Alcohol consumption and other psycho-social conditions as important factors in the development of diabetic foot ulcers.

AIMS: To characterize bio-psycho-social factors, particularly mental disorders and self-harm behaviour, associated with the development of diabetic foot ulcers. METHODS: Two groups of diabetic patients with and without foot ulcers (n=47 in each group) with similar sex, age and diabetes duration were assessed for mental disorders using the Composite International Diagnostic Interview. Self-harm behaviour, quality of life, depressive symptoms and self-compassion were rated using different standard questionnaires. RESULTS: Patients from the ulcer group visited their practitioners and/or psychotherapists less frequently in the last 12 months than patients in the control group 0 vs. 13%; P=0.026). The ulcer group patients had a history of increased alcohol consumption (43 vs. 19%; P=0.025), lower levels of education (8 vs. 10 grades; P=0.014) and income (1190 vs. 1535 €/month; P=0.039). Additionally, they were less likely to be diagnosed with anxiety disorders (11 vs. 32%; P=0.022). No significant differences in glycated haemoglobin, body mass index, smoking and direct self-harm behaviour were identified. CONCLUSIONS: Patients with foot ulcers tend to exhibit lower health-conscious behaviour, particularly higher lifetime alcohol consumption, lower utilization of medical services and less general anxiety. Practitioners should be aware of these behaviours, since early detection of diabetes patients at psycho-social risk and consecutive psychological intervention may be an effective preventive strategy in avoiding the development of foot ulcers.

[Evaluation of a multimodal pain therapy at the University Pain Centre Dresden]. / Evaluation einer multimodalen Schmerztherapie am UniversitätsSchmerzCentrum Dresden.

BACKGROUND: Data of a multimodal pain management program of the multidisciplinary pain management centre at the University Hospital of Dresden is presented. Over a period of 4 weeks, supplemented by an additional week 3 months later (booster week), patients with chronic pain of different origins are being treated in groups of 12. Based on the principles of the biopsychosocial pain model and the idea of functional restoration, the program is dedicated for pain patients where outpatient treatment was insufficient. METHODS: The program was evaluated on the basis of pain intensity (NRS), pain disability (PDI), fear and depression (HADS-D), catastrophizing (CSQ) and health-related quality of life and vitality (SF-36). The data were collected at the beginning and end of the initial 4 week treatment period, at the end of the booster period as well as 6 and 12 months after the end of active treatment. RESULTS: A total of 189 patients were included in the program in the period from January 2006 until August 2008. All outcome parameter showed statistically significant improvements with small to high effect sizes (ES 0.20-0.95). The results stayed stable even 1 year after the treatment. The highest effect sizes were found in catastrophizing (ES 0.86) and average pain intensity (ES 0.95). The primary pain diagnosis (e. g. low back pain versus headache) had no impact on treatment outcome. CONCLUSION: Significant and clinically relevant improvements could be achieved with the multimodal pain management program in groups of 12 patients. The results were stable over a time period of 1 year. Pain diagnosis had no impact on the outcome.

The social phobia psychotherapy research network. The first multicenter randomized controlled trial of psychotherapy for social phobia: rationale, methods and patient characteristics.

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and 6 and 12 months after the end of treatment. For quality assurance and treatment integrity, a specific project using highly elaborated measures has been established (project Q). Study A is complemented by 4 interrelated add-on projects focusing on attachment style (study B1), on cost-effectiveness (study B2), on variation in the serotonin transporter gene in SP (study C1) and on structural and functional deviations of the hippocampus and amygdala (study C2). Thus, the Social Phobia Psychotherapy Research Network program enables a highly interdisciplinary research into SP. The unique sample size achieved by the multicenter approach allows for studies of subgroups (e.g. comorbid disorders, isolated vs. generalized SP), of responders and nonresponders of each treatment approach, for generalization of results and for a sufficient power to detect differences between treatments. Psychological and biological parameters will be related to treatment outcome, and variables for differential treatment indication will be gained. Thus, the results provided by the network may have an important impact on the treatment of SP and on the development of treatment guidelines for SP.

