Outpatient Psychotherapy in Germany­An Evaluation of the Structural Reform.

BACKGROUND: A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients a comorbidity of mental disorders and chronic physical conditions (cMP). METHODS: Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344). RESULTS: From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic phyisical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist. CONCLUSION: Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population.

Background: The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population. Methods: In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values. Results: Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning. Conclusion: The OPD-SQS is a viable measure to assess personality functioning in the general population.

Changes in Corneal Power up to 2 Years After Endothelial Keratoplasty: Results From the Randomized Controlled Descemet Endothelial Thickness Comparison Trial.

PURPOSE: To compare changes in corneal power measurements after Descemet membrane endothelial keratoplasty (DMEK) vs ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). DESIGN: Post hoc subanalysis of the randomized controlled Descemet Endothelial Thickness Comparison Trial. METHODS: A total of 50 eyes (38 patients) with endothelial dysfunction from Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy were randomized to DMEK or UT-DSAEK 1 to 2 days before surgery. Total corneal refractive power (TCRP) and anterior/posterior simulated keratometry were obtained using Scheimpflug imaging preoperatively (baseline) and postoperatively at 3, 6, 12, and 24 months. Spectacle refractions were performed at 6, 12, and 24 months after surgery. SETTING: Hospital centers. RESULTS: The mean hyperopic shift of TCRP from baseline to 12 months was 0.80 ± 1.1 (P = .002) in the DMEK group and 0.69 ± 0.84 (P < .001) in the UT-DSAEK group. Posterior corneal curvature (average K from simulated keratometry) steepened (more negative dioptric power) by 0.42 ± 0.10 (P < .001) in DMEK and 0.54 ± 0.09 (P < .001) in UT-DSAEK. The mean change in TCRP and posterior corneal curvature did not differ between DMEK and UT-DSAEK (TCRP, P = .71; posterior average K from simulated keratometry, P = .36). CONCLUSIONS: Sustained steepening in posterior corneal curvature with loss in total corneal power contributes to hyperopic shifts after endothelial keratoplasty. Changes in corneal measurements do not differ between DMEK and UT-DSAEK. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Supplementary data for the mediation effect of personality functioning - Gender differences, separate analyses of depression and anxiety symptoms and inferential statistics of the relationship between personality functioning and different types of child maltreatment.

This article provides supplementary data for the original research article 'The Mediation Effect of Personality Functioning Between Different Types of Child Maltreatment and the Development of Depression/Anxiety Symptoms - a German Representative Study' [1]. The representative data were acquired as part of a broader survey on different aspects of mental health in the German population. This supplementary data article contains the statistical analyses of the relationship between the different subtypes of child maltreatment (CM) and impairments of personality functioning, which were only presented as a diagram in the original article. Additionally, the analyses conducted separately for symptoms of depression and anxiety as well as gender are provided. For the mediation analyses, the variables of depression/anxiety symptoms, personality functioning and CM types were standardized. The data may be useful for discussion, further insights and as a starting point for the development of further studies.

The mediation effect of personality functioning between different types of child maltreatment and the development of depression/anxiety symptoms - A German representative study.

BACKGROUND: Child maltreatment (CM) is associated with an increased risk to develop symptoms of depression/anxiety across an individual's lifespan. Recent studies indicated that impairments in personality functioning might mediate this association. The purpose of this study is to add evidence of this mediating effect by regarding different types of CM (emotional, physical and sexual abuse as well as emotional and physical neglect) in the general population. METHODS: A representative sample of the German population (N = 2,354) completed a set of standardized measures (OPD-SQS: Operationalized Psychodynamic Diagnosis - Structure Questionnaire Short, PHQ-4: Patient Health Questionnaire, CTQ: Childhood Trauma Questionnaire). Mediation analyses were carried out to examine the association between CM types, symptoms of depression/anxiety, and personality functioning. RESULTS: Up to two-thirds of the associations between CM types and symptoms of depression/anxiety are mediated by personality functioning [indirect effect: emotional abuse (ß = 0.219, 95%-CI: 0.187-0.251, p < .001), physical abuse (ß = 0.151, 95%-CI: 0.123-0.178, p < .001), sexual abuse (ß = 0.163, 95%-CI: 0.138-0.188, p < .001), emotional neglect (ß = 0.131, 95%-CI: 0.104-0.159, p < .001) and physical neglect (ß = 0.102, 95%-CI: 0.078-0.127, p < .001)]. LIMITATIONS: Symptoms of depression/anxiety were measured with screening instruments and results are based on cross-sectional data. CONCLUSIONS: The present investigation expands the evidence on the mediating effect of personality functioning in the association between CM and depression/anxiety symptoms based on data of the general population. Our results show the relevance of types, as the mediating effects are slightly stronger in CM abuse types than in CM neglect types. Knowledge about impaired personality might be an angle for clinical interventions and inspire future research.

