Medizinisches Zentrum für Seelische Gesundheit

AIMS: To collect information on the use of the Reveal implantable loop recorder (ILR) in the patient care pathway and to investigate its effectiveness in the diagnosis of unexplained recurrent syncope in everyday clinical practice. METHODS AND RESULTS: Prospective, multicentre, observational study conducted in 2006-2009 in 10 European countries and Israel. Eligible patients had recurrent unexplained syncope or pre-syncope. Subjects received a Reveal Plus, DX or XT. Follow up was until the first recurrence of a syncopal event leading to a diagnosis or for ≥1 year. In the course of the study, patients were evaluated by an average of three different specialists for management of their syncope and underwent a median of 13 tests (range 9-20). Significant physical trauma had been experienced in association with a syncopal episode by 36% of patients. Average follow-up time after ILR implant was 10±6 months. Follow-up visit data were available for 570 subjects. The percentages of patients with recurrence of syncope were 19, 26, and 36% after 3, 6, and 12 months, respectively. Of 218 events within the study, ILR-guided diagnosis was obtained in 170 cases (78%), of which 128 (75%) were cardiac. CONCLUSION: A large number of diagnostic tests were undertaken in patients with unexplained syncope without providing conclusive data. In contrast, the ILR revealed or contributed to establishing the mechanism of syncope in the vast majority of patients. The findings support the recommendation in current guidelines that an ILR should be implanted early rather than late in the evaluation of unexplained syncope.

OBJECTIVE: To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. METHODS: This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. RESULTS: Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. CONCLUSION: The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).

BACKGROUND/AIMS: Only rather few data on the validity of screening questionnaires to detect problem drinking in adolescents exist. The aim of this study was to compare the performance of the Alcohol Use Disorders Identification Test (AUDIT), its short form AUDIT-C, the Substance Module of the Problem Oriented Screening Instrument for Teenagers (POSIT), and CRAFFT (acronym for car, relax, alone, forget, family, and friends). METHODS: The questionnaires were filled in by 9th and 10th graders from two comprehensive schools. All students received an interview using the alcohol section of the Composite International Diagnostic Interview. Alcohol abuse and alcohol dependence according to DSM-IV as well as episodic heavy drinking served as criteria to validate the screening instruments. RESULTS: All 9th and 10th graders (n=225) of both schools participated. No significant differences were found for areas under the receiver operating characteristic curves ranging from 0.810 to 0.872. Cronbach's alpha was satisfactory (0.77-0.80) but poor for CRAFFT (0.64). Different cut-offs are discussed. CONCLUSIONS: Considering validity as well as reliability, AUDIT, AUDIT-C and POSIT performed well; however, the POSIT is quite lengthy. AUDIT-C showed good psychometric properties and has clear advantages because of its brevity.

The German federal states initiated the "Pathological Gambling and Epidemiology" (PAGE) program to evaluate the public health relevance of pathological gambling. The aim of PAGE was to estimate the prevalence of pathological gambling and cover the heterogenic presentation in the population with respect to comorbid substance use and mental disorders, risk and protective factors, course aspects, treatment utilization, triggering and maintenance factors of remission, and biological markers. This paper describes the methodological details of the study and reports basic prevalence data. Two sampling frames (landline and mobile telephone numbers) were used to generate a random sample from the general population consisting of 15,023 individuals (ages 14 to 64) completing a telephone interview. Additionally, high-risk populations have been approached in gambling locations, via media announcements, outpatient addiction services, debt counselors, probation assistants, self-help groups and specialized inpatient treatment facilities. The assessment included two steps: (1) a diagnostic interview comprising the gambling section of the Composite International Diagnostic Interview (CIDI) for case finding; (2) an in-depth clinical interview with participants reporting gambling problems. The in-depth clinical interview was completed by 594 participants, who were recruited from the general or high-risk populations. The program provides a rich epidemiological database which is available as a scientific use file.

