Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Background: Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. Methods: A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. Results: 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Conclusions: Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients

Health Care for Persistent Somatic Symptoms Across Europe: A Qualitative Evaluation of the EURONET-SOMA Expert Discussion

Background: Persistent somatic symptoms (PSS), referred to as somatoform disorders and lately somatic symptom disorders, are frequent but often remain under-recognized and under-treated. Although European guidelines overlap, presumably, there is large diversity in their practical use and in the actual health care situation. The aim of this qualitative evaluation was to compare health care for PSS across 9 European countries, to illustrate commonalities and differences, and to discuss challenges for a pan-European research agenda.Methods: A case vignette fulfilling ICD-10 criteria of undifferentiated somatization disorder was presented to 24 experts from 9 European countries, who completed a semi-structured assessment regarding the routine management including diagnostic procedures, treatment recommendations, and country-specific health care aspects. A qualitative evaluation was conducted using the video-transcripts of the presentations. Results were validated by additional expert interviews.Results: Across all countries, primary care physicians serve as the gate keeper for further diagnostic and treatment procedures. Apart from this commonality, there is a large variability in health care routines. Experts concluded that individuals with PSS appear to be a non-identified patient group within many European health care systems. To overcome the gap between evidence-based guidelines and clinical reality needs, three key challenges were identified: (1) Defining a clinically useful, acceptable, and non-stigmatizing diagnostic term, (2) implementing guideline recommendations into routine care, (3) developing effective dissemination strategies.Conclusions: The results advocate for more research on the actual European health care situation. A systematic European research agenda with unified goals and interdisciplinary collaboration that integrates all stakeholders could answer this challenge

Weight Bias Internalization Scale: psychometric properties and population norms

Objective: Internalizing the pervasive weight bias commonly directed towards individuals with overweight and obesity, cooccurs with increased psychopathology and impaired quality of life. This study sought to establish population norms and psychometric properties of the most widely used self-report questionnaire, the Weight Bias Internalization Scale (WBIS), in a representative community sample. Design and Methods: In a survey of the German population, N = 1158 individuals with overweight and obesity were assessed with the WBIS and self-report measures for convergent validation. Results: Item analysis revealed favorable item-total correlation of all but one WBIS item. With this item removed, item homogeneity and internal consistency were excellent. The one-factor structure of the WBIS was confirmed using confirmatory factor analysis. Convergent validity was shown through significant associations with measures of depressive and somatoform symptoms. The WBIS contributed to the explanation of variance in depressive and somatoform symptoms over and above body mass index. Higher WBIS scores were found in women than in men, in individuals with obesity than in individuals with overweight, and in those with lower education or income than those with higher education or income. Sex specific norms were provided. Conclusions: The results showed good psychometric properties of the WBIS after removal of one item. Future research is warranted on further indicators of reliability and validity, for example, retest reliability, sensitivity to change, and prognostic validity

Public Beliefs About Somatic Symptom Disorders

Objectives: Despite satisfactory effectiveness of treatment for somatic symptom disorders (SSD), treatment rates are low and treatment is usually initiated many years after first symptoms. In order to understand whether a lack of public mental health literacy might contribute to these poor treatment rates, we aimed to focus on two research questions: (1) What does the German public know and think about SSD? (2) Are knowledge and beliefs associated with socio-demographic factors and experiences with the disorder?Methods: Two vignettes with symptoms of a SSD were used in a national telephone survey in Germany (N = 1,004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked concerning knowledge and beliefs about causes, symptoms, and treatment using a standardized questionnaire.Results: 66% of the respondents agreed that a possible cause of the symptoms is a misinterpretation of body signals. About 1/3 recognized a mental health problem when confronted with the vignettes of cases with SSD. This rate was lower in case of a SSD with pain as the main symptom without a comorbid somatic disease (24.8%, 95%-CI: 21.1–28.6) compared to a case with fatigue as the main symptom and an earlier severe somatic disease (44.0%, 95%-CI: 39.6–48.3). Female respondents tended to have a more positive view on treatability and effectiveness of psychotherapy, while associations of knowledge and beliefs with education and age were inconsistent. Respondents who had contact with a person with SSD were more likely to think that psychotherapy is effective and that they know a lot about SSD compared to those who never had contact.Conclusions: While most of the German public seems to be well informed about causes of SSD as well as treatability and the effectiveness of psychotherapy, the majority has problems with interpreting symptoms and does not think they know a lot about symptoms like that. Increasing knowledge about SSD by education interventions may help to promote adequate help seeking

