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This study explored the subjective bodily experiences of patients with a diagnosis of anorexia nervosa (AN) during vibro-acoustic stimulation sessions with the Body Monochord (BoMo), a body sound treatment instrument. A total of 20 female patients diagnosed with AN received two BoMo treatments. Subsequent to the treatments, semi-structured interviews were conducted. Analysis was conducted using Grounded Theory. The following main categories were identified: differentiated perception, focussed attention, emergence of body-related feelings, emergence of emotions, emergence of thoughts, emergence of inner images, relaxation, spatial and temporal experience, new bodily experiences and self-reflection. The subjective experiences during the BoMo treatment were independent of patient body shape and weight, were not exclusively focussed on usual illness-related body problem areas like the belly and the thighs and had both positive and negative connotations. New therapeutic approaches that are suited to handling and integrating new bodily experiences in patients diagnosed with AN may develop from these observations. Due to the variety of issues that emerge during the treatments BoMo might present a meaningful extension to verbal psychotherapy.

Background There has been a marked tendency for researchers, clinicians, and policy makers to shift their focus from risk to resilience. This should be assessed by comparing the outcome to a context specific reference group. The objectives of the study were to generate normative data for the BRCS for different age groups for men and women and to further investigate the construct validity and factor structure in a general population. Methods Nationally representative face-to face household surveys were conducted in Germany in 2013 (n = 2508). Results Normative data for the BRCS were generated for men and women (53.2% female) and different age levels (mean age (SD) of 49.7 (18.0) years). Men had significantly higher mean scores compared with women (14.9 [SD = 3.2] vs. 14.6 [SD = 3.1]). The results of the EFA and CFA clearly indicate a unidimensional solution with one factor. Furthermore, the invariance of the one-factor model was tested for the whole sample across gender and six age groups. Conclusions The normative data provide a framework for the interpretation and comparisons of resilience with other populations. Electronic supplementary material The online version of this article (10.1186/s12955-017-0822-6) contains supplementary material, which is available to authorized users.

Background Patients with severe obesity need to adapt to surgically induced changes in their eating behaviors to maintain treatment success. Objectives This study examined the effects of laparoscopic sleeve gastrectomy (LSG) on weight loss and on 3 dimensions of eating behavior, namely, cognitive restraint, disinhibition, and hunger. Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight-reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support. Setting The study setting was a multidisciplinary obesity center located in a university hospital. Methods A sample of 102 patients with obesity were investigated using the Three-Factor Eating Questionnaire before and, on average, 19 (±5) months after weight loss intervention. Of the 102 patients, 62 (age 45.8±10.8 years, 71% females) underwent LSG, and 40 patients (age 50.6±11.3 years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference. Results In the LSG group, total weight loss was 25.9±11.0%, excess weight loss was 52.8±24.1%, and body mass index decreased from 51.4±8.1 to 38.0±7.8 kg/m². In the CT group, total weight loss was 5.4±10.6%, excess weight loss was 13.9±27.1%, and body mass index decreased from 40.3±6.7 to 38.0±7.2 kg/m². Significant improvements in self-reported eating behaviors were observed in both groups, that is, an increased cognitive restraint of eating, a decreased disinhibition of eating control, and a reduced degree of perceived hunger. In contrast, whereas Three-Factor Eating Questionnaire scores before weight loss intervention did not differ between groups, LSG patients reported significantly greater reductions in disinhibition and hunger than CT patients did after weight loss intervention. In both groups, greater weight loss was associated with decreased hunger sensations. Conclusion In the second follow-up year, LSG was associated with greater weight loss and greater improvements in self-reported eating behaviors compared with conservative treatment.

Psychooncological interventions are an integral component of the treatment of breast cancer patients in certified breast cancer centers. Effective multidisciplinary care requires excellent communication among the team members, including written communication. The study explores how written communication can be implemented in a multidisciplinary team treating cancer patients.A computerized form to enter psychooncological findings into a software designed for the documentation of the diagnostics and therapy of patients with breast cancer was developed.The psychooncological module includes the sectionsThe psychooncological module facilitates the combination of oncological and psychooncological documentation. It can give structured psychooncological information to the physicians. However, the development of the module has to be continued.Psychoonkologische Versorgung ist ein integraler Bestandteil der Behandlung in einem zertifizierten Brustzentrum. Erfolgreiche multidisziplinäre Versorgung erfordert ausgezeichnete Kommunikation zwischen den Teammitgliedern, insbesondere auch schriftliche Kommunikation. Die Studie stellt dar, wie ein schriftlicher Austausch in einem multidisziplinären Team umgesetzt werden kann.Für das im Brustzentrum der Charité eingesetzte Dokumentationssystem wurde ein Formular zur Eingabe psychoonkologischer Befunde entwickelt.Das Psychoonkologie-Modul ist gegliedert in die KategorienDas vorgestellte computergestützte Psychoonkologie-Modul ermöglicht eine Verbindung zwischen onkologischer und psychoonkologischer Dokumentation. Es kann strukturierte Informationen an die behandelnden Ärzte vermitteln, muss jedoch in einigen Punkten überarbeitet werden.

Living with a donated organ raises not only clinical aspects, such as surgery risks and possible graft rejection, but also questions regarding the psychological integration of the donor organ and the recipient's body experience. Organ recipients need to cope with the transplantation and its impact on their bodies and lives. This study presents findings concerning the psychological outcome of liver recipients and their body experience after transplantation. The focus lies on the psychological integration of the liver by the recipients and on differences in the body experience between recipients of a living liver donation (LDLT) and a deceased donor donation (LTx). To study the subjective body experience and the donor-organ integration, we used the body grid, a modification of the repertory grid technique pioneered by Kelly (1955). This technique allows both a quantitative and a qualitative research approach. We examined 22 liver recipients (12 LDLT; 10 LTx), matched for age, gender, years since transplanta...

Relaxation and meditation techniques are generally characterized by focusing attention, which is associated with an increase of frontal EEG Theta. Some studies on music perception suggest an activation of Frontal Midline Theta during emotionally positive attribution, others display a lateralization of electrocortical processes in the attribution of music induced emotion of different valence. The present study examined the effects of vibroacoustic stimulation using a Body Monochord and the conventional relaxation music from an audio CD on the spontaneous EEG of patients suffering from psychosomatic disorders (N = 60). Each treatment took about 20 min and was presented to the patients in random order. Subjective experience was recorded via self-rating scale. EEG power spectra of the Theta, Alpha-1 and Alpha-2 bands were analysed and compard between the two treatment conditions. There was no lateralization of electrocortical activity in terms of the emotional experience of the musical pieces. A reduction in Alpha-2 power occurred during both treatments. An emotionally positive attribution of the experience of the vibroacoustically induced relaxation state is characterized by a more pronounced release of control. In the context of focused attention this is interpreted as flow experience. The spontaneous EEG showed an increase in Theta power, particularly in the frontal medial and central medial area, and a greater reduction in Alpha-2 power. The intensity of positive emotional feelings during the CD music showed no significant effect on the increase in Theta power.