Background: In response to the COVID-19-pandemic, a lockdown was established in the middle of March 2020 by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas. Research Questions: We seek evidence on whether the lockdown has led to a reduced availability of illegal drugs and whether subjects with substance-related problems tried to cope with possible drug availability issues by increasingly obtaining drugs via the internet, replacing their preferred illegal drug with novel psychoactive substances, including new synthetic opioids (NSO), and/or by seeking drug treatment. Methods: A questionnaire was anonymously filled in by subjects with substance-related disorders, typically attending low-threshold settings, drug consumption facilities, and inpatient detoxification wards from a range of locations in the Western part of Germany. Participants had to both identify their main drug of abuse and to answer questions regarding its availability, price, quality, and routes of acquisition. Results: Data were obtained from 362 participants. The most frequent main substances of abuse were cannabis ( n = 109), heroin ( n = 103), and cocaine ( n = 75). A minority of participants reported decreased availability (8.4%), increased price (14.4%), or decreased quality (28.3%) of their main drug. About 81% reported no change in their drug consumption due to the COVID-19 pandemic and the lockdown. A shift to the use of novel psychoactive substances including NSO were reported only by single subjects. Only 1–2% of the participants obtained their main drug via the web. Discussion: Present findings may suggest that recent pandemic-related imposed restrictions may have not been able to substantially influence either acquisition or consumption of drugs within the context of polydrug users (including opiates) attending a range of addiction services in Germany.

The aim of this study was to evaluate the change of psychological distress measured by the symptom checklist in alcohol dependent inpatients during treatment and at follow-up. In addition, psychological distress as a predictive variable for abstinence or relapse during a 1-year follow-up was investigated. In a sample of 314 alcohol-dependent inpatients, we found a statistically significant reduction of psychological distress during therapy. Comparison of patients within 1-year follow-up showed a significant reduction of psychological distress only for the later abstinent subgroup. Later abstinent patients were significantly less distressed at the end of therapy and at follow-up. Logistic regression indicated that a higher Global Severity Index (GSI) of psychological distress at the end of therapy increases the relapse risk.

The lives of lesbian, gay, bi-, pan-, asexual, and transgender (LGBTA+/LGBT) people are not considered to be standard in society, unlike those of heterosexual cisgender people. This can lead to prejudices against LGBT people and may negatively influence their access to high-quality health care. Medical and mental health care have been characterized by attitudes (psycho-)pathologizing LGBT lives and therefore supported the stigmatization of LGBT people in the service of heteronormativity. Mental health professionals (MHPs) largely have transferred principles guiding counseling and psychotherapy with heterosexual (straight) cisgender persons to treatment of LGBT individuals without considering the specific features of LGBT lives. This is true even if the treatment is not exclusively LGBT-related, but can address LGBT-unrelated issues. To counteract this, the present paper aims to provide an insight into ethically sound mental health care for LGBT people. By applying the principles of biomedical ethics, we have analyzed how LGBT individuals can be discriminated against in mental health care and what MHPs may need to offer LGBT-sensitive high-quality mental health care. We argue that MHPs need LGBT-related expertise as well as LGBT-related sensitivity. MHPs should acquire specialist knowledge for the diverse lives and the challenges of LGBT people. We encourage MHPs to develop an understanding of how their own implicit attitudes towards LGBT people can affect treatment. However, the demand for special training should not be mistaken as a demand for a specific type of mental health care. The principles of general psychotherapy are equally the basis of psychotherapy with LGBT people.

Stress significantly influences marital satisfaction. Women tend to be more emotionally involved in problems than men. Furthermore, employed women encounter more stressors especially when their job is stressful which it is often the case in medical professionals. In the present cross-sectional study, relationships were analyzed between marital satisfaction (ENRICH Marital Satisfaction Inventory), ways of coping (Ways of Coping questionnaire) with marital stress and social support (Social Support Questionnaire) in 100 female medical staff members in Tehran university hospitals. The results revealed a significant negative relationship between subscales of marital satisfaction and using “seeking social support”, “confrontive coping”, “escape avoidance”, “distancing”, and “self-controlling” as ways of coping related to marriage related problems. Furthermore, the analyses showed that job satisfaction, social support, and ways of coping explain between 24% and 38% of the variance in subscales of marital satisfaction. Therefore focusing on these factors could be an effective approach to promote marital satisfaction in female medical staff members.

