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Recording of heart rate variability (HRV) is a noninvasive and continuous measurement method that allows investigating the autonomic nervous system (ANS) and its reaction to environmental influences. For a precise measurement of HRV data, a carefully chosen study design and environment is required to minimize secondary influences. One major influence to be avoided is movement. However, in the daily routine and for some scientific questions, movement can often not be avoided. If so, a manual or automated method to differentiate between artifacts caused by body movement and the actual psychophysiological effect is needed to ensure the data quality. In this approach, a chest-worn sensor was developed, that measures the heart rate using a single lead ECG and filters the measured change of the HRV caused by movement. Data from an integrated accelerometer is used to detect upper body movements that affect the resting heart rate. The movementcorresponding time stamps are then used to filter the Interbeat Intervals (IBI) accordingly. Functionality and effectiveness of the sensor system have been tested against state-of-the art sports- or clinical devices in varying scenarios. As our test series showed, motion filtering has a decisive effect when motion occurs, two-thirds of all cases showed a significant effect of motion filtering, with small to medium effect sizes for the parameters SD2, SD2/SD1, and SDNN. Thereby, automatic filtering of motion artifacts can help to significantly reduce the need for costly post-processing of distorted data sets. The results show a better data quality of HRV measurement, a method that is commonly used for the investigation of physiological processes in the field of chronic pain, psychology, psychiatry, or sports medicine.

Zusammenfassung Hintergrund Ein effektives Schmerzmanagement mit langandauernder Wirkung bei Menschen mit chronischen Schmerzen ist noch immer eine Herausforderung. Ziel der Arbeit Ziel der Arbeit ist die Untersuchung der Effekte einer gesundheitsförderlichen Intervention mit EMDR („eye movement desensitization and reprocessing“) bei Personen mit chronischen Schmerzen und eine mögliche Verbesserung ihrer Lebensqualität. Methodik Mit Hilfe einer Paper-pencil-Befragung wurden 30 Schmerzpatient:innen zu zwei Messzeitpunkten (MZP) mit Subskalen des Deutschen Schmerzfragebogens (DSF), dem Pain Disability Index (PDI) und der WHO Quality of Life-Kurzversion (WHOQOL-BREF) befragt. Zwischen den MZP wurden die Personen der Interventionsgruppe mit EMDR behandelt. Ergebnisse Einige signifikante Ergebnisse deuten darauf hin, dass durch die Intervention mit EMDR zur Behandlung chronischer Schmerzen die Lebensqualität verbessert wird. So verbesserte sich in der Interventionsgruppe die Lebensqualität in den Domänen physische, psychische und globale Lebensqualität signifikant im Vergleich beider MZP. Schlussfolgerung Da die erhobenen Befunde aufgrund des explorativen Studiencharakters nur unter Vorbehalt interpretiert werden können, sollten in Zukunft Langzeitstudien mit größeren Stichproben und Follow-up-Erhebungen durchgeführt werden, um eindeutige Aussagen über die Wirksamkeit und die Langzeiteffekte von EMDR zur Behandlung chronischer Schmerzen treffen zu können. In der Behandlungsmethode dürfte großes Potenzial liegen und es scheint vielversprechend zu sein, EMDR zu einem festen Bestandteil einer multimodalen, interdisziplinären Schmerztherapie werden zu lassen.

Zusammenfassung Hintergrund Positive Effekte von achtsamkeitsbasierten Programmen im Kontext Schule wurden bereits vielfältig belegt. Das in dieser Studie evaluierte Konzept Achtsamkeit in der Schule (AISCHU) richtet sich an Lehrkräfte und SchülerInnen und soll deren Stresswahrnehmung und Selbstregulationsfähigkeit schulen. Im Fokus dieser explorativen Studie steht erstmals der präventive Nutzen der AISCHU-Weiterbildung für Lehrkräfte und deren psychische Gesundheit. Methodik Etablierte Messinstrumente bezüglich Stresserleben (PSQ), Burn-out-Gefährdung („Tedium measure“ (TM)), Wohlbefinden (WHO-5) und Achtsamkeit (FFA, MAAS) wurden im Prä-Post-Vergleich eingesetzt. Die Daten beziehen sich auf 36 Lehrkräfte unterschiedlicher Schulformen. Ergebnisse Es ergaben sich hinsichtlich aller untersuchten Messgrößen signifikante Verbesserungen mit z. T. großen Effektstärken. Schlussfolgerung In dieser explorativen Pilotstudie zu AISCHU für Lehrkräfte konnten erstmals vielversprechende Hinweise auf die Wirksamkeit im Sinne von Stressreduzierung, Burn-out-Risikominimierung sowie Verbesserung der Lebensqualität bei belasteten LehrerInnen beobachtet werden.

