Refine
Has Fulltext
- yes (150)
Is part of the Bibliography
- yes (150)
Year of publication
Document Type
- Journal article (150) (remove)
Language
- English (150) (remove)
Keywords
- ischemic stroke (13)
- stroke (9)
- COVID-19 (8)
- asthma (8)
- tinnitus (7)
- prevalence (6)
- secondary prevention (6)
- Germany (5)
- epidemiology (5)
- mHealth (5)
- machine learning (5)
- mortality (5)
- physical activity (5)
- quality of life (5)
- atrial fibrillation (4)
- ecological momentary assessment (4)
- guideline adherence (4)
- heart failure (4)
- migrants (4)
- ARIA (3)
- Asthma (3)
- IgE (3)
- birth cohort (3)
- cardiovascular risk factors (3)
- cohort studies (3)
- coronary artery disease (3)
- coronary heart disease (3)
- crowdsensing (3)
- depression (3)
- diabetes mellitus (3)
- hypertension (3)
- mental health (3)
- public health (3)
- rhinitis (3)
- risk (3)
- risk factors (3)
- systematic review (3)
- EUROASPIRE (2)
- