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Capillary optical fibers with hole diameters of several micrometers are important for novel plasmonic applications and medical diagnosis. In order to ensure the optical functionality of these fibers, the diameter of the capillary hole needs to be realized with high accuracy. Here, we introduce a novel and noninvasive methodology to characterize optical fibers and discuss it for the assessment of capillaries. In this method, the fiber is side-illuminated by a coherent beam, and the resulting diffraction pattern is analyzed. This corresponds to an in-line holographic measurement in the presence of strong scattering. A numerical parameter retrieval allows us to characterize the capillary hole diameter with an accuracy of approximately 100 nm for radii between several hundreds of nanometers and several tens of micrometers.

Background: The night clinic which is part of the psychiatric department of the University of Zurich is a part-time treatment option with psychiatric treatment and support in the evening. This study aimed to characterize the patients and detect different functions of the treatment setting., Methods: Data of 253 patients covering a six-year period from 2008 up to 2013 were retrospectively assessed using descriptive methods. Subgroups according to the situation before admission and after discharge were compared., Results: Patients admitted from home differed considerably from those who were transferred from a psychiatric ward concerning sociodemographic and clinical factors. They were more frequently single, unemployed, received disability funds and suffered from a psychotic disorder. They were also more likely to be discharged in a supported housing condition., Conclusions: The night clinic serves as an alternative to full inpatient treatment for individuals who have work as well as a rehabilitative option for homeless patients with severe mental illness. It contributes to a reduction of avoidance of inpatients stays for those groups of patients.

We present a fiber-integrated laser enabling independent tuning of two emission wavelengths with a synchronized pulsed emission. The discrete tuning concept comprises a theta cavity fiber laser (TCFL), a fiber Bragg grating (FBG) array as a versatile spectral filter, facilitating tailored tuning ranges, and optical gating to control the emission spectrum. A novel electrical driving scheme uniquely enables independently tunable multi-wavelength emission from a single laser oscillator. Tunable dual-wavelength emission is experimentally investigated with a ytterbium (Yb)-doped TCFL using an FBG array with 11 gratings. Over a tuning range of 25 nm, 55 wavelength pairs have been demonstrated with high signal contrast (≈ 40 dB) and narrow linewidth (< 40GHz). Based on the demands of prospective applications, pulse synchronicity is studied with a fiber-based time-delay spectrometer (TDS) simultaneously measuring the joint temporal and spectral pulse properties down to a single-pulse analysis. Accordingly, tunable and fully synchronized dual-wavelength emissions have been verified by driving the TCFL with optimized electrical gating parameters. This unique operation mode achieved in a cost-efficient fiber-integrated laser design targets novel applications e.g. in nonlinear spectroscopy and biophotonics.

Study Design: A multicenter, population based, case-control study., Objective: The aim of the present analysis is to clarify potential differences in the "occupational risk profiles" of structural lumbar disc diseases on the one hand, and low back pain (LBP) on the other hand., Summary of Background Data: Physical workplace factors seem to play an important etiological role., Methods: We recruited 901 patients with structural lumbar disc diseases (disc herniation or severe disc space narrowing) and 233 control subjects with "low-back-pain." Both groups were compared with 422 "low-back pain free" control subjects. Case history, pain data, neurological deficits, and movement restrictions were documented. LBP was recorded by the Nordic questionnaire on musculoskeletal symptoms. All magnetic resonance imaging, computed tomography, and X-rays were inspected by an independent study radiologist. The calculation of cumulative physical workload was based on a computer-assisted interview and a biomechanical analysis by 3-D-dynamic simulation tool. Occupational exposures were documented for the whole working life., Results: We found a positive dose-response relationship between cumulative lumbar load and LBP among men, but not among women. Physical occupational risks for structural lumbar disc diseases [odds ratio (OR) 3.7; 95% confidence interval (95% CI) 2.3-6.0] are higher than for LBP (OR 1.9; 95% CI 1.0-3.5)., Conclusion: Our finding points to potentially different etiological pathways in the heterogeneous disease group of LBP. Results suggest that not all of the structural disc damage arising from physical workload leads to LBP., Level of Evidence: 4.