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

Hintergrund Das Projekt „Gesunde Sudstadt“ hat den Schwerpunkt Gesundheitsforderung in der Lebenswelt Kommune. Es wurde im Rahmen des „Praventionsgesetzes“ (SGB V §20a) initiiert und zielt ab auf die Verringerung der gesundheitlichen Ungleichheit in der Stadt Nurnberg. Die Masnahmen der kommunalen Gesundheitsforderung im Handlungsfeld Ernahrung wurden durch eine externe multiperspektivische, multimethodische Prozess- und Ergebnisevaluation begleitend untersucht. Methoden 55 Masnahmenberichte, 8 Interviews mit Teilnehmenden sowie 3 Interviews mit Masnahmendurchfuhrenden wurden mit qualitativer Inhaltsanalyse ausgewertet. Eine Teilnehmendenbefragung (n=35) mittels Fragebogen wurde quantitativ-statistisch ausgewertet. Ergebnisse Die Ergebnisse zeigen, dass die Gesundheitsforderungsmasnahmen durch die Teilnehmenden eine hohe Akzeptanz erfuhren und ein ausgepragtes Mas an Partizipation ermoglicht wurde. Weiterhin zeigen die Ergebnisse, dass die Masnahmen die interaktive sowie die funktionale Gesundheitskompetenz forderten. Ein empirisches Pfadmodell fur kommunale Gesundheitsforderungsprojekte wurde abgeleitet. Schlussfolgerung Die Ergebnisse belegen gesundheitsforderliche Effekte eines verhaltnis- und verhaltensbasierten, kommunalen Ansatzes zur Gesundheitsforderung bei Teilnehmenden an Masnahmen im Handlungsfeld Ernahrung. Das Projekt „Gesunde Sudstadt“ stellt einen systematischen, lebensweltrelevanten und niedrigschwelligen Ansatz der soziallagenbezogenen Gesundheitsforderung im kommunalen Setting dar. Methodische Einschrankungen, wie das Querschnittsdesign der Studie, werden diskutiert. Background and Objectives The Project “Gesunde Sudstadt” is focused on community-based health promotion interventions. It was initiated as part of the “Prevention Act” (SGB V §20a) and aims to reduce health inequalities in the city of Nuremberg. The community-based health promotion interventions focussing on nutrition were evaluated with an external multi-perspective, multi-method evaluation approach with a focus both on process and outcome results. Methods 55 reports on activities, 8 interviews with participants and 3 interviews with trainers were coded using qualitative content analysis. Statistical analyses were conducted on a participant survey (n=35). Results Results showed that the community-based health promotion interventions were not only widely accepted by the participants but also enabled them to participate in health-related activities. Additionally, health promotion interventions in the community were found to promote interactive and functional health competences. An empirically derived path model for community-based health promotion interventions was statistically tested. Conclusions Results show health promotion effects of community-based nutrition-related health promotion interventions on participants. The project “Gesunde Sudstadt” thus represents a systematic, relevant and low-threshold approach to health promotion in a communal setting. Methodological limitations such as the cross-sectional design are discussed.

