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Psychiatric disorders are common but underdiagnosed in cancer survivors. Research suggests that tumor type has an effect on the prevalence of clinically relevant depression, anxiety, comorbid anxiety-depression and posttraumatic stress disorder (PTSD).To identify studies that examined the prevalence of clinically relevant levels of depression, anxiety, comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.Four databases (PubMed, PsycInfo, PubPsych and the Cochrane Database) were searched and resulted in a total of 2387 articles to be screened. To be included, a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities. All articles were screened by two authors with a third author reviewing debated articles.Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review. The studies showed heterogeneity regarding the study characteristics, number of participants, time since diagnosis, and assessment tools. Generally, all four comorbidities show higher prevalences in cancer survivors than the general population. Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety. Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities. Regarding comorbidities, a wide range in prevalence existed across the tumor types. Within one cancer site, the prevalence also varied considerably among the studies.Psychiatric comorbidities are more frequent in cancer survivors than in the general population, as reflected by the prevalence of depression, anxiety, comorbid anxiety-depression and PTSD across all tumor subtypes. Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.

ZusammenfassungFunktionelle gastrointestinale Erkrankungen wie das Reizmagen- (funktionelle Dyspepsie, FD) und das Reizdarmsyndrom (RDS) sind stressassoziiert. Die seit 2020 grassierende COVID-19-Pandemie hat Ängste und Stress in der Bevölkerung ausgelöst. Distanzierende Maßnahmen zur Bekämpfung der Pandemie beeinflussen die psychische Gesundheit. Das Ziel dieser Studie war die Untersuchung der Auswirkungen des dritten Lockdowns 12/2020–01/2021 auf die Besorgtheit von Patient:innen mit FD oder RDS.Patient:innen mit der Diagnose FD oder RDS, die im Jahr 2020 in einer universitären Ambulanz oder in einem Krankenhaus der Regelversorgung im Süden Baden-Württembergs behandelt wurden, nahmen freiwillig an einer anonymen Online-Umfrage zu Begleiterkrankungen, Besorgtheit um COVID-19 und Stresserleben teil.106 Patient:innen (♀=67, ♂=38, 1 divers) nahmen an der Umfrage teil. Davon hatten 16 FD (♀=9, ♂=6, divers=1), 80 RDS (♀=52, ♂=28) und 10 beides (♀=6, ♂=4). Depressive und Angsterkrankungen waren die häufigsten Komorbiditäten in der FD- (jeweils 25%) und RDS-Gruppe (jeweils 20%). Im Vergleich von Teilnehmenden mit FD und RDS zeigten jene mit RDS signifikant höhere Werte für eine Zunahme der Magen- und Darmbeschwerden während der Pandemie (p=0,007), eine häufigere Vorstellung beim Arzt während der Pandemie, einen stärkeren sozialen Rückzug aufgrund gastrointestinaler Symptome (p=0,05) und höhere Werte für die Befürchtung, dass eine Impfung gegen COVID-19 die Magen- und Darmbeschwerden ungünstig beeinflussen könnte (p=0,05).In Zeiten der Pandemie scheint eine interdisziplinäre Zusammenarbeit in der Versorgung von Patient:innen mit FD oder RDS mehr denn je vonnöten, um Besorgnisse zu adressieren und eine gute Behandlung anzubieten.

Objectives Female genital malformations may be present in the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and uterine appendages, the clinical picture of malformations varies greatly. Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed and voted on using a structured consensus process with neutral moderation. Recommendations This guideline is the first comprehensive summary of female genital malformations from infancy to adulthood which covers clinical examinations, diagnostic workups and treatment options. Additional chapters have been included on complex urogenital malformations, vascular malformations, psychosomatic care, and tumor risk.

Serious games convey information and use interactive components to reinforce and train behaviours. A serious game addressing nutrition, physical activity and stress coping—the Kids Obesity Prevention Program (KOP)—was previously evaluated for efficacy in children. This study aimed at evaluating the KOP-game regarding: (i) its acceptance and efficacy with respect to parents of primary school children receiving the same game intervention as the children; and (ii) whether the children could benefit by parental involvement. A randomized controlled trial with two groups of children aged 9 to 12 years was conducted which included a 6-month follow-up period. All children played the game twice in two weeks. In the family-intervention group, the parents additionally played the game. The primary outcome was the gain in knowledge in parents and children measured with a pretested questionnaire. The secondary outcomes were knowledge maintenance as well as several behavior changes. Parents and children in both groups improved and maintained their knowledge equally. The KOP-game increases knowledge of nutrition in children independently of the involvement of their parents. KOP games are well accepted in children; further research should examine the structured involvement of parents.

The diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), a rare variant of female sexual development, is usually made during puberty. The uncertainty in self-image and the impos-sibility of becoming pregnant often lead to considerable stress. Although psychosomatic support is consistently recommended in the literature, there have been only a few studies on the psychological aspects of MRKHS. The aim of the present study is to investigate the quality of life or distress of women with MRKHS undergoing neovaginal surgery and, on the other hand, to evaluate effects of the intervention for support during treatment. Methods In an explorative quasi-experimental pre-post study at a national centre for neovaginal surgery, all patients were offered a psychosomatic intervention (intervention group IG, n=23) and their sexual function (FSFI), psychological distress (PHQ-D) and health-related quality of life (SF-12) were assessed before surgery (t0) and six months after (t1). These were compared with data from a sample collected before and after the intervention period (comparison group VG, n=30). Results While the physical quality of life (SF-12) of both groups was unremarkable at both time points, there was a significant impairment in the psychological quality of life. Both groups (IG, VG) improved from t0 to t1 in their sexual function (FSFI) and showed lower depression scores (PHQ-D). The specific intervention developed was well accepted by those affected and rated as helpful. However, this subjectively perceived effectiveness of the intervention was not reflected by improvement on the quality of life scale (SF-12) and depression scale (PHQ-D). Conclusion Those affected show a clear, clinically relevant distress (SF-12), but this is not reflected in the form of psychological comorbidity (PHQ-D). This apparent discrepancy points to psychologically stable women with acute distress due to the diagnosis of variant sex de-evolution. For them, a low-threshold support service with a supportive character seems to be necessary and helpful during the surgical treatment. The reconstructive therapy for the creation of a neovagina seems to have a positive influence on the psychological quality of life. The fact that pregnancy is still not possible due to the missing uterus could be a reason for not reaching the quality of life of the average population.Die Diagnose des Mayer-Rokitansky-Küster-Hauser Syndroms (MRKHS), eine seltene Variante der weiblichen Geschlechtsentwicklung, wird meist in der Pubertät gestellt. Die Verunsicherung im Selbstbild, die Unmöglichkeit schwanger zu werden führen häufig zu deutlicher Belastung. Obwohl eine psychosomatische Begleitung in der Literatur konsistent empfohlen wird gibt es bislang nur wenige Studien zu psychischen Aspekten von MRKHS. Ziel dieser Studie ist es, die Lebensqualität und Belastung von Frauen mit MRKHS bei der operativen Anlage einer Neovagina zu untersuchen und andererseits Effekte einer Intervention zur Vorbereitung und Unterstützung während der Behandlung zu evaluieren. Methoden An einem überregionalen Zentrum zur Neovaginaanlage wurde im Rahmen einer explorativen quasi-experimentellen Prä-Post-Untersuchung allen Patientinnen eine psychosomatische Intervention angeboten (Interventionsgruppe IG, n=23) und vor Operation (t0) sowie sechs Monate danach (t1) die sexuelle Funktion (FSFI), psychische Belastung (PHQ-D) und gesundheitsbezogene Lebensqualität (SF-12) erhoben. Diese wurden mit den Daten einer zuvor sowie im Anschluss an den Interventionszeitraum erhobenen Stichprobe verglichen (Vergleichsgruppe VG, n=30). Ergebnisse Während die körperliche Lebensqualität (SF-12) beider Gruppen zu beiden Zeitpunkten unauffällig war, zeigte sich eine signifikante Beeinträchtigung in der psychischen Lebensqualität. Beide Gruppen (IG, VG) verbesserten sich von t0 zu t1 in ihrer sexuellen Funktion (FSFI) und zeigten niedrigere Depressionswerte (PHQ-D). Die im Rahmen dieser Studie entwickelte Kurzintervention wurde von den Betroffenen gut akzeptiert und als hilfreich bewertet. Diese subjektiv empfundene Wirksam-keit der Intervention zeigte sich jedoch nicht durch eine Verbesserung auf der Lebensqualitätsskala (SF-12) und Depressionsskala (PHQ-D). Schlussfolgerung Die Betroffenen zeigen eine deutliche, klinisch relevante Belastung (SF-12), die sich aber nicht in Form psychischer Komorbidität (PHQ-D) abbildet. Diese scheinbare Diskrepanz weist auf psychisch stabile Frauen mit akuter Belastung durch die Diagnose der Variante der Geschlechtsentwicklung hin. Für sie scheint ein niederschwelliges Unterstützungsangebot mit supportivem Charakter zur Begleitung während der operativen Behandlung notwendig und hilfreich. Die rekonstruktive Therapie zur Anlage einer Neovagina scheint die psychische Lebensqualität positiv zu beeinflussen. Dass eine Schwangerschaft aufgrund des fehlenden Uterus weiterhin nicht möglich ist könnte ein Grund für das Nicht-Erreichen der Lebensqualität der Durchschnittsbevölkerung sein.

Functional gastrointestinal disorders such as functional dyspepsia (FD) and irritable bowel syndrome (IBS) are stress-associated. The COVID-19 pandemic, which has been rampant since 2020, has caused anxiety and stress in the population. Distancing measures to combat the pandemic have affected mental health. Our objective was to examine the impact of the 3rd lockdown in Germany in December 2020 and January 2021 on the apprehension of patients with FD and IBS.Patients diagnosed with FD or IBS treated in a tertiary or primary care hospital in the South of Baden-Württemberg in 2020 voluntarily participated in an anonymous online survey. Questions about concomitant diseases, concern about COVID-19 and stress perception were answered.A total of 106 patients (♀=67, ♂=38, 1 diverse) participated in the survey. Of these, 16 had FD (♀=9, ♂=6, diverse=1), 80 had IBS (♀=52, ♂=28), and 10 had both (♀=6, ♂=4). The average age was 43.6 years. Depressive and anxiety disorders were most frequently reported comorbidities in both the FD (25% each) and IBS group (20% each), followed by joint wear and tear (FD: 13%, RDS: 14%). In a direct comparison of participants with FD and IBS, those with IBS showed significantly higher scores for an increase in gastrointestinal (GI) symptoms during the pandemic (p=0.007), more frequent presentation to a physician during the pandemic, and greater social withdrawal due to GI symptoms (p=0.05). In direct comparison, those with IBS showed higher scores for fear that vaccination against COVID-19 would adversely affect GI symptoms compared to FD (p=0.05).In times of the pandemic, interdisciplinary collaboration in the care of patients with FD or IBS seems more necessary than ever to address concerns and provide good patient care.Funktionelle gastrointestinale Erkrankungen wie das Reizmagen- (funktionelle Dyspepsie, FD) und das Reizdarmsyndrom (RDS) sind stressassoziiert. Die seit 2020 grassierende COVID-19-Pandemie hat Ängste und Stress in der Bevölkerung ausgelöst. Distanzierende Maßnahmen zur Bekämpfung der Pandemie beeinflussen die psychische Gesundheit. Das Ziel dieser Studie war die Untersuchung der Auswirkungen des dritten Lockdowns 12/2020–01/2021 auf die Besorgtheit von Patient:innen mit FD oder RDS.Patient:innen mit der Diagnose FD oder RDS, die im Jahr 2020 in einer universitären Ambulanz oder in einem Krankenhaus der Regelversorgung im Süden Baden-Württembergs behandelt wurden, nahmen freiwillig an einer anonymen Online-Umfrage zu Begleiterkrankungen, Besorgtheit um COVID-19 und Stresserleben teil.106 Patient:innen (♀=67, ♂=38, 1 divers) nahmen an der Umfrage teil. Davon hatten 16 FD (♀=9, ♂=6, divers=1), 80 RDS (♀=52, ♂=28) und 10 beides (♀=6, ♂=4). Depressive und Angsterkrankungen waren die häufigsten Komorbiditäten in der FD- (jeweils 25%) und RDS-Gruppe (jeweils 20%). Im Vergleich von Teilnehmenden mit FD und RDS zeigten jene mit RDS signifikant höhere Werte für eine Zunahme der Magen- und Darmbeschwerden während der Pandemie (p=0,007), eine häufigere Vorstellung beim Arzt während der Pandemie, einen stärkeren sozialen Rückzug aufgrund gastrointestinaler Symptome (p=0,05) und höhere Werte für die Befürchtung, dass eine Impfung gegen COVID-19 die Magen- und Darmbeschwerden ungünstig beeinflussen könnte (p=0,05).In Zeiten der Pandemie scheint eine interdisziplinäre Zusammenarbeit in der Versorgung von Patient:innen mit FD oder RDS mehr denn je vonnöten, um Besorgnisse zu adressieren und eine gute Behandlung anzubieten.

