Das Immunsystem der Seele stärken : Evidenzbasierte Interventionen zur Resilienzförderung bei Menschen mit chronischen Schmerzen im erwerbsfähigen Alter

Hintergrund: Chronische Schmerzen sind ein weit verbreitetes Leiden und ihre Behandlung eine Herausforderung. Aktuelle Evidenz zeigt die vielfältigen positiven Effekte der Resilienz auf chronische Schmerzen. Die Resilienzförderung stellt daher einen vielversprechenden, neuen Ansatz in der Behandlung dar. Studien, welche die Wirksamkeit solcher (ergotherapeutischer) Interventionen belegen, sind jedoch kaum zu finden. Ziel: Ziel dieser Arbeit ist es, evidenzbasierte Interventionen zur Resilienzförderung bei Menschen mit chronischen Schmerzen im erwerbsfähigen Alter aufzuzeigen und Möglichkeiten für deren Anwendung in der Ergotherapie zu diskutieren. Methode: Es wurde eine Literaturrecherche anhand vordefinierter Ein- und Ausschlusskriterien in den Datenbanken CINAHL, Cochrane Library, MEDLINE, OTDBASE, Otseeker, PubMed, PubPsych und Web of Science durchgeführt. Es wurden 17 Interventionsstudien einbezogen. Ergebnisse: Zur Förderung der Resilienzfaktoren Positive Emotionen, Selbstwirksamkeit, Hoffnung, Optimismus und Soziale Unterstützung bei Menschen mit chronischen Schmerzen sind verschiedene Ansätze geeignet. Am besten belegt sind Achtsamkeitsinterventionen gefolgt von Selbstmanagement- und Gelenkschutzinterventionen. Validationstraining, Motivational Interviewing und Hoffnungsbasierte Psychologie sind weitere mögliche Ansätze. Schlussfolgerung: Die Ergebnisse zeigen, dass Resilienzförderung bei Menschen mit chronischen Schmerzen möglich ist und eine wertvolle Ergänzung zur bestehenden ergotherapeutischen Praxis darstellt. Ergotherapeutische Evidenz fehlt weitgehend. Ergotherapeuten können professionsfremde Interventionen unter gewissen Umständen miteinbeziehen, sie müssen dabei jedoch ihre Berufsidentität bewahren

Clozapine as add-on medication in the maintenance treatment of bipolar and schizoaffective disorders - A case series

Atypical neuroleptics are increasingly used in the treatment of bipolar and schizoaffective disorders. Currently, numerous controlled short-term studies are available for clozapine, olanzapine, risperidone or quetiapine, but long-term data are still missing. Three patients (2 with bipolar disorder, 1 with schizoaffective disorder) are described who showed a marked reduction of affective symptomatology after clozapine had been added to mood stabilizer pretreatment. The patients were seen once a month before and after the introduction of clozapine for at least 6 months. Treatment response was evaluated using different rating scales (IDS, YMRS; GAF; CGIBP) and the NIMH Life Chart Methodology. All patients showed a marked improvement after the add-on treatment with clozapine had been initiated. Clozapine was tolerated well with only transient and moderate weight gain and fatigue as only side effects. This case series underlines the safety and efficacy of clozapine as add-on medication in the treatment of bipolar and schizoaffective disorders. Copyright (C) 2002 S. Karger AG, Basel

Absorption and stationary times for the Λ\Lambda-Wright-Fisher process

We derive stationary and fixation times for the multi-type $\Lambda$-Wright-Fisher process with and without the classic linear drift that models mutations. Our method relies on a grand coupling of the process realized through the so-called lookdown-construction. A well-known process embedded in this construction is the fixation line. We generalise the process to our setup and make use of the associated explosion times to obtain a representation of the fixation and stationary times in terms of the waiting time in a coupon collector problem

The Stanley Foundation Bipolar Network: Results of the naturalistic follow-up study after 2.5 years of follow-up in the German centres