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

Pulmonary vascular disease and pulmonary hypertension (PH) belong to the most relevant complications of congenital heart disease (CHD) in the long-term course. Although PH might lead to a severely impaired quality of life (QOL), there are no current studies comparing QOL in adults with CHD (ACHD) with and without PH. Therefore, this study aimed to systematically examine QOL in ACHD with and without PH in order to generate a more differentiated understanding of their overall health-status and to employ newly gained findings into general care of this particular patient population.In this comparative cross-sectional study, a representative sample of 803 adults with various forms of CHD with or without PH was analyzed. Data collection took place between September 2017 until February 2018 in a tertiary care center for ACHD. Medical data was retrieved from medical records. QOL was assessed using the EQ-5D-5L questionnaire. Descriptive methods, chi-square and t-tests were used to compare QOL of patients with and without PH.Of 803 patients, 752 patients had no PH [93.6%; 47.3% female; mean age: 34.9±11.83 (range, 18-86) years], 51 were identified with manifest PH [6.4%; 55.8% female; mean age: 41.9±12.17 (range, 21-69) years]. PH patients showed significantly worse overall QOL [mean no PH: 86.78±13.30 (8.2-100)Since QOL is a significant predictor of outcome, PH-CHD patients need an early provision of psychosocial, health promoting support in addition to dedicated care and targeted PH treatment. It is therefore pivotal to timely identify unique psychosocial impairments in order to enhance quantity and QOL in this particularly vulnerable patient population.

Die Gesundheitsversorgung in Deutschland steht aufgrund des demografischen Wandels, veränderter Arbeits- und Lebensrealitäten und akut durch die pandemische Verbreitung des Covid-19 Virus vor multiplen und neuen Herausforderungen. Für eine zunehmend ältere Bevölkerung ergibt sich ein erhöhter Bedarf an komplexen Gesundheitsversorgungsdienstleistungen, die biopsychosoziale Belange chronisch und/oder multipel erkrankter Personen auch und gerade unter den Bedingungen der Covid-19 Pandemie berücksichtigen. Die Autoren plädieren dafür, ambulante Versorgungsstrukturen als Lebenswelt für gesundheitsförderliche Maßnahmen zu begreifen und zu nutzen. Sie stellen den Mehrwert der komplementären Integration einer salutogenetischen, von einem biopsychosozialen Verständnis getragenen Säule in die Primärversorgung im Sinne der WHO-Agenda zu Health Promotion dar und unterbreiten Vorschläge zur kurz- und langfristigen Umsetzung.

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

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

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

The present study examines connections between patient expectations and health-related quality of life. We explore a key distinction between expectations about general health and expectations for functional improvement. Patients were 1444 individuals with multiple conditions experiencing chronic pain who were seeking treatment at the Gastein Healing Gallery in Böckstein, near Bad Gastein, Austria. In addition to measures of expectations, patients completed measures of pain, mental and physical health, life satisfaction, fatigue, and sleep problems. Structural equation models were used to fit a latent variable model where both expectation variables were used to predict health-related quality of life. Results showed that expectations regarding potential functional improvement resulting from treatments at the Gastein Healing Gallery were associated with improved health-related quality of life. Expectations about general health improvements related to treatment were not associated with health-related quality of life. To facilitate optimal healing, clinicians may decide to emphasize expectations about functional recovery when discussing treatment methods similar to those offered at the Gastein Healing Gallery, and in so doing, health-related quality of life may benefit.

Volkshochschulen verstehen sich als Bildungsorte für alle Bevölkerungsgruppen. Es stellt sich die Frage, ob die sogenannten sozial benachteiligten Zielgruppen tatsächlich erreicht werden können. Das von 2016 bis 2020 in der Stadt Nürnberg durchgeführte Projekt „Gesunde Südstadt', ein Projekt zur kommunalen Gesundheitsförderung, liefert dazu einige Antworten. Im Projekt, das in einem Stadtteil mit sozial deprivierten Bevölkerungsgruppen durchgeführt wurde, konnte gezeigt werden, dass Volkshochschulen durchaus geeignete Orte sind, um diese Gruppen zu erreichen. Dazu müssen gewisse Rahmenbedingungen erfüllt und die Bereitschaft gegeben sein, bewährte Wege zu verlassen und neue Methoden in die Arbeit der Volkshochschulen zu integrieren.

The present study examined differences between fibromyalgia patients and healthy controls on anger rumination, mental health and quality of life and tested anger rumination as a mediator of patient-control differences in mental health and quality of life. Participants were a propensity score-matched sample of 58 fibromyalgia patients and 58 healthy controls. Participants completed measures of anger rumination, depression and anxiety and quality of life. Patients were higher than controls on all anger rumination scales and depression and anxiety and lower on quality of life. All anger rumination scales were related to poorer mental health and quality of life. Patient-control differences on mental health and quality of life were mediated by anger rumination. In multiple mediator models, the only subscale with unique mediating effects was anger memories. Anger rumination has potent associations with mental health and quality of life, and differences between patients and controls on mental health and quality of life are partially mediated by differences in anger rumination. Addressing tendencies to ruminate on anger experiences in the care of fibromyalgia patients may offer an important avenue to improved health and quality of life. © 2019 John Wiley & Sons, Ltd.

