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Research suggests that multiple forms of relaxation training (e.g., progressive muscle relaxation, meditation, breathing exercises, visualization, and autogenics) can help individuals reduce stress, enhance relaxation states, and improve overall well-being. We examined three different, commonly used approaches to stress relaxation—progressive muscle relaxation, deep breathing, and guided imagery—and evaluated them in a head-to-head comparison against each other and a control condition. Sixty healthy undergraduate participants were randomized to one of the four conditions and completed 20 minutes of progressive muscle relaxation, deep breathing, or guided imagery training that was delivered by recorded audio instruction. Baseline and follow-up assessment of psychological relaxation states were completed. Physiological relaxation was also assessed continuously using measures of electrodermal activity and heart rate. Results showed that progressive muscle relaxation, deep breathing, and guided imagery all increased the state of relaxation for participants in those groups, compared to participants in the control group. In each case, the increase was statistically significant and although the groups did not differ on relaxation before training, all groups were significantly higher on relaxation after training, as compared to the control group. Progressive muscle relaxation and guided imagery showed an immediate linear trend toward physiological relaxation, compared to the control group, and the deep breathing group showed an immediate increase in physiological arousal followed quickly by a return to initial levels. Our results lend support to the body of research showing that stress relaxation training can be effective in improving relaxation states at both the psychological and physiological level. Future research could examine stress relaxation techniques in a similar manner using designs where multiple techniques can be compared in the same samples.

To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). In this cross-sectional, observational study, “real world” data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (− 0.22), pain-related interference with everyday life (− 0.19), general activity (0.13), general health perception (0.11), punishing response from others (− 0.11), work status (− 0.10), vitality (− 0.11) and cognitive difficulties (− 0.12). Pain intensity or frequency was not an independent correlate. More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Objective Little is known about potential mechanisms of action linking protective positive psychological variables and functional disability in patients with rheumatic and musculoskeletal disease. The present study was undertaken to examine symptoms of psychopathology, including stress, depression, anxiety, and sleep quality, as serial mediators of the association between gratitude, self-compassion, self-forgiveness, and functional impairment. Methods We assessed risk and protective factors for functional disability in patients with fibromyalgia (FM), osteoarthritis (OA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) who were recruited from an Austrian health care facility. Respondents completed online surveys, including the Gratitude Questionnaire 6-item form, the Self-Compassion Scale short form, the Self-Forgiveness and Forgiveness of Others Index, the Perceived Stress Scale 4, the Patient Health Questionnaire 2, the 2-item Generalized Anxiety Disorder Scale, the Sleep Condition Indicator, and the Health Assessment Questionnaire. Bivariate and serial mediation analyses were conducted. Results For our sample of 1,218 patients (52% female, n = 632; AS [37%], OA [34%], RA [14%], and FM [24%]), stress, depression, and anxiety, in parallel as first-order mediators, and sleep quality as a second-order mediator, explained the association between positive psychological variables and functional disability. Conclusion Positive psychological factors exert a beneficial downstream effect on mental well-being, sleep health, and health-related functional impairment. Therapeutic promotion of gratitude, self-compassion, and self-forgiveness may improve mental and physical health in patients with rheumatic and musculoskeletal disease.

Objectives This study aims to evaluate the effectiveness of two multidisciplinary fibromyalgia programs with different intensities. Materials and methods In this retrospective real-world comparison of patient data, pre- and post-program datasets of Short Form 36 (SF36) and Fibromyalgia Impact Questionnaire (FIQ) were obtained from a total of 210 female patients in two fibromyalgia multidisciplinary day hospital programs including one intensive program with daily treatments summing up to 20 treatment days during four weeks (P20, n=70) versus a less intensive program with 12 treatment days during four weeks (P12, n=140). Results Multiple subscales of SF36 and FIQ were improved in the pre-post comparison in both groups. In the comparison between the two groups, a statistically significantly higher improvement was found in the P20 group compared to the P12 group for the FIQ subscales of stiffness (p=0.001) and the number of days during which the patient felt "good" (p=0.007). Conclusion An intensive program of daily treatments and activity seems to be more effective in reducing fibromyalgia-associated stiffness and improving the number of days during which patients feel good than a less intensive program.