AIM: For the reconstruction of extended acetabular bone defects in revision hip arthroplasty different implants and techniques are available.However, in cases with a broad operative range of new implants, specific indications must be determined. The aim of this study is to determine the risk factors for migration and loosening associated with implantation of the pedestal cup. METHOD: In a retrospective study the first 50 implantations of the pedestal cup in our hospital for high-grade acetabular defects (Paprosky classification II and III) were examined after a medium period of 26 months. Differences between radiologically loosened and osteal integrated implants in consideration of the preoperative osseous situation(defect size and morphology, bone density)as well as the implant positioning were determined as risk factors of an implant failure. RESULTS: Three (6%) intraoperative implant-associated complications occurred, which were in the phase of the initial learning curve. In the early postoperative period 10 hip dislocations (20%)occurred. Two septic loosenings (4%) and 6 aseptic loosenings (12%) were observed. In 7 further cases a significant migration of the implant was assessed in the first months after surgery, a solid osteal integration did not appear. As risk factors for an implant loosening were determined:a missing reconstruction of the defect behind the pedestal cup with allogenous bone graft(p = 0.002), a lateralisation of the rotation centre(p = 0.023), the absence of the craniolateral wall (p = 0.002) and the presence of osteoporosis(p = 0.026). CONCLUSION: The pedestal cup is an implant that is well usable in many high-grade acetabular defect situations with good mid-term results; however,contraindications do exist. In cases with a significant osteoporosis, a missing sclerosis of the cranial acetabulum as well as extended damage of the lateral ilium and its absence, respectively, alternative procedures should be considered.

BACKGROUND: PHACE syndrome is a rare inborn condition characterized by large facial hemangiomas and variable malformations of the arterial system, heart, central nervous system, and eyes. According to Orphanet estimates, the prevalence is <1.0 per million. Data from Europe are limited to small case series, and there are no population-based data available. OBJECTIVES: We conducted the present study to provide population-based estimates of the disease prevalence of PHACE syndrome in children in Germany, Switzerland, and Austria. We compared these first systematic data on PHACE syndrome from Europe to published data from the PHACE Syndrome International Clinical Registry and Genetic Repository (USA). Clinical features in our cohort with PHACE syndrome were assessed in detail, including the need for early supportive measures. METHODS: We used a population-based approach by means of a previously well-established network of child neurologists from Germany, Switzerland, and Austria ("ESNEK") to identify potential patients. The patients' guardians and child neurologists were asked to fill in questionnaires developed in collaboration with the International PHACE Registry. RESULTS: We identified 19 patients with PHACE syndrome. Estimated prevalence rates were 6.5 per million in Switzerland, 0.59 per million in Germany, and 0.65 per million in Austria. A subset of 10 patients from Germany and Switzerland participated in our study, providing detailed clinical assessment (median age: 2.5 years; 9 females, 1 male). Cerebrovascular involvement was frequent (80%). Facial hemangioma extent correlated significantly with the number of organs involved (p = 0.011). In 9 out of 10 patients, facial hemangiomas were treated successfully with oral propranolol. Baseline demographic data as well as the rate of cerebrovascular and cardiovascular anomalies were in line with those from the US International PHACE Registry and other published PHACE cohorts. CONCLUSIONS: Our study provides population-based estimates for PHACE syndrome in 3 German-speaking countries. The data from Switzerland indicate that PHACE syndrome may be more prevalent than demonstrated by previous reports. Underreporting of PHACE syndrome in Germany and Austria likely accounts for the differences in prevalence rates. The clinical observation of a potential association between the size of facial hemangioma and extent of organ involvement warrants further investigation.