Objective Stress occurs in surgeons with a significantly higher prevalence than in the general population. At the same time, learning of coping techniques and improving personal skills how to handle the daily workload are not integral parts of the medical education or during adjustment to the job as a surgeon. In this pilot study, we developed a training course to teach different stress management and coping techniques and analyzed individual conditions of the surgeons before and after the course. Methods In total, 68 junior surgeons in their first year at work participated in the training and were randomized in an intervention ( n = 35) or a control group ( n = 33). At the beginning and the end of the training, the intervention and the comparison group answered a standardized, validated questionnaire on job satisfaction, perceived stress, and personal skills (such as self-efficacy). Results The surgeons showed a significant decline in perceived stress. Furthermore, they showed an improvement in self-reported resilience and self-efficacy. Job satisfaction increased at the same time. The comparison cohort of surgeons showed comparable scores for the specified outcome variables at the beginning but showed no progressive changes during time. Conclusions The study findings indicate that the training for junior surgeons in their first year at work is suitable to implement as a group training program. Moreover, the training provides statistically significant improvement in perceptions of distress and strengthens individual protective factors and job satisfaction.

Vibroacoustic stimulation via a Body Monochord can induce states of relaxation and subjective well-being. Sometimes unpleasant experiences such as fear, loss of control and unpleasant imagery can occur. Previous results were mainly deduced from investigations in healthy subjects.In this study, we examined psychosomatic patients’ subjective experiences during a single treatment with a Body Monochord in comparison to a listening session of relaxation music via audio CD. Diagnosed disorders were anxiety disorders n = 14, depressive disorders n = 18, adjustment disorder n = 27 and somatoform disorders n = 6. Each of the two treatments took approximately 20 minutes and was presented to the patients in random order. Subjective experiences were recorded via a shortened version of the Phenomenology of Consciousness Inventory. Neither clinical disorders nor psychometric scales for depressiveness and anxiety showed any influence on the emotional experience of the Body Monochord. However, patients with highe...

Nesfatin-1 is cleaved from nucleobindin2 (NUCB2) and implicated in the regulation of hunger and satiety as anorexigenic peptide hormone. Circulating NUCB2/nesfatin-1 is elevated in obesity and decreased in anorexia nervosa. In addition, a role in the regulation of stress, anxiety and depression has been demonstrated. First evidence suggested that NUCB2/nesfatin-1 might be regulated in a sex-specific manner. Thus, we investigated NUCB2/nesfatin-1 plasma levels in association with perceived stress, anxiety and depressiveness in obese men and women. We enrolled 140 inpatients (87 female, 53 male; body mass index, BMI, 30.3-81.7 kg/m(2)) hospitalized due to obesity with mental and somatic comorbidities. Perceived stress (PSQ-20), anxiety (GAD-7), and depressiveness (PHQ-9) were measured psychometrically, and at the same time NUCB2/nesfatin-1 plasma levels by ELISA. Males and females did not differ in terms of age and BMI. NUCB2/nesfatin-1 did not show a correlation with age or BMI. Mean NUCB2/nesfatin-1 levels (+25%, p0.001) as well as mean scores for perceived stress (+26%, p0.01), anxiety (+54%, p0.001) and depressiveness (+32%, p = 0.02) were higher in females compared to males. Scores for perceived stress (r = 0.39; p0.001) and depressiveness (r = 0.35; p0.01) showed a positive correlation with NUCB2/nesfatin-1 in women, while in men no correlation was observed (p0.19). The strongest association was observed between NUCB2/nesfatin-1 and anxiety with a positive correlation in women (r = 0.54; p0.001), while in men even an inverse correlation was found (r = -0.32; p = 0.03). This result was reflected in higher NUCB2/nesfatin-1 levels in women with high versus low anxiety (+51%, p0.001) and an opposite alteration in men (-17%, p = 0.04) after a median split into two groups with high and low anxiety. In conclusion, circulating NUCB2/nesfatin-1 showed a positive correlation with anxiety, perceived stress, and depressiveness in obese women. In men, no correlation with perceived stress and depressiveness was observed, whereas the association with anxiety was inverse, pointing towards a sex-specific regulation. These results corroborate the suggestion of NUCB2/nesfatin-1 being relevantly involved in the regulation of mood and stress in a sex-specific way.

During the process of tinnitus diagnostics, various psychometric instruments are used to measure tinnitus-related distress. The aim of present work was to explore whether candidates for biological correlates of the tinnitus-related distress could be found in peripheral blood of patients and if so, whether there was association between them and psychometric scores that reflect tinnitus-related distress. The concentrations of interleukin-1β (IL1β), interleukin-6 (IL6), tumor necrosis factor-α (TNFα) and a brain-derived neutrotrophic factor (BDNF) were measured in serum of 30 patients diagnosed with chronic tinnitus and tested for correlation with psychometric scores collected on the same day. Spearman's correlation analyses detected significant positive association between the concentrations of tumor necrosis factor α and tinnitus loudness, total perceived stress, tension and depression and a negative association between tumor necrosis factor α and a psychometric score "joy". Concentrations of interleukin-1β correlated with the awareness grade of tinnitus. The correlation between visual analogue scale (VAS) "loudness" and tumor necrosis factor α as well as between "joy" and tumor necrosis factor α retained their significance (p < 0.00167) after the application of Bonferroni correction for multiple testing. Partial correlations removing the effects of age, hearing loss and the duration of tinnitus verified the results obtained using Spearman correlation. We conclude that measuring the concentrations of selected circulating cytokines could possibly become an additional objective element of tinnitus diagnostics in the future.

Dipeptidyl peptidase IV (DPPIV) is a protease with broad distribution involved in various homeostatic processes such as immune defense, psychoneuroendocrine functions and nutrition. While DPPIV protein levels were investigated in patients with hyporectic disorders, less is known under conditions of obesity. Therefore, we investigated DPPIV across a broad range of body mass index (BMI). Blood samples from hospitalized patients with normal weight (BMI 18.5-25 kg/m(2)), anorexia nervosa (BMI17.5 kg/m(2)) and obesity (BMI 30-40, 40-50 and50 kg/m(2), n = 15/group) were tested cross-sectionally and DPPIV concentration and total enzyme activity and the DPPIV targets, pancreatic polypeptide (PP) and glucagon-like peptide (GLP-1) were measured. DPPIV protein expression was detected in human plasma indicated by a strong band at the expected size of 110 kDa and another major band at 50 kDa, likely representing a fragment comprised of two heavy chains. Obese patients had higher DPPIV protein levels compared to normal weight and anorexics (+50%, p0.05) resulting in a positive correlation with BMI (r = 0.34, p = 0.004). DPPIV serum activity was similar in all groups (p0.05), while the concentration/activity ratio was higher in obese patients (p0.05). Plasma PP levels were highest in anorexic patients (∼ 2-fold increase compared to other groups, p0.05), whereas GLP-1 did not differ among groups (p0.05). Taken together, circulating DPPIV protein levels depend on body weight with increased levels in obese resulting in an increased concentration/activity ratio. Since DPPIV deactivates food intake-inhibitory hormones like PP, an increased DPPIV concentration/activity ratio might contribute to reduced food intake-inhibitory signaling under conditions of obesity.

