A Cross-Cultural Comparison of Climacteric Symptoms, Health-Seeking Behavior, and Attitudes towards Menopause Among Mosuo Women and Han Chinese Women in Yunnan, China

Cultural *YZ and XZ contributed equally. background has been shown to influence climacteric symptoms of women. This study compares various characteristics of climacteric symptoms, illness conception, health-seeking behavior, and attitude towards menopause of Mosuo women, a Chinese ethnic minority with a matriarchal structure, and Han Chinese women, the majority ethnic group of China with a patriarchal structure. Through convenience sampling, 51 Mosuo and 47 Han women ages 40 to 60 completed a sociodemographic questionnaire, the modified Kupperman Menopause Index (KMI), the Self-Rating Scale of Illness Conception and Health Seeking Behavior (SSICHSB) and the Menopause Attitude Questionnaire (MAQ). The Mosuo and Han Chinese women are comparable with regard to their age, educational levels and menstrual status. During climacteric, Mosuo women showed less severe melancholia ( p = .009), reported less health-seeking behavior ( p = .009), and displayed more positive attitudes towards menopause than their Han Chinese counterparts ( p < .001). One predictive variable of the melancholia severity in Mosuo was "menarche age", while that in the Han group was "social view on the menopause". Future research with a larger sample is needed to deepen our understanding about the interaction between culture and climacteric symptoms.

Adapting a perinatal empathic training method from South Africa to Germany

Background

Maternal mental health conditions are prevalent across the world. For women, the perinatal period is associated with increased rates of depression and anxiety. At the same time, there is widespread documentation of disrespectful care for women by maternity health staff. Improving the empathic engagement skills of maternity healthcare workers may enable them to respond to the mental health needs of their clients more effectively. In South Africa, a participatory empathic training method, the “Secret History” has been used as part of a national Department of Health training program with maternity staff and has showed promising results. For this paper, we aimed to describe an adaptation of the Secret History empathic training method from the South African to the German setting and to evaluate the adapted training.

Methods

The pilot study occurred in an academic medical center in Germany. A focus group (n = 8) was used to adapt the training by describing the local context and changing the materials to be relevant to Germany. After adapting the materials, the pilot training was conducted with a mixed group of professionals (n = 15), many of whom were trainers themselves. A pre-post survey assessed the participants’ empathy levels and attitudes towards the training method.

Results

In adapting the materials, the focus group discussion generated several experiences that were considered to be typical interpersonal and structural challenges facing healthcare workers in maternal care in Germany. These experiences were crafted into case scenarios that then formed the basis of the activities used in the Secret History empathic training pilot. Evaluation of the pilot training showed that although the participants had high levels of empathy in the pre-phase (100% estimated their empathic ability as high or very high), 69% became more aware of their own emotional experiences with patients and the need for self-care after the training. A majority, or 85%, indicated that the training was relevant to their work as clinicians and trainers, that it reflected the German situation, and that it may be useful ultimately to address emotional distress in mothers in the perinatal phase.

Conclusions

Our study suggests that it is possible to adapt an empathic training method developed in a South African setting and apply it to a German setting, and that it is well received by participants who may be involved in healthcare worker training. More research is needed to assess adaptations with other groups of healthcare workers in different settings and to assess empathic skill outcomes for participants and women in the perinatal period.

Cerebral Contusion: An Investigation of Etiology, Risk Factors, Related Diagnoses, and the Surgical Management at a Major Government Hospital in Cambodia

Introduction

Cerebral contusions are a common type of injury among the Cambodian population, mostly due to road traffic accidents. This article aims to assess various aspects around brain contusion focusing on the condition at admission, residing province, mechanism and time of injury, age and sex distribution with differing helmet wearing, and alcohol consumption patterns. Hospitalization-related data such as treatment and outcome were analyzed.

Methods

This was a retrospective analysis of 406 cases who have been admitted during the period between May 2013 and May 2016.

Results

Two hundred and ninety-five (75.51%) of the patients came from rural areas, 312 (76.84%) were male (mean age 31.17 ± 12.90 years for males and 38.5 ± 16.29 years for females). The average hospital stay amounted to 10.51 ± 6.67 days. One hundred and eight two cases (52.29%) happened between 4.00 and 11.00 p.m. Three hundred and nineteen (79%) of the injured patients were motorcycle drivers and 18% pedestrians. Male patients had an alcohol involvement in 135 (49.45%) (females in 5 [6.25%]) cases and 26 (10%) wore a helmet (females in 5 [6.25%]). Surgery was performed in 82 cases, specifically craniotomy and craniectomy +/- elevation of a depressed skull fracture. Two hundred and ninety-six (73.09%) patients showed related second diagnosis, mostly subdural hematoma in 96 (32.43%) and epidural hematoma in 63 (21.28%) cases. Fifty patients (13.16%) had a Glasgow Coma Scale of 3-8. 92 (24.21%) of 9-12 and 238 (62.63%) of 13-15 on admission. Most of the patients were discharged with an improved status 324 (91.52%) according to the Glasgow Outcome Scale 4 or 5.

Conclusion

The severity and resulting neurologic impairment of cerebral contusions show the importance of more in-depth research and prevention programs.

Body image after heart transplantation compared to mechanical aortic valve insertion

OBJECTIVE

Heart transplantation (HT) obviously affects body image and integrity. However, there are very few empirical data post-transplant.

METHODS

In a cross-sectional study, 57 HT patients were compared with 47 subjects with mechanical aortic valve replacement (AVR) using the Dresden-Body-Image questionnaire (DKB) and specific questions regarding integration of the organ/device. In addition, affective symptoms and quality of life (QoL) were assessed (12-Item Short-Form Health Survey and Hospital Anxiety and Depression Scale, HADS).

RESULTS

DKB-35 scores did not differ. HT patients scored higher than AVR on specific questions regarding integration of the organ/device. AVR patients showed more affective disturbance and lower mental QoL than HT subjects. Affective scores correlated negatively with body image scores. Seventeen percent of all patients showed psychological distress (HADS scores >8).

CONCLUSIONS

HT patients integrated the new organ well - and even better than AVR subjects did with the device. In general, our data corroborate a good adaptation process, in particular in HT patients. Similar to other reported data, a subgroup of 15-20% of patients shows stronger mental distress, including body image problems. These must be identified and treated by professionals. Patients with AVR deserve more attention in the future.