[The Dachau multidisciplinary treatment program for chronic pain. Efficacy data of a diagnosis-independent multidisciplinary treatment program for back pain and other types of chronic pain]. / Die Multimodale Schmerztherapie Dachau (MSD). Daten zur Wirksamkeit eines diagnose-unabhängigen multimodalen Therapieprogramms bei Rückenschmerzen und anderen Schmerzen.

BACKGROUND: Data on the efficacy of the Dachau multidisciplinary treatment program for chronic pain is presented. The treatment is administered in a primary care day clinic and the treatment period is 5 weeks plus 5 booster days 6 months later. The program is characterized by high treatment intensity (122.5 h over 5 weeks) and is aimed at patients where outpatient pain therapy proved to be insufficient. The treatment plan is applicable to different types of chronic pain and the main treatment objective is functional restoration. METHODS: Outcome criteria were pain intensity, disability, vitality, depression, catastrophizing, and employment status. The data was assessed at the beginning of treatment, after 5 weeks and 6 months after therapy. The patient population consisted of 189 chronic pain patients. RESULTS: All outcome criteria showed a significant and stable improvement over 6 months. Effect sizes demonstrated medium and high treatment effects. The back to work rate was 63% at 6 months follow-up. DISCUSSION: The Dachau multidisciplinary treatment for chronic pain achieved significant improvements which remained stable for 6 months after treatment.

Stress, burnout and health in the clinical period of dental education.

The study examined the extent of stress, burnout and health problems experienced by fourth and fifth year dental students from the three universities of Dresden, Freiburg and Bern. The objectives of the study were to: (i) identify frequent sources of stress and to report the prevalence rates of burnout and health problems in dental students, (ii) determine the rate of students suffering from severe burnout symptoms and (iii) identify stress factors related to the burnout symptoms of emotional exhaustion and depersonalization. A total of 161 dental students from Dresden, Freiburg and Bern participated in the study. They completed the Psychosocial Stress Inventory, the Maslach Burnout Inventory and the Health Survey Questionnaire. Frequent sources of stress were limitation of leisure time, examination anxiety and the transition stress that was related to the adaptation to the demands of the clinical phase of dental education. Few differences existed between the students of the fourth and the fifth study year. Study-related stress was lowest in Bern and considerably higher in Dresden. Differences of mean levels of burnout symptoms were found only for the burnout dimension of emotional exhaustion. Students from Dresden and Freiburg were more emotionally exhausted than students from Bern, students from Dresden also reported more health problems than students from Bern or Freiburg. Ten per cent of the dental students suffered from severe emotional exhaustion, 17% complained about a severe lack of accomplishment and 28% reported severe depersonalization symptoms. Forty-four per cent of the variance of emotional exhaustion was explained by study-related factors such as lack of leisure time, examination anxiety and transition stress. The only predictor of depersonalization was a lack of social integration, accounting for 3% of the variance. A lack of social integration may be an indicator of low social competence which may cause difficulties in dealing with patients adequately and therefore result in depersonalization. The results indicate a need to identify the group of students who may have insufficient social skills for dealing adequately with the patients, and to train them accordingly.

[Coping of diseases in old age--partnership as a resource]. / Krankheitsbewältigung im Alter--die Partnerschaft als Ressource.

Somatic as well as mental health of the elderly are to a high extent determined by the quality of their marriage, the reciprocity of social support, and the available socio-economic resources. The coping behavior does not change very much in the course ofa person's life. If he or she has sufficient skills and resources, the elderly person will engage in problem-focused coping. If demands are appraised as outside of the person's control, secondary control strategies aiming at a reappraisal are more frequently applied. A crucial coping resource in old age is the availability of social support that is experienced as adequate and useful by the recipient. The spouse and members and close family members are the most important sources of social support for the elderly.

Tracking wakes: the nocturnal predatory strategy of piscivorous catfish.