Nurses’ experiences of a screening and associated psychosomatic consultation service for mental comorbidities in somatic care inpatients – a qualitative study

BackgroundScreening for mental comorbidities and related liaison service can reduce hospital length of stay in somatic hospital care. To develop, test and sustain such health care services, stakeholder feedback is required. One of the most important stakeholders in general hospital care and health care processes are nurses.AimThe aim of this study is to explore nurses’ experiencess on standardized nurse-led screening for mental comorbidities and associated psychosomatic consultation service in routine somatic inpatient care.MethodSemi-structured qualitative interviews were conducted with 18 nurses that were involved in a nurse-led screening service for mental comorbidities on internal medicine or dermatological wards. Data were analyzed using thematic analysis.ResultsEight thematic groups were developed. On the one hand, participants reported benefits of screening: mental health education, general mental health awareness, holistic treatment approach, opportunity to build rapport with patients and reduction in workload. On the other hand, possible psychological effects of the intervention, reasons why patients may not want to be referred and application requirements to facilitate delivery were identified. None of the nurses opposed screening and associated psychosomatic consultation service.ConclusionAll nurses endorsed the screening intervention and considered it meaningful. Nurses particularly emphasized the potential for holistic patient care and nurses’ improved skills and competencies, but partly critizised current application requirements.Relevance to clinical practiceThis study adds on existent evidence on nurse-led screening for mental comorbidities and associated psychosomatic consultation service by emphasizing its potential to improve both patient care as well as nurses’ perceived self-efficacy and job satisfaction. To take full advantage of this potential, however, usability improvements, regular supervision, and ongoing training for nurses need to be considered

Tagungsband zum 4. BIH-Treffen 2019: Interdisziplinäre Forschung - Chancen und Herausforderungen: Fachtagung für wissenschaftlich Beschäftigte und Nachwuchskräfte an Bauingenieur-Institutionen deutscher Hochschulen