Objective This study aims to assess psychiatric morbidity and self-rated health (SRH) of homeless people in Zurich, Switzerland. Methods Cross-sectional study of N = 338 homeless people, assessement of psychiatric disorders (ICD-10), level of functioning (GAF, HoNOS), self-rated health. Comparison of SRH among homeless people with a sample of Zurich (N = 956) and Swiss (N = 21 579) population. Results 96 % of the homeless people had at least one psychiatric disorder, most of them drug- (60.9 %) or alcohol-dependence (41.5 %). Homeless people had a far lower SRH than the Zurich population. Higher impairment in HoNOS was associated with lower levels of SRH. Low SRH was associated with help care seeking (OR = 1.9, p < 0.001) and medication (OR = 1.5, p = 0.006). Conclusions The prevalence of psychiatric disorders is far higher among homeless people compared to the general population in Zurich. Implications for providing help at the intersection of social and health care are discussed., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

We demonstrate a novel tuning concept for pulsed fiber-integrated lasers with a fiber Bragg grating (FBG) array as a discrete and tailored spectral filter, as well as a modified laser design. Based on a theta cavity layout, the structural delay lines originating from the FBG array are balanced, enabling a constant repetition rate and stable pulse properties over the full tuning range. The emission wavelength is electrically tuned with respect to the filter properties based on an adapted temporal gating scheme using an acousto-optic modulator. This concept has been investigated with an Yb-doped fiber laser, demonstrating excellent emission properties with high signal contrast (>35  dB) and narrow linewidth (<150  pm) over a tuning range of 25 nm.

We report on detailed investigations of ytterbium (Yb) and aluminum (Al) doped silica fiber and preform samples co-doped with cerium (Ce). The prevention of pump-induced photodarkening (PD) by temporary oxidation of Ce 3+ to Ce 4+ (or rather Ce 3++ ) was proved by observed modifications in the ultraviolet (UV) spectra of transient absorption during near-infrared (NIR) pumping of thin preform slices. Only a small part of available Ce 3+ ions (< 4%) was found to be involved in this process despite Yb inversions of up to 0.28. The modifications in the UV absorption spectra disappeared completely when the pump power was switched-off. From these observations we conclude that the recombination to Ce 3+ takes place very fast thereby enabling these ions to capture liberated holes h + perpetually during further pumping. We found a concentration ratio of Ce/Yb ≈0.5 to be sufficient to reduce PD loss to 10% in comparison to Ce-free fibers. Thus, the thermal load caused by absorption of PD color centers at pump (and laser) wavelength is expected to be also reduced. Unfortunately, new heat sources arise with the presence of Ce which cannot be explained by the absorption of Ce ions at the pump wavelength but must be attributed to the interaction with excited Yb ions. Fiber temperature increase of more than 200 K was observed if both, Yb 2 O 3 and Ce 2 O 3 concentration exceed 0.4 mol%.

Work is beneficial for the recovery from mental illness. Although the approach of individual placement and support (IPS) has been shown to be effective in Europe, it has not yet been widely implemented in European health care systems. The aim of this randomized controlled trial was to assess the effectiveness of IPS for disability pensioners with mental illnesses new on disability benefits in Switzerland. In the study at hand, 250 participants were randomly assigned to either the control or the intervention group. The participants in the intervention group received job coaching according to IPS during 2 years. The control group received no structured support. Both groups were interviewed at baseline and followed up every 6 months (baseline, 6, 12, 16, 18, 24 months) for 2 years. Primary outcome was to obtain a job in the competitive employment. IPS was more effective for the reintegration into the competitive employment market for disability pensioners than the control condition. Thirty-two percent of the participants of the intervention group and 12% of the control group obtained new jobs in the competitive employment. IPS is also effective for the reintegration into competitive employment of people with mental illness receiving disability pensions.

Acousto-optic modulation of a 1 cm fiber Bragg grating at 10.9 MHz frequency and 1065 nm wavelength is demonstrated for the first time. A special modulator design is employed to acoustically induce a dynamic radial long period grating which couples power of the fundamental mode to the higher-order modes supported by the Bragg grating. A modulated reflection band with a depth of 16 dB and 320 pm bandwidth has been achieved. The results indicate a higher modulation frequency compared to previous studies using flexural acoustic waves. In addition, the reduction of the grating length and the modulator size points to compact and faster acousto-optic modulators.

