Congruence and trajectories of device-measured and self-reported physical activity during therapy for early breast cancer.

PURPOSE: This study examines congruence between self-reported and device-measured physical activity data in women with early breast cancer and compares trajectories under different treatments. METHODS: Women with non-metastatic breast cancer were recruited before primary therapy. In four weeks distributed over six months after treatment start, patients reported time spent on work, transport, chores and sports via diary and wore Garmin® vivofit 3 accelerometers to assess steps taken. Associations between these measures and agreement regarding guideline adherence were tested with Spearman's Correlation Coefficient and Weighted Kappa statistic. Effects of time and treatment were evaluated using mixed analyses of variance. RESULTS: Ninety-nine participants (median age = 50) were treated with adjuvant (N = 23), neoadjuvant (N = 21) or without chemotherapy (N = 55). Coherence between self-report and device data was strong (r = 0.566). Agreement about reaching recommendations was only "fair" (kappa coefficient = 0.321 and 0.249, resp.). Neither treatment or week nor their interaction had effects on step counts (all p > 0.05). Self-reported activity time was lower for patients with chemotherapy than for those without (adjuvant: ∆ = 69min, p = 0.006, neoadjuvant: ∆ = 45min, p = 0.038) and lower in week 18 than in week 3 (∆ = 43min, p = 0.010). CONCLUSION: Results show that consumer-grade activity monitors and self-reports correlate but show different perspectives on physical activity in breast cancer patients. In general, patients perceive some decline regardless of primary treatment regimen. Those affected should be offered assistance to gain the benefits of activity. Accelerometers may help professionals to identify these individuals and patients to verify appraisal of their activity levels.

[Evidence-based psychotherapy of addictive disorders]. / Evidenzbasierte Psychotherapie bei Abhängigkeitserkrankungen.

BACKGROUND: Addictive disorders form the group of the most common mental disorders. A wide range of psychotherapeutic treatment interventions exists; however, the proportion of patients receiving evidence-based interventions or psychotherapeutic treatment in outpatient care is very low. OBJECTIVE: The aim of the present review was a systematic reassessment of the empirical evidence for the efficacy of the different forms of psychotherapeutic treatment, identification of new effective interventions and derivation of recommendations for treatment practitioners. MATERIAL AND METHODS: A comprehensive literature search in a multistage method in the relevant national and international data banks was conducted. Subsequent analysis of topical guidelines, systematic reviews and original studies about addictions and therapy was performed. RESULTS: A total of 3 topical national guidelines, 2 reviews and 16 original studies could be identified. In particular, cognitive behavioral therapy, behavioral interventions and motivational interventions could be identified as evidence-based interventions for the treatment of addictive disorders. Hypnotherapy can be recommended alternatively for patients dependent on tobacco. Also interesting for practitioners could be new treatment methods, such as neurocognitive training and mindfulness-based interventions. CONCLUSION: At present, although of high quality, results from existing studies are sometimes inconsistent or are numerically insufficient with respect to special treatment options. Future studies are warranted with respect to different substance use disorders and further patient groups.

Personality disorders and obesity: a systematic review.

BACKGROUND: Studies demonstrate an association between personality traits and obesity as well as their prognostic influence on weight course. In contrast, only few studies have investigated the association between personality disorders (PDs) and obesity. OBJECTIVE: The present review summarizes through a comprehensive and critical evaluation the results of 68 studies identified by database research (PubMed and PsycINFO) covering the last 35 years that investigated the association between PDs, overweight and obesity as well as the predictive value of PDs for the development of obesity and the effectiveness of weight reduction treatments. RESULTS: Adults with any PD have a higher risk of obesity. In the female general population, there is an association between avoidant or antisocial PD and severe obesity. Further, women with paranoid or schizotypal PD have a higher risk of obesity. Clinical studies including foremost female participants showed a higher comorbidity of PDs, especially borderline PD and avoidant PD, in binge-eating disorder. Regarding both genders, patients with PD show less treatment success in conservative weight-loss treatment programmes for obesity than patients without PD. CONCLUSIONS: In prevention and conservative weight-loss treatment strategies, more care should be taken to address the special needs of patients with comorbid PDs.

Personality traits and obesity: a systematic review.

Based on a bio-social-ecological systems model of the development and maintenance of obesity, there has been in the last few years a growing research interest in the association of obesity and personality traits. The aim of the present review was a comprehensive and critical evaluation of the existing literature taking into account the methodological quality of studies to enhance our understanding of personality traits associated with body weight, the development of overweight and obesity as well as the effectiveness of weight loss interventions including bariatric surgery. Personality traits play an important role both as risk as well as protective factors in the development of overweight and obesity. While thus in particular 'neuroticism', 'impulsivity' and 'sensitivity to reward' appear as risk factors, 'conscientiousness' and 'self-control' have been shown to have a protective function in relation to weight gain. Conscientiousness is a measure of regulation of internal urges and self-discipline, and may thus provide a potential source of control over impulsive reward-oriented behaviour. The results of the present review suggest that, within the context of therapeutic weight reduction measures, it is meaningful to identify subgroups of patients for whom specific treatment options need to be developed, such as measures for strengthening self-control skills.