Schizophrenia is one of the most severe mental diseases and leads to significant personal and social impairments for affected persons. The illness is characterized by frequent relapses, results in increased mortality and is associated with the highest socioeconomic costs of all diseases. Moreover, patients with schizophrenia are often stigmatized in everyday life and also in most treatment settings. In 1998 the first German schizophrenia guidelines were published, followed by the first S3 guidelines for schizophrenia in 2006. The revision process started in 2012 coordinated by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the revised guidelines were published in 2019. The target group for the revised S3 guidelines includes all persons involved in the care of patients with schizophrenia in all sectors of the German healthcare system, including decision makers and insurance funds. Starting with an introduction of the biological, clinical and epidemiological basis of the disorder, recommendations for the diagnostics of schizophrenia, the detection of comorbidities, the use of antipsychotic medication and other somatic procedures, for psychotherapy, psychosocial interventions, handling of special treatment conditions and rehabilitation are made. Finally, recommendations for an evidence-based and optimal coordination within the healthcare system are made, followed by a discussion of the cost-effectiveness of treatment and presentation of strategies for improved quality management. The most important aspect of the revised S3 guidelines on schizophrenia is the multiprofessional cooperation in all phases of the disorder and an empathic and respectful therapeutic alliance.

Fragestellung: Es wurde anhand eines Entlassungsjahrganges stationär behandelter pathologischer Glücksspieler untersucht, wie hoch die katamnestische Erfolgsquote, definiert als Glücksspielfreiheit zum Nachbefragungszeitpunkt, ist. Weiter wurden die Anlässe für erneutes Glücksspielen und Veränderungen der Involvierheit in das Glücksspielen untersucht. Ferner wurde der Frage nachgegangen, wie sich die Lebenssituation der Betreffenden entwickelt hat, und ob sich spezifische Risikofaktoren für die Aufrechterhaltung von Glücksspielfreiheit bestimmen lassen. Methodik: Erhoben wurden soziodemographische Merkmale, Kennzeichen des Störungsverlaufes, die gedankliche und emotionale Involviertheit in das Glücksspielen, komorbide Störungen sowie Behandlungsmerkmale. Datenbasis: Untersucht wurden 617 Patienten, die zwischen dem 01. 10. 2009 und dem 30. 09. 2010 mit der Zuweisungsdiagnose Pathologisches Glücksspielen in fünf Fachkliniken für Psychosomatik und Abhängigkeitserkrankungen behandelt wurden. Die Messungen fanden statt bei Aufnahme (T1), bei Entlassung (T2) und 12 Monate nach der Behandlung (T3). Ergebnisse: Die Rücklaufquote lag bei 55,9 % (N = 345). Die katamnestische Erfolgsquote lag berechnet auf Basis der Gesamtstichprobe bei 39,7 % und berechnet auf Basis der Katamneseantworter bei 71,0 %. Die soziale und ökonomische Situation hat sich für einen erheblichen Teil der Befragten verbessert. Als Risikofaktoren für die Aufrechterhaltung von Glücksspielfreiheit erwiesen sich: Eine geringe Fähigkeit zum Umgang mit negativ getönten Affekten, eine hohe Anzahl von Spieltagen pro Monat, eine hohe kognitive und emotionale Involviertheit in das Glücksspielen, eine geringe Anzahl glücksspielfreier Tage vor Behandlungsbeginn, sowie das Vorliegen von Arbeitslosigkeit. Schlussfolgerungen: Die Rücklaufquote kann als gut bewertet werden. Die katamnestischen Erfolgsquoten sind vergleichbar denen aus der Behandlung alkoholabhängiger Patienten. Sie liegen über denjenigen, die von ambulanten Behandlungsprogrammen berichtet werden. In zukünftigen Katamnesestudien sollten die bisher identifizierbaren Risikofaktoren für die Aufrechterhaltung von Glücksspielfreiheit genauer untersucht werden. Weiter sollten Wege gefunden werden, die Rücklaufquoten noch zu verbessern.