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

Das Projekt "Gesunde Südstadt" hat den Schwerpunkt Gesundheitsförderung in der Lebenswelt Kommune. Es wurde im Rahmen des "Präventionsgesetzes" (SGB V §20a) initiiert und zielt ab auf die Verringerung der gesundheitlichen Ungleichheit in der Stadt Nürnberg. Die Maßnahmen der kommunalen Gesundheitsförderung im Handlungsfeld Ernährung wurden durch eine externe multiperspektivische, multimethodische Prozess- und Ergebnisevaluation begleitend untersucht.55 Maßnahmenberichte, 8 Interviews mit Teilnehmenden sowie 3 Interviews mit Maßnahmendurchführenden wurden mit qualitativer Inhaltsanalyse ausgewertet. Eine Teilnehmendenbefragung (n=35) mittels Fragebögen wurde quantitativ-statistisch ausgewertet.Die Ergebnisse zeigen, dass die Gesundheitsförderungsmaßnahmen durch die Teilnehmenden eine hohe Akzeptanz erfuhren und ein ausgeprägtes Maß an Partizipation ermöglicht wurde. Weiterhin zeigen die Ergebnisse, dass die Maßnahmen die interaktive sowie die funktionale Gesundheitskompetenz förderten. Ein empirisches Pfadmodell für kommunale Gesundheitsförderungsprojekte wurde abgeleitet.Die Ergebnisse belegen gesundheitsförderliche Effekte eines verhältnis- und verhaltensbasierten, kommunalen Ansatzes zur Gesundheitsförderung bei Teilnehmenden an Maßnahmen im Handlungsfeld Ernährung. Das Projekt "Gesunde Südstadt" stellt einen systematischen, lebensweltrelevanten und niedrigschwelligen Ansatz der soziallagenbezogenen Gesundheitsförderung im kommunalen Setting dar. Methodische Einschränkungen, wie das Querschnittsdesign der Studie, werden diskutiert.The Project "Gesunde Südstadt" is focused on community-based health promotion interventions. It was initiated as part of the "Prevention Act" (SGB V §20a) and aims to reduce health inequalities in the city of Nuremberg. The community-based health promotion interventions focussing on nutrition were evaluated with an external multi-perspective, multi-method evaluation approach with a focus both on process and outcome results.55 reports on activities, 8 interviews with participants and 3 interviews with trainers were coded using qualitative content analysis. Statistical analyses were conducted on a participant survey (n=35).Results showed that the community-based health promotion interventions were not only widely accepted by the participants but also enabled them to participate in health-related activities. Additionally, health promotion interventions in the community were found to promote interactive and functional health competences. An empirically derived path model for community-based health promotion interventions was statistically tested.Results show health promotion effects of community-based nutrition-related health promotion interventions on participants. The project "Gesunde Südstadt" thus represents a systematic, relevant and low-threshold approach to health promotion in a communal setting. Methodological limitations such as the cross-sectional design are discussed.

The extent to which individuals perceive stigma from others and internalize stigmatizing beliefs is increasingly recognized as a contributor to psychological and physical distress. Individuals in poverty may feel increasingly stigmatized as a result of financial hardship; however, little research has examined the linkage of financial stigma to health outcomes, nor the potential underlying explanatory mechanisms of such an association. According to Self-Determination Theory, loss of social capital, which often occurs when a person is stigmatized, may deleteriously affect health outcomes, yet this premise has not been tested. We assessed the incremental impact of sociodemographic characteristics, and experienced and internalized financial stigma, on health-related quality of life (HRQL), as well as the mediating effect of belongingness, in a sample of 100 working, uninsured primary care patients. Results confirmed that experienced and internalized perceived stigma contributed additional variance, over the effects of sociodemographic factors, to poor HRQL, and belongingness was a significant mediator. Financial stigma may increase isolation, reducing opportunities for meaningful social connections, thereby deleteriously impacting mental and physical health outcomes. Therapeutically addressing stigma, and bolstering social connectedness, may improve HRQL in the underserved and impoverished.