In addition to its anorexigenic properties in the neuroendocrine regulation of hunger and satiety, mounting evidence indicates a role for NUCB2/nesfatin-1 in the regulation of emotional stress responses which seems to occur in a sex-specific way. In the present study, we investigated the association of NUCB2/nesfatin-1 plasma levels with anxiety, depressiveness and perceived stress in obese men and women and their alterations during inpatient treatment. We expected a decrease of NUCB2/nesfatin-1 levels in female and an increase in male patients reporting a relevant alleviation of anxiety. We analyzed 69 inpatients (44 female, 25 male; body mass index, mean: 50.2±9.5kg/m2, range: 31.8-76.5kg/m2; mean age: 45.0±12.4years) hospitalized due to morbid obesity with mental (not necessarily anxiety disorders) and somatic comorbidities. NUCB2/nesfatin-1 plasma levels were measured by ELISA. Anxiety (GAD-7), depressiveness (PHQ-9) and perceived stress (PSQ-20) were concurrently determined as patient-reported outcomes. All measurements were carried out at the initiation of and during inpatient treatment when a clinically meaningful improvement of anxiety was achieved (≥5 points on GAD-7) or missed (±1 point). NUCB2/nesfatin-1 was positively correlated with anxiety scores in women at the beginning of (r=0.411; p=0.006) and during (r=0.301; p=0.047) inpatient treatment. In men, a significant negative correlation was observed following treatment (r=-0.469; p=0.018), while at the outset of treatment only a trend was observed (r=-0.381; p=0.059). Unexpectedly, neither women (n=19; at beginning vs. during treatment; 0.49±1.00ng/ml vs. 0.38±0.72ng/ml; p=0.687) nor men (n=9; 0.17±0.31ng/ml vs. 0.19±0.36ng/ml; p=0.427) who improved in anxiety scores (p

Vibroacoustic stimulation by a Body Monochord can induce relaxation states of various emotional valence. The skin conductance level (SCL) of the tonic electrodermal activity is an indicator of sympathetic arousal of the autonomic nervous system and thus an indicator of the relaxation response. Salivary cortisol is considered to be a stress indicator of the HPA-axis. The effects of the treatment with a Body Monochord and listening to relaxation music (randomized chronological presentation) on SCL and salivary cortisol in relation to the emotional valence of the experience were examined in patients with psychosomatic disorders (N = 42). Salivary cortisol samples were collected immediately before and after the expositions. Subjective experience was measured via self-rating scales. Overall, both the exposure to the Body Monochord as well as the exposure to the relaxation music induced an improvement of patients’ mood and caused a highly significant reduction of SCL. A more emotionally positive experience of relaxation correlated with a slightly stronger reduction of the SCL. Both treatment conditions caused a slight increase in salivary cortisol, which was significant after exposure to the first treatment. The increase of salivary cortisol during a relaxation state is contrary to previous findings. It is possible that the relaxation state was experienced as an emotional challenge, due to inner images and uncommon sensations that might have occurred.

Using a standardized instrument to evaluate patients' stress reactions has become more important in daily clinical routines. Different signs or symptoms of stress are often unilaterally explored: the physiological, psychological or social aspects of stress disorders are each viewed on a single dimension. However, all dimensions afflict patients who have persistent health problems due to chronic stress. Therefore, it is important to use a multidimensional approach to acquire data. The 'Psycho-Physiological-Stress-Test' (PPST) was established to achieve a comprehensive understanding of stress and was further developed at the Charité-Universitätsmedizin Berlin in collaboration with the Psychological Department of Freie Universität Berlin. The PPST includes a series of varying stress phases, embedded in two periods of rest. Physiological and psychological parameters are simultaneously measured throughout the test session. Specifically, the PPST activates the sympathetic stress axis, which is measured by heart rate, blood pressure, respiration depth and rate, electro dermal activation and muscle tension (frontalis, masseter, trapezius). Psychological data are simultaneously collected, and include performance, motivation, emotion and behavior. After conducting this diagnostic test, it is possible to identify individual stress patterns that can be discussed with the individual patient to develop and recommend (outpatient) treatment strategies. This paper introduces the PPST as a standardized way to evaluate stress reactions by presenting the results from a sample of psychosomatic inpatients (n = 139) who were treated in Charité-Universitätsmedizin Berlin, Germany. We observed that the varying testing conditions provoked adjusted changes in the different physiological parameters and psychological levels.

Background Work engagement has become a topic of great interest in recent years. However, clinicians' work engagement has rarely been studied and relatively little is known about its predictors and consequences. Therefore the objective of this cross-sectional questionnaire study was to test a model of possible institutional and personal predictors and significant relations to job and life satisfaction. Methods 123 clinicians specializing in Surgery Medicine participated in the study. Self-administered questionnaires, including the Copenhagen Psychosocial Questionnaire, the Utrecht Work Engagement Scale, the Brief Resilient Coping Scale and the Questionnaire for Self-efficacy, Optimism and Pessimism, were administered. Bivariate analyses and a stepwise regression analysis were performed. Results The whole sample of surgeons rated work engagement with a high mean of M = 4.38; SD = .91. Job satisfaction and perceived quality of life have been rated with moderate scores. The results show that job resources have a greater impact on surgeons' work engagement than their job demands. Significant correlations between surgeons' work engagement, their job satisfaction and quality of life were found. Moreover, work engagement mediated the relation between institutional factors and surgeons' job satisfaction. Conclusion Our research suggests that strengthening surgeons' work engagement will contribute to a more sustainable workplace, in terms of both individual and hospital performance. Therefore, increasing work engagement among surgeons should be of concern for supervisors and hospital managers. Future research should focus on further predictors that may have an influence on health professionals' work engagement. Another field for future research is to study potential effects of interventions on work engagement.