OBJECTIVE: Though in most psychotherapy schools a high self-responsibility (SR) of patients is considered as the basis necessary for the success of psychological treatment, there is neither a uniform definition nor a psychometric operationalisation of SR. Hence, there is no empirical evidence for the actual importance of SR in psychotherapy. This work aims (1) to introduce a definition of SR as well as to develop a questionnaire for its measurement and (2) to evaluate SR in the treatment of depression. METHODS: In two studies with samples of healthy adults (n=233, n=301), the "Self-Responsibility Inventory" (German: "Selbstverantwortungs-Inventar", SV-I) was developed. In a third study, the SV-I was administered to n=231 psychiatric inpatients with major depression according to the ICD-10 diagnostic criteria. Patients were mainly treated with psychotherapy. RESULTS: The final SV-I version consisted of three scales with 10 items each: "Being determined by others", "Self-determination", "Orientation towards the expectations of others". In healthy adults, poor SR was accompanied by high levels of depression, and high trait anxiety. Inpatients with mental disorders show less SR than healthy individuals. During treatment, SR increased from admission to discharge. It was found that the higher the SR at discharge, the stronger the decrease of depression from admission to discharge. DISCUSSION: The SV-I appears to be suitable for use in healthy individuals and in clinical groups. Our findings suggest that low SR is related to the development of psychological symptoms and illnesses. CONCLUSIONS: SR may be a critical factor for outcome in the psychotherapy of major depression. The SV-I could be a useful tool for understanding psychotherapeutic processes.

An alarming stigmatization and discrimination of homosexual people persists despite the formal depathologization of homosexuality, which occurred through the removal of the diagnosis from the DSM- (1973) and classification from the ICD (1991). The adoption of an expedited Statement on sexual orientation by the majority at the 64th General Assembly of the WMA is therefore an important and overdue measure. The Statement clearly asserts, among other things, that homosexuality is not an illness and therefore requires no cure. It also suggests that direct and indirect discrimination and stigmatization of people due their sexual orientation often leads to psychological and physical illnesses. Furthermore, delegates of the WMA condemned so-called reparative or conversion “therapies”, which strive to induce heterosexual or asexual behavior. These are not only ineffective and unethical, but are strongly associated with serious negative impacts on health. Such a statement from the World Medical Association (WMA) is of particular importance as ambivalence and uncertainty in regards to homosexuality exists even within the medical and therapeutic professions. The latent or manifest attribution of homosexuality as an illness or developmental disorder is still widespread. One possible explanation for this may be the disruption of an open and sustainable discourse on causes, effects and definitions of sexual orientation following the “official depathologization”. Especially those working in the medical and therapeutic contexts should be aware of their special responsibility not to pathologize homosexuality.

Zusammenfassung: Theoretischer Hintergrund: Mit konstruktiver Aggression ist ein evolviertes Verhaltensmuster gemeint, mit dem Individuen gewaltlos Interessen, Bedürfnisse und Grenzen in interpersonalen Beziehungen einbringen können. Es wird postuliert, dass die Hemmung konstruktiver Aggression (i. e., Aggressionshemmung) schädlich ist. Fragestellung: Es sollte zunächst ein Instrument zur Erfassung von Aggressionshemmung entwickelt und evaluiert werden. Damit sollten die Zusammenhänge von Aggressionshemmung mit Depressivität, Trait-Angst und Lebenszufriedenheit untersucht werden. Methode: In zwei Studien (299 bzw. 253 Gesunde) wurde das „Aggressionshemmungs-Inventar“ (AHI) entwickelt. In einer dritten Studie wurde das AHI bei 263 Depressiven in vollstationärer Behandlung eingesetzt. Ergebnisse: Das AHI korrelierte bei Gesunden mit Depressivität, Trait-Angst und Lebenszufriedenheit. Die Depressiven zeigten eine ausgeprägte Aggressionshemmung, die bis zur Entlassung abnahm. Der Rückgang der Depressivität hing von der Aggressionshemmung bei Entlassung ab. Schlussfolgerungen: Das AHI kann die Hemmung konstruktiver Aggression zuverlässig messen. Der Abbau von Aggressionshemmung könnte wichtig bei der Behandlung von Depression sein.

