electrophysiological correlates of error processing

Peer reviewedPublisher PD

Predicting violent infractions in a Swiss state penitentiary: A replication study of the PCL-R in a population of sex and violent offenders

BACKGROUND: Research conducted with forensic psychiatric patients found moderate correlations between violence in institutions and psychopathy. It is unclear though, whether the PCL-R is an accurate instrument for predicting aggressive behavior in prisons. Results seem to indicate that the instrument is better suited for predicting verbal rather than physical aggression of prison inmates. METHODS: PCL-R scores were assessed for a sample of 113 imprisoned sex and violent offenders in Switzerland. Logistic regression analyses were used to estimate physical and verbal aggression as a function of the PCL-R sum score. Additionally, stratified analyses were conducted for Factor 1 and 2. Infractions were analyzed as to their motives and consequences. RESULTS: The mean score of the PCL-R was 12 points. Neither the relationship between physical aggression and the sum score of the PCL-R, nor the relationship between physical aggression and either of the two factors of the PCL-R were significant. Both the sum score and Factor 1 predicted the occurrence of verbal aggression (AUC=0.70 and 0.69), while Factor 2 did not. CONCLUSION: Possible explanations are discussed for the weak relationship between PCL-R scores and physically aggressive behavior during imprisonment. Some authors have discussed whether the low base rate of violent infractions can be considered an explanation for the non-significant relation between PCL-R-score and violence. The base rate in this study, however, with 27%, was not low. It is proposed that the distinction between reactive and instrumental motives of institutional violence must be considered when examining the usefulness of the PCL-R in predicting in-prison physical aggressive behavior

Investment in online self-evaluation tests: A theoretical approach

BACKGROUND: Large-scale traumatic events may burden any affected public health system with consequential charges. One major post-disaster, expense factor emerges form early psychological interventions and subsequent, posttraumatic mental health care. Due to the constant increase in mental health care costs, also post-disaster public mental health requires best possible, cost-effective care systems. Screening and monitoring the affected population might be one such area to optimize the charges. METHODS: This paper analyzes the potential cost-effectiveness of monitoring a psychologically traumatized population and to motivate individuals at risk to seek early treatment. As basis for our model served Grossman's health production function, which was modified according to fundamental concepts of cost-benefit analyzes, to match the basic conditions of online monitoring strategies. We then introduce some fundamental concepts of cost-benefit analysis. RESULTS: When performing cost-benefit analyses, policy makers have to consider both direct costs (caused by treatment) and indirect costs (due to non-productivity). Considering both costs sources we find that the use of Internet-based psychometric screening instruments may reduce the duration of future treatment, psychological burden and treatment costs. CONCLUSION: The identification of individuals at risk for PTSD following a disaster may help organizations prevent both the human and the economic costs of this disease. Consequently future research on mental health issues should put more emphasis on the importance of monitoring to detect early PTSD and focus the most effective resources within early treatment and morbidity prevention

Internal and external information in error processing

<p>Abstract</p> <p>Background</p> <p>The use of self-generated and externally provided information in performance monitoring is reflected by the appearance of error-related and feedback-related negativities (ERN and FRN), respectively. Several authors proposed that ERN and FRN are supported by similar neural mechanisms residing in the anterior cingulate cortex (ACC) and the mesolimbic dopaminergic system. The present study is aimed to test the functional relationship between ERN and FRN. Using an Eriksen-Flanker task with a moving response deadline we tested 17 young healthy subjects. Subjects received feedback with respect to their response accuracy and response speed. To fulfill both requirements of the task, they had to press the correct button and had to respond in time to give a valid response.</p> <p>Results</p> <p>When performance monitoring based on self-generated information was sufficient to detect a criterion violation an ERN was released, while the subsequent feedback became redundant and therefore failed to trigger an FRN. In contrast, an FRN was released if the feedback contained information which was not available before and action monitoring processes based on self-generated information failed to detect an error.</p> <p>Conclusion</p> <p>The described pattern of results indicates a functional interrelationship of response and feedback related negativities in performance monitoring.</p

The effects of economic deprivation on psychological well-being among the working population of Switzerland

BACKGROUND: The association between poverty and mental health has been widely investigated. There is, however, limited evidence of mental health implications of working poverty, despite its representing a rapidly expanding segment of impoverished populations in many developed nations. In this study, we examined whether working poverty in Switzerland, a country with substantial recent growth among the working poor, was correlated with two dependent variables of interest: psychological health and unmet mental health need. METHODS: This cross-sectional study used data drawn from the first 3 waves (1999–2001) of the Swiss Household Panel, a nationally representative sample of the permanent resident population of Switzerland. The study sample comprised 5453 subjects aged 20–59 years. We used Generalized Estimating Equation models to investigate the association between working poverty and psychological well-being; we applied logistic regression models to analyze the link between working poverty and unmet mental health need. Working poverty was represented by dummy variables indicating financial deficiency, restricted standard of living, or both conditions. RESULTS: After controlling other factors, restricted standard of living was significantly (p < .001) negatively correlated with psychological well-being; it was also associated with approximately 50% increased risk of unmet mental health need (OR = 1.55; 95% CI 1.17 – 2.06). CONCLUSION: The findings of this study contribute to our understanding of the potential psychological impact of material deprivation on working Swiss citizens. Such knowledge may aid in the design of community intervention programs to help reduce the individual and societal burdens of poverty in Switzerland

Exposure to the tsunami disaster, PTSD symptoms and increased substance use – an Internet based survey of male and female residents of Switzerland

BACKGROUND: After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with mental health services. Although primarily designed for surviving Swiss tourists as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms. METHODS: One section of the screening covered addiction related behavior. We analyzed the relationship between increased substance use, the level of PTSD symptoms and trauma exposure using multivariable logistic regression with substance use as the dependent variable. Included in the study were only subjects who reported being residents of Switzerland and the analyses were stratified by gender in order to control for possible socio-cultural or gender differences in the use of psychotropic substances. RESULTS: In women PTSD symptoms and degree of exposure enlarged the odds of increased alcohol, pharmaceuticals and cannabis use significantly. In men the relationship was more specific: PTSD symptoms and degree of exposure only enlarged the odds of increased pharmaceutical consumption significantly. Increases in alcohol, cannabis and tobacco use were only significantly associated with the degree of PTSD symptoms. CONCLUSION: The tsunami was associated with increased substance use. This study not only replicates earlier findings but also suggests for a gender specificity of post-traumatic substance use increase