Impairment of inhibitory control in response to food-associated cues and attentional bias of obese participants and normal-weight controls.

OBJECTIVE: Starting from a model of impaired response inhibition and salience attribution for addictive behaviour we investigated whether obese participants show a greater impairment of inhibitory control in response to food-associated cues compared with neutral stimuli and whether this is seen in normal-weight control subjects. In addition, we questioned whether an attentional bias towards food-associated cues can be observed in an early stage of information processing. DESIGN: Control-group study including the administration of behavioural tasks (that is, go/no-go task with food-associated and neutral words, visual dot probe task with food-associated and neutral pictures) and self-reported measures of eating behaviour and impulsivity. RESULTS: Although self-reported measures indicated disinhibition of eating behaviour of obese patients, we found that food-associated stimuli induced an impairment of inhibitory control in both obese participants as well as normal-weight controls. Results from the visual dot-probe task indicated that food-associated cues did not modulate attention allocation in a very early stage of information processing, which suggests that the incentive salience of food-associated stimuli might be lower than that of drug-associated cues. CONCLUSION: These findings are not in line with hypotheses derived from models of addictive behaviour and call into question that an impairment of inhibitory control in response to food-associated cues and salience attribution might be at the core of obesity. Future studies using larger sample sizes and refined experimental procedures are warranted to further investigate mechanisms controlling food intake in obesity.

Oxcarbazepine in combination with Tiaprid in inpatient alcohol-withdrawal--a RCT.

INTRODUCTION: Oxcarbazepine (OXC), a derivative of Carbamazepine (CBZ), may represent a solution to metabolic and side effects of CBZ treatment due to the fact that renal excretion is its major route of elimination. The goal of the study is to compare the efficacy and tolerability of OXC/Tiaprid (TIA) combination therapy to the well established Clomethiazole (CLO) therapy in an inpatient setting. METHODS: To investigate the efficacy of OXC/TIA in terms of lower alcohol withdrawal symptoms and better tolerability, 56 alcohol-dependent patients participated in a randomized open-label trial, where OXC/TIA and CLO treatments were compared. RESULTS: Following admission, we observed that severity of alcohol withdrawal syndrome was comparable between OXC/TIA and CLO-patients. Overall tolerability was good. However, significantly more patients in the OXC/TIA-group (48.1%) displayed no AE compared to the CLO-group (24.1%). We found no significant differences between groups regarding total number of recorded adverse events (AEs). DISCUSSION: OXC/TIA inpatient therapy proved to be as effective and participants demonstrated the same tolerance as with CLO. In medication-based alcohol withdrawal, OXC/TIA could have the potential to become a promising alternative for alcohol dependent patients unable to undergo inpatient withdrawal therapy with CLO. Our findings further indicate that it could be worthwhile testing OXC/TIA in alcohol withdrawal in daily care units and outpatient settings. This is an important question for national health care services, since outpatient therapy is more and more asked for as alternative to inpatient settings.

[Treatment outcome after inpatient alcohol withdrawal: impact of motivational interventions: a comparative study]. / Behandlungserfolg nach qualifiziertem Alkoholentzug: Vergleichsstudie zum Einfluss motivationaler Interventionen.

AIMS: The aim of the present study was to evaluate whether attending an extended inpatient detoxification treatment programme for alcohol-dependent patients providing psychotherapeutic interventions and coping skills training (QE) is associated with higher aftercare treatment attendance and higher abstinence rates compared with conventional detoxification treatment (KE). METHODS: A total of 117 patients were investigated. (QE sample n=61, KE sample n=56). Patients were followed up for at least 2 months and attendance at different aftercare treatment facilities and drinking behaviour were assessed. RESULTS: At discharge from inpatient treatment patients receiving QE report an increased perceived ability to stay abstinent when confronted with high-risk situations in the future. At follow-up, a higher abstinence rate and a higher frequency of self-help group attendance and outpatient psychotherapeutic treatment were reported in the QE sample. A regression analysis supports the chosen treatment as the main factor for success and rules out a potential sampling bias. CONCLUSIONS: Although methodological limitations have to be taken into account, our results suggest that QE provides better chances of treatment success than KE.

[Questionnaire for the evaluation of drug preventive intervention programmes at the workplace (FEBSI)]. / Der Fragebogen zur Evaluation betrieblicher suchtpräventiver Interventionsmassnahmen (FEBSI).