Forschung und Wissenschaft sind wichtige Standbeine einer modernen Hochschule. Sie stellen eine Grundlage für die primäre Aufgabe der Hochschulen dar, die praxisnahe und berufsbefähigende Lehre auf dem aktuellen Stand der Technik und Wissenschaft. Mittlerweile widmen sich auch die Hochschulen der Ausbildung von wissenschaftlichem Nachwuchs. Prosperierende Forschungsarbeit ist dafür ein unverzichtbarer Bestandteil. Der Leitgedanke „Interdisziplinäre Forschung – Chancen und Herausforderungen“ des BIH-Treffens 2019 soll zum fachübergreifenden Austausch von Know-how in Forschungs- und Lehrmethoden anregen. Eine große Bandbreite an Fachbeiträgen bietet spannende Einblicke in die Arbeit der Kolleginnen und Kollegen in den unterschiedlichen Fachbereichen des Bauwesens der zahlreichen deutschen Hochschulen. Dazu gehören Beiträge zu modernen Messmethoden in der Geotechnik und dem Bahnbau ebenso wie Forschungsergebnisse aus dem konstruktiven Ingenieurbau, der Baukonstruktion, der Haustechnik und der Verkehrsplanung und nicht zuletzt Erfahrungen zu interdisziplinären Lehrmethoden.:Einfluss der Nachverdichtung granularer Böden auf die Phasengeschwindigkeiten von Rayleighwellen Sommerliche Überhitzung in Wohngebäuden – Baukonstruktive und haustechnische Anpassungsmaßnahmen Die „Hochschulweite Interdisziplinäre Projektwoche (HIP)“ an der TH Köln – andere Welten kennenlernen! Forschungsprojekt „Duale Radlösung“ – Wahlfreie Führung als Mittel der Radverkehrslösung Zwang in Hochbaudecken aus Stahlbeton (Kooperative Promotion) Robustheit und Vulnerabilität der Wasserstraßeninfrastruktur Vergleichbarkeit der Messsysteme an Zug- und Biegeproben aus den Werkstoffen Stahl und Holz Entwicklung einer Messmethodik zur Bestimmung der Schienenbewegung unter dem rollenden RadResearch and science are important mainstay of a modern university. They provide a basis for the primary task of the universities, the practical and occupational teaching on the current state of technology and science. In the meantime, the universities are also dedicating themselves to the training of junior scientists. Prospering research is an indispensable part of this. The guiding idea 'Interdisciplinary Research - Opportunities and Challenges' of the BIH meeting 2019 is intended to stimulate the interdisciplinary exchange of expertise in research and teaching methods. A wide range of specialist contributions provides exciting insights into the work of colleagues in the various specialized fields of civil engineering at numerous German universities. This includes papers to modern measuring methods in geotechnical engineering and railway construction, as well as research results from structural engineering, building construction, building technology and traffic planning, and last but not least, experience in interdisciplinary teaching methods.:Einfluss der Nachverdichtung granularer Böden auf die Phasengeschwindigkeiten von Rayleighwellen Sommerliche Überhitzung in Wohngebäuden – Baukonstruktive und haustechnische Anpassungsmaßnahmen Die „Hochschulweite Interdisziplinäre Projektwoche (HIP)“ an der TH Köln – andere Welten kennenlernen! Forschungsprojekt „Duale Radlösung“ – Wahlfreie Führung als Mittel der Radverkehrslösung Zwang in Hochbaudecken aus Stahlbeton (Kooperative Promotion) Robustheit und Vulnerabilität der Wasserstraßeninfrastruktur Vergleichbarkeit der Messsysteme an Zug- und Biegeproben aus den Werkstoffen Stahl und Holz Entwicklung einer Messmethodik zur Bestimmung der Schienenbewegung unter dem rollenden Ra

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Study

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Stud

Needs of multimorbid heart failure patients and their carers: a qualitative interview study and the creation of personas as a basis for a blended collaborative care intervention

IntroductionInvolving patients and carers in the development of blended collaborative care (BCC) interventions for multimorbid heart failure (HF) patients is recommended but rarely practised, and research on the patient perspective is scarce. The aim of this study is to investigate patients’ and carers' care-related needs and preferences to better customize a novel international BCC intervention.MethodsA qualitative study design using framework analysis was employed. The study was performed in accordance with the EQUATOR standards for reporting qualitative research (SRQR). Patients aged at least 65 years with HF and at least two other physical diseases as well as their carers completed semistructured interviews in Germany, Italy, and Denmark. Based on these interviews, personas (prototype profiles of patients and carers) were created.ResultsData from interviews with 25 patients and 17 carers were analysed. Initially, seven country-specific personas were identified, which were iteratively narrowed down to a final set of 3 personas: (a) the one who needs and wants support, (b) the one who has accepted their situation with HF and reaches out when necessary, and (c) the one who feels neglected by the health care system. Carers identifying with the last persona showed high levels of psychological stress and a high need for support.DiscussionThis is the first international qualitative study on patients' and carers' needs regarding a BCC intervention using the creation of personas. Across three European countries, data from interviews were used to develop three contrasting personas. Instead of providing “one size fits all” interventions, the results indicate that BCC interventions should offer different approaches based on the needs of individual patients and carers. The personas will serve as a basis for the development of a novel BCC intervention as part of the EU project ESCAPE (Evaluation of a patient-centred biopSychosocial blended collaborative CAre Pathway for the treatment of multimorbid Elderly patients)