For most crops, like Capsicum, their diversity remains under-researched for traits of interest for food, nutrition and other purposes. A small investment in screening this diversity for a wide range of traits is likely to reveal many traditional varieties with distinguished values. One objective of this study was to demonstrate, with Capsicum as model crop, the application of indicators of phenotypic and geographic diversity as effective criteria for selecting promising genebank accessions for multiple uses from crop centers of diversity. A second objective was to evaluate the expression of biochemical and agromorphological properties of the selected Capsicum accessions in different conditions. Four steps were involved: 1) Develop the necessary diversity by expanding genebank collections in Bolivia and Peru; 2) Establish representative subsets of ~100 accessions for biochemical screening of Capsicum fruits; 3) Select promising accessions for different uses after screening; and 4) Examine how these promising accessions express biochemical and agromorphological properties when grown in different environmental conditions. The Peruvian Capsicum collection now contains 712 accessions encompassing all five domesticated species (C. annuum, C. chinense, C. frutescens, C. baccatum, and C. pubescens). The collection in Bolivia now contains 487 accessions, representing all five domesticates plus four wild taxa (C. baccatum var. baccatum, C. caballeroi, C. cardenasii, and C. eximium). Following the biochemical screening, 44 Bolivian and 39 Peruvian accessions were selected as promising, representing wide variation in levels of antioxidant capacity, capsaicinoids, fat, flavonoids, polyphenols, quercetins, tocopherols, and color. In Peru, 23 promising accessions performed well in different environments, while each of the promising Bolivian accessions only performed well in a certain environment. Differences in Capsicum diversity and local contexts led to distinct outcomes in each country. In Peru, mild landraces with high values in health-related attributes were of interest to entrepreneurs. In Bolivia, wild Capsicum have high commercial demand.

Objectives: Main goal of this review is to identify predictive factors for the outcome of Individual Placement and Support (IPS) with a focus on Supported Employment (SE) and of pre-vocational training (PVT) of individuals with mental illness., Method: A systematic search of PsychInfo, PubMed, PsychIndex and PsyArticles was conducted. Studies were included if they compared both approaches, SE and PVT, contained predictors to optimize SE or PVT, investigated the effectiveness of SE or examined what constitutes adequate job coaching., Results: 45 articles have been included. 27 articles referred to predictors that influence the outcome of SE or PVT, 9 showed a direct comparison between both approaches, 5 investigated job coaching and 4 examined the effectiveness of SE.In summary motivation, work experience and high fidelity of IPS criteria seem to be the most important predictors for a successful job reintegration using SE., Discussion: Overall, SE is more effective than PVT. The success of SE can be enhanced by keeping the predictors in mind. However, future research should focus more specifically on predictors., (© Georg Thieme Verlag KG Stuttgart · New York.)

We present a novel method to discretely tune the emission wavelength of pulsed fiber-integrated lasers. As spectral filter, a step-chirped fiber Bragg grating (FBG) array is employed combining a monolithic structure with an unrivaled design freedom enabling large tuning bandwidths as well as tailored spectral characteristics towards fingerprint tuning features. Together with an electrical control mechanism ensuring programmable operation, this tuning method promotes fiber-integrated lasers to access new fields of applications e.g. in biophotonics and distributed sensing. The potential of this tuning concept is investigated based on an Ytterbium-doped fiber laser. The system shows superb emission properties including excellent wavelength stability, high spectral signal contrast (up to 50dB) and narrow linewidth (15GHz) as well as adjustable pulse durations in the nanosecond range with peak powers up to 100W. Additionally, the unique spectral potential of this method is demonstrated by realizing filter designs enabling e.g. a record tuning range of 74nm for fiber-integrated lasers.

This study aims to investigate clients' satisfaction with individual placement and support (IPS) at the University Hospital for Psychiatry Zurich (PUK). Furthermore, this study aims to investigate if clients feel the approach of IPS as a useful approach to fulfill their needs. One hundred twenty-five people were recruited from one of the three IPS services of PUK and were asked to complete a structured questionnaire. The following IPS services were available: (i) randomized controlled trial (RCT) ZHEPP (www.zhepp.ch), (ii) RCT ZInEP (www.zinep.ch), and (iii) us clinical supported employment service of PUK (IPS-PUK). The clients mostly indicated that IPS was generally useful and fitted their needs. Overall satisfaction of the participants with the IPS services of the PUK was very high. Furthermore, client satisfaction and symptom severity are inversely associated. In conclusion, participants of the IPS services received the support they were looking for. This means that the approach of IPS fits the needs of different patient groups and can be used without any modifications. The most important limitation is the unequal group sizes. Therefore, the obtained results need to be strengthened by future research.

We present a dual-focus second harmonic generation (SHG) microscopy approach based on stable, compact, and inexpensive fiber technology. One-tenth of the fiber laser output is coupled into a 100 m (≙500  ns) long single-mode fiber and further amplified to achieve two separately guided beams with time-alternating pulse trains. SHG detection is performed sequentially, generating two individual images in one scan. Thus, the configuration allows for imaging of distinct areas within the field of view at twice the repetition rate of the fiber laser but is readily extended to a multiple of the repetition rate with tens of foci.

