314 research outputs found

    Eigenverantwortlich, informiert und anspruchsvoll ... Der Diskurs um den mündigen Patienten aus ärztlicher Sicht

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    "Der mündige Patient ist populär. Verschiedenste gesundheitspolitische Akteure verwenden diesen Begriff überraschend einhellig. Auffällig ist, dass dem mündigen Patienten ein breites Spektrum an Aufgaben und Eigenschaften zugewiesen wird, z.B. mehr Partizipation, mehr finanzielle Verantwortung oder mehr Compliance. Es ist zu vermuten, dass der mündige Patient als strategischer Begriff dient, hinter dem inhaltlich heterogene Konzepte stehen. Die Studie fokussiert auf die ärztliche Perspektive: Wie wird der mündige Patient von der Ärzteschaft bewertet? Welche Eigenschaften und Aufgaben werden ihm zugesprochen? Welche Interessen und Ziele werden verfolgt? Die empirische Grundlage bilden Artikel aus dem 'Deutschen Ärzteblatt', zentralem Publikationsorgan von Bundesärztekammer und Kassenärztlicher Bundesvereinigung. Mit einer systematischen Literaturrecherche wurden im Zeitraum 1996-2005 insgesamt 73 Artikel einbezogen, die den mündigen Patienten thematisieren. Die Textanalyse erfolgte mit Methoden qualitativer Sozialforschung, die Untersuchungsperspektive orientierte sich an der Diskursanalyse nach Keller, 2004. Die gefundenen Einschätzungen des mündigen Patienten sind heterogen. In den vier abgrenzbaren Diskurssträngen 'Recht und Ethik', 'Wissen und Information', 'Strukturprobleme' und 'Finanzierungsfragen' finden sich jeweils charakteristische Positionierungen: Idealbildern von aktiven und eigenverantwortlichen PatientInnen, die mit ihren ÄrztInnen kooperieren, stehen bedrohlichere Szenarien gegenüber, in denen per Internet informierte, anspruchsvolle PatientInnen ihre ÄrztInnen fachlich infrage stellen. Wesentliche Gemeinsamkeit der gefundenen Positionierungen ist es, dass sie das individuelle Handeln von PatientInnen in den Mittelpunkt stellen und es in eine gewünschte Richtung verstärken oder schwächen, fördern oder modifizieren wollen. Damit fügt sich der Diskurs um den mündigen Patienten in übergeordnete gesellschaftliche Modernisierungsprozesse ein, die neue Entfaltungsmöglichkeiten, aber auch neue Formen der Einbindung und Zwänge zur selbstverantwortlichen Lebensgestaltung mit sich bringen." (Autorenreferat)"In German health policy debates the idea of the modern patient (mündiger Patient) has been receiving increasing attention. Various actors refer to this keyword, which is surprising, since policy debates in recent decades have tended to be controversial. It seems striking that the modern patient is linked with a broad spectrum of characteristics (e.g. more participation, more financial responsibility, more self determination or more compliance). This confluence suggests that the idea of the modern patient may be a strategic concept that can serve heterogeneous goals. This study focuses on physicians' perspectives and examines how the German professional medical community employs the idea of the modern patient: How is the image of the modern patient being used by physicians? Which specific descriptions, attributes, characteristics are used? Which interests and goals can be found? The weekly journal 'Deutsches Ärzteblatt', the opinion-leading publication of the German medical community, was systematically searched for articles addressing the topic of the modern patient over a period of ten years (1996-2005). A total of 73 articles were analyzed with qualitative research methods and a perspective of discourse analysis (Keller, 2004) Physicians' perspectives on patients' attributes are heterogeneous. Four definable discourses ('Law and Ethics', 'Knowledge and Information', 'Structural Health Care problems' and 'Funding issues') are each positioning the modern patient in characteristic ways: Visions of well-informed patients who cooperate actively as partners of their physicians are confronted with more threatening scenarios of self-confident and demanding patients who challenge their physicians and critically question their decisions. As a common element the different positions share their focus on patients' individual attributes and actions: they all aim to reinforce or weaken, support or modify patients' behaviour. This way the discourse on the modern patient fits into broader modernisation processes, accompanied by new opportunities for patients' empowerment, but at the same time by new forms of involvement and forces to accept selfresponsibility." (author's abstract