The coronavirus disease 2019 (COVID-19) pandemic has led to major health-related concerns in the population. Several risk factors for a severe course of COVID-19 disease have been identified, with obesity taking an important role. However, it is unclear whether this association is only known in the expert world or whether individuals also experience themselves as risk patients due to their obesity and whether the desire for weight reduction may also be associated with a hoped-for risk reduction. These questions were addressed in a cross-sectional study of patients who have presented to an obesity center in order to lose body weight.Patients (In our explorative study, overall worries correlated significantly with worries about contracting COVID-19 (An increased risk for a more severe course of COVID-19 infection is not generally perceived by obese individuals. In particular, individuals with very high BMI (50)-although being at very high risk for a severe course of the COVID-19 disease-do not display increased worries, which might point toward heightened denial.

ZusammenfassungEine bedürfnisorientierte psychoonkologische Unterstützung für Frauen, die an Brustkrebs erkrankt sind, ist v. a. in strukturschwachen Gebieten nicht genügend vorhanden. Moderne telemedizinische und webbasierte Angebote (eHealth) können einen wichtigen Mehrwert in der psychoonkologischen Versorgung darstellen, da sie im Rahmen des Selbstmanagements unabhängig von personellen Ressourcen, Zeit und Ort verfügbar sind. Bisher fehlen solche supportive psychoonkologische Angebote weitestgehend im deutschsprachigen Raum. Aus diesem Grund wurde ein psychoonkologisches Online-Programm entwickelt. Inhalte für die zeitgemäße webbasierte, bedürfnisorientierte, psychoonkologische Intervention wurden aus Literatur und eigenen Vorstudien entwickelt. Ein Manual für ein Skills- und Achtsamkeitstraining (Make It Training- Mindfulness and skills based distress reduction training in oncology) im Websetting wurde entworfen, programmiert und elektronisch umgesetzt. Diese Intervention beinhaltet insgesamt acht krankheitsbezogene Sitzungen mit Lehrvideos, Audiodateien, interaktiven Arbeitsblättern, persönlicher Skillsbox sowie daraus entstehendem Abschlussmaterial nach jeder Sitzung. Die hier vorgestellten Bausteine zur Psychoedukation und Vermittlung von verhaltenstherapeutischen Skills zu den Themen Emotionsmanagement, Ressourcen, Stressmanagement und Selbstzuwendung, sowie ein fortlaufendes Achtsamkeitsmodul wurden entwickelt. Eine Akzeptanzüberprüfung (N=35) ergab hohe Werte für Akzeptanz und Zufriedenheit seitens der Patientinnen. 87% der Patientinnen würden anderen betroffenen Frauen das Make It Training weiterempfehlen. Mit dem Make It Training steht ein Programm zur Verfügung, das effektive Bewältigungsstrategien und Fertigkeiten im Umgang mit psychischen Belastungen und Anforderungen, die durch eine Krebserkrankung entstehen, vermittelt. Das webbasierte psychoonkologische Selbstmanagementprogramm kann die Versorgung in einem gestuften Ansatz nicht zuletzt in strukturschwachen Regionen für Patienten mit onkologischen Erkrankungen verbessern.

Objectives Female genital malformations may take the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and adnexa, the clinical picture of malformations may vary greatly. Depending on the extent of the malformation, organs of the urinary system or associated malformations may also be involved.Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed using a structured consensus process with neutral moderation and voted on.Recommendations The guideline is the first comprehensive presentation of the symptoms, diagnosis and treatment options for female genital malformations. Additional chapters on classifications and transition were included.

Objective Hopelessness and depression are strongly associated with suicidality. Given that physical and psychological outcomes can be altered with hope, hope is a therapeutic goal of increasing importance in the treatment of brain tumor patients. Moreover, it is not yet understood which factors affect the perception of hope in brain tumor patients. In addition, it remains uncertain whether lower-grade brain tumor patients suffer less from psycho-oncological distress than higher-grade brain tumor patients. Methods Neuro-oncological patients were examined perioperatively with the Distress Thermometer (DT) and the Herth Hope Index (HHI). In addition, psychological comorbidities (anxiety GAD-2, depression PHQ-2) and an assessment of general psycho-oncological distress were recorded. Results Sixty-six brain tumor patients were included (median age 53 years, 35% higher-grade brain tumors, i.e., WHO grade III/IV). No differences between higher- and lower-grade brain tumor patients were observed for general psycho-oncological distress and hope. However, higher-grade brain tumor patients showed a significantly higher level of depression (p ≤ 0.001) and more negative expectations regarding therapeutic success (H = 4.873, p ≤ 0.050). The extent of depression correlated negatively with hope. Conclusion Unexpectedly, higher-grade brain tumor patients remained as hopeful as lower-grade brain tumor patients despite the devastating diagnosis, higher levels of depression, and a worse expectation of therapeutic success. Conversely, lower-grade brain tumor patients experience as much psycho-oncological distress as patients with a higher-grade brain tumor, underpinning the imperative need for comprehensive psycho-oncological screening. For all brain tumor patients, considering hope is important to avoid suicides resulting from hopelessness and depression.