Zusammenfassung Ziel der Studie Der Anteil an erwachsenen Bluthochdruckpatienten wurde 2010 weltweit auf 31,1% geschatzt. Ziel dieser Studie war es die Effekte von Lebensstilanderungen bei Patienten mit arterieller Hypertonie (AH) in der Primarversorgung zu untersuchen. Methodik Systematische Literaturrecherche in den Online-Datenbanken PubMed, Embase, Cochrane und Opengrey. Es wurden nur randomisierte kontrollierte Studien der Jahre 2005-2017 in deutscher oder englischer Sprache berucksichtigt. Ergebnisse Von 458 identifizierten Texten, wurden 11 Studien ausgewertet. Die untersuchten Patientengruppen waren sehr heterogen und unterzogen sich verschiedenen Interventionstypen. Besonders haufig waren Schulungen zum Krankheitsbild, regelmasige Selbstmessungen des Blutdrucks oder Patientenerinnerungen zur Einhaltung eines gesunden Lebensstils angewandt worden. Schlussfolgerung Es bedarf weiterer Studien, welche gezielt die hausarztliche Versorgung betrachten. Viele Lebensstilinterventionen scheinen aber sehr gute Effekte bei Patienten mit bereits bestehender AH zu zeigen (Sekundarprophylaxe), so dass diese Masnahmen die Basis einer antihypertensiven Therapie bei allen Patienten mit AH bilden sollten. Zudem ist es wichtig die Beratung zu einem gesunden Lebensstil wahrend der medikamentosen Therapie aufrecht zu erhalten.

Introduction: Patients with atopic dermatitis (AD) have several potential stressors including the symptoms of the disease itself, the stigmatization due to their appearance, and emotional and psychological strain. Psychological factors and stress can trigger and exacerbate the symptoms of skin diseases and there is evidence that stress has a relevant clinical effect on the function of skin cells in vivo. Our objective was to evaluate in a pilot study the feasibility, acceptance, and effectiveness of a Mindfulness-Based Stress Reduction (MBSR) programme in AD patients in a clinical setting. Methods: 10 patients took part in an 8-week MBSR programme, which included, e.g., mindful and conscious awareness of the body and bodywork, and seated meditation. We assessed sociodemographics and disease related variables with standardized measures at predefined time points including Score of Atopic Dermatitis, Patient Oriented Eczema Measure, Dermatology Life Quality Index, Perceived Stress Questionnaire, Freiburg Mindfulness Inventory (FMI), and others. Participants also gave qualitative feedback regarding the effects of the intervention. Results: The mean age was 53.10 years (SD = 15.04), seven patients were female, and disease duration was 36.6 years (SD = 25.5). Calculating pre-post effect sizes (Cohen’s d), the FMI indicated significant improvement in the “presence” and “acceptance” subscales. There was also tendency for less stress. This was confirmed by the qualitative statements of the participants. Conclusions: The MBSR programme is feasible and acceptable for AD patients. Considering the long disease history and the severity of disease burden, the effects of this intervention seem promising as an adjunct to conventional treatments for patients with AD.

Fibromyalgia has a significant impact on the lives of patients, symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

Hamodialysepatienten (HDP) leiden neben einer terminalen Niereninsuffizienz haufig an Depression, Angsten und Stress. Korperliche Aktivitat (KA) hat auf diese Komorbiditaten einen positiven Einfluss. Neben der aktuellen korperlichen Aktivitat wurden potentielle Korrelate der KA bei HDP erhoben, um mogliche Praventionsansatze abzuleiten. Die Daten wurden in 13 Dialysezentren in Bayern erhoben. Ein standardisierter Fragebogen wurde verwendet, um die KA (EHIS-PAQ) und Korrelate der KA in 240 HDP abzufragen. Geschlechtsunterschiede wurden mittels t‑ bzw. Mann-Whitney-U-Test ermittelt (Signifikanzniveau p

Background The study of resilient traits (RT) including self-compassion, self-forgiveness, forgiveness of others, and gratitude has garnered the attention of investigators involved in health and healthcare research (1, 2). Little is known about such RT in patients with AS, RA, and FM. Objectives To examine patient group differences in levels and mental and physical health correlates of self-compassion, self-forgiveness, forgiveness of others, and gratitude. Methods We conducted an online survey with patients attending the Gastein Healing Galleries in Bad Gastein, Austria. In this health facility, approximately 12,000 patients suffering from different diseases are treated annually. Of those, 6,465 patients were invited by email to participate anonymously. Socio-demographics and health-related variables including depression, pain, and current health status were measured in all respondents. Also measures of self-compassion, self-forgiveness, forgiveness of others, and gratitude were administered in a subset of participants. Results In total 2,017 patients responded (=31%) of which a subset of 562 patients with AS (44%), FM (38%), and RA (18%) completed measures of RT. Sex ratio (male/female) was 52%/48%, mean age 57 (SD=11) and level of education was: Elementary School 28%, Junior High School 22%, High School 20%, College 13%, and University 17%. Across patient groups, no differences emerged in levels of self-forgiveness, forgiveness of others, or gratitude (ps>.30), although FM patients reported lower levels of self-compassion compared to patients with AS and RA (p Conclusion We found that only self-compassion varied across patient groups, with FM patients reporting lower levels. All RT were consistently related to depression across the three patient groups, but gratitude was also related consistently across groups to both pain and health. RT may well vary according to patient diagnoses with some traits offering more support and resilience-building to the patient than other traits. An important key for treatment support and management may be to identify which traits are most useful to encourage the development of resilience and health in specific patient groups. References [1] Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2015). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 14(3), 334-347. [2] Liu L, Xu X, Xu N, Wang L. Disease activity, resilience and health-related quality of life in Chinese patients with rheumatoid arthritis: a multi-center, cross-sectional study. Health Qual Life Outcomes. 2017Jul24;15(1):149. Disclosure of Interests None declared

Background Sleep problems and fatigue are very common in rheumatic diseases and painful conditions. There is mounting evidence that sleep problems and fatigue have reciprocal influences on musculoskeletal pain, mood, and overall well-being of patients with rheumatic disorders. In addition, sleeping problems are a risk factor for developing chronic widespread pain. Objectives To assess and compare sleep problems and fatigue in a cohort of patients with AS, RA and FM. Methods We conducted an online survey with patients regularly attending the Gastein Healing Galleries in Bad Gastein, Austria. In this health facility appr. 12,000 patients with a variety of disease are being treated annually. Of those, 6,465 patients were invited by email to fill out the survey anonymously. Sociodemographics and disease related variables (e.g. pain, depression) were assessed, including current health status, three items concerning sleep quality, duration of sleep problems, and the number of nights affected by sleep problems, and four items from the Multidimensional Fatigue Inventory (general fatigue subscale) concerning feeling fit, tired, rested, and tiring easily. Results In total 2,017 patients responded (=31%) of which a subset of 784 respondents indicated a diagnosis of AS (43%), RA (40%), or FM (17%). Their mean age (SD) was 58 years (11) and 53% were male. Level of education was: Elementary School 30%, Junior High School 22%, High School 20%, College 13%, and University 15%. Only 17% of AS, 20% of RA and 12% of FM patients indicated that their sleep quality is not affected. In 51.6% of AS, 47.2% of RA and 64% of FM patients the duration of the sleeping problem persists more than one year. Examining levels of sleep problems and fatigue across these three groups revealed significant variation (p Conclusion We found sleep problems and fatigue to be common, chronic and elevated in AS, RA and FM, but not equally so across diagnostic categories. FM patients showed the greatest problems with sleep and fatigue. Furthermore, it appears that fatigue and sleep problems may have the most important connection to health for FM patients. To conclude, it is important to address sleep problems and fatigue in routine clinical assessment and management of patients with AS, RA and FM. Disclosure of Interests None declared