The present study evaluated a new integrated treatment concept offering inpatient care, acute psychiatric day hospital and outpatient treatment by the same therapeutic team. 178 patients participated in this randomized controlled trial. Data on psychopathology, global and social functioning, patient satisfaction, continuity of care and administrative data was gathered on admission, throughout the course of treatment, upon discharge and at 1-year follow-up. In addition, the physicians in charge rated the therapeutic relationship. The data analysis consists of group-wise comparisons and regression analyses (cross-tabulations and χ(2) test statistics for categorical data and Mann-Whitney U tests for continuous data). Differences between groups over time were analyzed with a series of generalized linear mixed model. The integrated care group showed a significant reduction in psychopathological impairment (20.7%) and an improvement of psychosocial functioning (36.8%). The mean number of days before re-admission was higher in the control group when compared to the integrated care group (156.8 vs. 91.5). There was no difference in the number of re-admissions and days spent in psychiatric institutions. This new approach offers a treatment model, which facilitates continuity of care. Beside it improves psychopathological outcome measures and psychosocial functioning in patients with mental illness.

Subject: This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted., Methods: Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489)., Results: Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables., Conclusions: The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.

Subject: Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with "heavy user" profiles. These individuals often times change their residence and are extensively hospitalized on acute psychiatric wards. To date, little is known about the needs of providers of sheltered and supported housing concerning cooperation with psychiatric hospitals and support by psychiatric services., Methods: An explorative survey was conducted among the sheltered and supported housing facilities in the canton of Zurich. A short questionnaire was distributed among all 140 institutions in written form. The responses were analyzed thematically with respect to four predefined categories., Results: Fifty-six institutions providing 1,600 places (about 50 % of the capacity in the canton of Zurich) responded. Experiences and problems with the focus group of residents as well as causes for problematic courses are described. A sound working routine with the psychiatric hospitals was considered as a precondition for the provision of high quality housing support. The needs concerned regular and flexible cooperation with psychiatric hospitals as well as open communication in particular at discharge from the clinic and intake at the housing facility., Conclusions: Concentration of competencies and knowledge within psychiatric hospitals about sheltered housing institutions and their needs could improve service provision and may result in higher certitude of housing facilities. Thereby, their ability to manage patients with severe mental illness could be improved and extensive hospitalization of individuals from this group could be reduced.

Objective: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility., Methods: We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010., Results: 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients., Conclusions: A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Manual patient handling commonly induces high mechanical load on the lower back of healthcare workers. A long-term research project, the 'Third Dortmund Lumbar Load Study' (DOLLY 3), was conducted to investigate the lumbar load of caregivers during handling activities that are considered 'definitely endangering' in the context of worker's compensation procedures. Nine types of handling activities in or at a bed or chair were analysed. Measurement of action forces via specifically developed devices and posture recording by means of optoelectronic marker capturing and video recordings in order to quantify several lumbar-load indicators was previously described in detail. This paper provides the results of laboratory examinations and subsequent biomechanical model calculations focused on lumbar load and the potentials of load reduction by applying biomechanically 'optimized' transfer modes instead of a 'conventional' technique and, for a subgroup of tasks, the supplementary usage of small aids such as a sliding mat or a glide board. Lumbosacral-disc compressive force may vary considerably with respect to the performed task, the mode of execution, and individual performance. For any activity type, highest values were found for conventional performance, lower ones for the improved transfer mode, and the lowest compressive-force values were gathered when small aids were applied. Statistical significance was verified for 13 of these 17 comparisons. Analysing indicators for asymmetric loading shows that lateral-bending and torsional moments of force at the lumbosacral disc may reach high values, which can be reduced considerably by implementing an improved handling mode. When evaluating biomechanical loads with respect to age- and gender-specific work-design limits, none of the analysed tasks, despite execution mode, resulted in an acceptable load range. Therefore, applying a biomechanically adequate handling mode combined with small aids to lower the friction between patient and surfaces is highly recommended, especially to prevent overload in older caregivers.

Objectives: The acceptance and use of long-acting depot antipsychotics has been shown to be influenced by the attitudes of patients and clinicians. Depot treatment rates are low across countries and especially patients with first-episode psychosis are rarely treated with depot medication. The aim of this article was to review the literature on patients' and clinicians' attitudes towards long-acting depot antipsychotics in subjects with first-episode psychosis., Methods: A systematic search of Medline, Embase, PsycINF and Google Scholar was conducted. Studies were included if they reported original data describing patients' and clinicians' attitudes towards long-acting depot antipsychotic in subjects with first-episode psychosis., Results: Six studies out of a total of 503 articles met the inclusion criteria. Four studies conveyed a negative and two a positive opinion of clinicians toward depot medication. No systematic study directly addressed the attitude of patients with first-episode psychosis. Psychiatrists frequently presume that patients with first-episode psychosis would not accept depot medication and that depots are mostly eligible for chronic patients., Conclusions: Full information of all patients especially those with first episode psychosis in a therapeutic relationship that includes shared decision-making processes could reduce the negative image and stigmatization attached to depots.