Zusammenfassung Einleitung In der sexualwissenschaftlichen Fachliteratur wird Aggression oft als wichtiger positiver Faktor betrachtet, insbesondere im Zusammenhang mit männlicher Sexualität. Ihre Unterdrückung führe zu sexuellen Störungen, z. B. zu Lustlosigkeit. Dies ist unschlüssig angesichts der gängigen Definition von Aggression als einem gewalttätigen Verhalten, das auf die Schädigung anderer Personen zielt. Forschungsziele Zur Auflösung dieses Widerspruchs wird die Unterscheidung zwischen konstruktiver und destruktiver Aggression vorgeschlagen. Unter konstruktiver Aggression wird ein eigenständiges, evolviertes Verhaltenssystem verstanden, welches auf gewaltfreie Art eine Balance zwischen den kooperativen und konkurrierenden Interessen der Mitglieder eines sozialen Systems (z. B. Paarbeziehung, Familie, Gruppe) bei der Verteilung wichtiger Ressourcen herstellt und damit zur Stabilisierung des Systems beiträgt. Methoden In zwei Stichproben gesunder Erwachsener (N = 253; N = 229) wurden mit standardisierten Fragebögen die Zusammenhänge zwischen konstruktiver und destruktiver Aggression einerseits und der Zufriedenheit mit der eigenen Sexualität und der aktuellen Partnerschaft andererseits untersucht. Insbesondere wurde die Bedeutung der Hemmung konstruktiver Aggression für Sexualität und Partnerschaft geprüft. Die Hemmung konstruktiver Aggression wurde mit dem neuen Aggressionshemmungs-Inventar (AHI) gemessen. Ergebnisse Destruktive Aggression zeigte kaum Zusammenhänge mit der Zufriedenheit mit Sexualität und Partnerschaft; bei den wenigen signifikanten Korrelationen war eine hohe destruktive Aggression mit geringer Zufriedenheit assoziiert. Demgegenüber korrelierte die Hemmung der konstruktiven Aggression (gemessen mit dem AHI) durchgehend mit geringer Zufriedenheit, sowohl bei Männern als auch bei Frauen. Schlussfolgerung Konstruktive und destruktive Aggression sind zwei unterschiedliche Verhaltenssysteme. Destruktive Aggression hat keinen Nutzen für die sexuelle oder partnerschaftliche Zufriedenheit. Konstruktive Aggression könnte hingegen eine wichtige Bedingung für funktionierende Partnerschaften und eine befriedigende Sexualität sein. Ihre Hemmung könnte zu sexuellen Störungen führen.

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AbstractThe UN Convention on the Rights of Persons with Disabilities emphasizes supporting individuals with disabilities, including those with dementia, in making self-determined decisions, as cognitive decline often challenges their capacity to consent. This study explored a new approach to supported decision-making by examining whether conducting decision-making conversations in a familiar home setting, rather than a clinical environment, reduces complexity and strengthens consent capacity. We used a randomized AB/BA crossover design to assess the impact of spatial intervention on capacity to consent in N = 28 individuals with suspected or confirmed dementia. We computed linear mixed models for consent capacity facets and secondary endpoints (e.g., task complexity), including baseline covariates. Overall, the participants scored high on consent capacity subscales and showed low anxiety and uncertainty during decision-making. Regression analyses showed no significant differences in capacity to consent depending on location and period. Descriptively, there was a slight increase at the second time point, which was more distinct for participants first assessed at home. Although we found no significant differences, the descriptive results suggest potential learning effects, with the home environment possibly providing supportive conditions. Limitations included a small sample size, challenges faced by physicians unfamiliar with home visits, and ceiling effects.