Background: Patient education is an important part of the management of rheumatic and other diseases. Since patients do not have the same needs, it is crucial to assess needs of a targeted group to be able to tailor educational interventions. Objectives: To assess educational needs of a large cohort of patients with different rheumatic and musculoskeletal diseases attending a health facility in Austria. Methods: We conducted an online survey with patients attending the Gastein Healing Galleries in Bad Gastein, Austria. Approximately 12,000 patients with a variety of diseases are treated in the centre every year. Of those, 6,465 patients were invited by email to fill out an anonymous online survey. Socio-demographics and health outcomes were collected from all respondents. In addition, the Educational Needs Assessment Tool (Austrian version - OENAT) was administered to a subset of respondents. The OENAT (39 items) assesses 7 domains of educational needs: Managing Pain, Movement, Managing Feelings, Arthritis/Disease process, Treatments, Self Help Measures, Support Systems. Results: In total 2017 (31%) patients responded of which 516 had data on educational needs: AS (63%), RA (14%), and FM (24%). Their mean (SD) age was 56 (11), and 54% were male. Level of education was: Elementary School (32%), Junior High School (22%), High School (21%), College (12%), and University (14%). Table 1 presents differences in educational needs across disease groups. Across the groups, there were significant differences in following OENAT domains: Managing Pain, Feelings, Treatments, and Support Systems. There were no differences in the level of educational needs in Movements, Disease Process, and Self-Help Measures. Patients with FM had significantly lower needs for managing and higher needs for feeling education, compared to those with AS and RA (p Conclusion: Educational needs vary by disease groups and depend on the domain under consideration. Disclosure of Interests: None declared

Background:Stigma, defined as social devaluation of an individual, can be an important stressor for chronic pain patients [1]. Not every condition is stigmatized. A relevant factor for illness stigmatization seems to be whether the cause is mental-behavioural or physical. Chronic pain is often regarded as an imaginary illness or caused by psychological problems [2]. Sources of stigma for chronic pain patients are perceived negative attitudes from family members, the general public, and physicians [1]..Objectives:To assess perceived stigma and the associations with disease variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey, and we sent the survey battery to 192 potential participants via postal mail. To measure perceived stigma, we used the Chronic Pain Stigma Scale (CPSS) developed by Reed [3], which has 30 items and 3 subscales (public, physicians, family). We also assessed sociodemographic characteristics, disease related variables (e.g., pain, stress, depression, anxiety), and other health-related factors, including health related quality of life [Healthy Days Core Module (CDC HDQOL-4)], disease specific impact (FIQ), fear avoidance belief questionnaire (physical activity subscale) (FABQ-PA), pain catastrophizing scale (PCS) and pain self-efficacy questionnaire (PSEQ).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). There was no significant gender difference in the stigma subscales, nor was there an association with duration of chronic pain. Table 1 presents the significant Pearson correlations.Table 1.Correlations of CPSS stigma subscales with health variables. *CPSS-publicCPSS-physicianCPSS-familyRegional pain scalens.19*.20*VAS pain todaynsnsNsFIQ.20*.16*.22**HADS-anxiety.37*.20*.24*HADS-depression.41**.16*.25**CDC-HDQOL-4 General health.19*.18*.22** Physical health.19*nsns Mental health.20*ns.21* Impairment.24*nsnsPerceived stress scale.44**.24**.37**FABQ-PAns-.17*nsPCS.21*nsnsPSEQ.19*ns.18*Conclusion:Perceived stigma in our FM patient cohort has an important impact on a variety of different disease variables including mental and general health, physical functioning, and on pain coping. Stigmatizing attitudes perceived from the general public exhibited the greatest association with most variables in our chronic pain patients. Perceived stigma from physicians and the family were also related to negative disease consequences in our FM patients. To conclude, we assert that assessing and addressing multi-source perceived stigmatization in routine clinical care may improve the management and wellbeing of patients with FM.References:[1]Waugh OC, Byrne DG, Nicholas MK. Internalized stigma in people living with chronic pain. J Pain 2014;15(5):550 e1-10.[2]Werner A, Isaksen LW, Malterud K. ‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain. Soc Sci Med 2004;59(5): 1035-45[3]Reed P. Chronic pain stigma: developement of the Chronic Pain Stigma Scale. 2005.Disclosure of Interests:None declared