Effect of individualized communication skills training on physicians' discussion of clinical trials in oncology: results from a randomized controlled trial

Background

Discussing randomized clinical trials (RCTs) with cancer patients is one of the most challenging communication tasks a physician faces. Only two prior Communication Skills Trainings (CSTs) focused on RCTs in oncology have been reported. Their results demonstrated the need for further improvement. We developed and evaluated an enhanced, individually-tailored CST focused on improving physicians’ communication during discussions of RCTs.

Methods

The CST focused on personal learning goals derived from video pre-assessment that were addressed in a 1.5-day group workshop and one-on-one coaching sessions. Forty physicians were recruited and randomly assigned to intervention and control groups. Video-recorded standardized consultations with actor-patients were utilized. As a primary outcome (1), training success was evaluated by blinded raters using a previously developed checklist. Change in checklist items was evaluated between pre- and post-training assessment and compared against control group results. As a secondary outcome (2), the physicians’ feeling of confidence was assessed by a questionnaire.

Results

(1) Significant improvements in the intervention group were observed for the score on all items (p = 0.03), for the subgroup of content-specific items (p = 0.02), and for the global rating of communication competence (p = 0.04). The improvement observed for the subgroup of general communication skill items did not achieve significance (p = 0.20). (2) The feeling of confidence improved in nine out of ten domains.

Conclusion

While the individually-tailored CST program significantly improved the physicians’ discussions of RCTs, specifically related to discussion content, what remains unknown is the influence of such programs in practice on participant recruitment rates.

The study was registered retrospectively in 2010/07/22 under DRKS-ID: DRKS00000492.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3238-0) contains supplementary material, which is available to authorized users.

Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data

BACKGROUND

With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa.

METHODS

The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted.

RESULTS

Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care.

CONCLUSION

Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.

[Communication Test for Foreign Physicians in Germany: The Patient Communication Test]

INTRODUCTION

The number of foreign doctors in Germany has increased steadily in recent years. To obtain the German medical license, sufficient language competence is mandatory. Nevertheless, in practice, foreign doctors have considerable difficulties in their communication with patients, medical colleagues and other health professionals. This can lead to misunderstandings and thus impair patient safety. To overcome this problem, the "patient communication test" was developed and piloted as an additional requirement to be granted license to practice medicine in Germany. The aim of this study is to present our results in the development and piloting of this test.

METHODS

3 OSCE stations (Objective Structured Clinical Examination) were designed, which evaluate communication skills in 3 medical competences: history taking, case presentation and explaining to patients before obtaining informed consent. After extensive instruction of actors as patients and raters on the basis of the evaluation criteria, the communication test was subjected to pilot studies in 6 different cities (Freiburg, Jena, Mainz, Mannheim, Tübingen, and Ulm).

RESULTS

In 2013, 639 foreign doctors participated in the test; 461 (72.14%) of these doctors passed the test on their first try, 51 (7.98%) on their second attempt and 6 (0.93%) on their third try.

CONCLUSION

The patient communication test evaluates the communication skills of foreign doctors in OSCE-setting using standardized actor-patients. This improves the communication skills and enhances patient safety in the German health care system by smooth inter-professional and patient-centered communication.

Self-perspective leads to increased activation of pain processing brain regions in fibromyalgia

BACKGROUND

Dysfunction of central nervous pain processing is assumed to play a key role in primary fibromyalgia (FM) syndrome. This pilot study examined differences of pain processing associated with adopting different interpersonal perspectives.

METHODS

Eleven FM patients and 11 healthy controls (HC) were scanned with functional magnetic resonance imaging. Participants were trained to take either a self-perspective or another person's perspective when viewing the visual stimuli. Stimuli showed body parts in painful situations of varying intensity (low, medium, and high) and visually similar but neutral situations.

RESULTS

Patients with FM showed a higher increase in blood oxygen level dependent (BOLD) response, particularly in the supplementary motor area (SMA). All pain-related regions of interest (anterior insula, somatosensory cortices, anterior cingulate cortex, and SMA) showed stronger modulation of BOLD responses in FM patients in the self-perspective. In contrast to pain processing regions, perspective-related regions (e.g. temporoparietal junction) did not differ between FM and HC.

CONCLUSIONS

The stronger response of all four pain processing cerebral regions during self-perspective is discussed in the light of disturbed bottom-up processing. Furthermore, the results confirm earlier reports of augmented pain processing in FM, and provide evidence for sensitization of central nervous pain processing.

Disordered eating behaviors in university students in Hanoi, Vietnam

BACKGROUND

The aim of the study was to examine disordered eating behaviors in university students in Vietnam.

METHODS

A total of 244 female university students participated, and 203 data could be analyzed. The Body Mass Index, the SCOFF screening questionnaire and the Eating Disorder Inventory 2 were used to explore disordered eating behaviors.

RESULTS

45.3% of the participants were underweight, 53.2% were normal weight and 1.5% were overweight. 48.8% of students reported two or more yes-responses on the SCOFF screening questionnaire which indicates a high possibility of having eating disorder symptoms. The mean score for underweight subjects (M = 14.79, SD = 6.81) indicated a lower level on the drive for thinness scale of the EDI-2 compared to normal weight subjects (M = 24.65, SD = 6.86) and overweight subjects (M = 31.33, SD = 6.66). Additionally, underweight subjects (M = 27.24, SD = 7.57) were less dissatisfied with their body than normal weight subjects (M = 35.94, SD = 8.67) and overweight subjects (M = 43.33, SD = 11.24). A significant positive correlation appeared between the BMI and the EDI-2. The SCOFF questionnaire showed a statistically significant negative correlation with the BMI and the EDI-2.

CONCLUSIONS

Despite some limitations the current study shows a tendency in young females in urban Vietnam to be underweight and to develop disordered eating symptoms such as drive for thinness and body dissatisfaction. However, more studies using the SCOFF and the EDI-2 would be needed to verify these findings.

Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China

OBJECTIVE

In primary care populations in Western countries, high somatic symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients.

METHODS

This multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15<10, n=203, SOM-) were compared to patients who reported high SSS (PHQ-15≥10, n=201, SOM+).

RESULTS

As compared to SOM- patients, SOM+ patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with "catastrophising" and "illness vulnerability"; low physical QoL was associated with "avoidance of physical activities" and "disuse of body parts"; low mental QoL was associated with "need for immediate medical help."

CONCLUSION

In accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.