Swimming fish leave wakes containing hydrodynamic and chemical traces. These traces mark their swim paths and could guide predators. We now show that nocturnal European catfish (Silurus glanis) locate a piscine prey (guppy, Poecilia reticulata) by accurately tracking its three-dimensional swim path before an attack in the absence of visible light. Wakes that were up to 10 s old were followed over distances up to 55 prey-body lengths in our setup. These results demonstrate that prey wakes remain sufficiently identifiable to guide predators, and to extend considerably the area in which prey is detectable. Moreover, wakes elicit rear attacks, which may be more difficult to detect by prey. Wake tracking may be a common strategy among aquatic predators.

[Phenomenology of ether administration. With a review of the literature]. / Zur Phänomenologie bei Etherapplikation. Mit einer Literaturübersicht.

A 45-year-old man was found dead lying on a sofa in his house. He had pulled a plastic bag over his head, the bag containing a pad of cotton-wool soaked with diethylether. Different aspects are discussed in this paper including a review of the literature: anamnesis, scene of death, utensils used for inhalation and autopsy findings. There are especially pointed out the results of chemical-toxicological analyses in many body compartments. Furthermore are interpreted the manners and the relations of the distribution of ether as well as possible effects on the consciousness. In consideration of other published cases, the analytical results concerning ether are discussed with regard to the presumed cause of death (e.g. asphyxia) and other potential competitive mechanisms.

[Elderly patients requiring help and nursing care: instrumental support by chief caregiver and professional helping services]. / Altere Menschen mit Hilfe- und Pflegebedarf: Instrumentelle Unterstützung durch Hauptpflegeperson und professionelle Hilfsdienste.

The study "Chances and Limits of Independent Living in Old Age" ("MUGSLA") interviewed 1092 frail people (60 years and older), as well as 406 of their primary caregivers. This paper examines the intensity of help provided, size and composition of task support networks, level of distress, and changes experienced by the primary caregiver as a result of taking care of the elderly. We also analyze which conditions support the inclusion of formal providers. The main results of the study are: the lower the functional status of the frail person the more likely they are taken care of by a primary caregiver. Assistance for the elderly is mainly provided by family members. Professional providers are part of the support system when the degree of need of care is extremely high and/or the primary caregiver reported extremely high levels of burden. We found that lack of information about services only partly explains the low rate of service utilization. Their role as caregiver affects virtually all areas of life.

[Ophthalmologic spectrum of neurofibromatosis type 2 in childhood]. / Ophthalmologisches Spektrum der Neurofibromatose Typ 2 im Kindesalter.

BACKGROUND: Neurofibromatosis type 2 (NF2) is a disorder with autosomal dominant inheritance which leads to tumor growth in the central and peripheral nervous system. In affected adult patients there is a typical association with ocular abnormalities like juvenile cataract. METHODS: Ophthalmologic investigation was carried out in ten children aged one to fourteen years with suspected NF2. The diagnosis was confirmed by further clinical examination and-in one patient-by segregation analysis. RESULTS: Nine of these ten children showed ocular abnormalities such as juvenile subcapsular cataracts, retinal hamartomas, optic nerve sheath tumors, fibrotic maculopathies as well as one case of a perineural calcification of the optic nerve and one case of a cerebral hamartoma on the ground of the third ventricle. DISCUSSION: In six children ophthalmological symptoms were the presenting symptom of the disease. The knowledge of these symptoms allows for the diagnosis of NF2 in children who present with isolated ocular deficits or with other typical criteria of the disease. The early diagnosis of the disease may lead to an improved prognosis with regard to preservation of hearing by surgery of bilateral vestibular schwannoma which occur in more than 90% of the NF2-patients.

[Pain, independence and subjective attitude to aging--an empirical contribution from the study "Possibilities and limits of independent living by the elderly"]. / Schmerz, Selbständigkeit und subjektives Alterserleben--Ein empirischer Beitrag aus der Studie "Möglichkeiten und Grenzen selbständiger Lebensführung im Alter".