Ghrelin is the only known peripherally produced and centrally acting peptide hormone stimulating food intake. The acylation of ghrelin is essential for binding to its receptor. Recently, the ghrelin activating enzyme ghrelin-O-acyltransferase (GOAT) was identified in mice, rats and humans. In addition to gastric mucosal expression, GOAT was also detected in the circulation of rodents and its expression was dependent on metabolic status. We investigated whether GOAT is also present in human plasma and whether expression levels are affected under different conditions of body weight. Normal weight, anorexic and obese subjects with body mass index (BMI) 30-40, 40-50 and50 were recruited (n=9/group). In overnight fasted subjects GOAT protein expression was assessed by Western blot and ghrelin measured by ELISA. GOAT protein was detectable in human plasma. Anorexic patients showed reduced GOAT protein levels (-42%, p0.01) whereas obese patients with BMI50 had increased concentrations (+34%) compared to normal weight controls. Ghrelin levels were higher in anorexic patients compared to all other groups (+62-78%, p0.001). Plasma GOAT protein expression showed a positive correlation with BMI (r=0.71, p0.001) and a negative correlation with ghrelin (r=-0.60, p0.001). Summarized, GOAT is also present in human plasma and GOAT protein levels depend on the metabolic environment with decreased levels in anorexic and increased levels in morbidly obese patients. These data may indicate that GOAT counteracts the adaptive changes of ghrelin observed under these conditions and ultimately contributes to the development or maintenance of anorexia and obesity as it is the only enzyme acylating ghrelin.

Determining hitherto uninvestigated and safe targets to halt the aging process is important in our aging society. Graying is a hallmark of the aging process and may be used to identify aging tissue for comparative analysis. Here we analyzed differential gene expressions between pigmented, gray, and white human scalp skin hair follicles (HFs) from identical donors. Forming intersections between five donors identified 194/192 downregulated and 186/177 upregulated genes in gray/white HFs. These included melanogenesis (tyrosinase; tyrosinase-related protein 1)- and melanosome structure (Melan-A; Pmel17)-associated genes and regulation of melanocyte relevant tyrosine kinases. Alongside these expected changes, regulated genes included nonmelanocyte-related genes associated with aging as well as nonaging-related genes associated with melanocytes. Intriguingly, among them, genes associated with energy metabolism (i.e., glutaminase) and axon guidance (plexin C1) were altered. These results were reflected by pathway analysis and exemplarily confirmed by PCR and immunohistochemical studies. Supplementing cultured HFs with glutamine or plexin C1 revealed biological relevance and pharmacointerventional potential of these microarray results in altering the HF aging process. Together, we present intriguing data obtained from intra-individual sample comparison that suggest the graying HF to be a valid aging model and a promising target for testing therapeutic interventions.

Uberpruft werden Hypothesen zu Zusammenhangen von Ressourcen, chronisch aktiviertem Distress und Erschopfung. Die Datenerhebung erfolgte durch ein Meinungsforschungsinstitut in einer Mehrthemenumfrage in der Allgemeinbevolkerung (N=2 552). Eingesetzt wurden das TICS, die CFS-Skala sowie der SWOP. Die theoretischen Annahmen wurden im Strukturgleichungsmodell uberpruft und bewahrten sich analog zu Anforderungs-Ressourcen-Modellen. Eine zentrale Bedeutung scheint dabei speziell dispositionellem Optimismus zuzukommen. Die Pravalenzrate fur chronischen Stress lag bei 19,1%. Es zeigten sich weiterhin signifikante Unterschiede zwischen den Alters-, nicht aber zwischen den Geschlechtergruppen. Von der Arbeitstatigkeit her besonders belastet zeigte sich die Gruppe der Teilzeiterwerbstatigen. Die Zugehorigkeit zu einer niedrigen sozialen Schicht begunstigt ebenfalls erhohte chronische Stresswerte. Die theoretischen Implikationen und die praktischen Konsequenzen fur die Gesundheitsforderung und Pravention werden ebenso diskutiert wie die Begrenzungen der Untersuchung.

The aim of this study was to examine relations and influences between work-related factors, personal resources, work engagement and work ability of surgeons working in German hospitals. The study was conducted as a cross-sectional survey investigation. We used the Utrecht Work Engagement Scale, the Copenhagen Psychosocial Questionnaire and the Work Ability Index to evaluate surgeons’ work engagement, working conditions and work ability. Bivariate analyses and a stepwise regression analysis were performed. Surgeons reported a moderate work ability and work engagement. The results indicated significant associations between surgeons’ sources of work engagement, work ability and work-related factors (e.g. job resources). Significant differences regarding these variables were also detected between males and females and the various age groups. The study results reflect the positive effect of supportive working conditions and work engagement on the preservation of work ability, indicating their importance in promoting surgeons’ work ability. Due to the elderly population and the continuing development of health care in Germany, the demand for surgeons increases. These circumstances give reasons for a strong need to preserve and restore surgeons’ work ability. New strategies for training and improving the capacity and performance of surgeons are necessary.

Irisin was recently identified as cleavage product of fibronectin type III domain containing 5 (FNDC5) and shown to increase energy expenditure in mice and humans and therefore was discussed as potential treatment option in obesity. However, the regulation of irisin under conditions of severely altered body weight such as anorexia nervosa and obesity remains to be investigated. We analyzed circulating irisin levels over a broad spectrum of body weight in 40 patients with anorexia nervosa (mean body mass index, BMI 12.6±0.7 kg/m(2)), normal weight controls (22.6±0.9 kg/m(2)) and obese patients with BMI of 30-40 (36.9±1.2 kg/m(2)), 40-50 (44.9±1.1 kg/m(2)) and50 (70.1±2.7 kg/m(2), n=8/group). Correlation analyses were performed between irisin and different body indices, parameters of body composition and hormones involved in various homeostatic processes. Obese patients showed higher circulating irisin levels compared to normal weight and anorexic patients (p0.05) resulting in a correlation of irisin with body weight (r=0.47, p0.01) and BMI (r=0.50, p0.001). Plasma irisin was also positively correlated with fat mass (r=0.48, p0.01), body cell mass (r=0.45, p0.01) and fat free mass (r=0.40, p0.05). Insulin levels were positively correlated with irisin (r=0.45, p0.01), whereas circulating ghrelin, cortisol, thyroid-stimulating hormone or C-reactive protein were not (p0.05). These data indicate that circulating irisin is affected under conditions of altered BMI with highest levels in severely obese patients. The increase of irisin under conditions of obesity may indicate a physiological function to improve glucose tolerance which is often impaired in obese subjects.

Recent research has indicated that neuroenhancement (NE), the use of legal or illegal drugs by healthy individuals to improve their cognitive performance, is widely practiced among students in both the United States and Germany. The primary objective of this study was to identify the motives for and beliefs regarding the benefits and risks of practicing NE among a sample of German university students and graduates. The secondary objective was to determine the relationship between the use of neuroenhancers and the use of several common psychoactive lifestyle drugs. A web-based survey was used to interview students and postgraduates. Of the 1,324 participants, 93 reported having practiced NE for the primary motives of improving concentration (55%) and increasing vigilance (49%). Participants who reported having practiced NE were more likely to assess NE as more beneficial and less harmful compared to participants who reported not having practiced NE. The former also reported greater use of all lifestyle drugs except alcohol compared to the latter. The primary motives for practicing NE are associated with management of a high level of stress and a large academic workload. As such, decreasing the prevalence of NE among students requires implementation of strategies targeting stress reduction and workload management.