In contrast to Yb/Al-doped fibers, the influence of very low Tm(2)O(3) concentrations (≥ 0.1 mol-ppm) on photodarkening (PD) is clearly detectable in Yb/P-doped fibers that are known to show little degradation effects. For Tm(2)O(3) additions of more than 50 mol-ppm, the measured PD loss is even similar to Yb/Al-doped fibers with comparable rare earth concentrations. Our work reveals the risk of color center generation by pumping at wavelengths of 915 nm or 976 nm even in Al-free Yb-doped fibers and emphasizes the importance of high purity of raw materials for the preparation of Yb laser fibers with expected very low PD.

We demonstrate the inscription of a 266 nm UV femtosecond pulse-induced fiber Bragg grating (FBG) in an Yb-doped fiber during optical pumping at 976 nm and the initiation of lasing with increasing grating reflectivity. Output spectra show the emission of the pumped fiber changing from the broad-ranged amplified spontaneous emission in the nonlasing case to the narrow-range laser operation due to the enhancement of FBG reflectivity during inscription. The proposed technique enables the direct characterization and control of FBG performance in fiber lasers. After FBG fabrication, we investigate the spectral characteristics of the fiber laser for different laser powers and study the influence of a thermal treatment of the FBG.

We have realized a modified time-delay spectrometer based on a step-chirped fiber Bragg grating array. This method allows simultaneous spectral and temporal characterization of pulsed light sources in the nanosecond regime, which can also be applied to the investigation of single pulses. With a spectral resolution in the 100 pm range, pulse spectrograms are measured and exemplarily used to explore the emission behavior of a wavelength-stabilized laser diode directly modulated in the nanosecond range.

Subject: The largest European multicenter randomized controlled trial to date on the effectiveness of supported employment (EQOLISE) was conducted in six European centres until 2005. It revealed that the intervention "individual placement and support" was more effective than conventional prevocational training services. The aim of this investigation was to assess the Zurich sample (individuals with schizophrenic, schizoaffective or bipolar disorders) 24 months after termination of the EQOLISE trial in terms of working situation, income, and hospital admissions. More favorable outcomes concerning these parameters were assumed for the intervention group., Methods: Assessment of the working situation and psychiatric hospitalizations since the end as well as the development of salaries since the start of EQOLISE. Comparisons between groups and illustration of incomes using a random coefficient model were conducted., Results: 50% of the original sample could be assessed. All subjects who worked in competitive workplaces at the end of EQOLISE were met in a different situation. No differences were found concerning hospital admissions. The mean monthly income considerably increased during EQOLISE and decreased during the third year. At the time of follow-up it was approximately at the same level as the slightly increased control group., Conclusions: This investigation points at limited sustainability of supported employment among individuals with severe mental disorders in terms of maintenance of employment and income if the job coaching is not continued.

The relationship between patient and therapist in mental health care is one of the most important treatment factors. It is a reliable predictor of treatment outcome, regardless of diagnosis, setting or of the type of therapy used. On the other hand, influence and coercion occur in patient-physician relationships in psychiatry. We investigated the associations between patients' perceived coercion and the therapeutic relationship. A total of 116 psychiatric patients, who have been admitted to the Psychiatric University Hospital Zurich, were interviewed using a structured interview. Data were collected by using Scale To Assess the Therapeutic Relationship (STAR) (therapeutic relationship) and Mac Arthur Admission Experience Survey (AES) (perceived coercion). Associations were investigated using bivariate and multivariate methods. Perceived coercion predicts the patients' appraisal of the therapeutic relationship. We found a moderate relation between the patients' and the clinicians' view of their relationship. Perceived coercion is related to a higher symptom level and a lower level of global functioning at admission, and higher perceived coercion is related to a more negative patient-therapist relationship rated by the patient. Perceived loss of autonomy goes hand in hand with a more negative relationship between the patient and the clinician. This phenomenon has to be impeded, regarding the unambiguous impact relationship quality has on treatment outcome., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Polarization instability (PI) of ultrashort light pulses, giving rise to vectorial supercontinuum generation, is demonstrated using a subwavelength-core, highly birefringent, normally dispersive optical fiber. The evolution of ultrashort pulses in the regime of PI is shown to radically differ from polarization-instability dynamics of cw fields and longer laser pulses. As the peak power of the laser field decreases along the propagation path due to dispersion-induced pulse stretching, the Poincaré-sphere map of field dynamics is shown to evolve from the behavior typical of PI in the highly nonlinear regime toward the beating dynamics of uncoupled polarization modes, characteristic of low field intensities and cw fields.