    relationships and interdependencies

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    Behavioral and personality characteristics are factors that may jointly regulate body weight. This study explored the relationship between body mass index (BMI) and self-reported behavioral and personality measures. These measures included eating behavior (based on the Three-Factor Eating Questionnaire; Stunkard and Messick, 1985), sensitivity to reward and punishment (based on the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales) (Carver and White, 1994) and self-reported impulsivity (based on the Barratt Impulsiveness Scale-11; Patton et al., 1995). We found an inverted U-shaped relationship between restrained eating and BMI. This relationship was moderated by the level of disinhibited eating. Independent of eating behavior, BIS and BAS responsiveness were associated with BMI in a gender-specific manner with negative relationships for men and positive relationships for women. Together, eating behavior and BIS/BAS responsiveness accounted for a substantial proportion of BMI variance (men: ∼25%, women: ∼32%). A direct relationship between self-reported impulsivity and BMI was not observed. In summary, our results demonstrate a system of linear and non-linear relationships between the investigated factors and BMI. Moreover, body weight status was not only associated with eating behavior (cognitive restraint and disinhibition), but also with personality factors not inherently related to an eating context (BIS/BAS). Importantly, these relationships differ between men and women

    The Cards and Lottery Task: Validation of a New Paradigm Assessing Decision Making Under Risk in Individuals With Severe Obesity

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    Background: A growing body of research demonstrated impaired executive functions in individuals with severe obesity, including increased sensitivity to reward and impulsive decision making under risk conditions. For the assessment of decision making in patients with severe obesity, studies widely used the Iowa Gambling Task (IGT) or the Delay Discounting Task (DDT), which cover short-term or long-term consequences of decisions only. A further development originating from the field of addiction research is the Cards and Lottery Task (CLT), in which each decision made has conflicting immediate and longterm consequences at the same time. The present study aimed to validate the CLT in individuals with severe obesity. Methods: Patients with severe obesity (N = 78, 67% women, 42.9 ± 10.4 years old, body mass index of 48.1 ± 8.3 kg/m2) were included. Convergent validity was evaluated using the computerized Delay Discounting Task and well-established self-report questionnaires assessing different aspects of impulsivity. For discriminant validity, CLT performance was compared between symptom groups characterized by high versus low impulsivity. The task’s clinical validity was evaluated based on associations with general and eating disorder psychopathology, and body mass index. Test-retest reliability was determined by administering the CLT in n = 31 participants without weight-loss treatment one year later. The task’s sensitivity to change due to weight loss was evaluated by retesting n = 32 patients one year after receiving obesity surgery. Results: The number of advantageous decisions in the CLT was significantly positively associated with delay discounting and effortful control, and significantly negatively correlated with behavioral impulsivity. CLT performance differed significantly between individuals with and without symptoms of attention-deficit/hyperactivity disorder and between samples with severe obesity and healthy controls. Clinically, CLT performance was significantly associated with general, but not eating disorder psychopathology. The CLT showed moderate test-retest reliability after one year in weight-stable individuals and was sensitive to change in those undergoing obesity surgery. Conclusions: This study identified the CLT to be a highly promising, new complex measure of short- and long-term decision making with good reliability and validity in individuals with severe obesity. Future studies should assess its association with the IGT and predictive value for real-life health behavior

    Changes in visual attention towards food cues after obesity surgery: An eye-tracking study

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    Research documented the effectiveness of obesity surgery (OS) for long-term weight loss and improvements in medical and psychosocial sequelae, and general cognitive functioning. However, there is only preliminary evidence for changes in attentional processing of food cues after OS. This study longitudinally investigated visual attention towards food cues from pre- to 1-year post-surgery. Using eye tracking (ET) and a Visual Search Task (VST), attentional processing of food versus non-food cues was assessed in n = 32 patients with OS and n = 31 matched controls without weight-loss treatment at baseline and 1-year follow-up. Associations with experimentally assessed impulsivity and eating disorder psychopathology and the predictive value of changes in visual attention towards food cues for weight loss and eating behaviors were determined. During ET, both groups showed significant gaze duration biases to non-food cues without differences and changes over time. No attentional biases over group and time were found by the VST. Correlations between attentional data and clinical variables were sparse and not robust over time. Changes in visual attention did not predict weight loss and eating disorder psychopathology after OS. The present study provides support for a top-down regulation of visual attention to non-food cues in individuals with severe obesity. No changes in attentional processing of food cues were detected 1-year post-surgery. Further studies are needed with comparable methodology and longer follow-ups to clarify the role of biased visual attention towards food cues for long-term weight outcomes and eating behaviors after OS

    Untersuchung der mentalen Repräsentation von Energiemanagement bei der Flugzeugführung zur Entwicklung eines Pilotenassistenzsystems