Differentiating cerebral ischemia from functional neurological symptom disorder: a psychosomatic perspective

BACKGROUND

The differential diagnosis of pseudo-neurological symptoms often represents a clinical challenge. The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, made an attempt to improve diagnostic criteria of conversion disorder (functional neurological symptom disorder). Incongruences of the neurological examination, i.e. positive neurological signs, indicate a new approach--whereas psychological factors are not necessary anymore. As the DSM-5 will influence the International Classification of Diseases, ICD-11, this is of importance. In the case presented, a history of psychological distress and adverse childhood experiences coexisted with a true neurological disorder. We discuss the relevance of an interdisciplinary assessment and of operationalized diagnostic criteria.

CASE PRESENTATION

A 32-year-old man presented twice with neurological symptoms without obvious pathological organic findings. A conversion disorder was considered early on at the second admission by the neurology team. Sticking to ICD-10, this diagnosis was not supported by a specialist for psychosomatic medicine, due to missing hints of concurrent psychological distress in temporal association with neurological symptoms. Further investigations then revealed a deep vein thrombosis (though D-dimers had been negative), which had probably resulted in a crossed embolus.

CONCLUSION

The absence of a clear proof of biological dysfunction underlying neurological symptoms should not lead automatically to the diagnosis of a conversion disorder. In contrast, at least in more complex patients, the work-up should include repeated psychological and neurological assessments in close collaboration. According to ICD-10 positive signs of concurrent psychological distress are required, while DSM-5 emphasizes an incongruity between neurological symptoms and neurophysiological patterns of dysfunction. In the case presented, an extensive medical work-up was initially negative, and neither positive psychological nor positive neurological criteria could be identified. We conclude, that, even in times of more sophisticated operationalization of diagnostic criteria, the interdisciplinary assessment has to be based on an individual evaluation of all neurological and psychosocial findings. Prospective studies of inter-rater reliability and validity of psychological factors and positive neurological signs are needed, as evidence for both is limited. With respect to ICD-11, we suggest that positive neurological as well as psychological signs for functional neurological symptom disorder should be considered to increase diagnostic certainty.

[Equivalency examinations for foreign physicians in Baden-Wuerttemberg]

INTRODUCTION

Recent years have seen an increasing number of foreign doctors starting to practice medicine in German hospitals (or more rarely, in surgeries). In order to be granted the German license to practice medicine, doctors with a medical degree from outside the European Union have to undergo an equivalency examination. The supervisory authority for this is the examination office of the relevant federal state, which is why different procedures are being applied in the individual states. The aim of this paper is to point out the problems that frequently arise when conducting this specialist exam and to make suggestions as to how to improve the quality of the procedure.

METHOD

6 senior professors from the examination boards of the 4 medical schools in Baden-Wuerttemberg formed a focus group and discussed the difficulties associated with the exam, recorded problems in its actual implementation and then analysed the minutes of the meeting in a results-based manner in order to compile proposals for optimisation.

RESULTS

In view of the deficits in subject knowledge, general communication skills and specific communication skills, the difficulties of the current recognition procedure and the existing equivalency exam fall into 3 categories: structure and content of the exam, examiners and exam candidates.

CONCLUSIONS

In consultation with the State Examination Office Stuttgart, some processes for optimisation have been devised, e. g., to develop a special curriculum which could be used for guidance and to recruit more examiners. The recommendations of the focus group from Baden-Wuerttemberg are an important step towards more transparency and possibly towards a Germany-wide standardisation of this exam.

Psychological and behavioral variables associated with the somatic symptom severity of general hospital outpatients in China

OBJECTIVE

In high-income countries, the number and severity of somatic symptoms - irrespective of etiology--are associated with adverse psychobehavioral and functional characteristics. This study aimed to assess these key features among Chinese general hospital outpatients with high levels of somatic symptoms.

METHODS

This multicenter, cross-sectional study evaluated four outpatient departments of internal medicine and Traditional Chinese Medicine in Beijing and Kunming and enrolled a total of 281 consecutive patients. The patients answered questionnaires concerning somatic symptom severity [Patient Health Questionnaire (PHQ-15)], illness perception (Brief Illness Perception Questionnaire), illness behavior (Scale for the Assessment of Illness Behavior), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (12-Item Short Form Health Survey). Subsamples reporting high scores of somatic symptom severity (PHQ-15 ≥10, SOM+) versus low scores (PHQ-15 <10, SOM-) were compared.

RESULTS

Twenty-eight percent (79/281) of all outpatients showed high somatic symptom severity. The strongest correlations between high somatic symptom severity and psychobehavioral variables were found for high emotional distress, female gender, living alone, low physical quality of life and high dysfunctional illness behavior. The proportion of the explained variance was 36.1%.

CONCLUSION

In Chinese outpatients, high somatic symptom severity is frequent and associated with psychobehavioral characteristics. With the PHQ-15 cutoff of 10, SOM+ patients could be differentiated from SOM- patients using these characteristics.

Illness attribution of patients with medically unexplained physical symptoms in China

The illness behavior of patients with medically unexplained physical symptoms (MUS) depends largely on what the patient believes to be the cause of the symptoms. Little data are available on the illness attributions of patients with MUS in China. This cross-sectional study investigated the illness attributions of 96 patients with MUS in the outpatient departments of Psychosomatic Medicine, biomedicine (Neurology, Gynecology), and Traditional Chinese Medicine in Shanghai. Patients completed the Illness Perception Questionnaire (IPQ) for illness attribution, the Screening Questionnaire for Somatoform Symptoms, the Hospital Anxiety and Depression Scale for emotional distress, and questionnaires on clinical and sociodemographic data. The physicians also filled out a questionnaire regarding the cause of the illness (IPQ). In contrast to previous research, both physicians and patients from all three areas of medicine most frequently reported "psychological attributions." The concordance between the physicians' and the patients' illness attributions was low. Emotional distress was an important predictor of psychological attributions. Further research should include large-scale studies among patients from different regions of China and qualitative studies to deepen our understanding of cultural influences on illness attribution.