Phoenixin was recently identified in the rat hypothalamus and initially implicated in reproductive functions. A subsequent study described an anxiolytic effect of the peptide. The aim of the study was to investigate a possible association of circulating phoenixin with anxiety in humans. We therefore enrolled 68 inpatients with a broad spectrum of psychometrically measured anxiety (GAD-7). We investigated men since a menstrual cycle dependency of phoenixin has been assumed. Obese subjects were enrolled since they often report psychological comorbidities. In addition, we also assessed depressiveness (PHQ-9) and perceived stress (PSQ-20). Plasma phoenixin levels were measured using a commercial ELISA. First, we validated the ELISA kit performing a spike-and-recovery experiment showing a variance of 6.7±8.8% compared to the expected concentrations over the whole range of concentrations assessed, while a lower variation of 1.6±0.8% was observed in the linear range of the assay (0.07-2.1ng/ml). We detected phoenixin in the circulation of obese men at levels of 0.68±0.50ng/ml. These levels showed a negative association with anxiety scores (r=-0.259, p=0.043), while no additional associations with other psychometric parameters were observed. In summary, phoenixin is present in the human circulation and negatively associated with anxiety in obese men, a population often to report comorbid anxiety.

Objective The present study examined the effects of laparoscopic sleeve gastrectomy (LSG) on self-reported eating-related psychopathology and health-related quality of life (HRQoL). Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support. The setting was a multidisciplinary obesity center. Method A sample of 103 patients with obesity were investigated using the Eating Disorder Inventory and the Short Form Health Survey before and, on average, 19 (± 5) months after weight loss intervention. Thereof, 63 patients (age 45.6 ± 10.9 years, 71.4% females) underwent LSG, and 40 patients (age 50.6 ± 11.3 years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference. Results In the LSG group, excess weight loss (%EWL) was 53.0 ± 24.0%, and body mass index (BMI) decreased from 51.5 ± 8.1 to 38.0 ± 7.7 kg/m 2 . In the CT group, %EWL was 13.9 ± 27.1%, and BMI decreased from 40.3 ± 6.7 to 38.0 ± 7.2 kg/m 2 . Significant improvements in eating-related psychopathology were observed in both groups. Although both groups had a similar BMI after the respective interventions, LSG patients reported significantly greater body satisfaction and substantial improvement in perceived physical health from a lower baseline level than CT patients. Discussion In the second follow-up year, LSG was associated with greater weight loss from a higher baseline weight, and greater improvements in self-reported eating-related psychopathology and physical HRQoL compared with conservative treatment.

While physical hyperactivity represents a frequent symptom of anorexia nervosa and may have a deleterious impact on the course of the disease, the underlying mechanisms are poorly understood. Since several food intake-regulatory hormones affect physical activity, the aim of the study was to investigate the association of physical activity with novel candidate hormones (kisspeptin, ghrelin, oxyntomodulin, orexin-A, FGF-21, R-spondin-1) possibly involved in patients with anorexia nervosa. Associations with psychometric parameters and body composition were also assessed. We included 38 female anorexia nervosa inpatients (body mass index, BMI, mean ± SD: 14.8 ± 1.7 kg/m2). Physical activity was evaluated using portable armband devices, body composition by bioelectrical impedance analysis. Blood withdrawal (hormones measured by ELISA) and psychometric assessment of depressiveness (PHQ-9), anxiety (GAD-7), perceived stress (PSQ-20) and disordered eating (EDI-2) were performed at the same time. Patients displayed a broad spectrum of physical activity (2479–26,047 steps/day) which showed a negative correlation with kisspeptin (r = −0.41, p = 0.01) and a positive association with ghrelin (r = 0.42, p = 0.01). The negative correlation with oxyntomodulin (r = −0.37, p = 0.03) was lost after consideration of potential confounders by regression analysis. No correlations were observed between physical activity and orexin-A, FGF-21 and R-spondin-1 (p > 0.05). Kisspeptin was positively correlated with BMI and body fat mass and negatively associated with the interpersonal distrust subscale of the EDI-2 (p 0.05). In conclusion, kisspeptin is inversely and ghrelin positively associated with physical activity as measured by daily step counts in anorexia nervosa patients suggesting an implication of these peptide hormones in the regulation of physical activity in anorexia nervosa.

Research in the field of food intake regulation is gaining importance. This often includes the measurement of peptides regulating food intake. For the correct determination of a peptide's concentration, it should be stable during blood processing. However, this is not the case for several peptides which are quickly degraded by endogenous peptidases. Recently, we developed a blood processing method employing Reduced temperatures, Acidification, Protease inhibition, Isotopic exogenous controls and Dilution (RAPID) for the use in rats. Here, we have established this technique for the use in humans and investigated recovery, molecular form and circulating concentration of food intake regulatory hormones. The RAPID method significantly improved the recovery for (125)I-labeled somatostatin-28 (+39%), glucagon-like peptide-1 (+35%), acyl ghrelin and glucagon (+32%), insulin and kisspeptin (+29%), nesfatin-1 (+28%), leptin (+21%) and peptide YY3-36 (+19%) compared to standard processing (EDTA blood on ice, p 0.001). High performance liquid chromatography showed the elution of endogenous acyl ghrelin at the expected position after RAPID processing, while after standard processing 62% of acyl ghrelin were degraded resulting in an earlier peak likely representing desacyl ghrelin. After RAPID processing the acyl/desacyl ghrelin ratio in blood of normal weight subjects was 1:3 compared to 1:23 following standard processing (p = 0.03). Also endogenous kisspeptin levels were higher after RAPID compared to standard processing (+99%, p = 0.02). The RAPID blood processing method can be used in humans, yields higher peptide levels and allows for assessment of the correct molecular form.

Background These days physicians' work is characterized by an increase in economic demands, pressure and challenges in establishing a balance between work and family life. The current study investigates the relationship between physicians' job demands and resources, perceived job stress, work-family conflict, work engagement and job satisfaction. Methods 564 clinicians specialising in different medical fields participated in the cross-sectional study. Self-administered questionnaires, including the COPSOQ and the UWES- Scale were administered. Results Our results illustrated significant relationships between physicians' work engagement and their job satisfaction as well as between job stress and work family conflict. Moreover, perceived job stress moderated the effect of high job demands on work family conflict. In addition, significant gender differences have been found in perceived stress levels, work family conflict and work engagement. Conclusion This study proves and verified associations between work engagement, work-family conflict, job demands and resources that may influence employees' satisfaction. Implications for both working physicians and hospital management are given.