In a study on chances and limits of independent life in old age, we collected data about sensations of pain in 990 participants. Information about intensity and frequency of pain sensations was combined to differentiate empirically between five patterns of pain sensations. According to severity, these patterns can be ordered hierarchically. 873 persons could be grouped into the five patterns of pain sensations. There was no relationship between chronological age and patterns of pain sensations. The relationship between patterns of pain sensations and degree of independence in everyday life was only weak. Comparing the five patterns of pain sensations in seven psychological variables, we found only few statistically significant differences, mainly between people who had no pain and those who suffered from strong or very strong pain most of the time or permanently. In KLC-measures of external and internal control beliefs related to health and body, in PGC-dimensions attitude towards age, lonely dissatisfaction and agitation as well as in PGC-score for life satisfaction, we found only few and weak differences between patterns of pain sensations. Stepwise multiple regression analysis with the independent variables degree of independence in everyday life, pattern of pain sensations and chronological age could explain 1.4% to 6.7% of variance in those psychological variables. In contrast, patterns of pain sensations greatly differed in NAF-measures of subjective aging. A stepwise multiple regression with the independent variables degree of independence in everyday life and pattern of pain sensations could explain 24.6% of variance. Degree of independence in everyday life alone could explain 17.9% of variance. We hypothesize that effects in most psychological variables are weak, because what people mean by a "good" or personally satisfying life is only partly influenced by their health status.

[Vascular etiopathogenesis and degenerative dementias--current state of knowledge]. / Atiopathogenese vaskulärer und degenerativer Demenzen--aktueller Kenntnisstand.

Dementia due to vascular and degenerative abnormalities has become more frequent with increasing life expectancy. Although the origin of both dementia types is still unknown, pathobiochemical perturbations comprising energy loss, lactic acidosis, calcium homeostasis and free radical formation have been found in both dementia types in incipient stages at the neuronal level. A therapeutic rational against these abnormalities is discussed.

[Chloroquine as a poison in murder. Report of fatalities after criminal or suicidal chloroquine administration]. / Chloroquin als Mordgift. Mitteilung über Todesfälle nach krimineller und suizidaler Chloroquinbeibringung.

Presented is a case of murder by means of chloroquine, committed on a 36-year-old male. The wife of the deceased had confessed to have secretely administered chloroquine-containing tablets to her husband. She was lawfully sentenced to life-imprisonment. The toxicological findings of this case are compared to the results of two chloroquine suicide cases and discussed in the context of the referring literature. An additional case where chloroquine intoxication was doubtful is introduced because of the unusual circumstances under which it occurred.

[A new method for the determination of carboxyhemoglobin in fluid and dried blood using Fourier transformation infrared spectrometry]. / Eine neue Methode zur Carboxyhämoglobinbestimmung in flüssigem und getrocknetem Blut mittels Fourier-Transform-Infrarot-Spektrometrie (FTIR).

A new technique is presented for the fast quantitative determination of carboxy-hemoglobin (CoHb) in liquid blood with the aid of Fourier transformation infrared spectrometry. The bands at v = 1953 and 1969 (cm-1), which are characteristic for the CoHb complex, were measured without the blood being prepared. In liquid samples the band at 1953 cm-1 is prominent; in dry samples, however, it appears. In moist samples both bands--each to be coordinated with a different CoHb conformer--are observed at about the same intensity. Even with dried blood spots of less than 0.1 mg, quantitative determination of CoHb at v = 1969 (cm-1) is possible. Systematic investigations of the thermic stability of the CoHb complex were performed. The typical interference phenomena associated with UV spectrometry were not observed when the above-described method was employed nor are they to be expected. Even under extreme measuring conditions, as for example when measuring transmission through lab-coat material, different CoHb contents could be determined in traces of dried blood.

[The reaction of lung mast cells to acute barbiturate and bromureide poisoning (author's transl)]. / Das Verhalten der Lungen-Mastzellen bei der akuten Vergiftung mit Barbituraten und Bromureiden.

Guinea pigs were poisoned by large oral doses of hypnotics in order to study the effect of bromureides on the mast cell contents of the lungs in comparison to the influence of barbiturate intoxication. The dose of the hypnotics chosen was thus, that all animals died within the first three hours after the beginning of feeding. Then the degranulation of mast cells with decrease of the mast cell number in the lung tissue was merely small in the barbiturate poisoned animals, but very extensive in the animals intoxicated by bromureides. The difference is highly significant. The possible influence of this effect upon the different clinical course of both kinds of intoxication is discussed.