Three-Month Evaluation of Vital Tooth Bleaching Using Light Units—A Randomized Clinical Study

The aim of this study was to evaluate the color stability of vital bleaching using a halogen unit, laser, or only chemical activation up to three months after treatment. A total of 60 patients were divided into three groups, and their teeth were bleached with 38% hydrogen peroxide using three methods: acceleration of the bleaching process with halogen (eight minutes), laser (30 seconds), or chemical activation only. All teeth were bleached a maximum of four times (4 × 15 minutes) until a change of six shade tabs took place. The color was evaluated both visually and with a spectrophotometer before bleaching, immediately after bleaching, and one and three months after bleaching. Directly after bleaching, the use of halogen showed better results than laser (p≤0.05). One and three months after bleaching, no significant difference was found between the tested methods relative to the shade change, independent of the method of shade evaluation (p&gt;0.05). As far as the color stability is concerned, bleaching with halogen resulted in stable color throughout the three months (p&gt;0.05), whereas the other two methods resulted in whiter teeth after one and three months compared with the color directly after bleaching (p≤0.05). Bleaching with laser needed more time than halogen for the desired shade change (p≤0.05). Although directly after treatment bleaching with halogen resulted in better results, one and three months after bleaching the kind of acceleration used in the bleaching process did not have any effect on the esthetic results.

A manual-based group program to improve mental health: what kind of teachers are interested and who stands to benefit from this program?

PURPOSE

In order to evaluate a manual-based group program for teachers aiming at strengthening mental health, we examined (1) whether the teachers interested in participating differ from their colleagues without interest and (2) whether there is evidence of subgroups benefiting more than others among those who participated.

METHODS

Out of a basic sample of 949 schoolteachers, 337 teachers declared interest in a group program. All teachers were surveyed with the "General Health Questionnaire", the "Maslach Burnout Inventory" and the "Effort Reward Imbalance Questionnaire". In addition, participating teachers were screened with the "Symptom Checklist 27" T and χ(2)-tests were calculated to detect differences between those interested in the program and the remaining 612 teachers. Six factors were established and used for a regression analysis that identified specific parameters more or less correlating with health benefits of those who participated in the program.

RESULTS

Findings showed that those declaring interest in the intervention displayed a higher degree of occupational stress according to all health parameters examined. Teachers interested in the program were significantly younger, more frequently female and single. The regression analysis showed that the baseline scores of the six health parameters were the strongest predictors for improvement. Worse scores before the beginning of the intervention correlated with a more positive effect.

CONCLUSIONS

Intervention programs aiming at alleviating the mental stress of teachers find the interest of those who need it most. More importantly, the latter are the ones who--at least if our program is applied-benefit best.

Results of a psychosomatic training program in China, Vietnam and Laos: successful cross-cultural transfer of a postgraduate training program for medical doctors

Background

With the “ASIA-LINK” program, the European Community has supported the development and implementation of a curriculum of postgraduate psychosomatic training for medical doctors in China, Vietnam and Laos. Currently, these three countries are undergoing great social, economic and cultural changes. The associated psychosocial stress has led to increases in psychological and psychosomatic problems, as well as disorders for which no adequate medical or psychological care is available, even in cities. Health care in these three countries is characterized by the coexistence of Western medicine and traditional medicine. Psychological and psychosomatic disorders and problems are insufficiently recognized and treated, and there is a need for biopsychosocially orientated medical care. Little is known about the transferability of Western-oriented psychosomatic training programs in the Southeast Asian cultural context.

Methods

The curriculum was developed and implemented in three steps: 1) an experimental phase to build a future teacher group; 2) a joint training program for future teachers and German teachers; and 3) training by Asian trainers that was supervised by German teachers. The didactic elements included live patient interviews, lectures, communication skills training and Balint groups. The training was evaluated using questionnaires for the participants and interviews of the German teachers and the future teachers.

Results

Regional training centers were formed in China (Shanghai), Vietnam (Ho Chi Minh City and Hue) and Laos (Vientiane). A total of 200 physicians completed the training, and 30 physicians acquired the status of future teacher. The acceptance of the training was high, and feelings of competence increased during the courses. The interactive training methods were greatly appreciated, with the skills training and self-experience ranked as the most important topics. Adaptations to the cultural background of the participants were necessary for the topics of “breaking bad news,” the handling of negative emotions, discontinuities in participation, the hierarchical doctor-patient relationship, culture-specific syndromes and language barriers. In addition to practical skills for daily clinical practice, the participants wanted to learn more about didactic teaching methods. Half a year after the completion of the training program, the participants stated that the program had a great impact on their daily medical practice.

Conclusions

The training in psychosomatic medicine for postgraduate medical doctors resulted in a positive response and is an important step in addressing the barriers in providing psychosomatic primary care. The transferability of western concepts should be tested locally, and adaptations should be undertaken where necessary. The revised curriculum forms the basis of training in psychosomatic medicine and psychotherapy for medical students and postgraduate doctors in China, Vietnam and Laos.

Development and evaluation of a checklist assessing communication skills of oncologists: the COM-ON-Checklist

OBJECTIVES

Communication skills training (CST) has to be proven effective, and therefore reliable instruments to evaluate CST are required. Most instruments assessing medical consultations do not take individual aspects of CST into consideration. Such assessment tools should naturally also be closely associated with the communication skills taught to the participants. Thus, we developed a new instrument which evaluates the effects of specific CST.

DEVELOPMENT

Based on a literature review, we developed a checklist with questions ('items') which assess the behaviour of a doctor in a special doctor-patient consultation (The COM-ON-Checklist, COM-ON = communication in oncology). First, we developed items for general communication skills that are a requirement of every doctor-patient consultation, and in addition to this, we developed items for specific situations which present a particular challenge for doctors in terms of communication skills, namely: the situation in which the doctor is required to discuss the shift from curative to palliative care, and the disclosure of information about clinical trials. For assessment, a 5-point rating scale with anchor points was used.

EVALUATION

Blinded raters were trained to use the COM-ON-Checklist. The intra-class correlation (ICC) was used to calculate the agreement between raters.

RESULTS

The COM-ON-Checklist consists of two parts: the first part evaluates general communication skills; the second part evaluates content-specific aspects of the consultation. The ICC ranged from 0.5 to 0.8, which demonstrates moderate to very good results of inter-rater reliability.

DISCUSSION

The COM-ON-Checklist can be used to evaluate specific CST. It is also a feedback source for clinicians because it assesses their personal communication skills in different settings. In conclusion, the COM-ON-Checklist provides a reliable, structured method for assessing communication skills in oncological settings.

Mental health and patterns of work-related coping behaviour in a German sample of student teachers: a cross-sectional study

PURPOSE

The aim of this cross-sectional study was to evaluate the mental health of student teachers, to analyse the extent to which they feel prepared for their profession by the university curriculum and to investigate patterns of coping with occupational stress.