Zusammenfassung Einleitung Während einer Krebserkrankung stellen sich Fragen nach Lebenssinn in neuer Prägnanz. Studien zeigen, dass ein Großteil der Patienten spirituelle Bedürfnisse äußern und Religiosität/ Spiritualität eine wichtige Ressource in der Krankheitsbewältigung sein kann. Bislang liegen zur Entwicklung psychischer Belastung und der Rolle spiritueller Bedürfnisse im Krankheits- und Behandlungsverlauf von Patienten mit malignem Melanom wenige Studien vor. Methoden Die Studie untersucht religiöse/spirituelle Bedürfnisse und psychosoziale Belastungen bei n = 22 Patienten mit malignem Melanom zu 2 Zeitpunkten: stationärer Aufenthalt zur Entfernung der Wächterlymphknoten (t1) sowie 8 Wochen später (t2). Distress, Angst, Depressivität sowie spirituelle Bedürfnisse und Religiosität wurden mithilfe standardisierter Assessments (HSI, DT, HADS, PHQ; SpNQ; SpREUK) erfasst. Ergebnisse Unabhängig von Belastung und Messzeitpunkt äußerten alle Patienten spirituelle Bedürfnisse. Besonders wichtig waren das Bedürfnis nach ganzheitlichem Heilsein, sozialer Einbindung, Gewissheit von Lebenssinn und Gespräch über Sorgen und Ängste. Es zeigte sich eine geringere psychische Belastung von Patienten, die sich selbst als religiös bezeichneten. Diskussion Die Ergebnisse zeigen die Relevanz einer Berücksichtigung von spirituellen Bedürfnissen im klinischen und ambulanten Kontext der Krebsbehandlung. Die Befunde deuten außerdem darauf hin, dass Religiosität/Spiritualität eine wichtige Ressource bei der Krankheitsverarbeitung sein kann. Schlussfolgerung Spirituelle Bedürfnisse sollten im Behandlungsprozess im Sinne eines integrativen Behandlungskonzepts sowohl von psychoonkologischer als auch von seelsorgerlicher Seite erfragt und berücksichtigt werden.

Der Bereich des „Patient Empowerment“ befasst sich mit dem ergänzenden, aber auch eigenständigen Beitrag der PatientInnen zur Genesung – nicht als Konkurrenz, sondern als Ergänzung und Erweiterung zu dem Leistungsspektrum der Medizin. Initial wurde der Begriff etwa um das Jahr 2000 populär, insbesondere wurde dieser früh von Patienteninitiativen im Bereich der Krebstherapie benutzt. Ein zentraler Bestandteil des Patient Empowerment ist es dabei, den PatientInnen durch patientenorientierte Information eine bessere Mitwirkung und somit auch Mitentscheidung zu ermöglichen. Die WHO (WHO-Dokument „World Alliance of Patient Safety“) definiert Patient Empowerment als integralen Bestandteil von Programmen zur Verbesserung der Patientensicherheit 1 2.

Simple Summary A large proportion of patients with metastatic melanoma suffer from psychological distress. Early identification of these patients is important to be able to offer them adequate support. This longitudinal study aimed to investigate the extent to which the psychological distress of patients with malignant melanoma might change during their first three months of treatment with immune checkpoint inhibitors. We found a high proportion of distressed patients in a cohort of 113 patients at the beginning of immunotherapy, which decreased during therapy. A binary logistic regression analysis provided additional factors indicating an increased risk of developing distress—female gender and occurrence of adverse events correlated significantly with distress values above the threshold. The strongest factor was patients’ self-assessment. When initiating immunotherapy, it is also important to consider the needs of patients and offer them psycho-oncological support. Abstract Background: Immune checkpoint inhibitors (ICI) provide effective treatment options for advanced melanoma patients. However, they are associated with high rates of immune-related side effects. There are no data on the distress of melanoma patients during their ICI treatment. We, therefore, conducted a prospective longitudinal study to assess distress and the need for psycho-oncological support in these patients. Methods: Questionnaires were completed before initiation of ICI (T0), after 6–8 weeks (T1), and after 12–14 weeks (T2). We furthermore included the Hornheide Screening Instrument (HSI), distress thermometer (DT), and patients’ self-assessment. Binary logistic regression was performed to identify factors indicating a need for psychooncological support. Results: 36.3%/55.8% (HSI / DT) of the patients were above the threshold, indicating a need for psychooncological support at T0, and 7.8% of the patients reported practical problems. In contrast, at T2, the distress values had decreased to 29.0%/40.2% (HSI/DT), respectively. Female gender and occurrence of side effects significantly correlated to values above the threshold. The strongest factor was the patient’s self-assessment. Conclusion: With the beginning of ICI, psychooncological support should be offered. Furthermore, practical problems should be considered, e.g., transport to therapy. Female patients and patients with side effects should be given special attention, as well as the patient self-assessment.

Objective and Method A systematic literature search was conducted to assess the chances and limitations of video games to combat and prevent childhood obesity. This search included studies with video or computer games targeting nutrition, physical activity and obesity for children between 7 and 15 years of age. Results The study distinguished between games that aimed to (i) improve knowledge about nutrition, eating habits and exercise; (ii) increase physical activity; or (iii) combine both approaches. Overall, the games were well accepted. On a qualitative level, most studies reported positive effects on obesity-related outcomes (improvement of weight-related parameters, physical activity or dietary behaviour/knowledge). However, the observed effects were small. The games did not address psychosocial aspects. Conclusions Using video games for weight management exclusively does not deliver satisfying results. Video games as an additional guided component of prevention and treatment programs have the potential to increase compliance and thus enhance treatment outcome. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Eine bedarfsgerechte integrierte Mitbehandlung psychischer Belastungen und Storungen gehort zu den Herausforderungen einer modernen Krebsmedizin. Ohne standardmasiges Screening auf psychischen Distress bleibt ein groser Teil der versorgungsbedurftigen Krebspatienten unerkannt. Mit der verpflichtenden Einfuhrung von Distress-Screenings in die onkologische Routineversorgung entsteht fur die deutschen Krebszentren ein erhohter Dokumentationsaufwand. IT-gestutzte Screening-Prozeduren konnen diesen kompensieren. Wahrend die S3-Leitlinie Psychoonkologie Methoden und strukturelle Masnahmen zur fachkundigen Umsetzung eines standardgemasen Screenings beschreibt, fehlen bisher Handlungsempfehlungen zur Implementierung eines IT-gestutzten Distress-Screenings. Es wurde ein Konsensusmeeting „IT-gestutztes Distress-Screening in der onkologischen Routineversorgung“ durchgefuhrt. Es wurden Konsensempfehlungen zur Implementierung und Nutzung IT-gestutzter Distress-Screenings ausgearbeitet. Diese beziehen sich auf: 1) Vorbereitung der Implementierung, 2) IT-Ausstattung, 3) Implementierung, 4) Praktische Nutzung, 5) Qualitatssichernde Masnahmen im Forschungskontext. Ausgewahlte deutschsprachige Forschungsprojekte und aktuelle Entwicklungen in der klinischen Versorgungsforschung unterstreichen, welches Potenzial in der Zusammenfuhrung von klinischer Expertise mit der Informationstechnologie steckt. Mit den Ergebnissen des Konsensusmeetings stehen nun ein Leitfaden und Kriterienkatalog fur die Implementierung eines IT-basierten Distress-Screenings in der onkologischen Routineversorgung zur Verfugung. Die Umsetzung dieser Empfehlungen kann die Versorgungsqualitat von Krebspatienten in Deutschland verbessern.

Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer&ndash, Rokitansky&ndash, K&uuml, ster&ndash, Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conclude that parameters crucial to successful transplantation, pregnancy, and childbirth include careful selection of donor/recipient pairs, donor organ quality, meticulous surgical technique, a multidisciplinary team approach, and comprehensive follow-up. Surgery duration and blood vessel selection await further optimization, as do the choice and duration of immunosuppression, which are crucial to timing the first embryo transfer. Data need to be collected in an international registry due to the low prevalence of MRKHS.

Objective To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program. Design Part of an observational program. Setting University hospital. Patient(s) Patients with absolute uterine factor infertility (AUFI). Intervention(s) Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation. Main Outcome Measure(s) Age, cause of AUFI, exclusion reasons, and preoperative workup. Result(s) A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19–41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22–35) years, and mean donor age was 51.3 (37–62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications. Conclusion(s) The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success.

To identify distressed patients in oncology using screening questionnaires is quite challenging in clinical routine. Up to now there is no evidence based recommendation which instrument is most suitable and how to put a screening to practice. Using computer based screening tools offers the possibility to automatically analyse patient's data, inform psycho-oncological and medical staff about the results, and use reactive questionnaires. Studies on how to empower patients in decision making in psycho-oncology are rare.Methods Women with breast and gynaecological cancer have been consecutively included in this study (n=103) at time of inpatient surgical treatment in a gynaecological clinic. They answered the computer based screening questionnaire (ePOS-react) for routine distress screening at time of admission. At the end of the tool an individual recommendation concerning psycho-oncological treatment is given ( i) psycho-oncological counselling, ii) brief psycho-oncological contact, iii) no treatment suggestion). The informed patients could choose autonomously either the recommended treatment or an individually more favoured alternative possibility. Additionally, a clinical interview (approx. 30 min) based on the "Psychoonkologische Basisdiagnostik (PO-Bado)" has been carried out for a third-party assessment of patients' need for treatment.Results 68.9% followed the treatment recommendation. 22.3% asked for a more "intense" (e. g. counselling instead of recommended brief contact) and 8,7% for a "less intense" intervention than recommended. The accordance of third-party assessment (clinical interview "PO-Bado") and treatment recommendation is about 72.8%. The accordance of third-party assessment and patient's choice (ePOS-react) is about 58.3%. The latter is smaller because 29.1% asked for a brief psycho-oncological contact for whom from the third-party assessment's perspective no indication for treatment has been existent.Discussion A direct response of the screening result (treatment recommendation) during the computer based screening and asking for a patient's choice leads to an increase of brief psycho-oncological contacts for personal information about psycho-oncological interventions. Compared with a third-party assessment (clinical interview) there is no improvement of the accuracy of the indications. But it improves the transparency for the access to psycho-oncological interventions which may strengthen patient's autonomy and adherence.Die Identifizierung belasteter onkologischer Patienten mithilfe von Screening-Instrumenten stellt in der Praxis eine große Herausforderung dar. Bislang fehlen evidenzbasierte Empfehlungen, welches Instrument am geeignetsten ist, sowie zur Implementierung eines Screenings. Die Nutzung computerbasierter Instrumente eröffnet neben automatisierter Auswertung und Information psychoonkologischer sowie medizinischer Behandler die Möglichkeit eines reaktiven Fragebogens. Welche Faktoren die Behandlungsentscheidung in der Psychoonkologie unterstützen können ist bislang wenig untersucht.Methode Frauen mit Brustkrebs und gynäkologischen Tumoren, die sich zur stationären operativen Behandlung in der Universitäts-Frauenklinik befanden, wurden konsekutiv in die Studie eingeschlossen (n=103). Bei Aufnahme erfolgte ein computerbasiertes Screening zur Belastungsmessung (ePOS-react). Hierbei wird abschließend auf dem Computer basierend auf der im Screening ermittelten Belastung eine Behandlungsempfehlung gegeben: i) psychoonkologische Beratung/Behandlung, ii) psychoonkologischer Kurzkontakt/Informationsgespräch, iii) kein Angebot. Die Patienten konnten sich für eine der 3 Optionen entscheiden (Behandlungswunsch). Am ersten postoperativen Tag wurde ferner ein klinisches Interview (Psychoonkologischen Basisdiagnostik, PO-Bado) zur Fremdbeurteilung des Behandlungsbedarfs durchgeführt.Ergebnisse 68,9% folgten der Behandlungsempfehlung, 22,3% wünschten ein „intensiveres“ (z. B. Beratung anstelle von empfohlenem Kurzkontakt) und 8,7% ein weniger „intensives“ als das empfohlene Angebot. Die Übereinstimmung zwischen Fremdbeurteilung und screeningbasierter Behandlungsempfehlung liegt bei 72,8%. Die Übereinstimmung zwischen Fremdbeurteilung und Behandlungswunsch der Patientinnen liegt bei 58,3%. Letztere ist niedriger, da sich 29,1% einen psychoonkologischen Kurzkontakt wünschten, für welche aus Sicht der Fremdeinschätzung keine akute Behandlungsindikation bestand.Diskussion Die direkte Rückmeldung des Screening-Ergebnisses in Form einer Behandlungsempfehlung während des computerbasierten Screenings und anschließende Abfrage eines Behandlungswunsches der Patientinnen führt zu einem Anstieg von Kurzkontakten zur persönlichen Informationsvermittlung. Dies erhöht zwar nicht die Genauigkeit hinsichtlich der Fremdbeurteilung, führt jedoch zu einer höheren Transparenz im Zugang zu psychoonkologischer Behandlung und kann damit Patientenautonomie und Adhärenz stärken.