Due to the deficits of schizophrenic patients regarding the understanding of vague meanings (D. Ketteler and S. Ketteler (2010)) we develop a special test battery called HOLF (high order linguistic function test), which should be able to detect subtle linguistic performance deficits in schizophrenic patients. HOLF was presented to 40 schizophrenic patients and controls, focussing on linguistic features such as ambiguity, synonymy, hypero-/hyponymy, antinomy, and adages. Using the HOLF test battery we found that schizophrenic patients showed significant difficulties in discriminating ambiguities, hypero- and hyponymy, or synonymy compared to healthy controls. Antonyms and adages showed less significant results in comparing both groups. The more difficult a linguistic task was, the more confusion was measured in the schizophrenic group while healthy controls did not show significant problems in processing high order language tasks.

Background: The human spine is often exposed to mechanical load in vocational activities especially in combination with lifting, carrying and positioning of heavy objects. This also applies in particular to nursing activities with manual patient handling. In the present study a detailed investigation on the load of the lumbar spine during manual patient handling was performed., Methods: For a total of 13 presumably endangering activities with transferring a patient, the body movements performed by healthcare workers were recorded and the exerted action forces were determined with regard to magnitude, direction and lateral distribution in the time course with a "measuring bed", a "measuring chair" and a "measuring floor". By the application of biomechanical model calculations the load on the lowest intervertebral disc of the lumbar spine (L5-S1) was determined considering the posture and action force data for every manual patient handling., Results: The results of the investigations reveal the occurrence of high lumbar load during manual patient handling activities, especially in those cases, where awkward postures of the healthcare worker are combined with high action forces caused by the patient's mass. These findings were compared to suitable issues of corresponding investigations provided in the literature. Furthermore measurement-based characteristic values of lumbar load were derived for the use in statement procedures concerning the disease no. 2108 of the German list of occupational diseases., Conclusions: To protect healthcare workers from mechanical overload and the risk of developing a disc-related disease, prevention measures should be compiled. Such measures could include the application of "back-fairer" nursing techniques and the use of "technical" and" small aids" to reduce the lumbar load during manual patient handling. Further studies, concerning these aspects, are necessary.

Objective: The assessment of the therapeutic relationship has become increasingly important due to evidence suggesting that it has a direct therapeutic effect and may improve outcome indirectly. In Great Britain and Sweden the STAR (Scale To Assess Therapeutic Relationship) was developed for pan-theoretical assessment of therapeutic relationships from both clinicians' and patients' points of view. We translated the English version of the instrument into German and made an analysis of its feasibility and reliability., Methods: The German translation (STAR-D) was generated in a consensus procedure. The STAR-D was then administered to 100 patients admitted to the Psychiatric University Hospital Zurich (STAR-P) and their clinicians in charge (STAR-C). The psychometric qualities of feasibility and reliability were assessed., Results: The overall results for the scales in terms of feasibility and reliability were satisfactory. We did, however, find shortcomings concerning the subscales. They could not be extracted in the principal component analysis and showed high inter-correlation coefficients., Conclusions: STAR can serve as an important tool in research concerning the therapeutic relationship. We suggest conducting further analyses concerning the validity of the subscales in the German version., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In a German multicenter case-control study of lumbar disc diseases, we calculated risk and rate advancement periods (RAP) for physical workload., Methods: Patients aged 25-70 years with clinically and radiologically verified lumbar disc herniation (286 males, 278 females) or symptomatic lumbar disc narrowing (145 males, 206 females) were compared with population control subjects (453 males and 448 females). For this analysis, all manual handling of objects of about ≥5 kg and postures with trunk inclination of ≥20 °, as assessed by technical experts, were included in the calculation of cumulative lumbar load, determined by biomechanical model calculations. Logistic regression analysis was applied to calculate RAP, adjusted for region., Results: We found a steep positive dose-response relationship between age and lumbar disc narrowing among men as well as women; however, we did not find a monotonic increase in lumbar disc herniation risk with age. As a monotonic increase in disease risk with age constitutes a fundamental assumption underlying the RAP concept, we restricted our RAP analysis to cases with symptomatic lumbar disc narrowing. Among men, there was a positive dose-response relationship between the cumulative lumbar load and the acceleration of lumbar disc narrowing. In the highest exposure category, a RAP of 28.0 years [95% confidence interval (95% CI) 9.7-46.3 years] was found. Among women, the RAP was 8.8 years (95% CI 2.4-15.2 years) in the highest exposure category., Conclusion: This study emphasizes the conceptual importance of risk acceleration - causation not only comprises the occurrence of a disease (that without a specific exposure would not have occurred at all) but also the accelerated occurrence of a disease (that without exposure would have occurred later in life).