METHODS

A sample of 481 German student teachers was investigated using two standardised instruments: GHQ-12 (General Health Questionnaire) and AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster), an occupational stress and coping questionnaire describing four patterns of work-related coping behaviour. In addition, we asked how well the student teachers felt that the curriculum prepared them for their profession.

RESULTS

Forty-four per cent of the student teachers report impaired mental health in the second teacher training period, indicated by a GHQ value equal to or over the cut-off of four. The AVEM responses revealed more than 40% showing risk patterns (A or B) compared to only 26.3% displaying a healthy coping style (G), while 32.8% demonstrate an unambitious style (S). These GHQ values are inversely correlated with the extent to which student teachers feel prepared for their work by the university curriculum.

CONCLUSIONS

Our data indicate a problematic stress level for student teachers in the second training phase (high exposure to health risks and unfavourable coping styles). Since teaching is clearly an extremely demanding job, it is vital that teacher training systems contribute towards protecting the health of teachers by focusing on fostering healthy personal attitudes and equipping young teachers with coping styles and skills that will better prepare them for the challenges facing them in their daily work. Self-care health management should also be part of the teacher training curriculum.

The treatment of patients with medically unexplained physical symptoms in China: a study comparing expectations and treatment satisfaction in psychosomatic medicine, biomedicine, and traditional Chinese medicine

OBJECTIVE

Little is known about treatment for patients with medically unexplained symptoms (MUS) in China. This study investigates the treatment expectations and treatment satisfaction of patients with MUS in psychosomatic medicine, biomedicine, and Traditional Chinese Medicine (TCM).

METHOD

In a cross-sectional survey, n = 96 (10.3%) out of 931 participating patients were screened positive for multiple somatoform symptoms. These patients answered questionnaires concerning symptom duration, number of doctor visits, functional impairment, emotional distress, treatment expectations, treatment satisfaction, and empathy in the consultation. The physicians filled in a questionnaire about applied or recommended treatment.

RESULTS

Most of the patients from psychosomatic medicine wanted psychotherapy. In TCM, 55% of the patients had already received TCM treatment and most of them wanted to continue TCM treatment. Patients in biomedicine did not express clear expectations; most of them had had no previous treatment. A combination of treatment methods was most prevalent in biomedicine in comparison to psychosomatic medicine and TCM. The outcome from the patients' point of view was significantly better in TCM than in psychosomatic medicine and biomedicine. Psychosomatic medicine's strength was the empathetic physician-patient interaction.

CONCLUSIONS

From a biopsychosocial perspective, these results suggest that various treatment approaches with various emphases can be effective depending on the patient's complaints, his illness beliefs, and what the physician offers. The results will be verified in a larger multicenter longitudinal study.

Specific Training Program Improves Oncologists' Palliative Care Communication Skills in a Randomized Controlled Trial

Purpose

The aim of the study was to demonstrate that COM-ON-p, concise and individualized communication skills training (CST), improves oncologists' communication skills in consultations focusing on the transition to palliative care.

Methods

Forty-one physicians were randomly assigned to a control (CG) or intervention group (IG). At t0, all physicians held two video-recorded consultations with actor-patient pairs. Afterward, physicians in the IG participated in COM-ON-p. Five weeks after t0, a second assessment took place (t1). COM-ON-p consists of an 11-hour workshop (1.5 days), pre- and postassessment (2 hours), and coaching (0.5 hours). Physicians focused on practicing individual learning goals with actor patients in small groups. To evaluate the training, blinded raters assessed communication behavior of the physicians in video-recorded actor-patient consultations using a specific checklist. Data were analyzed using a mixed model with baseline levels as covariates.

Results

Participants in the IG improved significantly more than those in the CG in all three sections of the COM-ON-Checklist: skills specific to the transition to palliative care, global communication skills, and involvement of significant others (all P < .01). Differences between the CG and IG on the global items of communication skills and involvement of significant others were also significant (P < .01). Effect sizes were medium to large, with a 0.5-point improvement on average on a five-point rating scale.

Conclusion

Physicians can be trained to meet better core challenges during the transition to palliative care through developed concise CST. Generalization and transfer into clinical practice must be proven in additional studies.

Emotional perception in patients with eating disorders in comparison with depressed patients

OBJECTIVE

Emotion regulation is a key issue for many psychiatric and psychosomatic disorders, including eating disorders. Eating disordered patients (EDP) show high levels of depressive comorbidity, and there is much uncertainty about disorder-specific deficits. This study is aimed at delineating disorder-specific disturbances of emotional perception in EDP.

METHOD

Fifty-two EDP were compared with 35 depressed patients (DP) and 25 healthy controls. They rated their emotional experience when viewing visual emotional stimuli. Emphasis was placed on the patients' perception of their own emotions and not on the recognition of emotions in others. Severity of depression was assessed by the Beck Depression Inventory.

RESULTS

Eating disordered patients and DP reported less anger than healthy controls-independent of the severity of depression. In addition, DP showed increased levels of disgust when confronted with anger stimuli. Happiness was rated less in EDP and DP, which was associated with severity of depression. There were no differences between the EDP subgroups bulimia nervosa and anorexia nervosa.

CONCLUSION

Eating disordered patients and DP showed alterations of emotional perception of anger, an emotion which is closely linked to interpersonal difficulties. Alterations in emotional perception of EDP and DP might be due to more general emotion regulation disturbances. In order to detect more subtle differences between psychiatric subgroups, more sophisticated investigation tools are needed. Increased disgust ratings in DP merit further investigation.

Disclosing information about randomised controlled trials in oncology: training concept and evaluation of an individualised communication skills training for physicians COM-ON-rct

When physicians disclose information about randomised controlled trials, they have to balance the requirements of conducting high standard research and the respect for patients' rights. Physicians need training in this difficult matter. An individualised communication skills training (CST) about randomised controlled trials for oncologists has been developed. The aim of this publication is to describe the concept of our CST and present data of evaluation by the participants: First, a theoretical introduction about a communication model and important ethical and legal issues was presented. Individual learning goals of participants were then derived through video assessment with actor-patients. The learning goals were the basis for practicing in role play. Individual coaching helped physicians to transfer the made experience into their daily work. Forty physicians have been trained. The acceptance of the training concept was assessed by a questionnaire consisting of 14 items and using a 6-point scale from 1 (very best) to 6 (very bad): the individualised CST was highly accepted (mean = 1.33). Practicing with actor-patients (mean = 1.4), providing constructive feedback (mean = 1.3) and assessing individual learning goals (mean = 1.85) were seen as helpful. Our CST trains physicians to realise best research standards and incorporate patients' rights.