Physical-mechanical properties of Bis-EMA based root canal sealer with different fillers addition.

AIM: To evaluate influence of three different filler particles on an experimental Bisphenol A ethoxylated dimethacrylate (Bis-EMA) based root filling material. MATERIALS AND METHODS: Resin-based endodontic sealers were produced using Bis-EMA, camphorquinone, ethyl 4-dimethylaminobenzoate (EDAB), N, N-dihydroxyethyl-p-toluidine (DHEPT), butylated hydroxytoluene (BHT), and benzoyl peroxide. The experimental groups were formulated adding 10, 20, 30, 40, and 50% of calcium tungstate (CaWO4), ytterbium trifluoride(YbF3), and tantalum oxide(Ta2O5). Flow, thickness, and radiopacity tests were conducted in accordance with ISO 6876. Sorption and solubility (SL) tests were conducted in accordance with ISO 4049, pH was measured with a pH meter, and degree of conversion (DC) was evaluated with Fourier transform infrared spectroscopy (FTIR). For radiopacity, two-way analysis of variance (ANOVA) and Tukey's multiple comparison test was performed. For DC analysis, one-way ANOVA and Tukey's multiple comparison test was performed. All statistical analyses were performed with a significance level of 5%. RESULTS: All groups showed lower flow with increased filler concentration. All groups showed film thickness values lower than 50µm, as ISO recommends, except CaWO450% group (76.7µm). pH values varied from 5.95 (± 0.07) in YbF340% group to 6.90 (± 0.07) in Ta2O540% group. In the radiopacity test, YbF330%, Ta2O540%, and Ta2O550% groups showed no statistical significant difference to 3mmAl. Ta2O5 and YbF3 groups in 10, 20, and 30% concentrations presented sorption and SL values as ISOrecommendation. Addition ofTa2O5 and CaWO4 decreased DC after 14 days. YbF3 addition showed no difference in DC from control group. CONCLUSION: YbF3 filler addition promoted higher properties compared to CaWO4 and Ta2O5 on Bis-EMA based root canal sealer.

Elementary Schoolteachers' Knowledge and Decision-making Regarding Dental Trauma.

PURPOSE: To evaluate elementary schoolteachers' knowledge and decision making regarding dental trauma in Porto Alegre, Brazil. MATERIALS AND METHODS: A questionnaire-based survey was conducted among elementary schoolteachers (n=442). Questions encompassed sociodemographic characteristics and decision making regarding dental trauma. Data on the appropriate answer regarding what to do with a traumatised or avulsed tooth were analysed with multiple logistic regressions, adjusting for age, gender, work experience and previous training. RESULTS: The study population consisted largely of women (90%), was 40 to 49 years old (44.3%) and had more than 15 years of work experience (56.6%). Women (OR=2.68/p=0.041), teachers under 30 years old (OR=4.95/p=0.041), those with more than 15 years of work experience (OR=8.95/p<0.001) or those who had already received previous dental trauma instructions (OR=1.95/ p=0.119) were more likely to choose the appropriate answer for an avulsion situation. Teachers under 30 years old (OR=2.88/ p=0.279), those with more than 15 years of work experience (OR=4.55/p=0.001) or those who had received previous training (OR=3.39/p=0.009) presented higher probabilites of choosing the appropriate answer for a crown fracture event. CONCLUSION: Greater work experience or previous instructions on how to approach dental trauma in the school environment were found to be major factors in schoolteachers' decision making regarding dental trauma.