Moving patients or other care activities with manual patient handling is characterized by high mechanical load on the lumbar spine of healthcare workers (HCWs). During the patient transfer activity, the caregivers exert lifting, pulling, and pushing forces varying over time with respect to amplitude and direction. Furthermore, the caregivers distinctly change their posture and frequently obtain postures asymmetrical to the median sagittal plane, including lateral bending and turning the trunk. This paper describes a procedure to determine lumbar load during patient transfer supported by measurement techniques and an exemplary application; this methodology represents the basis of a complex research project, the third 'Dortmund Lumbar Load Study (DOLLY 3)'. Lumbar load was determined by simulation calculations using a comprehensive biomechanical model ('The Dortmunder'). As the main influencing factors, the hand forces of the caregiver exerted during typical patient transfers and the posture and movements of the HCW were recorded in laboratory studies. The action forces were determined three-dimensionally with the help of a newly developed 'measuring bed', two different 'measuring chairs', a 'measuring bathtub', and a 'measuring floor'. To capture the forces during transfers in or at the bed, a common hospital bed was equipped with an additional framework, which is attached to the bedstead and connected to the bedspring frame via three-axial force sensors at the four corners. The other measuring systems were constructed similarly. Body movements were recorded using three-dimensional optoelectronic recording tools and video recordings. The posture and force data served as input data for the quantification of various lumbar-load indicators.

Introduction: In the large-scale case-control study EPILIFT, we investigated the dose-response relationship between lifestyle factors (weight, smoking amount, cumulative duration of different sports activities) and lumbar disc disease., Methods: In four German study regions (Frankfurt am Main, Freiburg, Halle/Saale, Regensburg), 564 male and female patients with lumbar disc herniation and 351 patients with lumbar disc narrowing (chondrosis) aged 25 to 70 years were prospectively recruited. From the regional population registers, 901 population control subjects were randomly selected. In a structured personal interview, we enquired as to body weight at different ages, body height, cumulative smoking amount and cumulative duration of different sports activities. Confounders were selected according to biological plausibility and to the change-in-estimate criterion. Adjusted, gender-stratified odds ratios with 95% confidence intervals were calculated using unconditional logistic regression analysis., Results: The results of this case-control study reveal a positive association between weight and lumbar disc herniation as well as lumbar disc narrowing among men and women. A medium amount of pack-years was associated with lumbar disc herniation and narrowing in men and women. A non-significantly lowered risk of lumbar disc disease was found in men with high levels of cumulative body building and strength training., Conclusions: According to our multi-center case-control study, body weight might be related to lumbar disc herniation as well as to lumbar disc narrowing. Further research should clarify the potential protective role of body building or strength training on lumbar disc disease.

Background: During transurethral endoscopic prostate and bladder operations the influence of an ergonomic redesign of the arrangement of the operation equipment - including the introduction of a video-assisted resection method ('monitor endoscopy') instead of directly viewing onto the operation area via the endoscope ('direct endoscopy') - was studied with respect to the postures of the surgeons., Methods: Postures were analysed on the basis of video recordings of the surgeons performed in the operation theatre during live operations and subsequent visual posture estimation executed by an observer. In particular, head, trunk and arm positions were assigned to posture categories according to a newly developed posture classification schema. 10 urological operations with direct endoscopy and 9 with monitor endoscopy were included., Results: Application of direct endoscopy coincides with distinct lateral and sagittal trunk and head inclinations, trunk torsion and strong forearm and upper arm elevations of the surgeons whereas operations with monitor endoscopy were performed with an almost upright head and trunk and hanging arms. The disadvantageous postures observed during direct endoscopy are mainly caused by the necessity to hold the endoscope continuously in close contact with the eye., Conclusion: From an ergonomic point of view, application of the video-assisted resection method should be preferred in transurethral endoscopic operations in order to prevent awkward postures of the surgeons and to limit muscular strain and fatigue. Furthermore, the application of the monitor method enables the use of a chair equipped with back support and armrests and benefits the reduction of postural stress.

Background: The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study., Methods: In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg), patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females) or symptomatic lumbar disc narrowing (145 males, 206 females) were prospectively recruited. Population control subjects (453 males and 448 females) were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males) or psychosocial strain at work (in females), respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag-time analyses., Results: We found a positive dose-response relationship between cumulative occupational lumbar load and lumbar disc herniation as well as lumbar disc narrowing among men and women. Even past lumbar load seems to contribute to the risk of lumbar disc disease., Conclusion: According to our study, cumulative physical workload is related to lumbar disc diseases among men and women.