Symptom presentation, interventions, and outcome of emotionally-distressed patients in primary care

BACKGROUND

Patients with psychosocial problems often present somatic symptoms in primary care.

OBJECTIVE

The authors compare interventions and outcomes of emotionally-distressed patients by presenting physical disease, somatoform symptoms, or psychological symptoms.

METHOD

General practitioners (N=191) documented data from 1,286 patients with psychosocial problems. Experts rated the presented reasons for encounter.

RESULTS

Somatoform symptoms, as well as physical disease, result in patients' receiving physical treatments. Psychologically-oriented treatment is more likely with psychological presentation, but not significantly related to somatoform symptoms.

CONCLUSION

These findings underline the importance of a specific treatment approach for patients with somatoform symptoms, so as to avoid inappropriate treatment.

Work-related behavior and experience patterns and predictors of mental health in German physicians in medical practice

BACKGROUND AND OBJECTIVES

Work-related stress and burnout among physicians are of increasing relevance. The aim of this study was to investigate work-related behavior and experience patterns and predictors of mental health of physicians working in medical practice in Germany.

METHODS

We surveyed a stratified, random sample of 900 physicians from different specialties. The questionnaire included the standardized instruments Work-related Behavior and Experience Pattern (AVEM) and the Short Form-12 Health Survey (SF-12).

RESULTS

Only one third of physicians reported high or very high general satisfaction with their job, but 64% would choose to study medicine again. Only 18% of physicians presented a healthy behavior and experience pattern. Almost 40% presented a pattern of reduced motivation to work, 21% were at risk of overexertion, and 22% at risk for burnout. Willingness to study medicine again, fulfilled job expectations, professional years, marital status, and behavior patterns were significant predictors of mental health and accounted for 35.6% of the variance in mental health scores. Job-related perceptions also had a significant effect on burnout.

CONCLUSIONS

The strong influence of work-related perceptions suggests a need for realistic expectation management in medical education, as well as support in stress management and coping strategies during medical training.

Medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions

OBJECTIVE

Interactions between patients suffering from medically unexplained symptoms (MUS) and their physicians are usually perceived as difficult and unsatisfactory by both parties. In this qualitative study, patients' reactions to psychosomatic attributions were analyzed on a micro-level.

METHODS

144 consultations between consultation-and-liaison (CL) psychotherapists and inpatients with MUS, who were treated according to a modified reattribution model, were recorded. Linguists and psychologists evaluated these consultations by applying conversation and positioning analysis.

RESULTS

When introducing a psychosomatic attribution, therapists use discursive strategies to exert interactional pressure on the patient; while simultaneously using careful and implicit formulations. Three linguistic patterns could be found in which patients subtly refute, drop or undermine the psychosomatic attribution in their reply. Moreover, in this context patients position themselves as somatically ill or justify their own life situation.

CONCLUSION

The results suggest that patients interpret psychosomatic attributions and even subtle suggestions from the psychotherapists as face-threatening 'other-positionings'.

PRACTICE IMPLICATIONS

When implementing the reattribution model, it should be taken into account that interactional resistance might be a necessary step in the process of the patient's understanding. Nevertheless therapists should introduce reattribution in a patient-centered rather than persuasive way and they should openly address patients' fears of being stigmatized.

Addressing the transition from curative to palliative care: concept and acceptance of a specific communication skills training for physicians in oncology--COM-ON-p

BACKGROUND

There are several reasons why consultations addressing the transition to palliative care are especially challenging, and physicians are generally not very well prepared to meet these challenges. We therefore conceptualized and evaluated a concise, individualized communication skills training (CST) addressing i) communication concerning the transition to palliative care, and ii) involvement of significant others in the conversation. Core aspects of the CST and data of acceptance will be presented.

METHODS

The core elements of the CST are a 1.5-day workshop held in small groups and a subsequent individual coaching session during everyday routine. The workshop is practice-oriented and highly individualized. Acceptance was assessed by using a self-developed 13-item questionnaire.

RESULTS

All 41 participating physicians completed the evaluation questionnaire. The participants' overall evaluation of the workshop was very positive and indicated a high personal benefit. Individualized learning tools like 'assessment of individual learning goals' and 'closing with individual take-home messages' were also seen as positive, but not as positive as other elements like practicing with actor patients and feedback from actors and facilitators.

CONCLUSIONS

The presented specific, individualized, and concise CST is well accepted, and physicians see a high practical relevance and strong personal benefits.

Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial

BACKGROUND

In bulimia nervosa, more intense treatments are recommended if outpatient treatment fails. This is the first randomized controlled trial comparing the options of inpatient versus day clinic treatment.

METHOD

Patients with severe bulimia nervosa were randomly assigned to inpatient or day clinic treatment of similar length and intensity. Specific and general psychopathology was assessed at the end of treatment and a 3-month follow-up.

RESULTS

Fifty-five patients were randomized; 22 day clinic patients and 21 inpatients started the program. At the end of treatment, a significant reduction of general and specific pathology was found in both settings. Following discharge, there was more deterioration in bulimic symptoms after inpatient treatment, but overall, results were comparable.

CONCLUSIONS

Inpatient and day clinic programs are effective treatments for severely disturbed bulimic patients with similar results at the 3-month follow-up. Further follow-up will show if a higher instability of results after inpatient treatment is of importance in the long term.

Emotional perception in eating disorders

OBJECTIVE

It remains an open question whether there are basic emotional perception and emotional processing deficits in eating disorders (ED). The aim of this study was to explore deficits in emotional perception in restrictive anorexia nervosa (AN-R) and bulimia nervosa (BN), using visual emotional stimuli.

METHOD

Thirty-four patients with ED (19 with BN and 15 with AN-R) were compared with 25 controls. Visual stimuli from the international affective picture system were used.

RESULTS

Patients with AN-R showed increased fear when confronted with stimuli containing anger, whereas patients with BN showed a tendency towards decreased fear. There were no other fundamental differences in the emotional perception of fear, happiness, sadness, and anger.

