Investigating non-inferiority of internet-delivered versus face-to-face cognitive behavioural therapy for insomnia (CBT-I): a randomised controlled trial (iSleep well).

BACKGROUND: Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined. METHODS: This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment). DISCUSSION: The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I. TRIAL REGISTRATION: Trial registration number in the German Clinical Trials Register: DRKS00028153 ( https://drks.de/search/de/trial/DRKS00028153 ). Registered on 16th May 2023.

Patients' experiences in a guided Internet- and App-based stress intervention for college students: A qualitative study.

INTRODUCTION: Academic education is often associated with increased stress and adverse effects on mental health. Internet-based interventions have shown to be effective in reducing stress-related symptoms. However, college students as target group so far have not been reached appropriately with psychological interventions and little is known about college students' perception of Internet-based stress management interventions. The objective of this study was to explore the experiences of students participating in an Internet- and App-based stress management intervention originally developed for stressed employees and subsequently adapted and tailored to college students. METHOD: Semi-structured interviews were conducted with ten participants selected from a randomized controlled trial that evaluated the effectiveness of an Internet- and App-based stress training. The selection of participants aimed to include students with different levels of treatment success. In order to enable an in-depth examination of intervention elements causing dissatisfaction, the interviews were systematically adapted regarding participants' statements in a precedent questionnaire. The interview material was analyzed based on the grounded theory method and thematic analysis. RESULTS: Results suggest students perceive a necessity to adapt Internet-based interventions to their particular needs. Students' statements indicate that a scientific perspective on the intervention and instable life circumstances could be student-specific factors affecting treatment experience. General themes emerging from the data were attitudes towards individualization and authenticity as well as demands towards different functions of feedback. DISCUSSION: Participants' experiences hint at certain intellectual and lifestyle-related characteristics of this population. Future studies should explore whether adaptions to these characteristics lead to a higher acceptance, adherence and effectiveness in the target population.

[Internet-based resilience training and prevention of mental disorders]. / Internetbasierte Resilienzförderung und Prävention psychischer Erkrankungen.

BACKGROUND: Resilience is associated with a positive and resource-oriented perspective. Therefore, it seems especially attractive for health promotion and prevention. In recent years, interventions to foster resilience have been increasingly developed, which train resilience factors and are mainly conducted in a face to face group format. OBJECTIVE: The question is raised what potential internet-based interventions (i-interventions) that train resilience factors have for health promotion and prevention. MATERIAL AND METHODS: Based on a narrative overview, the possibilities for i­interventions that train resilience factors for health promotion and prevention are investigated and the state of research is described. RESULTS: The effects of the i­interventions presented here, which aim at fostering resilience, on measures of mental health and well-being are heterogeneous and vary between low to high effects. Stronger evidence for the efficacy of these measures exists for more general i­interventions that also train resilience factors but are conceptualized for the prevention of specific disorders, such as depression or for stress reduction. DISCUSSION: Given the heterogeneous nature of intervention contents, theoretical foundations and therapeutic methods used, the heterogeneity of the evidence is discussed. In addition, perspectives for the further development of resource-oriented resilience interventions are outlined.

The 6-month effectiveness of Internet-based guided self-help for depression in adults with Type 1 and 2 diabetes mellitus.

AIM: The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes. METHODS: Participants (n = 260) with Type 1 or 2 diabetes and elevated depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) ≥ 23] were randomly assigned to a guided Internet-based self-help intervention or a control condition (treatment as usual + online psychoeducation about depression). The primary outcome was a change in depressive symptom severity (CES-D) from baseline to 6-month follow-up. The secondary outcomes included numbers of people achieving treatment response (reliable change of depressive symptoms) and remission (CES-D ≤ 16), as well as the effects on glycaemic control, diabetes-related emotional distress and diabetes acceptance. Repeated measures analysis of variance examined between-group differences using intent-to-treat principles. RESULTS: Both conditions showed improvements in depression severity: intervention condition, d = 1.48 [95% confidence interval (95% CI): 1.21 to 1.76]; control condition d = 0.55 (95% CI: 0.30 to 0.80). Changes were significantly greater in the intervention condition with a large between-group effect size (d = 0.83, 95% CI: 0.57 to 1.08). Accordingly, effects on response [relative risk (RR) = 2.60 (95% CI: 2.01 to 3.36), P < 0.001] and remission [RR = 3.36 (95% CI: 2.98 to 5.44), P < 0.001] were in favour of the intervention group, as were differences in change in diabetes emotional distress (d = 0.50, 95% CI: 0.04 to 0.54), and physical and mental functioning [Short Form Health Survey (SF-12) Physical d = 0.27 (95% CI: 0.01 to 0.51) and SF-12 Mental d = 0.68 (95% CI: 0.11 to 0.40)]. The intervention group was not superior with regard to glycaemic control, diabetes self-management and diabetes acceptance. CONCLUSIONS: The trial indicates that Internet-based guided self-help treatments for depression in people with diabetes can have sustained effects on depressive symptoms, well-being and emotional distress associated with diabetes.

Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials.

BACKGROUND: Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach. METHOD: Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data. RESULTS: A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration. CONCLUSIONS: Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.

A generalized Kerker condition for highly directive nanoantennas.

A nanoantenna with balanced electric and magnetic dipole moments, known as the first Kerker condition, exhibits a directive radiation pattern with zero backscattering. In principle, a nanoantenna can provide even better directionality if higher order moments are properly balanced. Here, we study a generalized Kerker condition in the example of a nanoring nanoantenna supporting electric dipole and electric quadrupole moments. Nanoring antennas are well suited since both multipole moments can be almost independently tuned to meet the generalized Kerker condition.

Increasing the acceptance of internet-based mental health interventions in primary care patients with depressive symptoms. A randomized controlled trial.

BACKGROUND: Internet-based interventions (IBI) are effective in treating depression. However, uptake rates in routine care are still limited. Hence, this study aimed to (1) assess the acceptance of IBIs in primary care patients with depressive symptoms and to (2) examine the effects of a brief acceptance facilitating intervention in the form of an informational video on patients' acceptance of IBIs. METHODS: Primary care patients (N=128) with Minor or Major Depression were randomly assigned to an intervention (IG) or control group (CG). Patients in the IG were shown a brief informational video about IBIs before receiving a questionnaire that assessed their acceptance of IBIs and other secondary outcomes. Patients of the CG filled out the questionnaire immediately. RESULTS: Baseline acceptance of IBIs in the CG was high for 6.3%, moderate for 53.1% and low for 40.6% of patients. Acceptance of IBIs was significantly higher in the IG when compared to the CG (d=.71, 95%-CI:.09-2.91). Except for social influence and the general attitude towards psychological treatment, all secondary outcomes were also significantly improved (e.g. effort- (d=.40) and performance-expectancy: d=.65; knowledge about Internet interventions d=.35). LIMITATIONS: Depression of the participants was only assessed using a self-report measure (PHQ-9). CONCLUSION: Primary care patients' acceptance of IBIs for depressive symptoms was low but could be increased significantly using a brief acceptance facilitating intervention on the basis of an informational video. Future studies should further examine the potential of acceptance facilitating interventions for patients and health care providers to exploit the public health impact of IBIs.

[Burnout phenomenon exemplified by the teaching profession: paradigms, findings and perspectives of profession-related therapy and prevention approaches]. / Das Burnout-Phänomen am Beispiel des Lehrerberufs : Paradigmen, Befunde und Perspektiven berufsbezogener Therapie- und Präventionsansätze.

In the public view as well as amongst teachers burnout was commonly regarded as an innate problem of this particular profession. Based on a critical evaluation of the phenomenon of burnout current concepts of mental health in teachers are presented. On the one hand they encompass job-related profiles of coping in schoolteachers. Other concepts focus on vocational competence of stress management or organizational factors, their perception and individual appraisal (e.g. effort-reward imbalance). Beyond that the role of functional recovery is illustrated. These concepts relate to elevated levels of occupational stress and increased risk of mental disorders. The current state of research is limited by the lack of longitudinal studies; however, practical job-specific approaches in the prevention and treatment of mentally stressed teachers can be deduced.

[Internet based cognitive behavioral interventions: state of the art and implementation possibilities in rehabilitation]. / Internetbasierte kognitiv-behaviorale Behandlungs-ansätze: State of the Art und Einsatzmöglichkeiten in der Rehabilitation.

