A physiotherapy-directed occupational health programme for Austrian school teachers: a cluster randomised pilot study.

BACKGROUND: Although physiotherapists have long advocated workplace health, school teachers have not traditionally been a focus of study by these professionals. However, classroom teaching contributes to a range of occupational health issues related to general health as well as ergonomics that can be prevented or addressed by physiotherapists. OBJECTIVES: To undertake a pilot study to explore the potential effects of a physiotherapy-directed occupational health programme individualised for school teachers, develop study methodology and gather preliminary data to establish a 'proof of concept' to inform future studies. DESIGN: Cluster randomised pilot study using a convenience sample. SETTING: Eight Austrian regional secondary schools. PARTICIPANTS: Schools and their teachers were recruited and allocated to an intervention group (IG, n=26 teachers) or a control group (CG, n=43 teachers). Teachers were eligible to participate if they reported no health issues that compromised their classroom responsibilities. INTERVENTIONS: The IG participated in an individualised physiotherapy-directed occupational health programme (six 30-minute sessions) related to ergonomics and stress management conducted over a 5-month semester. The CG had a pseudo-intervention of one oral education session. MAIN OUTCOME MEASURES: Primary outcomes included scores from the physical and mental components and health transition item of the Short-Form-36 Health Survey questionnaire (SF-36), and emotional well-being and resistance to stress items from the work-related behaviour and experience patterns questionnaire. Data were collected before and after one semester. RESULTS: The primary outcome measure, the SF-36 physical component score, showed a reduction in the CG and no change in the IG, meaning that the CG deteriorated over the study semester while the IG did not show any change. CONCLUSIONS: A physiotherapy-directed occupational health programme may prevent deterioration of physical health of school teachers in one semester (proof of concept). This pilot study provided valuable information to inform the design of replication and extension studies related to this work.

Patterns of social distance towards people suffering from schizophrenia in Austria: a comparison between the general public, relatives and mental health staff.

OBJECTIVE: The aims of this study were to identify the different aspects of the attitudes towards people suffering from schizophrenia and to find factors influencing these attitudes -- especially the willingness to contact people suffering from schizophrenia -- as well as to obtain information on how to reduce stigma and discrimination. METHOD: We conducted a study to investigate these attitudes in Austria. A representative sample of the general public, different professional groups working in the field and relatives of mentally ill people were interviewed. The public, relatives and people working in the mental health field were asked a number of the same questions, to allow for comparisons between groups. RESULTS: We found great differences in key dimensions of the attitude towards people suffering from schizophrenia between groups: these included different causal attributions to schizophrenia, different attitudes concerning the perceived success of the treatment of schizophrenia, different fears concerning perceived dangerousness and a different willingness to interact voluntarily with schizophrenia patients. CONCLUSION: The factors influencing the distance towards people suffering from schizophrenia differ between groups. Our findings should help to optimize campaigns fighting against stigma and discrimination.

[Schizophrenia--an illness and its treatment reflected in public attitude]. / Schizophrenie--eine Erkrankung und ihre Behandlung im Bild der Offentlichkeit.

Stigmatization with regard to mental illness and especially schizophrenia has been known from time immemorial. Meanwhile the negative attitudes have become metaphorical for unpredictability, violence, and bizarrely (grotesquely) contradictory behaviour. Persons concerned with these prejudices are excluded from the society and there is little willingness for contact. Particularly afflicted are also the relatives of schizophrenic persons. Media and motion pictures play an essential role in the maintenance of these negative attitudes. There will be suggestions (stimuli), especially by opinion leaders, to reach a change of the attitudes towards diseases and their methods of treatment.

Attitudes towards suicide among medical students: comparison between Madras (India) and Vienna (Austria).

Attitudes towards suicide among medical students in Madras (India) and Vienna (Austria) were compared using the SUIATT questionnaire by Diekstra and Kerkhof (1989). Results show a very restrictive attitude in Madras, rejecting the right to commit suicide, nearly always judging suicide as a cowardly act, and rejecting the idea of assisted suicide. On the other hand, in Vienna a more permissive attitude was found. It is interpreted that the Indian pattern comes close to a "medical" or "disease model", with stronger emphasis on mental illness, impulsiveness and emotional aspects, whereas the Viennese pattern reflects a "theoretical", "rational model", concentrating on cognitive factors and minimizing the influence of mental illness, emotional difficulties and restrictions related to suicidal behaviour. This pattern may be influenced by the public discussion on assisted suicide and the right to die in Europe in the last decade. Possible relations to the risk for actual suicidal behaviour are discussed using respective answers concerning previous suicidal ideation and suicide attempts. The answers concerning suicidal ideation seem to be strongly influenced by the different attitude patterns: only 16.8% reported previous suicidal ideation in Madras, compared to 51.5% in Vienna, whereas the percentage of reported suicide attempts is equal in both centres (5.9%:4.9%).

Efficacy and safety of moclobemide compared with imipramine in the treatment of major depressive disorder. Double-blind multicenter study, Austria.