BACKGROUND Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients. OBJECTIVE This cross-sectional study aimed to explore the cancer-affected women’s needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden. METHODS Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated. RESULTS Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications. CONCLUSIONS Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a promising medium to improve the psychosocial care and enhance individual disease management and engagement among women with cancer.

Questions of meaning and purpose in life are becoming relevant during cancer. Studies have shown that most patients have spiritual needs and that religion/spirituality can be an important ressource in coping with illness. So far, only few studies examine the psychosocial burden and the role of spiritual needs during the treatment process of patients with malignant melanoma. 22 patients were included in this study and assessed for psychosocial distress and spiritual needs while being screened for cancer metastases (t1) and 8 weeks later (t2). Distress, anxiety and depression, furthermore spiritual needs and religiousness were examined with standardized assessments (HSI, DT, HADS, PHQ-2, SpNQ, SpREUK). All patients express spiritual needs independent of the time of measurement and overall burden. Important needs are the need to be complete and safe, the need for social support, for actively giving and for inner peace and the possibility to talk about anxiety and sorrow. Analyses have shown that religious patients are less distressed 8 weeks later, while there was no difference in the first time of measurement. The results show the importance to include spiritual needs in the process of treatment of cancer in a clinical and ambulatory context. Results indicate that religion/spirituality could be an important resource to cope with cancer. During the process of treatment, spiritual needs could be addressed by psychooncology and pastoral care with respect for their different approach and address this topic to support cancer patients.Während einer Krebserkrankung stellen sich Fragen nach Lebenssinn in neuer Prägnanz. Studien zeigen, dass ein Großteil der Patienten spirituelle Bedürfnisse äußern und Religiosität/ Spiritualität eine wichtige Ressource in der Krankheitsbewältigung sein kann. Bislang liegen zur Entwicklung psychischer Belastung und der Rolle spiritueller Bedürfnisse im Krankheits- und Behandlungsverlauf von Patienten mit malignem Melanom wenige Studien vor. Die Studie untersucht religiöse/spirituelle Bedürfnisse und psychosoziale Belastungen bei n=22 Patienten mit malignem Melanom zu 2 Zeitpunkten: stationärer Aufenthalt zur Entfernung der Wächterlymphknoten (t1) sowie 8 Wochen später (t2). Distress, Angst, Depressivität sowie spirituelle Bedürfnisse und Religiosität wurden mithilfe standardisierter Assessments (HSI, DT, HADS, PHQ; SpNQ; SpREUK) erfasst. Unabhängig von Belastung und Messzeitpunkt äußerten alle Patienten spirituelle Bedürfnisse. Besonders wichtig waren das Bedürfnis nach ganzheitlichem Heilsein, sozialer Einbindung, Gewissheit von Lebenssinn und Gespräch über Sorgen und Ängste. Es zeigte sich eine geringere psychische Belastung von Patienten, die sich selbst als religiös bezeichneten. Die Ergebnisse zeigen die Relevanz einer Berücksichtigung von spirituellen Bedürfnissen im klinischen und ambulanten Kontext der Krebsbehandlung. Die Befunde deuten außerdem darauf hin, dass Religiosität/Spiritualität eine wichtige Ressource bei der Krankheitsverarbeitung sein kann. Spirituelle Bedürfnisse sollten im Behandlungsprozess im Sinne eines integrativen Behandlungskonzepts sowohl von psychoonkologischer als auch von seelsorgerlicher Seite erfragt und berücksichtigt werden.

ZusammenfassungDie Identifizierung belasteter onkologischer Patienten mithilfe von Screening-Instrumenten stellt in der Praxis eine große Herausforderung dar. Bislang fehlen evidenzbasierte Empfehlungen, welches Instrument am geeignetsten ist, sowie zur Implementierung eines Screenings. Die Nutzung computerbasierter Instrumente eröffnet neben automatisierter Auswertung und Information psychoonkologischer sowie medizinischer Behandler die Möglichkeit eines reaktiven Fragebogens. Welche Faktoren die Behandlungsentscheidung in der Psychoonkologie unterstützen können ist bislang wenig untersucht.Methode Frauen mit Brustkrebs und gynäkologischen Tumoren, die sich zur stationären operativen Behandlung in der Universitäts-Frauenklinik befanden, wurden konsekutiv in die Studie eingeschlossen (n=103). Bei Aufnahme erfolgte ein computerbasiertes Screening zur Belastungsmessung (ePOS-react). Hierbei wird abschließend auf dem Computer basierend auf der im Screening ermittelten Belastung eine Behandlungsempfehlung gegeben: i) psychoonkologische Beratung/Behandlung, ii) psychoonkologischer Kurzkontakt/Informationsgespräch, iii) kein Angebot. Die Patienten konnten sich für eine der 3 Optionen entscheiden (Behandlungswunsch). Am ersten postoperativen Tag wurde ferner ein klinisches Interview (Psychoonkologischen Basisdiagnostik, PO-Bado) zur Fremdbeurteilung des Behandlungsbedarfs durchgeführt.Ergebnisse 68,9% folgten der Behandlungsempfehlung, 22,3% wünschten ein „intensiveres“ (z. B. Beratung anstelle von empfohlenem Kurzkontakt) und 8,7% ein weniger „intensives“ als das empfohlene Angebot. Die Übereinstimmung zwischen Fremdbeurteilung und screeningbasierter Behandlungsempfehlung liegt bei 72,8%. Die Übereinstimmung zwischen Fremdbeurteilung und Behandlungswunsch der Patientinnen liegt bei 58,3%. Letztere ist niedriger, da sich 29,1% einen psychoonkologischen Kurzkontakt wünschten, für welche aus Sicht der Fremdeinschätzung keine akute Behandlungsindikation bestand.Diskussion Die direkte Rückmeldung des Screening-Ergebnisses in Form einer Behandlungsempfehlung während des computerbasierten Screenings und anschließende Abfrage eines Behandlungswunsches der Patientinnen führt zu einem Anstieg von Kurzkontakten zur persönlichen Informationsvermittlung. Dies erhöht zwar nicht die Genauigkeit hinsichtlich der Fremdbeurteilung, führt jedoch zu einer höheren Transparenz im Zugang zu psychoonkologischer Behandlung und kann damit Patientenautonomie und Adhärenz stärken.