Internet-based health interventions (IHIs) provide a way to treat people via the Internet. The spectrum is wide, comprising interventions for mental disorders and somatic diseases as well as health and risk behavior change interventions. Numerous international studies have demonstrated the efficacy of IHIs for the aforementioned areas. Through the resource-saving applications IHIs are cost-efficient, not least suggesting their usefulness for medical rehabilitation. The present overview starts with a description of IHIs with a differentiation of technical-formal and thematic aspects. In doing so, the focus lies primarily on cognitive-behavioral treatment approaches, as the best scientifically investigated IHIs to date. An overview of the empirical evidence of IHIs is given, followed by a discussion of the implementation possibilities in medical rehabilitation.

Transmission enhanced optical lenses with self-organized antireflective subwavelength structures for the UV range.

We present transmission increased fused silica lenses produced by using self-organized antireflective structures for which we developed an efficient manufacturing process. The spectral transmission measured over the whole lens aperture shows a significant transmission enhancement of up to 3.5% in the UV range. Local measurements on the lens's surface reveal a strongly reduced reflection of below 0.1% for 300 nm wavelength, which is homogeneous over the whole lens. Further, the lenses show a broadband spectral antireflection behavior. For 600 nm wavelength the reflection was measured at about 1%.

Aripiprazole as an adjunct to clozapine therapy in adolescents with early-onset schizophrenia: a retrospective chart review.

INTRODUCTION: Combination of antipsychotic substances is a therapeutic option increasingly applied in patients with schizophrenia, who do not respond to antipsychotic monotherapy. Recently, various reports on combination of clozapine with aripiprazole in adults have been published. As there is not yet data on adolescent patients, we aimed to study the above-mentioned augmentation strategy in this population. METHODS: We included 15 patients with schizophrenia from a child and adolescent psychiatric department (8 male; mean age 19.3 [SD+/-1.2, range 17.2-21.2] years). Patients had been under clozapine treatment, followed by aripiprazole augmentation. Retrospectively, patients' medical records were reviewed, using a rating scale in analogy to the Clinical Global Impressions (CGI) scale. RESULTS: Mean observation time was 11.1 [SD+/-9.7] months. Mean CGI-Severity scores improved significantly (p=0.003, d=0.76) from 5.3 (baseline) to 4.5 (endpoint; last observation carried forward (LOCF)). CGI-Improvement scores decreased from 3.7 (after 1 month) to 3.3 (endpoint; LOCF) (p=0.212, d=0.45). CONCLUSIONS: In adolescents with schizophrenia, aripiprazole augmentation of clozapine treatment might be an effective therapeutic strategy. Prospective studies for this age group are required to obtain more specific clinical data on clinical effectiveness.

Prospective analysis of patient management in severe head injury.

Severe head injury with and without peripheral trauma is the most frequent cause of death and of severe disability up to 45 years. Outcome is determined by two major factors, the extent and nature of the irreversible primary brain damage, and the evolving secondary sequelae, which contrary to the former are responsive in principle to therapeutic intervention. An improvement of outcome from severe head injury can be expected only from an increased efficiency of the measures to prevent secondary brain damage. A research consortium "Neurotrauma" was formed by the University of Munich in collaboration with almost all city hospitals in Munich, Augsburg, Murnau, Ingolstadt, Vogtareuth and Southern Bavaria, providing care for neurotrauma patients. These hospitals together with the associated organizations carry out a system analysis on the management, logistics, organization, patient referral, etc. In severe head injury. Data acquisition is e.g. also concerned with outcome-relevant time periods of emergency care measures in the pre-clinical phase until hospital admission, conclusion of diagnostic procedure, and of the initial clinical care. Current results and experiences with establishment of this comprehensive research organization are presented, where no less than 31 hospitals. Institutions and organizations, and a study group of more than 40 physicians, students and statisticians are collaborating. Emerging data appear to be suitable to further improve pertinent aspects of the patient management as a basis to lower the incidence of secondary brain damage from severe head injury.

A possible beneficial effect of selenium administration in antiarrhythmic therapy.