OBJECTIVES: At present, only a few studies have assessed the efficacy of intervention programmes that focus on drug prevention at the workplace, and there is only little information available with respect to the development and evaluation of suitable instruments for the evaluation of such prevention programs. Questionnaire procedures, nevertheless, seem to be basically suitable. We developed and evaluated the questionnaire for the evaluation of drug preventive intervention programs at the workplace (FEBSI) to provide a suitable instrument to assess the effectiveness of programmes that focus on drug prevention at the workplace. METHODS: We assessed and analysed data for the evaluation of this questionnaire in the context of a prevention programme in two large industrial companies. RESULTS: We found a three-factor solution with satisfying reliability scores for each factor. The extracted factors of the questionnaire reflect the following areas: consequences of substance use at work, compliance with employment agreements, and knowledge and behaviour. Programme participants could be reliably distinguished from non-participants by using the FEBSI. CONCLUSIONS: So far, the questionnaire seems to be a suitable and reliable instrument for the evaluation of drug prevention programmes.

[Substance abuse prevention in the workplace: theoretical knowledge and expertise after interventions]. / Betriebliche Suchtprävention: Theoretisches Wissen vs. Handlungskompetenz durch Schulungsmassnahmen.

Although several companies are requesting interventions for substance abuse prevention at the workplace and a wide variety of interventions is successfully introduced into practice, empirical studies investigating the efficacy of such interventions are rare. In the present study 100 executive managers of a German chemical company, who had participated in an intervention to prevent substance consumption at the workplace one year before, were applied a questionnaire to assess effects of the intervention. Data from 22 managers, who had so far not received such an intervention, were collected to serve as a control condition. The intervention itself was designed as a theory oriented half a day course and was conducted in groups of 10 to 12 executive managers of the company. By comparing participants and non-participants, we found significant differences with respect to the knowledge how to deal with substance-related problems of staff members. For example, participants reported more frequently to know the company agreement about addiction. Further, participants reported less frequently to wait until such problems were solved anyway. However, we found no evidence for transfer of theoretical knowledge into practice. For example, we detected no significant group differences with respect to the number of appraisal interviews conducted because of substance-related problems. Taken together, the results of our study indicate, that the implementation of a company agreement about addiction and its introduction into practice based on theoretical courses is not sufficient to produce considerable effects. As an alternative, based on previous experiences we propose a series of workshops with role-plays and feedback to establish expertise in interviewing techniques with substance-related problems.

[Long-term follow-up on alcohol use in a big company after brief intervention by a company physician]. / Längsschnittuntersuchung alkoholauffälliger Mitarbeiter in einem Grossbetrieb nach werksärztlicher Kurzintervention.

BACKGROUND: Many examinations have shown that brief medical interventions are useful when seeking to influence the drinking behavior of problem drinkers and alcohol-dependent subjects. The working environment is particularly useful when trying to influence problematic drinking behavior. Our report is about the long-term effects on alcoholic employees. METHODS: The drinking behavior of 100 employees was categorized according to WHO criteria. By motivational interviewing, the employees were asked to reduce their alcohol consumption or quit completely and then come back at a later control date. The data collected was: drinking behavior (TLFB, time-line follow-back), biological markers (GGT, CDT, MCV), changes in personal situations, and the factors and reasons involved. RESULTS: Forty-five percent of the employees went to their company physician after recommendation by their supervisors, and 24% went on their own initiative. Of the employees examined, 82% were diagnosed as being alcohol-dependent, 4% as harmful abusers, 6% as risky drinkers, and 8% as questionably risky drinkers. At the time of catamnesis, 78% of the employees that were originally diagnosed as alcohol-dependent were abstinent. Of those participants, 17% that were initially classified as not dependent were abstinent, and the overall quantity of alcohol consumed was also reduced significantly by 79.3%. Personal realms especially concerning happiness in life, happiness at work, and physical health improved. CONCLUSION: The results show that a brief medical intervention conducted by a company physician is suited to influencing the drinking behavior of employees effectively and efficiently. The fear of demotion at work and job loss may prove to be a helpful influence on changing drinking behavior.

[The development of evidence-based psychotherapy for use in alcoholism. A review]. / Entwicklung einer evidenzbasierten Psychotherapie bei Alkoholismus. Eine Ubersicht.

Past decades have seen enormous advances in the development and validation of evidence-based approaches to psychotherapy for alcoholism. While psychoanalytic and early behavioral techniques were the original basis of psychotherapy in this field, evidence-based approaches are now built up on the principles of motivational interviewing and cognitive-behavior therapy. Different techniques have been developed to modify preceding and persisting conditions favoring problem behavior, e.g., training in coping/social skills and the community reinforcement approach. According to the results of the project MATCH, one of the largest treatment trials, "cognitive-behavioral intervention" combines motivational enhancement therapy, the 12-step approach, and cognitive-behavior therapy, with the aim of providing new and even more efficacious psychotherapy for alcohol dependent patients. These very promising developments are beset with huge problems, however, insofar as few of the new evidence-based treatment approaches are accepted as standard treatment in Germany, in addition to which only a fraction of all alcohol-dependent persons in the country find their way into the care system, for various reasons. Early diagnosis and facilitation of access to the various treatment options available could be a future task for general practitioners and also for company / industrial medical schemes.