Nesfatin-1 was recently identified and introduced as food intake-regulatory hormone. Soon thereafter, mounting evidence indicated a much broader role for nesfatin-1 with an involvement in the regulation of food intake, gastrointestinal motility, glucose homeostasis, blood pressure and stress. Despite the growing knowledge on the physiological regulation and functions of nesfatin-1, the receptor mediating these effects remains to be characterized. Therefore, the aim of this study was to investigate the peripheral and central localization of the nesfatin-1 receptor by autoradiography. Male Sprague-Dawley rats were used and peripheral as well as brain tissue was processed for (125)I-nesfatin-1 autoradiography. In peripheral tissues, an autoradiographic signal was observed in the gastric mucosa of corpus and antrum, in duodenum, jejunum and ileum, while no signal was detected in the colon. Preabsorption of (125)I-nesfatin-1 with non-labeled nesfatin-1 greatly diminished the autoradiographic signal in the stomach indicating specificity (-32%, p

Research over the past decades has revealed close interactions between the nervous and immune systems that regulate peripheral inflammation and link psychosocial stress with chronic somatic disease. Besides activation of the sympathetic and the hypothalamus-pituitary-adrenal axis, stress leads to increased neurotrophin and neuropeptide production in organs at the self-environment interface. The scope of this short review is to discuss key functions of these stress mediators in the skin, an exemplary stress-targeted and stress-sensitive organ. We will focus on the skin's response to acute and chronic stress in tissue regeneration and pathogenesis of allergic inflammation, psoriasis, and skin cancer to illustrate the impact of local stress-induced neuroimmune interaction on chronic inflammation.

The purpose of this study was to give an overview whether German students regularly use stimulants for enhancing their academic performance. Reasons associated with the use of these substances were explored. Moreover, gender differences were analyzed. A cross-sectional survey study was performed analyzing a random sample of 1,053 students of different fields of study in Germany. Students were asked to complete an anonymous self-administered web-based survey containing questions on cognitive performance-enhancing substance use. We used statistical analyses, e.g. non-parametric tests to evaluate the data of our questionnaire. Among 1,053 students, 61 % responded to our questionnaire. The average age wasM = 24.58; 635 participants were female and 418 were male students. Total 1–13 % of the participating students have taken prescription stimulants (e.g. modafinil) or illicit drugs (e.g. cannabis) at least once in their lifetime. The most common reasons for taking stimulants were to support concentration, to relax and to increase alertness. We found significant gender differences with regard to frequency and reason for using performance-enhancing substances. Our study results give an overview about the actual situation on frequency and reasons for taking performance-enhancing substances. Departments of Public Health should address this issue in national health debates and discussions. Based on our study findings health education programmes should be developed.

OBJECTIVES: The study assesses the experience of pregnancy of women who have pregnancy induced hypertension (PIH) compared to women with an uncomplicated course of pregnancy. METHODS: 21 women were retrospectively investigated between 5 and 13 months after giving birth via a semistandardised interview focussing on the personal experience of pregnancy. The interviews were analysed by means of qualitative content analysis. The categories "development and course," "coping with anxiety," "image of one's mother" and "relationship with partner" were determined and described. Finally, we developed data-driven, ideal-type models of pregnancies with pregnancy-induced hypertension versus normal pregnancies by detecting the similarities and contrasts between the groups. RESULTS: Interviewees with pregnancy-induced hypertension showed an ambivalence with regard to their pregnancy, which was more often than not unplanned and/or unwanted. Conflicts with significant others, especially with their partners, were also reported more often. Emotions tended to be understated. DISCUSSION: The results can be employed in the operationalisation of future projects in a hitherto unclear research field. They should also be considered in the care of patients with pregnancy-induced hypertension.

Objective The utility of bioelectrical impedance analysis (BIA) in patients with anorexia nervosa (AN) is imperfectly defined. Furthermore, any advantage accrued by BIA with vector analysis (BIVA) is unknown. Method We conducted a retrospective analysis of 57 women with AN admitted to our service who underwent BIA and BIVA. Twenty-seven women were observed during short-term (3 weeks) and 13 women during longer-term (3 months) weight gain. Results Bioelectrical impedance analysis produced implausible results in 47% of the patients. BIVA demonstrated low body cell mass and highly variable extracellular water (ECW) volume, ranging from volume contraction to volume expansion on admission and during treatment. BIVA suggested that short-term weight gain predominantly consisted of ECW volume, whereas longer-term weight gain resulted in increased hydrated body cell mass. Conclusion Conventional BIA has little utility in these patients. However, BIVA could be a suitable alternative in the medical management reflecting ECW volume changes and later genuine tissue mass increases. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

In women with anorexia nervosa (AN), resting energy expenditure (REE) is decreased due to reduced energy intake and severe underweight. The assessment of REE allows estimating individual metabolic downregulation and better understanding body weight regulatory mechanisms in severely underweight patients with AN. However, REE predictive equations are known to have considerable shortcomings in patients with AN. Our aim was to evaluate a portable armband device (SenseWear armband [SWA]; BodyMedia, Inc, Pittsburgh, PA) for the assessment of REE against the measurement with indirect calorimetry (IC) as the reference method.We assessed REE simultaneously by IC and SWA in 50 women with AN at the start of inpatient therapy and calculated REE using 2 predictive equations.Reliable data for IC measurement were obtained for 34 patients (age: 27.0 ± 8.0 years; body mass index: 14.4 ± 2.0 kg/m²). REE assessed with SWA was overestimated by 23% ± 27% compared with REE measured by IC (1166 ± 174 vs 979 ± 198 kcal/d, P.001). REE estimation with SWA gave an accurate prediction within 10% deviation of REE measured with IC in 35% of the patients. In contrast, REE calculated with 2 predictive equations underestimated REE measured with IC by -26% ± 17% and -5% ± 20%, respectively.A mean difference of 187 kcal/d between both techniques for the assessment of REE may be of methodological relevance. Therefore, SWA and IC are not interchangeable methods for the assessment of REE in underweight females with AN.

Nesfatin-1 is well-established to induce an anorexigenic effect. Recently, nesfatin-130−59, was identified as active core of full length nesfatin-11−82 in mice, while its role in rats remains unclear. Therefore, we investigated the effects of nesfatin-130−59 injected intracerebroventricularly (icv) on the food intake microstructure in rats. To assess whether the effect was also mediated peripherally we injected nesfatin-130−59 intraperitoneally (ip). Since obesity affects the signaling of various food intake-regulatory peptides we investigated the effects of nesfatin-130−59 under conditions of diet- induced obesity (DIO). Male Sprague–Dawley rats fed ad libitum with standard diet were icv cannulated and injected with vehicle (5 μl ddH2O) or nesfatin-130−59 at 0.37, 1.1, and 3.3 μg (0.1, 0.3, 0.9 nmol/rat) and the food intake microstructure assessed using a food intake monitoring system. Next, naïve rats were injected ip with vehicle (300 μl saline) or nesfatin-130−59 (8.1, 24.3, 72.9 nmol/kg). Lastly, rats were fed a high fat diet for 10 weeks and those developing DIO were icv cannulated. Nesfatin-1 (0.9 nmol/rat) or vehicle (5 μl ddH2O) was injected icv and the food intake microstructure assessed. In rats fed standard diet, nesfatin-130−59 caused a dose-dependent reduction of dark phase food intake reaching significance at 0.9 nmol/rat in the period of 4–8 h post injection (−29%) with the strongest reduction during the fifth hour (−75%), an effect detectable for 24 h (−12%, p < 0.05 vs. vehicle). The anorexigenic effect of nesfatin-130−59 was due to a reduction in meal size (−44%, p < 0.05), while meal frequency was not altered compared to vehicle. In contrast to icv injection, nesfatin-130−59 injected ip in up to 30-fold higher doses did not alter food intake. In DIO rats fed high fat diet, nesfatin-130−59 injected icv reduced food intake in the third hour post injection (−71%), an effect due to a reduced meal frequency (−27%, p < 0.05), while meal size was not altered. Taken together, nesfatin-130−59 is the active core of nesfatin-11−82 and acts centrally to reduce food intake in rats. The anorexigenic effect depends on the metabolic condition with increased satiation (reduction in meal size) under normal weight conditions, while in DIO rats satiety (reduction in meal frequency) is induced.