The Stanley Foundation Bipolar Network (SFBN) is an international, multisite network investigating the characteristics and course of bipolar disorder. Methods (history, ratings and longitudinal follow-up) are standardized and equally applied in all 7 centres. This article describes demographics and illness characteristics of the first 152 German patients enrolled in them SFBN as well as the results of 2.5 years of follow-up. Patients in Germany were usually enrolled after hospitalisation. More than 72% of the study population suffered from bipolar I disorder and 25% from bipolar 11 disorder. The mean +/- SD age of the study participants was 42.08 +/- 13.5 years, and the mean SD age of onset 24.44 +/- 10.9 years. More than 40% of the sample reported a rapid-cycling course in history, and even more a cycle acceleration overtime. 37% attempted suicide at least once. 36% had an additional Axis I disorder, with alcohol abuse being the most common one, followed by anxiety disorders. During the follow-up period, only 27% remained stable, 56% had a recurrence, 12.8% perceived subsyndromal symptoms despite treatment and regular visits. 27% suffered from a rapid-cycling course during the follow-up period. Recurrences were significantly associated with bipolar I disorder, an additional comorbid Axis I disorder, rapid cycling in history, a higher number of mood stabilizers and the long-term use of typical antipsychotics. Rapid cycling during follow-up was only associated with a rapidcycling course in history, a higher number of mood stabilizers and at least one suicide attempt in history. Copyright (c) 2003 S. Karger AG, Basel

The bias of gender in discourse and psychiatric interventions

El artículo aborda el sesgo de género existente en el campo de la psiquiatría. Para explorar este tema, hemos dividido nuestra presentación en tres partes. Inicialmente exploramos el sesgo de género en la historia de la psiquiatría, particularmente en el nacimiento de la psiquiatría moderna. En un segundo momento, analizamos las críticas feministas a la psiquiatría actual, observando la persistencia del sesgo de género desde la década de 1970, cuando aparecieron los primeros estudios críticos, hasta la actualidad. Finalmente, en la tercera parte de este escrito, presentamos una narración en primera persona, resultado de una entrevista con una usuaria de un CAPS en Florianópolis.O artigo aborda o viés de gênero existente no campo da psiquiatria. Para explorar esta questão, dividimos nossa apresentação em três partes. Inicialmente exploramos o viés de gênero na história da psiquiatria, particularmente no nascimento da psiquiatria moderna. Em um segundo momento, analisamos as críticas feministas à psiquiatria atual, observando a persistência do viés de gênero desde a década de 1970, quando surgiram os primeiros estudos críticos, até os dias atuais. Por fim, na terceira parte desta escrita apresentamos uma narrativa em primeira pessoa, resultado de uma entrevista com uma usuária de um CAPS de Florianópolis.The article addresses the existing gender bias in the field of psychiatry. To explore this topic, we have divided our presentation into three parts. Initially we explore the gender bias in the history of psychiatry, particularly in the birth of modern psychiatry. In a second moment, we analyze the feminist criticisms of current psychiatry, regarding the persistence of the gender bias since the 1970s, when the first critical studies appeared, up to the present. Finally, in the third part of this writing, we present a first-person narrative, the result of an interview with a user of a CAPS in Florianópolis.Ministerio de Ciencia, Tecnología e Innovacioón de Brasil, Consejo Nacional de Desarrollo Científico y Tecnológico CNPqBeca María Zambran

The Effect of Including eHealth in Dietary Interventions for Patients with Type 2 Diabetes with Overweight or Obesity:A Systematic Review

eHealth has a growing impact on the delivery of healthcare, making health systems more efficient. This study examined the effect of dietary interventions using eHealth compared to face-to-face contact in patients with (pre-) type 2 diabetes (T2D) and who are overweight/obese. Literature databases were searched upon November 2022. Inclusion criteria: randomized controlled trial; duration ≥ 6 months; involving dietary interventions; performed in adults with (pre-) T2D and who are overweight/obese; using eHealth compared to face-to-face contact; and report outcomes on weight loss, glycemic regulation, and/or cost-effectiveness. Selection of articles was performed manually and using ASReviewLab. Fifteen studies were included for data extraction, investigating a wide variety of eHealth interventions. Seven studies reporting on weight loss showed a significant between-group difference (−1.18 to −5.5 kg); five studies showed a trend in favor of the eHealth programs. Eleven studies reported on HbA1c; three found a significant between-group difference (−0.23 to −0.70%) in favor of the eHealth programs and six studies showed non-significant improvements. Interaction with healthcare professionals led to better results of the dietary interventions. Two studies reported incomplete data on cost-effectiveness. In conclusion, eHealth shows better results of dietary interventions in (pre-) T2D patients compared to face-to-face, especially when combined with interaction with healthcare professionals.</p