In this chapter we report results from a study on a digital health communication campaign initiated by Children’s Healthcare of Atlanta. This campaign has triggered a highly controversial discussion in the USA, because it used obese children and showed them in online media talking about being stigmatized. Our research is based on the assumption that controversial campaigns disseminated via online media run the risk of being re-contextualized, with the possible negative result of jeopardizing the original communicator’s intentions. Results showed that contextual reinforcement of the campaign message (in three contexts: Facebook, online-news, and a health-related blog) improved the self-relevance-perceptions of adolescent recipients. Also, the participants’ affective self-perceptions concerning their own weight were significantly influenced by the argumentative reframing of the original message on a Facebook site, a Blog, and an online news site. In addition, we report about the development and evaluation of a motion-controlled serious game used to address barriers of obesity prevention in school aged children. In the media, communication about health-related risks mainly uses fear as a motivation for lifestyle-changes, as the time window to communicate the message is usually very short. In contrast, to support motivation in an informal unguided learning context which has to be viable for a longer time, the gamification of learning content is an important strategy. The focus of the serious game is on (1) self-reflective diagnostic tools to analyse the daily food intake and free-time activities, (2) gamified information and knowledge-tests about food groups, drinks, and energy density, as well as (3) relaxation exercises to aid addressing psychosocial aspects.

Deficits of care exist during the transitional period, when young people with ongoing needs of support to achieve their physical, social, and psychological potential are entering adulthood. This study aims to develop a patient oriented, structured provisional model to improve transitional care for adolescents withMayer-Rokitansky-Kuester-Hauser-Syndromeas an example for orphan diseases, where problems of access and continuity are even more complex. The study is funded by the German Federal Ministry of Education and Research (BMBF-Funding Code 01GY1125). The target patient group are young females with this disorder, treated at the Centre for Rare Genital Malformations in Women (ZSGF), University Hospital of Tuebingen. The study comprises five phases: an appraisal of literature, assessment of patients (n=25), parents’, partners’, and health and social care providers’ (n=24) needs and experienced deficits in care and support in a qualitative approach, construction of a provisional model via scenario technique, followed by communicative validation (including interested public,n=100), preference finding, and identification of patient-oriented quality aims for follow-up. Quantitative data from questionnaires and chart review (as sociodemographic data, nonresponder analysis, and preference rating) are worked up for descriptive statistics. The results provide a platform for the development of future multidisciplinary transitional intervention programs in orphan diseases.

Screeningverfahren zur Erfassung von Distress bei Tumorpatienten sind in vielen onkologischen Zentren etabliert. Klassische Papierfragebogen konnen aufgrund zeitaufwandiger Datenauswertung zu Verzogerungen in der Planung psychoonkologischer Behandlung fuhren. Dies stellt insbesondere aufgrund kurzer Liegezeiten ein Problem dar. In dieser randomisiert-kontrollierten Studie wurde ein elektronisches Verfahren uberpruft, welches den Informations- und Versorgungsfluss verbessern und den Anforderungen einer elektronischen Patientenakte gerecht werden soll. 206 Brustkrebs-Patientinnen wurde randomisiert ein Papier- oder elektronischer Fragebogen vorgelegt. Die Akzeptanz des elektronischen Screenings war hoher als die des konventionellen. Die Messergebnisse der elektronisch erfassten Daten waren mit den mittels Papierfragebogen erhobenen vergleichbar. Ein elektronisches Screening konnte damit – fur Patienten und Behandler – eine zeitsparende Alternative bei hoher Datenqualitat darstellen.

A systematic literature search was conducted to assess the chances and limitations of video games to combat and prevent childhood obesity. This search included studies with video or computer games targeting nutrition, physical activity and obesity for children between 7 and 15 years of age.The study distinguished between games that aimed to (i) improve knowledge about nutrition, eating habits and exercise; (ii) increase physical activity; or (iii) combine both approaches. Overall, the games were well accepted. On a qualitative level, most studies reported positive effects on obesity-related outcomes (improvement of weight-related parameters, physical activity or dietary behaviour/knowledge). However, the observed effects were small. The games did not address psychosocial aspects.Using video games for weight management exclusively does not deliver satisfying results. Video games as an additional guided component of prevention and treatment programs have the potential to increase compliance and thus enhance treatment outcome. Copyright © 2017 John WileySons, Ltd and Eating Disorders Association.

Understanding the intermediate- and long-term psychological consequences of genetic testing for cancer patients has led to encouraging research, but a clear consensus of the psychosocial impact and clinical routine for cancer-affected BRCA1 and BRCA2 mutation carriers is still missing. We performed a systematic review of intermediate- and long-term studies investigating the psychological impact like psychological distress, anxiety, and depression in cancer-affected BRCA mutation carriers compared to unaffected mutation carriers. This review included the screening of 1243 studies. Eight intermediate- and long-term studies focusing on distress, anxiety, and depression symptoms among cancer-affected mutation carriers at least six months after the disclosure of genetic testing results were included. Studies reported a great variety of designs, methods, and patient outcomes. We found evidence indicating that cancer-affected mutation carriers experienced a negative effect in relation to psychological well-being in terms of an increase in symptoms of distress, anxiety, and depression in the first months after test disclosure. In the intermediate- and long-term, no significant clinical relevant symptoms occurred. However, none of the included studies used specific measurements, which can clearly identify psychological burdens of cancer-affected mutation carriers. We concluded that current well-implemented distress screening instruments are not sufficient for precisely identifying the psychological burden of genetic testing. Therefore, future studies should implement coping strategies, specific personality structures, the impact of genetic testing, supportive care needs and disease management behaviour to clearly screen for the possible intermediate- and long-term psychological impact of a positive test disclosure.