Background:In chronic pain care a multidimensional perspective with attention to patients’ cognitions, emotions, and their ability to cope is needed (1). Previous studies are also pointing to the role of experiencing meaningfulness in life in the adjustment to disability.Therefore care should additionally focus on the existential domain of patients’ lives to live up to a holistic care approach (2). However, there are only a few studies on how FM patients are satisfied with practitioners’ attention to multiple aspects of life with a chronic pain condition.Objectives:To assess perceived satisfaction with chronic pain care and its associations with health variables in a cohort of patients with FM.Methods:We invited 18 FM self-help groups in Germany to participate anonymously in our survey and sent them in total 192 paper-and-pencil surveys. Sociodemographics, disease related variables (e.g. pain, general health) and psychological variables [e.g. depression, anxiety, hope, stress] were assessed with standardized instruments, including 5 items (answer format 1=very unsatisfied – 10=very satisfied) assessing subjective satisfaction with medical care in different domains with the following questions: How satisfied are you with the attention of your treatment team/physician at home for physiological aspects of your pain (Physio)/ the consequences of the pain on your physical functioning (Physical)/ on your psychological well-being (Mental)/ on your social life (Social)/ on your meaning in life (Meaning).Results:In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). The satisfaction with care scale showed good internal consistency and measured one factor. The means of the subscale were: Physio 5.7 (SD=2.5)/ Physical 5.5 (SD=2.5)/ Mental 5.5 (SD=2.6)/ Social 5.0 (SD=2.5)/ Meaning 5.3 (SD=2.6). Correlations of the subscales are depicted in Table 1. There were no associations between pain variables and satisfaction with care, but satisfaction with care was associated with mental health, but not physical health, outcomes.Table 1.Correlations of satisfaction of care with different health variables. Subscales physiological and physical aspects and HADS-anxiety were not significantly correlated. *PhysioPhysicalMentalSocialMeaningHADS-depression-.10 (ns)-.12 (ns)-.19*-.16*-.14 (ns)General Health .02 (ns) .14 (ns) .13 (ns) .18* .12 (ns)Stress-.15 (ns)-.14 (ns)-.17*-.17*-.13 (ns)Hope .18 (ns) .18 (ns) .26** .26* .22*Conclusion:In this cohort of German FM patients the average satisfaction with care overall, as well as the specific aspects of care, was only moderate. Interestingly we found associations between satisfaction with care in mental, social and meaning in life aspects with psychological well-being pointing to the fact that care for chronic pain patients should also include those aspects in addition to just addressing biomedical aspects.References:[1]Flor H and Turk D. Chronic pain: an integrated approach. Seattle, WA: IASP Press, 2011.[2]Dezutter J, Casalin S, Wacholtz A, et al. Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitat Psychol 2013; 58:334–341.Disclosure of Interests:None declared

Die meisten grippalen Infekte oder „Erkaltungen“ werden durch Viren verursacht — doch selbst bei bakteriellen Infektionen sollte zunachst eine rein symptomatische Behandlung versucht werden. Hierfur stehen hauptsachlich Analgetika, Dekongestiva und pflanzliche Mittel zur Verfugung. Fur eine erfolgreiche Therapie mussen diese immer kombiniert werden.

