Self-care strategies for medical students: an uncontrolled mixed-methods evaluation of a mind-body-medicine group course

Background High stress during medical education and its detrimental effects on student health is well documented. This exploratory evaluation study assesses a 10-week Mind-Body-Medicine student course, created to promote student self-care at Charité Universitätsmedizin Berlin, Germany. Methods During 2012–2019, uncontrolled quantitative and qualitative data were gathered from 112 student participants. Outcomes including changes in perceived stress (PSS), mindfulness (FMI/MAAS), self-reflection (GRAS), self-efficacy (GSE), empathy (SPF), and health-related quality of life (SF-12) were measured between the first (T0) and last sessions (T1). Qualitative data were obtained in focus groups at course completion and triangulated with quantitative data. Results Quantitative outcomes showed decreases in perceived stress and increased self-efficacy, mindfulness, self-reflection, and empathy. In focus groups, students reported greater abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. Triangulation grounded these effects of MBM practice in its social context, creating an interdependent dynamic between experiences of self and others. Conclusion After completing an MBM course, students reported reduced perceived stress, increased self-efficacy, mindfulness, empathy and positive engagement with integrative concepts of doctor–patient relationships. Further research with larger randomized confirmatory studies is needed to validate these benefits

Acupressure in patients with seasonal allergic rhinitis: a randomized controlled exploratory trial

Background: Acupuncture has shown beneficial effects for seasonal allergic rhinitis (SAR); however, it is time and cost intensive. We investigated feasibility and effects of self-administered body acupressure as a self-care technique that stimulates acupuncture points with manual pressure in SAR patients. Methods: We conducted a two-armed randomized controlled exploratory trial to compare effects of self-administered acupressure over 4 weeks at five acupuncture points plus rescue medication (RM) with cetirizine compared to RM alone in SAR patients. Among other outcome parameters, we assessed disease-related quality of life (Rhinitis Quality of Life Questionnaire [RQLQ]), overall SAR symptoms by a visual analogue scale (VAS) and a rescue medication score (RMS) after 4 and 8 weeks. Results: Forty-one SAR patients (mean age 38.5 +/- 10.0 years, n = 21, 51.2% women) were randomized. Compared to RM alone (n = 21), acupressure plus RM (n = 20) was associated with relevant improvements after 4 weeks, shown by the difference between groups in adjusted means of RQLQ: - 0.9 points (95% CI - 1.6 to - 0.2; p = 0.011) and VAS overall SAR symptoms: - 21.6 mm (95% CI - 36.3 to - 6.8; p = 0.005). The RMS was lower in the acupressure group than in the control group: 1.9 points (95% CI - 3.8 to - 0.1; p = 0.120). Group differences decreased slightly until week 8. The acupressure was feasible and safe. Conclusion: Results of this exploratory study indicate that self-applied acupressure is feasible, may improve disease-specific quality of life and reduce disease-related symptoms as well as anti-allergic medication intake in SAR patients. High-quality confirmatory studies including a sham-control group are needed in the future

Realized copulae in moderate dimensions

Copulae sind ein hilfreiches Werkzeug um die Abhängigkeitsstrukturen zwischen Risikofaktoren in Wirtschaft und Finanzwesen zu modellieren und zu quantifizieren. Dank technologischen Entwicklungen der letzten Jahrzehnte, können hoch-frequentierte Daten mit innertäglichen Beobachtungen genutzt werden um die Covarianz zwischen Wertpapieren zu schätzen. Aus dieser Schätzung und zusätzlichen Annahmen über die Randverteilungen werden in dieser Arbeit Realized Copula Modelle an Hand von Aktienkursen auf verschiedenen Wegen geschätzt und untersucht. Basierend auf hoch-frequentierten Daten werden drei Schätzer für den Copula Parameter angewendet und durch die Nutzung von täglichen Renditen wird ein Maximum Likelihood Schätzer bestimmt. Dabei werden Eigenschaften erfasst, wo die multivariate Verteilung an ihre Grenzen kommt, wie zum Beispiel im Falle von Heavy-tailed Verteilungen und asymetrischen Abhängigkeiten. Copulae ermöglichen es die Randverteilungen seperat von der gemeinsamen Verteilung zu bestimmen. Die unterschiedlich geschätzten Copula parameter werden verglichen und die resultierenden Copula Modelle bezüglich ihrer Angepasstheit an die Daten und ihrer Vorhersage von Verlusten untersucht. Die modellierte Abhängigkeit ändert sich über die Zeit und unterscheidet sich je nach verfügbarer Kovarianzschätzung und Ziehungshäufigkeit der innertages Stichproben. Dabei werden die Realized Kernel Schätzer, bei sehr häufiger Ziehung, zum Teil bei der Schätzung der Copula Parameter genutzt. Einige Parameterschätzer liefern präzisere Quantilsschätzungen der Verlustverteilung als andere, was durch eine Value-at-Risk Schätzung und durch backtesting gezeigt wird.Abstract For modeling and quantifying the dependence structure between financial risk factors like stock returns, copula models are a useful instrument. Abstract Due to technological growth and improvements of the last decades, high-frequency data with intra-daily observations can be used to estimate covariance of assets. From these estimates and assumed marginal distribution, realized copula models are constructed and analyzed using real price data. Abstract Based on high-frequency data, three different estimation methods are applied and in addition daily stock return are used to get Maximum Likelihood estimates. All estimators are implemented and the resulting copula models are compared according to their ability to describe the true multivariate distribution and forecast the losses. Abstract The modeled dependence parameter are time-varying and differ according to the estimated covariance matrix and to the sampling frequency. Moreover, all estimation steps are done based on data with high sampling frequencies like seconds and lower frequency of 5 minutes. The realized kernel estimator is used to cope with market microstructure effects and the sensitivity to this noise can be reflected in the Value-at-Risk performance

Self-care strategies for medical students: an uncontrolled mixed-methods evaluation of a mind-body-medicine group course

Abstract Background High stress during medical education and its detrimental effects on student health is well documented. This exploratory evaluation study assesses a 10-week Mind-Body-Medicine student course, created to promote student self-care at Charité Universitätsmedizin Berlin, Germany. Methods During 2012–2019, uncontrolled quantitative and qualitative data were gathered from 112 student participants. Outcomes including changes in perceived stress (PSS), mindfulness (FMI/MAAS), self-reflection (GRAS), self-efficacy (GSE), empathy (SPF), and health-related quality of life (SF-12) were measured between the first (T0) and last sessions (T1). Qualitative data were obtained in focus groups at course completion and triangulated with quantitative data. Results Quantitative outcomes showed decreases in perceived stress and increased self-efficacy, mindfulness, self-reflection, and empathy. In focus groups, students reported greater abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. Triangulation grounded these effects of MBM practice in its social context, creating an interdependent dynamic between experiences of self and others. Conclusion After completing an MBM course, students reported reduced perceived stress, increased self-efficacy, mindfulness, empathy and positive engagement with integrative concepts of doctor–patient relationships. Further research with larger randomized confirmatory studies is needed to validate these benefits