9514 Background: There is limited data about the impact of melanoma on the psychological burden of patients. Despite some known predictors for distress like female gender or younger age, melanoma stages have not been found being related to distress in melanoma patients and there is no data concerning distress in melanoma patients under systemic treatment for metastases. Methods: Between July and September 2016, 820 melanoma patients at the outpatient clinic at the Department of Dermatology at the University of Tuebingen underwent psycho-oncological screening. The patients routinely completed the distress thermometer (DT), supplemented by a problem list, before consulting the physician. DT scores ≥ 5 are above-threshold, indicating the need for psycho-oncological support. We matched psycho-oncological data with tumor and patient specific data to examine tumor or patient specific influence on distress using logistic regression. Results: 406 (49.5%) men and 414 (50.5%) women were included, mean age was 62.35 years (IQR 52-75), mean time since primary diagnosis of melanoma was 54.84 months (IQR 15-76). 359 (44%) of the patients suffered from advanced melanoma (stage III n = 182, stage IV n = 177). 120 patients (14.6%) received systemic treatment for metastases: 90/120 (75%) checkpoint inhibitors, 27/120 (22.5%) targeted therapy and 3/120 (2.5%) chemotherapy. 338/820 (41.2%) of the patients met the cut-off score for distress. Significant influencing factors (p < 0.05) for DT values of ≥ 5 were: female gender, younger age, melanoma stage III and IV. Interestingly we found a lower risk for values above-threshold for patients under systemic treatment, although this was not significant (p = 0.252). Conclusions: This is the first analysis to demonstrate the impact of advanced melanoma stages on DT scores above-threshold. Our study is also the first to indicate a lower risk for distress in patients under systemic treatment. This might be due to the closer contact between these patients and their physicians. Nevertheless, more than 40% of our patients needed psycho-oncological support. Departments that care for melanoma patients should therefore be fitted by a sufficient number of psycho-oncologists.

Background Acne is a very common skin condition during adolescence and adulthood. Patients with uterovaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome, MRKH) treated at the Tübingen University Center for Rare Female Genital Malformations, however, clinically appeared to be less frequently affected by acne. The etiology of MRKH syndrome remains unknown. The only known MRKH-associated mutations are located within the WNT4 gene and lead to an atypical form of MRKH syndrome associated with clinical and biochemical hyperandrogenism. Our study aimed to assess the frequency, severity, and self-evaluation of acne in MRKH patients and to correlate the clinical findings with hormone analyses. Methods As part of a cross-sectional longterm follow-up study after laparoscopic assisted creation of a neovagina a questionnaire was sent to 149 MRKH patients aged 16–44 years comprising 26 items concerning prevalence and self-evaluation of acne, and the effects of acne on quality of life. The questionnaire was derived from one used in a former epidemiological study of acne in 4,000 women. Blood for hormone analyses was collected routinely during the clinical visit. Results Fully completed, evaluable questionnaires were returned by 69/149 (46%) women. Of these respondents, 42 (60.1%) showed hyperandrogenemia without other clinical signs of virilization but only 17 (24.6%) reported acne (8 (11.6%) had physiological acne and 9 (13.0%) clinical acne) and only 10 (14.5%) reported receiving medical treatment for their acne. Effects of acne on quality of life were minor. Only 4 patients (5.8%) with PCOS were identified, among them one with physiological acne, the other three within the acne-free group. Conclusions Although hyperandrogenemia is common, acne is significantly less frequent in women with MRKH than reported in the literature for non-MRKH women, and is seldom treated medically. Patients in this study appeared resistant to acne to some extent, possibly due to the sebaceous glands in the acne regions being less sensitive to androgens compared to the normal population. A WNT4 mutation is unlikely to be the main cause of MRKH syndrome in our hyperandrogenemic patients.

Many oncology centres have implemented a screening to identify distress in cancer patients. Assessments using paper-pencil questionnaires are time-consuming to score and may cause delays in providing psychooncological care. This challenges care-givers because it reduces the time available for inpatient treatment. In a randomized-controlled study, we examined an electronic screening tool which would enhance psychooncological clinical care by improving information flow, and by meeting demands of an electronic patient chart. In total 206 patients with breast cancer randomly received either a paper-pencil or electronic questionnaire to measure distress, as well as, the acceptance of the current screening procedure. The acceptance of the electronic screening was greater compared to that of the paper-pencil screening. The results of the two assessment approaches did not -differ. An electronic screening may provide a time -saving alternative with excellent data quality.

While Internet-based health-related offers for various disorders are increasing, little is known about the way patients with psychosomatic disorders use the Internet. We conducted a questionnaire survey in outpatient clinics at two university hospitals’ Departments of Psychosomatic Medicine. Seventy-four percent of N = 274 patients had Internet home access and 60 percent of those patients reported health-related Internet use. Patients expressed the wish for more professional, evidence-based online information and expert-guided treatment. The survey results support the Internet’s high potential in future treatment strategies for patients with psychosomatic disorders.

Background Informed consent talks are mandatory before invasive interventions. However, the patients’ information recall has been shown to be rather poor. We investigated, whether medical laypersons recalled more information items from a simulated informed consent talk after advanced medical students participated in a communication training aiming to reduce a layperson’s cognitive load. Methods Using a randomized, controlled, prospective cross-over-design, 30 5th and 6th year medical students were randomized into two groups. One group received communication training, followed by a comparison intervention (early intervention group, EI); the other group first received the comparison intervention and then communication training (late intervention group, LI). Before and after the interventions, the 30 medical students performed simulated informed consent talks with 30 blinded medical laypersons using a standardized set of information. We then recorded the number of information items the medical laypersons recalled. Results After the communication training both groups of medical laypersons recalled significantly more information items (EI: 41 ± 9% vs. 23 ± 9%, p Conclusion Short communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks.

Background Weight-related stigmatization is a public health problem. It impairs the psychological well-being of obese individuals and hinders them from adopting weight-loss behaviors. We conducted an experimental study to investigate weight stigmatization in work settings using a sample of experienced human resource (HR) professionals from a real-life employment setting. Methods In a cross-sectional, computer-based experimental study, a volunteer sample of 127 HR professionals (age: 41.1 ± 10.9 yrs., 56% female), who regularly make career decisions about other people, evaluated individuals shown in standardized photographs regarding work-related prestige and achievements. The photographed individuals differed with respect to gender, ethnicity, and Body Mass Index (BMI). Results Participants underestimated the occupational prestige of obese individuals and overestimated it for normal-weight individuals. Obese people were more often disqualified from being hired and less often nominated for a supervisory position, while non-ethnic normal-weight individuals were favored. Stigmatization was most pronounced in obese females. Conclusions The data suggest that HR professionals are prone to pronounced weight stigmatization, especially in women. This highlights the need for interventions targeting this stigmatization as well as stigma-management strategies for obese individuals. Weight stigmatization and its consequences needs to be a topic that is more strongly addressed in clinical obesity care.