Our objective was to translate the Functional Disability Inventory (FDI) into German, to evaluate its validity and to assess functional limitation in a large cohort of children and adolescents with juvenile fibromyalgia syndrome (jFMS). We administered several questions (e.g., sociodemographics, school-related issues) and questionnaires to 329 patients and one parent. The questionnaires included, among others, a German version of the FDI, the CHAQ (parent report), KIDSCREEN, tender point score (TPS), Depression Inventory for Children and Adolescents (DIKJ) and others. Patients were asked about the severity of pain today (NRS = numerical rating scale) and other symptoms. Internal consistency was evaluated with Cronbach's alpha. Construct validity of the FDI was evaluated by correlating the FDI with the questionnaires as well as with the pain and other variables, e.g., days missed school. An exploratory factor analysis (EFA) was also performed. Mean age was 13.9 years (SD ±2.48). Means were for pain today 5.37 (±2.39) and for the TPS 39.71 (±21.56). Internal consistency was α = .90. Low-to-moderate correlations were obtained between the FDI and the CHAQ (ρ = .51**), KIDSCREEN (e.g., physical well-being ρ = -.62**; peers and social support ρ = -.28**) as well as the pain variables (NRS ρ = .24**; TPS ρ = .38**). Psychological variables were also correlated with the FDI (e.g., DIJK ρ = .28**). An EFA suggested a two-factor solution. The FDI is a valid instrument for measuring functional limitations in German children and adolescents with jFMS.

Fibromyalgia is a chronic illness characterized by pain and fatigue. Persons with fibromyalgia experience increased the risk for poor mental and physical health-related quality of life, which may be dependent on multiple factors, including health beliefs, such as confidence in physicians and the health-care system, and health behaviors, such as treatment adherence. Respondents with fibromyalgia (n = 409) were recruited nationally, via support organizations, and completed self-report measures: Multidimensional Health Profile - Health Functioning Index (MHP-H), Short-Form-36 Health Survey (SF-36v2), and Medical Outcomes Study (MOS) Measure of Patient Adherence - General Adherence Items. In mediation models, belief in the healthcare system and health-care personnel, and health efficacy exerted an indirect effect through treatment adherence on mental and physical quality of life. Adaptive health beliefs and attitudes were related to greater treatment adherence and, in turn, to a better quality of life. Maladaptive health beliefs and mistrusting attitudes about physician-level and systemic-level healthcare provision are negatively related to both treatment adherence and consequent physical and mental health-related quality of life in persons with fibromyalgia. Future randomized controlled trials are needed to determine if therapeutic strategies to alter health values might improve adherence and self-rated health.

Background: The Bavarian Virtual University (BVU) offers resources to develop and implement e-learning courses and allows open access to information and provides the capacity to share information. Students of Bavarian universities can participate easily in these courses. Thus, the barriers to enter a university are now much lower. E-learning will be supported by the use of the learning and authoring software CASUS®. It optimises the creation of virtual patients and guarantees a common standard and a high quality throughout the whole e-learning course. Methods: This paper describes the application process of proposals at BVU and the development process of online courses with CASUS® using the example of “General Practice”. The conceptual structure of the program and its specific rationale is presented herein. In addition, the number of participating students is analysed when the online course is integrated in the curriculum or when it is not. Results: The e-learning course General Practice includes a total of 48 scenarios. They focus on the heuristics in General Practice of prevention and primary care. If the online courses are integrated in the curriculum, the number of students participating in e-learning courses increases. The integration of virtual patients (VPs) into practical training may improve the perceived benefit. Probably, there is no need for examinations to prove students’ knowledge if they can apply contents in the practical training. To answer this question, an evaluation of students’ and teachers’ perspective is needed. In addition, it is challenging to define one level of education for students of different universities. Hence, new methods are needed to develop and evaluate generally accepted standards that fit all participating universities and their students. Conclusions: The application of proposals at BVU and creating VPs with the learning and authoring system CASUS® can be highly recommended to other universities, as well as the establishment of organisations like BVU in other countries.