DISCUSSION

The finding of increased fear when exposed to the emotion of anger might be attributed to introversion and conflict avoidance of anorectic patients. No other basic deficiency of emotional perception was found.

Psychosocial health risk factors and resources of medical students and physicians: a cross-sectional study

BACKGROUND

Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions.

METHODS

The questionnaire -Related Behaviour and Experience "Work administered in cross-sectional surveys to students in the first (n = 475) and in the fifth year of studies (n = 355) in required courses at three German universities and to physicians in early professional life in the vicinity of these universities (n = 381).

RESULTS

Scores reflecting a healthy behaviour pattern were less likely in physicians (16.7%) compared to 5th year (26.0%) and 1st year students (35.1%) while scores representing unambitious and resigned patterns were more common among physicians (43.4% vs. 24.4% vs. 41.0% and 27.3% vs. 17.2% vs. 23.3 respectively). Female and male responders differed in the domains professional commitment, resistance to stress and emotional well-being. Female physicians on average scored higher in the dimensions resignation tendencies, satisfaction with life and experience of social support, and lower in career ambition.

CONCLUSION

The results show distinct psychosocial stress patterns among medical students and physicians. Health promotion and prevention of psychosocial symptoms and impairments should be integrated as a required part of the medical curriculum and be considered an important issue during the further training of physicians.

Improving the psychosomatic competence of medical doctors in China, Vietnam and Laos-the Asia-Link Program

OBJECTIVE

The European Union is supporting a 3-year cooperation project coordinated by the Freiburg University Clinic for the development and promotion of psychosomatic medicine in China, Vietnam, and Laos. The main objective is the development and performance of post-graduate training for medical doctors to improve doctor-patient communication and to acquire psychosomatic knowledge, skills, and attitudes.

METHOD

The project is based on contacts which have existed for several years with the Tongji University and the affiliated Tongji Hospital in Shanghai. Medical doctors in all disciplines are to learn to promptly recognize emotional disorders which frequently present in the primary care setting, to offer limited treatment themselves, and to cooperate with mental health specialists.

RESULTS

In the first year of the project, 50 medical doctors from different medical fields were trained as future teachers. In the second year, we are starting a pilot curriculum which will include 60 hours of theory and psychosocial interventions, divided into three blocks.

CONCLUSIONS

Future developments will involve setting up a psychosomatic network in Southeast Asia to establish advanced training in psychosomatic medicine and psychotherapy and to promote psychiatric and psychosomatic consultation and liaison services in the general hospitals.

Parameters influencing health variables in a sample of 949 German teachers

PURPOSE

Studies including investigations by our group indicate a significantly strained health of school teachers. Only little is known about the influence of single parameters that may act as predictors of teachers' ill health.

METHODS

By using stepwise regression, in a sample of N = 949 school teachers, we analyzed the correlation between personal and professional parameters on the one side and measures such as GHQ, MBI, and ERI on the other.

RESULTS

We found a significant correlation of work place-related factors with parameters of ill health. Compared to all other factors considered, verbal insults by pupils had the strongest impact. Positive feedback by parents and pupils or support by colleagues and school heads had a significant protective influence.

CONCLUSIONS

Our data demonstrate that interpersonal factors appear to play a prominent role with respect to both strain and protection of teachers' health.

[Treatment components of inpatient and day clinic treatment of anorexia nervosa: the patient's perspective]

The acceptance of a treatment depends on what patients experience as helpful or not. In the treatment of anorexia nervosa, the patient's perspective is of special importance as patients are typically highly ambivalent concerning a change in their dysfunctional attitudes and behaviour. 102 patients with anorexia nervosa (ICD-10) evaluated the components of a complex, multimodal treatment programme (inpatient and day clinic) at the end of therapy or follow-up. Overall, psychodynamic as well as symptom-oriented treatment components were experienced as "helpful". Psychodynamic individual sessions received the best assessments. Individual sessions got higher ratings than group sessions. Patients with less successful outcomes described symptom oriented elements like weight goals and work on eating behaviour as significantly less helpful. Lower rankings of some symptom oriented components were associated with more overall symptom severity and bulimic pathology and may point to a feeling of being overtaxed with the programme or a lack of motivation to change.

[Curriculum psychosomatic medicine and psychotherapy in medical education--concept, implementation, evaluation]

Many medical schools endeavor to improve teaching in the disciplines of Psychosomatic Medicine and Psychotherapy. This article describes the teaching methods for teaching psychosomatic and psychotherapeutic fundamentals and how they are applied in practice. The best possible learning effect is achieved by coordinating training and learning goals, contents and methods and the general environment of the discipline. The 1-week block course is part of a 7-week block on "The Nervous System and the Psyche". The contents and practical exercises are designed to enable students to continuously improve their knowledge and their practical skills during the course. The focus is on psychological relations with somatic illnesses, improvement of the doctor's interviewing techniques, the importance of the doctor-patient relationship, and the most important emotional and psychosomatic disorder patterns such as anxiety and depressive reaction when being informed about a life-threatening disease, somatoform disorders and eating disorders. The practical course, including lectures, was rated 1.6 (on a scale of 1-5 with 1 being the best and 5 the worst grade) in the last two semesters. The patient live interviews and the use of actors simulating patients for practice interviews were particularly well received. A description of the implementation difficulties and tasks for the future is included.

Short-term psychotherapeutic interventions for somatizing patients in the general hospital: a randomized controlled study

BACKGROUND

Treatment acceptance and motivation for psychotherapy of somatizing patients in the general hospital is low.

METHODS

Patients (n = 91) fulfilling the criteria for somatization were randomized into an intervention group (n = 49) and a control group (n = 42). The patients in the intervention group attended 5 psychotherapeutic sessions based on the modified reattribution model. The patients in the control group received psychoeducational reading material. The primary outcomes were motivation for psychotherapy and contacting a psychotherapist after discharge. The secondary outcomes consisted of changes regarding somatoform symptoms, emotional distress and quality of life.

RESULTS

Patients from the intervention group were significantly more motivated for psychotherapy (p = 0.001) than patients from the control group. At the 3-month follow-up, 42% of the patients from the intervention group had contacted a psychotherapist, compared to 20% of the patients from the control group (p = 0.045). At the 6-month follow-up, however, the ratio of patients having contacted a psychotherapist had changed to 44 and 29%, respectively, and was no longer significant. The intensity of somatoform symptoms and the anxiety symptoms decreased and mental functioning improved significantly over time for patients from both groups.