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

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

Studierende in Deutschland sind eine vulnerable und besonders stark durch psychische Belastungen betroffene Gruppe. Daher gewinnen Masnahmen zur Reduktion psychischer Belastungen – insbesondere innovative Ansatze – zunehmend an Bedeutung. In dieser teilrandomisierten 4‑armigen Interventionsstudie mit Kontrollgruppe wurde uberpruft, ob bei Studierenden der Hochschule Coburg durch die Smartphone-App „AOK Relax“, einen achtsamkeitsbasierten Stressbewaltigungskurs oder eine Kombination aus beiden die psychischen Belastungen reduziert und die Achtsamkeit sowie das Wohlbefinden gestarkt werden konnen. Es werden zu Beginn (T1) und am Ende (T2) des Interventionszeitraums (Wintersemester 2016/17) Achtsamkeit (Freiburg Mindfulness Inventory, FMI-13), Wohlbefinden (Wohlbefindens-Index, WHO-5D) sowie die aktuelle subjektiv erlebte Belastung (Perceived Stress Questionnaire, PSQ) gemessen. Um Veranderungen im Studienverlauf zu untersuchen werden der Wilcoxon-Test sowie die Effektstarke d von Cohen berechnet. Die Interventionsgruppen bestehen ausschlieslich aus weiblichen Studierenden. Studentinnen, die ausschlieslich die App verwendeten (n = 17), zeigten einen Anstieg der Achtsamkeit (p = n. s., d = 0,43). Bei den Teilnehmerinnen des Kurses (n = 12) war ebenfalls ein Anstieg der Achtsamkeit (p

The present study aims to analyse the association that different types of spiritual and religious practices have with the occurrence of Exceptional Human Experiences (EHEs) as well as their emotion...

Theory and evidence suggests that person-centred models may be especially relevant for elucidating the role of perfectionism in health and well-being in those with chronic health conditions. This may be particularly true for conditions, such as chronic fatigue syndrome (CFS), in which perfectionism is known to play a prominent role in health outcomes. Yet to date no research has taken a person-centred approach to examine how within-person combinations of perfectionistic strivings and perfectionistic concerns are linked to vulnerability for poor health in CFS. The current study compared matched samples of people with CFS and healthy controls (N = 163 each) on measures of stress, depression, and health problems. Consistent with the Stress and Coping Cyclical Amplification Model of Perfectionism in Illness and the tripartite model of perfectionism, within-person combinations of high perfectionistic concerns and strivings had the poorest health profile compared to other within-person combinations, but only among those with CFS. In addition, the perfectionism was indirectly associated with health through stress in those with CFS only. Findings add to a growing evidence base on the utility of person-centred models for understanding the health risks of perfectionism in the context of chronic illness.

Zusammenfassung Ziel der Studie Die personenzentrierte Medizin (PZM) mit Fokus auf einer humanistisch-biografisch orientierten Medizin und einem erweiterten, positiv-salutogenen Gesundheitsbegriff ist ein zentraler Bestandteil der Arzt-Patienten Beziehung in der Allgemeinmedizin. Ziel dieser Analyse ist es deshalb, Prävalenz und Typ von Forschungsprojekten in universitären Instituten für Allgemeinmedizin in Deutschland (D) und Österreich (Ö) sowie deren thematische Schwerpunkte in den Bereichen PZM, Gesundheitsförderung (GF), Prävention (PRÄ) und konventioneller Medizin (KM) zu erfassen. Methodik Es wurde eine Recherche auf den Webseiten von 30 Instituten für Allgemeinmedizin mit dem Fokus auf deren Forschungsprojekten im Zeitraum September–Dezember 2015 durchgeführt. Die erfassten Projekte wurden in die 5 Kategorien PZM, GF, PRÄ, KM und sonstige Themen eingeteilt. Anschließend erfolgte eine Identifikation der Zielgruppen und thematischen Schwerpunkte in den ersten 4 Kategorien, vertieft in den Bereichen PZM und GF. Ergebnisse Die Suche ergab insgesamt 541 Forschungsprojekte (FP), 452 in Deutschland und 89 in Österreich. Es wurden nur FP erfasst, die ausdrücklich als solche gekennzeichnet waren. 70 FP untersuchten Aspekte der PZM, 15 FP Aspekte der GF, 32 FP Aspekte der PRÄ und 395 FP Aspekte der konventionellen Medizin. Chronisch kranke Patienten stellten in den beiden Kategorien PZM (24 von 70) und GF (7 von 15) die häufigste Zielgruppe dar. Häufigster thematischer Schwerpunkt der PZM-Projekte war das Thema Kommunikation (13 von 70), bei den GF-Projekten die körperliche Aktivität (6 von 15). Schlussfolgerung Die Mehrzahl der Forschungsprojekte beschäftigt sich mit konventionellen medizinischen Themen. Mit einem Anteil von 13% (PZM) bzw. 16% (PZM & GF) liegt die Forschungsaktivität im Bereich PZM bzw. GF in D und Ö unter dem europäischen Durchschnitt von 20%. Um diese Themenbereiche verstärkt in die hausärztliche Versorgung zu integrieren ist es aus unserer Sicht notwendig u. a. die Forschung zu Voraussetzungen und Barrieren von PZM und GF im ärztlichen Alltag in Deutschland und Österreich zu vertiefen.