Objective Existing studies on the effects of physical activity on cognitive function have predominantly focused on pre- or post-exercise effects, leaving a gap in understanding with regard to immediate cognitive impacts during physical exertion. Understanding cognitive performance during activity could have significant implications for improving productivity and the development of therapeutic strategies. Methods This study examined the relationship between heart rate and cognitive performance, specifically attention, using the D2 attention test among 32 adolescents aged 12-18 years. Participants underwent attention assessments at rest and while moving at target heart rates of 100 bpm, 120 bpm, and 140 bpm. The influence of body mass index (BMI) and sleep quality on attention was also analyzed. Results A positive correlation between heart rate and attention was observed (r = 0.39, P &lt; .005), indicating enhanced cognitive performance with increased heart rate. Furthermore, a negative correlation was found between BMI and attention (r = −0.37, P = .039) and a positive correlation was found between sleep quality and attention (r = 0.66, P = .014). Conclusion These findings suggest that moderate physical activity can enhance attention, which could inform the design of educational, therapeutic, and occupational strategies. Future research should explore the generalizability of these findings across different cognitive domains, age group, and setting.

Die Usability-Forschung des Reha-Zentrums Lübben hatte im Projekt RehaInterAct die Aufgabe, mittels geeigneter Untersuchungsmethoden herauszufinden, wie zukünftige Anwender, durch die entwickelte Technologie dabei unterstützt werden können, ihre Therapieziele zu erreichen. Feedbackgestaltung, also die Art und der Inhalt der Kommunikation zwischen Anwender und Technologie, spielt dabei eine zentrale Rolle und ist u.a. Gegenstand der projektabschließenden Evaluation gewesen. Um die Art der Kommunikation zwischen Anwender und Technologie in vorliegendem Projekt RehaInterAct zu untersuchen und geeignete Schlüsse für die weitere Entwicklung des Gesamtsystems daraus zu ziehen, entwickelte das Reha-Zentrum Lübben einen Fragebogen und filmte die 30 rekrutierten Testpatienten während der eigentlichen Testphase. Der Fragebogen wurde anschließend mithilfe des Statistikprogramms SPSS ausgewertet, die Videostudien mithilfe eines eigens entwickelten Kategoriensystems. Virtuelle Feedbackmechanismen müssen eine möglichst eindeutige Beziehung zum Anwender haben oder der Anwender muss leicht erkennen können, dass sich das Feedback auf ihn bezieht. Ein Proband, der seine Gleichgewichtsverteilung auf zwei verschiedene Weisen kontrollieren kann, entscheidet sich für diejenige, die einen stärkeren Bezug zu seiner eigenen Person hat. In der vorliegenden Untersuchung orientierten sich die Probanden eher an einem virtuellen Seil zur Gleichgewichtskontrolle, an welchem sich der Avatar festhielt (optische Verbindung), als an virtuellen Füßen, die zwar ebenso eine Gleichgewichtskontrolle ermöglichten, aber keine sichtbare Verbindung zum Avatar hatten. So beantworteten die Probanden das Item Das virtuelle Seil half mir dabei, meine Gewichtsverteilung permanent zu kontrollieren mit MW = 1,96 (von stimmt = 1 bis stimmt nicht = 5), auf das Item Die auf dem Bildschirm sichtbaren Füße nutzte ich, um meine Gewichtsverteilung permanent zu kontrollieren dagegen mit MW = 2,81 (von stimmt = 1 bis stimmt nicht = 5). Wichtig bei der Art der Feedbackgestaltung ist auch, welches Sinnesorgan angesprochen wird. In der Untersuchung fiel auf, dass akustisches Feedback, dargeboten per Sprecheranweisungen, kaum zur Ausübung der spielbasierten, therapeutischen Übungen genutzt wurde. Weitere Untersuchungen müssen noch klarer herausarbeiten, welche verschiedenen Arten der Feedbackgestaltung, welchen Einfluss auf die avisierten Ziele haben. In der vorliegenden Untersuchung gab es Hinweise darauf, dass die Art der Kommunikation zwischen Anwender und Technologie einen Einfluss auf die erreichte therapeutische Leistung hat. So deutete sich an, dass das therapeutische Ziel eher mit optischen Feedbacksystemen als mit akustischem Feedback erreicht wurde. Um diese Hinweise auf eine belastbarere Datengrundlage zu stellen, bedarf es weiterer Tests. Zudem muss künftig noch stärker darauf geachtet werden, dass bei der Entwicklung neuer Gesundheitstechnologien die Bedürfnisse der späteren Anwender in die Entwicklung einfließen.