The benefits of mindfulness for a variety of clinical and nonclinical populations are well established and there is growing interest in the potential of mindfulness in higher education. This article reports on the results from a randomized wait-list controlled study of Mindfulness-Based Coping With University Life (MBCUL), an adaption of Mindfulness-Based Stress Reduction (MBSR) for university students. MBCUL is an 8-week program, which aims to help students bring mindful awareness to their academic work, stress management, approach to communication and relationships, and health. Participants were recruited from the general student body at the University of Northampton (United Kingdom) and were randomized into mindfulness or control groups. The mean age for students in the combined MBCUL group was M = 25.07, SD = 8.25 (18-50), and M = 28, SD = 7.26 (20-41) in the control group. A significant decrease in anxiety, F(1, 21) = 7.82, p =.01; depression, F(1, 22) = 4.15, p =.05; and perceived stress, F(1, 22) = 9.65, p =.01, was found in the MBCUL group compared with controls. Similarly, a significant increase in mindfulness was found in the MBCUL, F(1, 20) = 16.32, p =.001, compared with controls. Attrition was high, and the small numbers limit the generalizability of the data. However, the results suggest that MBCUL is an acceptable, useful mindfulness program for university students, which warrants further investigation with larger samples. Publisher PDF

Contractures are common problems for the elderly with far reaching functional and medical consequences. The aim of this systematic literature review was to give an overview of contracture and to identify potential risk factors associated with contractures.A systematic literature search with two objectives limited to the last 10 years was performed to identify studies dealing with definition of contracture (objective 1 = O1) and with risk factors (objective 2 = O2). Predefined information including age, sample size, study design, setting, condition, joint, definition of contracture, mode of measurement, and whether inter- and/or intra-rater reliability were assessed, as well as risk factors of contracture were extracted.One hundred and sixty one and 25 studies were retrieved. After applying exclusion criteria 47 studies (O1) and 3 studies (O2) remained. Only 9 studies (O1) provided a definition of contracture. In 3 studies (O2) several potential risk factors were identified.In most of the studies it seems that the presence of a contracture is equivalent with the presence of restriction in the range of motion (ROM) of a joint. Very little is known about risk factors for contractures. But it seems that immobility may play a pivotal role in the development of this condition. IMPLICATION FOR REHABILITATION: The prevalence of contractures in nursing home residents is estimated at 55% with significant functional and medical consequences. In most studies, which were published in the last 10 years, the presence of a contracture is equivalent with the presence of restriction in the range of motion of a joint. Immobility seems to play a role in the development of contractures. Potential avenues to prevention of contractures and subsequent functional limitations are exercise programmes for and maintenance of mobility of the elderly.

OBJECTIVES: We compared the magnitude and direction of associations between forgiveness and pain, mental and physical health, quality of life, and anger in a sample of fibromyalgia syndrome (FM) participants and healthy controls. In addition, we compared FM and controls on mean levels of these variables. MATERIALS AND METHODS: A total of 173 individuals with FM and 81 controls completed this study. FM participants and controls were residents of Germany recruited with the support of the German Fibromyalgia Patient Association and several self-help groups. FM participants and controls were about 53 years of age, mostly married (70%), Christians (81%), with levels of education ranging from 9 to 13+ years. All participants completed assessments of forgiveness, pain, health, quality of life, and anger. RESULTS: Analyses revealed that FM participants reported higher pain and anger and poorer health and quality of life. FM participants also reported lower levels of both forgiveness of self and others. Size and direction of associations of forgiveness with pain, health, quality of life, and anger in were not significantly different between healthy individuals and individuals with FM. DISCUSSION: Forgiveness of self and others is beneficially associated with pain, health, quality of life, and anger in FM participants at levels that are of similar size and direction as in healthy controls. However, FM participants manifest lower levels of forgiveness of self and others. Therapeutic promotion of forgiveness as a psychosocial coping strategy may help patients with FM to better manage psychological and physical symptoms, thereby enhancing well-being. ispartof: The Clinical Journal of Pain vol:33 issue:6 pages:528-534 ispartof: location:United States status: published

The objective of this study was to assess spiritual needs of patients with fibromyalgia syndrome (FMS) and to evaluate correlations with disease and health associated variables. Using a set of standardized questionnaires (i.e., Spiritual Needs Questionnaire, Fibromyalgia Impact Questionnaire, SF-36's Quality of Life, Brief Multidimensional Life Satisfaction Scale, etc.), we enrolled 141 patients (95% women, mean age 58 ± 10 years). Here, needs forinner peaceandgiving/generativityscored the highest, whileexistential needsandreligious needsscored lowest. Particularlyinner peaceneeds andexistential needscorrelated with different domains of reduced mental health, particularly with anxiety, the intention to escape from illness, and psychosocial restrictions. Thirty-eight percent of the patients stated needs to be forgiven and nearly half to forgive someone from their past life. Therefore, the specific spiritual needs of patients with chronic diseases should be addressed in clinical care in order to identify potential therapeutic avenues to support and stabilize their psychoemotional situation.