In a double-blind, 4-week, prospective, randomized multicenter (17 centers) study we checked on the efficacy, tolerability and safety of moclobemide (300-600 mg/d) compared to imipramine (100-200 mg/d) in parallel groups of patients with a Major Depressive Episode (DSM III). The mean % reduction of the HAMD at the end of treatment was 51.7 in the moclobemide group and 52.1 in the imipramine group. The percentage of patients in whom efficacy was globally judged as "good" or "very good" was 62% in the moclobemide group and 60% in the imipramine group. There was no statistically significant difference in the efficacy in both groups but in some factors there was a trend for a better amelioration favoring moclobemide. The final overall physician's judgement of tolerability was "good" or "very good" in 83% of moclobemide patients and in 74% of imipramine patients. Adverse events were reported or observed in 56% of moclobemide patients and in 69% of imipramine patients. The number of mild, moderate and severe adverse events was higher in the imipramine group with a total of 286 versus 189. There was a statistically high significant difference considering the tolerability favoring moclobemide again. In this project the basic goal to find a substance with at least the same efficacy but a much better tolerability for sure got fulfilled.

Rolipram in major depressive disorder: results of a double-blind comparative study with imipramine.

Rolipram improves signal transmission in central noradrenergic neurones at a pre- and postsynaptic level, and is thus a novel approach in antidepressant therapy. In order to prove efficacy, tolerance, and safety, several controlled studies are underway. Results of a randomized double-blind comparative trial versus imipramine involving 64 in-patients with Major Depressive Disorder (DSM III) in six independent centers will be presented and discussed. The chosen biometric model provided evidence that towards the end of the study imipramine was superior to Rolipram. The particular clinical relevance of this difference is discussed. As regards tolerance, nausea emerged as the typical side-effect of Rolipram, whereas imipramine precipitated mainly anticholinergic side-effects.

[Late rehabilitation of psychiatric patients]. / Spätrehabilitation psychiatrischer Patienten.

The results of a catamnestic study concerning patients of a psychiatric rehabilitation unit are reported. The patients were either longterm inpatients (mean duration of stay 8.5 years) or those, who had been transferred from the acute unit for lack of therapeutic progress and thus were probable to become longterm patients. Half the patients of the first and two third of the patients of the second group could be dismissed, living alone, with their families or in home accommodations. In a very few cases occupational rehabilitation could be achieved. Predictors of good outcome were higher age of the patient at first admission to a psychiatric hospital, longer duration of occupational practise, preserved contact to the family and pecuniary security warranted by a disablement pension. Further improvements of in- and outpatient psychiatric care are discussed.

[Organic psychosyndrome with and without lithium therapy]. / Untersuchung zum Organischen Psychosyndrom mit und ohne Lithiumtherapie.

After two years of treatment with Lithium-salts we did not find organic brain syndrome. Lithium treated patients have improved in thinking, concentration, the short-time memory, attention and conception. Control group did not have this improvement. Lithium-treated patients seemed to have more self-confidence, more flexibility and are able to master problems in a better way. Control group patients were more dependent on their moods and therefore did not improve in efficiency.

[Epidemiology of suicide in Upper Austria]. / Zur Epidemiologie des Selbstmordes in Oberösterreich.

In the years 1977-1980 1242 people committed suicide in Upper Austria. This affects 3 times more men than women. Distribution of age shows a slightly increasing tendency at higher age. More than 50% of the cases are committing suicide by hanging or strangulation. There are no clear seasonal assignments to be seen, though in February and August there are definitely less suicide cases than at other times, and in spring a slight increase can be stated. Of the 1242 patients 259 had already once been in stationary care of a psychiatric hospital. The majority of this group had left hospital more than one year before. Only with 7.7% suicide was committed within one week after leaving hospital. The distribution of diagnoses of previously hospitalized suicide patients shows a majority of neuroses and abnormal personalities, whereas endogenous psychoses have been diagnosed in about one third of the patients. It may be assumed that psychosis alone cannot be regarded as cause for committing suicide. An evaluation of suicidal tendency should principally be carried through at dismissal.

[Long-term treatment and rehabilitation of schizophrenic patients]. / Langzeitbehandlung und Rehabilitation schizophrener Patienten.

In summary it can be said that a treatment plan of a phase specific combination of psychopharmacological and psychotherapeutic measures in the multidisciplinary context of psychiatric rehabilitation yields considerable success in the reintegration of schizophrenic patients into society. To achieve this, an individually tapered rehabilitation program together with psychopharmacologic long-term therapy within an integrated psychiatric model is necessary.

[The psychiatrist's basic attitude in the treatment of acute psychoses]. / Die Grundhaltung des Psychiaters bei der Akutbehandlung von Psychosen.

The basic attitude of the psychiatrist is important from the onset of psychosis and during acute treatment for the course of illness and rehabilitation of the patient. One has to know systemic processes in human systems and its underlying rules. The system in which the patient is part of is confronted with the system of helpers. The meaning of this system for the course of psychosis and the efforts of helpers is to be explored, recognized and has to be ordered with clear rules and competences.

[Homes for psychiatric patients]. / Wohnheime für psychiatrische Patienten.

Home accommodation for psychiatric patients has to be adjusted to the needs of patients. We refer about the situation in Upper Austria, where we have short-term and long-term boarding houses as well as homes for old psychiatric patients. There are 140 patients living in such houses. We discuss the criterias of place of the home, working conditions, matters of team-work and choice of patients.

[Organization of outpatient crisis intervention ]. / Organisation ambulanter Krisenintervention.

The organization of outpatient crisis intervention is organized differently in various countries. Important is the speedy accessibility, the multidisciplinary cooperation for coverage of the total social environment and teams as mobile as possible. The team-members have to be specially trained and knowledgeable about the course of the crisis. All possibilities of psycho-social treatment have to be made use of. Besides the professional help, laywork and self-help groups should be available. The Crisis-Intervention Center in Linz and its work are presented in detail.