Previous research reported conflicting results concerning the influence of depression on cognitive task performance. Whereas some studies reported that depression enhances performance, other studies reported negative or null effects. These discrepant findings appear to result from task variation, as well as the severity and treatment status of participant depression. To better understand these moderating factors, we study the performance of individuals-in a complex sequential decision task similar to the secretary problem-who are nondepressed, depressed, and recovering from a major depressive episode. We find that depressed individuals perform better than do nondepressed individuals. Formal modeling of participants' decision strategies suggested that acutely depressed participants had higher thresholds for accepting options and made better choices than either healthy participants or those recovering from depression.

A wide range of questionnaires for measuring depression are available. Item Response Theory models can help to evaluate the questionnaires exceeding the boundaries of Classical Test Theory and provide an opportunity to equate the questionnaires. In this study after checking for unidimensionality, a General Partial Credit Model was applied to data from two different depression scales [Patient Health Questionnaire (PHQ-9) and ICD-10-Symptom Rating (ISR)] obtained in clinical settings from a consecutive sample, including 4517 observations from a total of 2999 inpatients and outpatients of a psychosomatic clinic. The precision of each questionnaire was compared and the model was used to transform scores based on the assumed underlying latent trait. Both instruments were constructed to measure the same construct and their estimates of depression severity are highly correlated. Our analysis showed that the predicted scores provided by the conversion tables are similar to the observed scores in a validation sample. The PHQ-9 and ISR depression scales measure depression severity across a broad range with similar precision. While the PHQ-9 shows advantages in measuring low or high depression severity, the ISR is more parsimonious and also suitable for clinical purposes. Furthermore, the equation tables derived in this study enhance the comparability of studies using either one of the instruments, but due to substantial statistical spread the comparison of individual scores is imprecise. Copyright © 2011 John Wiley & Sons, Ltd.

BACKGROUND: The purpose of this study was to investigate anesthesiologists' workflow in real time. METHODS: Anesthesiologists were observed for a total of 60 workdays. All tasks performed during this time were recorded in real time. RESULTS: The anesthesiologists were shadowed for a total of 517:16:36 hours. The average workday lasted 08:37:17 hours. Overall they spent 28.5% of each workday on indirect patient care, 14.7% on direct patient care and 18.8% on administrative work. Communication took up 19.9% of anesthesiologists' time, breaks and disruptions 15.2% and other job tasks 2.9%. CONCLUSIONS: The results comprise objective data about the workflow and working conditions in anesthesiology. We found support of the large imbalance between the direct patient care and the heavy administrative workload reported by physicians. These results may be useful in future efforts to improve anesthesiologists' working conditions and workflow optimization.

Background: Geriatricians are physicians who work primarily with the elderly and deal with diseases that often accompany old age, such as Alzheimer's disease. In the last few years, data from questionnaires have demonstrated increasing criticism of geriatricians regarding their working conditions in geriatric medicine. Ideally, such rather subjective statements should be compared to data about work strain that is not merely accurate but also evaluated on an objective real-time basis. Therefore, the aim of the current study is to deliver exact data about geriatricians' work in different geriatric departments to evaluate their working routines and afterwards to optimize their working conditions. Methods: An observational real-time study was conducted by shadowing 15 physicians in geriatric medicine individually during weekday shifts at four hospitals in urban German settings. A total of 368 h of observations were recorded by using an ultra-mobile computer. Results: The average workday lasted 9 h 36 min 14 s (95% CI = 9.07:35–10.01:23 h) with a high amount of elderly patients to deal with (M = 18) every day. Overall, they spent 14.75% of each workday on indirect patient care, 7.29% on direct patient care and 13.19% on administrative work. Communication took up 4.68% of geriatricians' time, breaks and disruptions 7.5%. Conclusion: To our knowledge, this is the first real-time analysis on how geriatricians deal with their working demands and how working routines are organized in geriatric hospital departments. Geriatricians' subjective statements on their working conditions have been partially confirmed. Improving geriatricians work flow could increase work efficiency, job satisfaction and quality of care. Geriatr Gerontol Int 2012; 12: 108–115.

Differentiation of endometrial stromal cells and formation of new maternal blood vessels at the time of embryo implantation are critical for the establishment and maintenance of gestation. The regulatory functions of decidual leukocytes during early pregnancy, particularly dendritic cells (DC) and NK cells, may be important not only for the generation of maternal immunological tolerance but also in the regulation of stromal cell differentiation and the vascular responses associated with the implantation process. However, the specific contributions of DC and NK cells during implantation are still difficult to dissect mainly due to reciprocal regulatory interactions established between them within the decidualizing microenvironment. The present review article discusses current evidence on the regulatory pathways driving decidualization in mice, suggesting that NK cells promote uterine vascular modifications that assist decidual growth but DC directly control stromal cell proliferation, angiogenesis and the homing and maturation of NK cell precursors in the pregnant uterus. Thus, successful implantation appears to result from an interplay between cellular components of the decidualizing endometrium involving immunoregulatory and pro-angiogenic functions of DC and NK cells.

Aim The aim of the present study was to define, besides prevalence data, regional and individual factors of stress experience in a representative sample of the German general population. Methods Regional factors were examined separately by federal state and the size of the political location. Individual factors were defined according to the severity of the stress experience as well as on the basis of central social factors such as family state, profession and earnings. The Perceived Stress Questionnaire (PSQ), a validated, self-evaluation process for recording a subjective representation of frequency estimates of stress experiences was used. Data acquisition was carried out by a market research institute in a multi-topic questionnaire (N=2,552). Households were selected by the random route procedure, target persons were also selected at random. Results The prevalence rate for an elevated stress experience was 14.5%, that for a very high stress experience 3.1% of the sample. People without education exhibited the highest rates of stress experience (36.8%), followed by the unemployed (30.6%). Individual and social factors that favour an increased stress experience are a subjectively poor state of health (OR: 3.42) or belonging to the lower social economic status (OR: 1.30). Furthermore, there are indications of regional factors such as size of the location as well as differences between the individual federal states. An east-west comparion did not show any significant differences with regard to stress experiences. Conclusion In the light of the illness burden associated with chronic stress situations, preventative measures in cases of unemployment or low level of education should be given priority.