Our objectives were to translate the Quality of Life Scale (QOLS) into German and to evaluate its reliability and validity for the use in patients with fibromyalgia (FMS). Together with German versions of the Fibromyalgia Impact Questionnaire (FIQ), the SF-36, a tender point count (TPC) and other questionnaires, we administered the QOLS to 146 patients with FMS. Patients were asked about the severity of pain today (VAS) and the duration of symptoms. Test-retest reliability was assessed using Spearman's correlations. Internal consistency was evaluated with Cronbach's alpha. Construct validity of the QOLS was evaluated by correlating the QOLS with the FIQ, the SF-36, the Beck Depression Inventory (BDI), and the Symptom Checklist (SCL-90-R) as well as with the pain variables. An exploratory factor analysis (EFA) was also conducted. Mean age was 53.1 years. Means were for pain today 6.8 and for duration of symptoms 11.8 years. Test-retest reliability for the total QOLS was rho = .91. Internal consistency was α = .90. Low-to-moderate correlations were obtained between the QOLS and the total FIQ (rho = -.42), the SF-36 (e.g. physical functioning rho = .37; mental health rho = .56) as well as the pain variables (VAS rho = -.11 ns; TPC rho = -.20). Psychological variables were moderately to substantially correlated with the QOLS (e.g. BDI rho = -.61). An EFA suggested a three-factor solution. The QOLS-G is a reliable and valid instrument for measuring quality of life in German patients with FMS.

The demographic change is having a strong impact upon Europe's societies and upon our financial and social security systems. To avoid cost intensive retirement homes, one main goal for European governments is to build up and maintain a socio-technological infrastructure that allows elderly people to stay in their familiar surroundings and cultivate their social networks as long as possible, with support of assistive technologies. However, when deployed in real-life settings, i.e. "in the wild", it has been shown that these will only be accepted and therefore effective, when integrated into an environment that aims at enhancing people's health and well-being in general. Although it is well known that moderate physical training as well as mental exercising are crucial for maintaining health and well-being, lack of motivation frequently prevents individuals from exercising regularly. We introduce a simple way to motivate elderly people for mental jogging and physical training with assistive indoor and outdoor technology.

Background: Distant healing, a form of spiritual healing, is widely used for many conditions but little is known about its effectiveness. Methods: In order to evaluate distant healing in patients with a stable chronic condition, we randomised 409 patients with chronic fatigue syndrome (CFS) from 14 private practices for environmental medicine in Germany and Austria in a two by two factorial design to immediate versus deferred (waiting for 6 months) distant healing. Half the patients were blinded and half knew their treatment allocation. Patients were treated for 6 months and allocated to groups of 3 healers from a pool of 462 healers in 21 European countries with different healing traditions. Change in Mental Health Component Summary (MHCS) score (SF-36) was the primary outcome and Physical Health Component Summary score (PHCS) the secondary outcome. Results: This trial population had very low quality of life and symptom scores at entry. There were no differences over 6 months in post-treatment MHCS scores between the treated and untreated groups. There was a non-significant outcome (p = 0.11) for healing with PHCS (1.11; 95% CI –0.255 to 2.473 at 6 months) and a significant effect (p = 0.027) for blinding; patients who were unblinded became worse during the trial (–1.544; 95% CI –2.913 to –0.176). We found no relevant interaction for blinding among treated patients in MHCS and PHCS. Expectation of treatment and duration of CFS added significantly to the model. Conclusions: In patients with CFS, distant healing appears to have no statistically significant effect on mental and physical health but the expectation of improvement did improve outcome.

Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.