EdTec Implementation in a global higher education network: Empirical data from a field study in South Asia

This paper examines the appropriateness of using educational technologies toward increasing flexibility of learning in a global higher education in South Asia. The integration of information and communication technology (ICT) into education is widely perceived as an essential aspect of teaching and learning in contemporary society and therefore embodied in education policies across many countries, Cambodia and Sri Lanka included. Authors consider the argument that while interactive educational technologies may be appropriate in countries in which self-directed study and student autonomy are emphasised, a similar use of educational technologies may be found appropriate. Yet, in South Asian countries, education has traditionally been more tightly structured and teacher-directed that is why this paper does examine government policies toward the use of educational technologies in higher education in Cambodia and Sri Lanka. Qualitative analyses of both needs and challenges of introducing and implementing ICT in these particular cultural contexts are considered as preconditions for an effective implementation of Higher Education (HE) skill development. Subsequently, a plan is concluded of how to implement EdTec in that HE network to trigger awareness about further steps of the recent measure

Metabolic imprinting, programming and epigenetics - a review of present priorities and future opportunities

Metabolic programming and metabolic imprinting describe early life events, which impact upon on later physiological outcomes. Despite the increasing numbers of papers and studies, the distinction between metabolic programming and metabolic imprinting remains confusing. The former can be defined as a dynamic process whose effects are dependent upon a critical window(s) while the latter can be more strictly associated with imprinting at the genomic level. The clinical end points associated with these phenomena can sometimes be mechanistically explicable in terms of gene expression mediated by epigenetics. The predictivity of outcomes depends on determining if there is causality or association in the context of both early dietary exposure and future health parameters. The use of biomarkers is a key aspect of determining the predictability of later outcome, and the strengths of particular types of biomarkers need to be determined. It has become clear that several important health endpoints are impacted upon by metabolic programming/imprinting. These include the link between perinatal nutrition, nutritional epigenetics and programming at an early developmental stage and its link to a range of future health risks such as CVD and diabetes. In some cases, the evidence base remains patchy and associative, while in others, a more direct causality between early nutrition and later health is clear. In addition, it is also essential to acknowledge the communication to consumers, industry, health care providers, policy-making bodies as well as to the scientific community. In this way, both programming and, eventually, reprogramming can become effective tools to improve health through dietary intervention at specific developmental point

Metabolic imprinting, programming and epigenetics - a review of present priorities and future opportunities

Metabolic programming and metabolic imprinting describe early life events, which impact upon on later physiological outcomes. Despite the increasing numbers of papers and studies, the distinction between metabolic programming and metabolic imprinting remains confusing. The former can be defined as a dynamic process whose effects are dependent upon a critical window(s) while the latter can be more strictly associated with imprinting at the genomic level. The clinical end points associated with these phenomena can sometimes be mechanistically explicable in terms of gene expression mediated by epigenetics. The predictivity of outcomes depends on determining if there is causality or association in the context of both early dietary exposure and future health parameters. The use of biomarkers is a key aspect of determining the predictability of later outcome, and the strengths of particular types of biomarkers need to be determined. It has become clear that several important health endpoints are impacted upon by metabolic programming/imprinting. These include the link between perinatal nutrition, nutritional epigenetics and programming at an early developmental stage and its link to a range of future health risks such as CVD and diabetes. In some cases, the evidence base remains patchy and associative, while in others, a more direct causality between early nutrition and later health is clear. In addition, it is also essential to acknowledge the communication to consumers, industry, health care providers, policy-making bodies as well as to the scientific community. In this way, both programming and, eventually, reprogramming can become effective tools to improve health through dietary intervention at specific developmental points