Background: Physicians currently working in hematology and oncology wards are often frustrated with their working conditions. They express dissatisfaction with the working hours, poor organization of work and a low salary compared with the burdens of cancer care. However, to date, there have been no real-time observational studies to verify these subjective reports. Therefore, this study is the first to provide objective data about residents’ workload. Methods: A real-time task analysis was conducted by individually observing 21 hematology and oncology residents at German hospitals. A total of 626 h of observation were performed using an Ultra Mobile PC. Results: The residents observed in this study worked an average of 9 h 56 min per day, during which time was divided among the following activities: 31.20% for internal communication, 22.06% for indirect patient care and 10.99% for ward rounds. Per workday residents spent an average 6.20% of their shift time talking to patients. Conclusions: This study provides the basis for future analyses on physicians’ workflow. Some key results may be used to recommend measures to improve physicians’ work performance and the quality of cancer care.

The increasing administrative workload of German psychiatrists has led to rising dissatisfaction among physicians. Previous studies have assessed job satisfaction by conducting surveys among medical professionals. However, to date, no objective work task analysis has been conducted to investigate the workflow of psychiatrists in Germany.The objective of this study was to evaluate physicians' workflow, to assess the level of work efficiency of German psychiatrists in a real time analysis.A trained observer accompanied 24 psychiatrists throughout complete shifts. A mobile computer was used to record all tasks. All psychiatrists were observed for total of 980:04:15 h.The average psychiatrist's workday lasted 09:03:19 h (standard deviation, s=01:01:20 h). Internal communication was the most frequently observed main activity (mean=2:58:15 h; s=0:48:10 h). Psychiatrists spent on average 0:52:12 h a day on indirect patient care (s=0:32:50 h; 5.60%). All administrative tasks accounted for roughly 1 h of the average workday (s=0:17:58 h; 10.75%). During the wobservation period, physicians were interrupted 17.37 times a day on average (s=5.81). During the observational period, simultaneous activities were recorded for a total of 17:27:54 h.This research is the first to investigate workflow of psychiatrists in German hospitals. Their work was found to be mostly communicative, although administrative work also demanded much of their time. High rates of multitasking and interruptions in the workflow, as seen for the psychiatrists in this study, could lead to possible medical errors, making further investigation of current working conditions necessary.

Cancer patients frequently suffer from psychological comorbidities such as depression and elevated stress. Previous studies could demonstrate that cancer patients benefit from massage therapy on the physical and psychological level. This pilot study investigates the effects of massage on depression, mood, perceived stress, and the Th1/Th2 ratio in breast cancer patients.Thirty-four breast cancer patients were randomly assigned to a massage group (n=17) and a control group (n=17). Patients of the massage group received two 30-min classical massages per week for 5 weeks. At baseline, at the end of the intervention period, and 6 weeks after the end of intervention, patients of both groups completed the Perceived Stress Questionnaire (PSQ), the Patient Health Questionnaire (PHQ), and the Berlin Mood Questionnaire (BFS) and blood was withdrawn for determining cytokine concentrations and the Th1/Th2 ratio.Twenty-nine patients were included in the statistical analysis. Depression (PHQ) and anxious depression (BSF) were significantly reduced immediately after massage compared to the control group. Stress (PSQ) and elevated mood (BSF) did not show significant alterations after massage therapy. Changes of cytokine concentrations and Th1/Th2 ratio were insignificant as well, although there was a slight shift towards Th1 in the massage group over time.Massage therapy is an efficient treatment for reducing depression in breast cancer patients. Insignificant results concerning immunological parameters, stress, and mood indicate that further research is needed to determine psychological and immunological changes under massage therapy.

Background The practice of living donor liver transplantation (LDLT) has been increasing over the past 20 years. In LDLT, a healthy individual offers a substantial part of his or her liver (up to 60%) for the benefit of a terminally-ill recipient. Objective The aim of the study was to identify decisionmaking and risk-assessment patterns of living liver donors and assess whether the principles of informed consent and decision autonomy are being met. Method The authors conducted semistructured clinical interviews with 28 donors before transplantation. Results The authors found that a decision was being reached before a decision-making process could take place. Surgery risks were perceived and processed in different ways, including the factors of risk-awareness, denial, limited acceptance, and fatalism. Discussion The authors assess concepts of informed consent and decision autonomy in LDLT, and offer suggestions for donor selection.

Cholecystokinin (CCK) plays a role in the short-term inhibition of food intake. Cocaine- and amphetamine-regulated transcript (CART) peptide has been observed in neurons of the paraventricular nucleus (PVN). It has been reported that intracerebroventricular injection of CART peptide inhibits food intake in rodents. The aim of the study was to determine whether intraperitoneally (ip) injected CCK-8S affects neuronal activity of PVN-CART neurons. Ad libitum fed male Sprague-Dawley rats received 6 or 10 μg/kg CCK-8S or 0.15 M NaCl ip (n = 4/group). The number of c-Fos-immunoreactive neurons was determined in the PVN, arcuate nucleus (ARC), and the nucleus of the solitary tract (NTS). CCK-8S dose-dependently increased the number of c-Fos-immunoreactive neurons in the PVN (mean ± SEM: 102 ± 6 vs. 150 ± 5 neurons/section, p < 0.05) and compared to vehicle treated rats (18 ± 7, p < 0.05 vs. 6 and 10 μg/kg CCK-8S). CCK-8S at both doses induced an increase in the number of c-Fos-immunoreactive neurons in the NTS (65 ± 13, p < 0.05, and 182 ± 16, p < 0.05). No effect on the number of c-Fos neurons was observed in the ARC. Immunostaining for CART and c-Fos revealed a dose-dependent increase of activated CART neurons (19 ± 3 vs. 29 ± 7; p < 0.05), only few activated CART neuron were observed in the vehicle group (1 ± 0). The present observation shows that CCK-8S injected ip induces an increase in neuronal activity in PVN-CART neurons and suggests that CART neurons in the PVN may play a role in the mediation of peripheral CCK-8S's anorexigenic effects.

Assessment of the retest-reliability and sensitivity to change of the ICD-10-Symptom-Rating (ISR) is provided. The ISR was filled out repeatedly by a non-clinical as well as different samples of psychosomatic patients. Between the two measurements either no or an integrated psychosomatic treatment took place. During the treatment free phase a high degree of stability of the test scores was expected, whereas a significant improvement of test scores was expected for the respective scales over the treatment phase. The retest-reliability for the individual scales ranges from 0.70 to 0.94. Between admission to a psychosomatic treatment and discharge significant differences were found for all scales. The retest-reliability showed satisfactory results comparable to similar, symptom-oriented instruments. Furthermore, the instruments reproduces symptomatic changes consistently and is - from our point of view - suitable for the assessment of change.