The proportion of adults suffering from hypertension worldwide was estimated at 31.1 % in 2010. The aim of this study was to evaluate the effects of lifestyle changes in patients with arterial hypertension (AH) in primary care.Systematic literature search in the online databases PubMed, Embase, Cochrane and Opengrey. Only randomized controlled trials of the years 2005 to 2017 in German or English were considered.11 studies out of 458 identified references were evaluated. The patient groups investigated were very heterogeneous and underwent different types of intervention. Educating patients about the clinical picture, regular self-measurements of blood pressure, or patient memories of maintaining a healthy lifestyle have been used most frequently.There is a need for further studies focusing on primary care. However, many lifestyle interventions seem to show very good effects in patients with pre-existing AH (secondary prophylaxis), so these measures should form the basis of antihypertensive therapy in all patients with AH. In addition, it is important to maintain advice on a healthy lifestyle during drug therapy.

(1) Background: Mind-body interventions (MBI), such as meditation or other relaxation techniques, have become the focus of attention in the clinical and health sciences. Differences in the effects of induction techniques are being increasingly investigated. (2) Methods: Here, we compared changes in the individual experience of time, space, and self in 44 students in an integrative health-promotion program. They participated in a study employing mindfulness meditation and a relaxation intervention with one week between sessions, thus employing a within-subjects design. (3) Results: No significant differences were detected when subjective reports were compared directly after each intervention. However, we found significant sequence effects between t1 and t2, independent of the meditation type. The sense of self diminished, the present orientation increased, and the past and future orientations decreased in both interventions. (4) Conclusions: We propose using scales to assess subjective time, self, and space as basic constituents of experience to measure the specificity of intervention methods, as well as longitudinal changes.

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

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

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

Individuals with fibromyalgia are at greater risk for depressive symptoms than the general population, and this may be partially attributable to physical symptoms that impair day‐to‐day functioning. However, individual‐level protective characteristics may buffer risk for psychopathology. For instance, the ability to perceive a “silver lining” in one’s illness may be related to better mental and physical health. We examined perceived silver lining as a potential moderator of the relation between fibromyalgia impact and depressive symptoms. Our sample of persons with fibromyalgia (N = 401) completed self‐report measures including the Fibromyalgia Impact Questionnaire‐Revised, Depression Anxiety Stress Scales, and the Silver Lining Questionnaire. Moderation analyses covaried age, sex, and ethnicity. Supporting hypotheses, increasing impact of disease was related to greater depressive symptoms, and perceptions of a silver lining attenuated that association. Despite the linkage between impairment and depressive symptoms, identifying positive aspects or outcomes of illness may reduce risk for psychopathology. Therapeutically promoting perception of a silver lining, perhaps via signature strengths exercises or a blessings journal, and encouraging cognitive reframing of the illness experience, perhaps via Motivational Interviewing or Cognitive Behavioral Therapy, may reduce depressive symptoms in persons with fibromyalgia.

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

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

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

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