CONCLUSIONS

Short-term psychotherapeutic interventions for somatizing patients in general hospitals have a moderately better effect on motivation for psychotherapy and contacting a psychotherapist than psychoeducational reading material alone. Future studies should attempt to prove the effectiveness of short-term psychoeducational interventions for somatizing patients in the general hospital.

Burnout and effort–reward-imbalance in a sample of 949 German teachers

OBJECTIVES

High rates of teachers' premature retirement initiated a research investigating their occupational burden. The aim of this study was to elaborate on and extend previous investigations exploring (1) teacher burnout and (2) the relationship between teachers' efforts and their rewards.

METHODS

A sample of 949 German teachers in 10 Gymnasien (grammar schools) and 79 Hauptschulen (secondary modern schools) was investigated applying the Maslach Burnout Inventory (MBI-D) and the Effort Reward Imbalance Inventory (ERI).

RESULTS

Compared with other studies investigating burnout in employees, we found high rates of burnout symptoms such as emotional exhaustion, depersonalisation, and low personal accomplishment. Male teachers showed significantly lower personal accomplishment and more depersonalization than female teachers. With respect to school types, teachers in Hauptschulen were more often affected by emotional exhaustion and showed more depersonalization. Part-time teachers felt less personal accomplishment than full-time teachers. The ERI cut off was exceeded by 21.6% of all teachers indicating that this subgroup is affected by an imbalance between too much effort and too little reward. With respect to the ERI, significant differences were found for school types, with a higher proportion of Hauptschulen teachers being above this cut off.

CONCLUSIONS

At present, the working situation of teachers appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.

Working conditions, adverse events and mental health problems in a sample of 949 German teachers

OBJECTIVES

The aim of this study was (1) to explore in detail the working load of teachers, (2) to analyse the extent of negative or threatening school-related events teachers are confronted with, and (3) to evaluate mental health strain by applying the general health questionnaire (GHQ).

METHODS

A sample of 949 teachers in 10 grammar schools (German: Gymnasien) and 79 secondary modern schools (German: Hauptschulen) was investigated applying (1) a questionnaire covering different aspects of the occupational burden and threatening school-associated events and (2) the general health questionnaire (GHQ-12).

RESULTS

Based on what teachers indicated in the questionnaire, full-time teachers work more than 51 h weekly. More than 42% of our sample indicated verbal insults, almost 7% deliberate damage of personal belongings, and 4.4% threat of violence by pupils during the past 12 months. When applying the GHQ-12, we found that 29.8% of the sample report significant mental health problems. With respect to school types, teachers in secondary modern schools indicated more of such problems, while no effects regarding age, gender, or full/part-time teaching were observed.

CONCLUSIONS

To be a teacher is a hard work and requires coping of considerable amount of adverse events. Based on the GHQ, nearly 30% of teachers suffer from significant mental health problems.

[Facilitating team development for nursing staff--prospects, effects and benefits]

Facilitating team development is a frequent intervention in hospitals and seen as a probate mean to support the staff. As the method spreads, a need for scientific evidence is articulated. At Freiburg University Hospital, facilitating team development for nursing teams has been empirically evaluated on a broad data basis. The studies focussed on how nurses in a university centre of high tech medicine experience their work situation, what (psychological) stress they feel exposed to and how they appraise the contribution of facilitating team development to prevent and come to terms with that stress. Results prove the effects and benefits of the intervention, particularly with regard to communicational difficulties within the nursing staff and to problems of interdisciplinary cooperation. The sine qua non of successful intervention, as notifying future participants about this particular method or the adequate formation of the group is highlighted.

[Comparison of inpatient and day clinic treatment of anorexia nervosa]

OBJECTIVES

Explorative comparison of short term outcomes of day clinic and inpatient treatment for anorexia nervosa.

METHODS

N = 13 consecutively admitted day clinic patients (anorexia nervosa; DSM IV) were matched with N = 13 inpatients (variables: age, duration of illness, gender, admission weight, subtype of anorexia nervosa). Results at discharge were compared using defined outcome criteria as well as scores of the SCL-90-R and EDI-2.

RESULTS

After inpatient treatment significantly more patients showed a good outcome (predefined criteria). Effect sizes also pointed to a superiority of inpatient treatment.

CONCLUSIONS

In the initial phase of therapy the structured and holding environment of an inpatient unit may be favourable for severely underweight anorexic patients. The interpretation of these results is limited due to the small sample size.

Psychosomatischer Liaisondienst am Universitätsklinikum

BACKGROUND

Little is known about the complex decision-making process involving recognition of psychosocial stress, its diagnosis, and psychotherapeutic intervention within the framework of a psychosomatic consulting and liaison service.

PATIENTS AND METHODS

Psychosocial stress was recorded using a psychometric questionnaire for 392 patients on admission to hospital, the estimated need of psychotherapeutic treatment, and the application of a psychosomatic liaison service.

RESULTS

Of the examined patients, 44% presented with at least one mental disorder requiring treatment according to ICD-10 criteria. According to the expert opinions, a need for psychotherapeutic treatment was present in 41%, while 54% were themselves motivated for at least one of the psychotherapeutic treatments offered. Psychotherapy was actually received by 35% of the patients. While mental disorders and emotional distress were significant predictors of the need for treatment as rated by experts, they played no genuine role in determining indication or whether a patient accepts the use of psychotherapy

CONCLUSION

Psychotherapeutic interventions in the liaison service are not always effective or related to the indication.

[Effectiveness of psychosocial interventions for emotional disorders by general practitioners. A systematic review]

OBJECTIVES

The introduction of psychosomatic primary care provides for the first time the possibility for general practitioners to treat emotional and psychosomatic disorders and problems which in the past were often not recognized.

METHODS

Using computer-based searches in data bases and journals we surveyed controlled studies in which general practitioners performed psychosocial interventions. The studies were assessed according to standardized procedures for systematic reviews.

RESULTS

A total of 9 studies were found which took place between 1966 and 2003. The clinical effects attained were usually limited and of short duration. Studies with specific therapeutic approaches in specific disorders showed the best results.

CONCLUSIONS

Psychosocial interventions by the general practitioner are effective, but there is need for improvement. Further conceptual development of structured psychosocial interventions which can be applied in the general practice for the most common emotional disorders is necessary. Considering the large number of patients with emotional disorders in primary care, these efforts will undoubtedly be worthwhile.