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    Um die mentale Repräsentation des Energiemanagements bei der manuellen Flugzeugführung zu untersuchen, wurde eine Simulatorkampagne mit n = 12 lizenzierten Verkehrspiloten durchgeführt. Ihre Aufgabe war es, künstlich generierte Höhen- und Geschwindigkeitsablagen auf dem Gleitpfad des Instrumentenlandesystems (ILS) im Endanflug zu korrigieren. Dabei wurde untersucht, ob und inwiefern sie von dem Prinzip des Energieaustauschs Gebrauch machen. Die Ergebnisse zeigen eine wenig einheitlich ausgeprägte Repräsentation des Wissens bezüglich des Energiemanagements. Des Weiteren war zu erkennen, dass nicht die vollen Möglichkeiten des Energieaustausches genutzt wurden. Vielmehr wurden damit lediglich kleine Korrekturen durchgeführt

    For example : martyrdom and imitation in early Christian texts and art

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    This volume explores the phenomenon of Christian martyrdom and ideas of “following Christ,” in particular focusing on theological and pragmatic difficulties in the early Christian period. How can martyrs successfully follow Christ without themselves entering into a competition with Christ? What happens when the idea of following Christ so faithfully as to experience martyrdom becomes impossible because of the fundamentally different living situation of the faithful? How are model and imitation shaped in comparison to pagan exempla? Contributions from archaeology, classical philology, ancient history, theology, and art history suggest some answers to these questions, drawing equally on ancient literature and material culture

    Организация пожарной безопасности мест хранения техники в ремонтных подразделениях вооруженных сил Российской Федерации

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    Проблему организацию противопожарной защиты мест обслуживания и ремонта ВВТ в войсковых частях необходимо решать комплексно, обращая внимание на реализацию противопожарных требований согласно строительных норм и правил пожарной безопасности, а также на организацию тушения пожара в случае его возникновения.The problem of organization of fire protection of the military service and maintenance sites in military units must be addressed in a comprehensive manner, paying attention to the implementation of fire safety requirements in accordance with building codes and fire safety rules, and also on the organization of fire extinguishing in the event of its occurrence

    Strong coupling in fully tunable microcavities filled with biologically-produced fluorescent proteins

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    We thank C. Schneider for fruitful discussions and A. Clemens and K. Ostermann (TU Dresden, Germany) for technical support with protein preparation. We acknowledge financial support from the European Research Council (ERC StG ABLASE, 640012), the Scottish Funding Council (via SUPA), the European Union Marie Curie Career Integration Grant (PCIG12-GA-2012-334407) and the EPSRC Hybrid Polaritonics program grant (EP/M025330/1). M.S. acknowledges funding from the German Science Foundation (DFG) through a Research Fellowship (SCHU 3003/1-1) and from the European Commission for a Marie Sklodowska-Curie Individual Fellowship (659213). S.H. gratefully acknowledges support by the Royal Society and the Wolfson Foundation.Strong coupling between cavity photons and excited states of biologically produced recombinant fluorescent proteins in fully tunable optical microcavities is demonstrated. Natural thickness and concentration gradients in blends of two different proteins allow precise adjustment of the spectral position of polariton states and of the effective coupling strength, thus providing control of the photonic and excitonic components of the system.Publisher PDFPeer reviewe

    Pre- and postbariatric subtypes and their predictive value for health-related outcomes measured three years after surgery

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    Background: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and two years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes three years after surgery

    Immunomodulation by Interleukin-10 Therapy Decreases the Incidence of Relapse and Prolongs the Relapse-free Interval in Psoriasis

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    The ability of interleukin-10 therapy to reduce the severity of exacerbated psoriasis has been demonstrated recently. Considering the immunobiologic properties of this cytokine we investigated the effects of long-term interleukin-10 application on the immune system and duration of psoriasis remission. We performed a placebo-controlled, double-blind, phase II trial using interleukin-10 in patients with chronic plaque psoriasis in remission. Patients received subcutaneous injections with either interleukin-10 (10 µg per kg body weight; n = 7) or placebo (n = 10) three times per week until relapse or study termination after 4 months. The treatment was well tolerated. In the placebo group almost all patients (90%) showed a relapse during the observation period. In contrast to this, only two of seven patients (28.6%) relapsed in the interleukin-10-treated group. Kaplan–Meier analysis revealed a significantly lower relapse incidence in the interleukin-10 than in the placebo group (p = 0.02). The mean relapse-free interval time was 101.6 ± 12.6 d in the interleukin-10 group in comparison with 66.4 ± 10.4 d in the placebo group. Immunologic activity of interleukin-10 application was indicated by an increase in soluble interleukin-2 receptor plasma levels and higher ex vivo interleukin-4 secretion capacities. Remarkably, a significant negative correlation was demonstrated between the interleukin-4 secretion capacity and Psoriasis Area and Severity Index score (r = -0.36, p < 0.01). Our data suggest that interleukin-10 therapy is immunologic effective, decreases the incidence of relapse and prolongs the disease-free interval in psoriasis. Its value should be further determined in larger trials and for the prevention of re-exacerbation of other inflammatory disorders with a similar immunologic profile
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