Actividad antimicrobiana del cloruro de 2-metacriloil oxietil trimetilamonio contra Candida sp / Antimicrobial activity of [2-(methacryloyloxy)ethyl]trimethylammonium chloride against Candida spp

Antecedentes. La estomatitis protética es la forma más común de infección bucal producida por especies de Candida, siendo Candida albicans el agente etiológico más común. Diversos autores han intentado asociar agentes antifúngicos o antisépticos a los materiales de revestimiento blando o a las resinas acrílicas de las prótesis dentales, pero sin éxito. Por ello, se ha investigado un compuesto de amonio cuaternario (2-metacriloil oxietil trimetilamonio [MADQUAT]), que copolimeriza con los metacrilatos y que podría actuar como inhibidor de levaduras. Objetivos. El objetivo de este estudio fue evaluar la actividad in vitro del MADQUAT contra especies de Candida. Métodos. Se utilizaron 31 cepas de Candida para determinar la actividad antifúngica in vitro. Se determinó la concentración mínima inhibitoria (CMI) y la concentración mínima fungicida del MADQUAT, así como de la nistatina. Resultados. El MADQUAT presentó propiedades antifúngicas en las concentraciones entre 6,25 y > 100mg/ml y actividad fungicida entre 25 y > 100mg/ml. Los estudios cuantitativos de la actividad fungistática y fungicida del MADQUAT demostraron actividad fungistática contra todas las cepas de Candida albicans, Candida krusei y Candida parapsilosis, revelando actividad fungicida contra algunas cepas de otras especies. Conclusiones. El MADQUAT presenta actividad antifúngica contra Candida spp. Además, la sensibilidad a dicho compuesto es distinta entre las diferentes especies considerando los valores de la CMI y la actividad fungicida o fungistática(AU)

Background. Candida-associated denture stomatitis is the most common manifestation of oral candidal infection, caused mainly by Candida albicans. Several authors have attempted to add antifungal agents or antiseptics to denture temporary soft lining materials or to denture acrylic resins, without relevant results. Therefore, the investigation of a quaternary ammonium functionalized compound [2-(methacryloyloxy)ethyl]trimethylammonium chloride (MADQUAT), which copolymerizes with methacrylates and which could act as a fungal inhibitor, is of paramount importance. Aims. To evaluate the in vitro activity of MADQUAT against Candida species. Methods. Thirty-one Candida strains were used to determine the in vitro antifungal activity of this compound. The minimum inhibitory concentrations and minimum fungicidal concentrations of MADQUAT and nystatin were determined. Results. MADQUAT showed antifungal properties at concentrations of 6.25 to > 100mg/ml, and fungicidal activity between 25 and > 100mg/ml. The quantitative determinations of the fungistatic and fungicidal activity of MADQUAT showed fungistatic activity against all Candida albicans, Candida krusei and Candida parapsilosis strains, revealing fungicidal activity against some strains of the other species. Conclusions. MADQUAT has antifungal activity against Candida spp. Moreover, the sensitivity to this substance varies across the different species in terms of MIC values and fungicidal or fungistatic activity(AU)

Influence of chlorhexidine application at longitudinal push-out bond strength of fiber posts.

OBJECTIVE: The objective of this study was to evaluate the influence of chlorhexidine application after dentin phosphoric acid etching at immediate and long-term bond strength of a fiber post cemented to root dentin. STUDY DESIGN: Seventy-two single-rooted, human upper teeth were selected. After phosphoric acid etching, each group received a different dentin treatment: no pretreatment or chlorhexidine 0.2% or 2.0%. Three-step etch-and-rinse adhesive and dual-cured resin cement was used to cementation procedure. Half of the teeth were submitted to push-out bond strength test after 24 hours and the other half after 6 months. Data were analyzed by 2-way ANOVA and Tukey. RESULTS: Chlorhexidine application had no influence on bond strength when teeth were stored at the same aging time (P > .05). The storage time significantly decreased the bond strength values of 24 hours to 6 months in all groups (P < .05). CONCLUSION: After 6 months, chlorhexidine application did not effectively arrest bond strength degradation of fiber posts cemented in human roots.