Objective: We aimed at assessing prevalence and risk factors of interventions including informal coercion to enhance treatment adherence (leverage) in Switzerland. Additionally, we studied attitudes of psychiatric patients towards these methods., Methods: A sample of 187 psychiatric patients with outpatient treatment underwent a semi structured interview., Results: 29% had experience with one or more methods to enhance treatment adherence. The most prevalent intervention was to link housing to patients' readiness to consent with psychiatric treatment. Announcing a less invasive criminal sanction to a psychiatric patient who was arrested or convicted due to a criminal offence was the method to enhance treatment adherence study subjects' endorsed the most. The use of child custody as a tool to enhance treatment acceptance was rejected by the majority of the sample., Conclusions: Interventions including informal coercion are prevalent in the treatment of psychiatric patients. In order to assess if and under what circumstances implementation of these interventions is justified we need to consider the subjective perspective of the affected individuals.

Questions Under Study: This study represents a first attempt at estimating Swiss resource allocation to brain research including both public and private spending., Methods: In order to estimate public spending (by governments and charities) a survey was conducted to evaluate the way brain research is funded across Europe and especially in Switzerland. Industry funding was measured using different approaches including a survey of pharmaceutical expenditures and the costs of developing new drugs., Results: Private spending is at a reasonable level because a highly developed Swiss pharmaceutical industry invests significantly in this branch of science. However, public spending is at a low level compared to other European countries, although Switzerland is the only European country where the total funding per capita exceeds that of US funding., Conclusions: A detailed investigation of Swiss resource allocation to different branches of biomedical research is warranted. Brain research should be an important part of such a study. The United States and the European Union have selected brain research as one of their priority areas within health related research. The present figures indicate that this may also be justified in Switzerland.

Questions Under Study: This study aims at estimating the costs of disorders of the brain in Switzerland based on the published epidemiological and economic evidence., Methods: the data presented for Switzerland are derived from the "cost of disorders of the brain in Europe" study of the European Brain Counsil (EBC). Available Swiss data were integrated., Results: There are an estimated 2 million people currently living with a brain disorder in Switzerland. This number amounts to about 25% of all people living in Switzerland. The total annual costs are estimated to amount to 8.9 billion Euros corresponding to 1200 Euros per inhabitant and per year. Direct medical expenditure accounts for 33% of all expenditure, while indirect costs add up to 49%. Mental disorders account for approximately 2/3 of the total costs of brain disorders, ie, 5.6 billion Euros. This cost estimate comes very close to the current expenses for mental health in Switzerland with 5.3 billion Euros constituting 16% of total health care costs. : The present study probably underestimates the full economic burden of brain and especially mental disorders in Switzerland. In order to better understand the impact of brain disorders on Swiss society prospective field studies are needed in all disorders of the brain.

Background: In a recent study, we showed that administration of low-dose creatine (Cr) (60 mg/kg daily) improved work capacity in patients with McArdle disease., Objective: To assess the efficacy of high-dose Cr therapy in McArdle disease., Design: Randomized, double-blind, placebo-controlled crossover study., Patients: Nineteen patients with McArdle disease., Intervention: Treatment with Cr, 150 mg/kg daily. Each treatment phase with Cr or placebo lasted 5 weeks., Main Outcome Measures: The patient's daily rating of symptoms of exercise intolerance. At the end of each treatment phase, serum creatine and serum creatine kinase levels, phosphorus 31 magnetic resonance spectroscopy, and surface electromyograms were assessed., Results: Clinical end points revealed increases in the intensity of exercise-induced pain in working muscles (mean treatment-induced difference [d], 0.30 in log(score); 95% confidence interval [CI], 0.05-0.55; P =.02), the limitation of daily activities (d, 0.59; 95% CI, 0.22-0.97;P =.005), and body mass index (d, 0.33 kg/m2, 95% CI, 0.10-0.56 kg/m2; P =.008) with Cr use. Surface electromyograms revealed a smaller increase in the electromyographic amplitude over time during muscle contraction with Cr use (d, -13.52%/min; 95% CI, -23.71%/min to -3.34%/min; P =.01). There were no significant changes in phosphorus 31 magnetic resonance spectroscopy variables., Conclusions: Administration of high-dose Cr worsened the main clinical symptoms of exercise intolerance in McArdle disease. These neurologic adverse effects represent a major dose-limiting factor in Cr therapy for McArdle disease. Taken together with results of a previous study, the indication for symptomatic therapy with Cr needs to be clarified. An effective Cr dosage without adverse effects may be between 60 and 150 mg/kg daily.