OBJECTIVE: The following review of the literature on the importance of Selenium (Se) in myocardial homeostasis and of the pharmacology of this trace metal, represents an attempt to search, without prejudice to other possible explanations, for a rationale of a beneficial effect of Se substitution as an adjuvant to antiarrhythmic therapy. BACKGROUND: For several years, in the early 1980s, I had to deal with the problem of a serious ventricular arrhythmia (non-sustained and sustained ventricular tachycardia) which was remarkably resistant to a battery of the most potent antiarrhythmic agents. Eventually, dramatic improvement, lasting for a period of 8 years, was achieved with Flecainide, which, however, left unsolved the episodic occurrence of disabling ventricular bigemini. Over the most recent period of 1 year and 8 months, there was a sudden and unexplained return to unbroken normal sinus rhythm. Among the multiplicity of possible reasons for this fortunate development, the concurrent introduction of Se substitution appeared as the most obvious, though very tentative explanation. Substitution of this trace metal preceded the extinction of ventricular bigemini by 1 week and actually represented the sole modification of otherwise reasonably standardized conditions of antiarrhythmic therapy, life style and diet.

Measurement of Laser-Plasma Electron Density with a Soft X-ray Laser Deflectometer.

A soft x-ray laser (wavelength lambda = 15.5 nanometers) was used to create a moiré deflectogram of a high-density, laser-produced plasma. The use of deflectometry at this short wavelength permits measurement of the density spatial profile in a long-scalelength (3 millimeters), high-density plasma. A peak density of 3.2 x 10(21) per cubic centimeter was recorded.

Hemodynamic changes after an intensive short-term exercise and nutrition program in hypertensive and obese patients with and without coronary artery disease.

PURPOSE: To assess the effectiveness of the Pritikin diet and exercise program on cardiovascular hemodynamics using the noninvasive technique of Thoracic Electrical Bioimpedance (TEB). MATERIAL AND METHODS: Twenty subjects divided in two groups, according to their body habitus and hemodynamic disturbances. These data were compared to a group of 10 healthy individuals not involved in the program. Hemodynamic parameters were collected at admission and at the end of the intensive 26-day program of exercise and nutrition. RESULTS: In obese and hypertensive subjects not on medication we observed that cardiac index increased from 3.27 +/- 0.4 to 3.58 + 0.5 L/min/m2; mean arterial pressure decreased from 100 +/- 8.5 to 94.8 +/- 7.9 mmHg while systemic vascular resistance index decreased from 2362 +/- 391 to 1934 +/- 357 dynes. sec. cm-5/m2; p less than 0.05 (Data obtained in supine position). Also documented was a improvement in ventricular performance after postural changes from upright to supine based on indices of left ventricular performance, uniquely obtained by the TEB technique. From admission to discharge, changes were: Ejection fraction 48% to 53%; Peak flow index 295 to 316 ml/s/m2 and Index of contractility 40 to 47 s-1, explained by a shift on the ascending limb of the Starling curve. CONCLUSION: In a selected population, this rehabilitation program is effective for hemodynamic improvement that can be partially explained by metabolic and biochemical changes already reported from this Center.

Enhanced incidence of isoproterenol-induced ventricular fibrillation in the magnesium-deficient rat.

The electrocardiogram was recorded and serum and bulk myocardial electrolytes were determined in male Sprague Dawley rats, subjected to dietary magnesium deficiency for various periods, to assess the time course of development and cessation of the enhanced arrhythmogenic action of isoproterenol (150 micrograms/kg, subcutaneously) and to establish possible relationships between electrolyte changes and severe ventricular dysrhythmias. Ventricular fibrillation occurred within 60 min following isoproterenol injection in 25, 25, 62.5, 50, and 62.5% of rats on magnesium deficient diet for 4, 7, 11, 15, and 19 days (N = 8), respectively, and resulted in death in most animals (83%). Reintroduction of normal chow following a 30-day period on magnesium-deficient diet normalized serum magnesium (from 1.42 +/- 0.23 to 1.90 +/- 0.08 mEq/liter, mean +/- SD) but did not significantly reduce the incidence of ventricular fibrillation. Magnesium deficiency did not produce statistically significant alterations in bulk myocardial content of sodium, potassium, magnesium, and calcium. However, sodium was elevated and potassium diminished in hearts from rats that died in ventricular fibrillation, but not in those that had recovered. Magnesium-deficient rats sacrificed 30 min after isoproterenol injection, that is before the occurrence of ventricular fibrillation, exhibited hypomagnesemia and hypokalemia as well as elevated sodium and diminished potassium and magnesium in the myocardium. In contrast, rats on Purina Chow exhibited hypermagnesemia, but also showed hypokalemia and diminished cardiac potassium. The results indicate that magnesium deficiency enhances the arrhythmogenic propensity of isoproterenol and that the development of ventricular fibrillation is preceded by serum and myocardial electrolyte alterations.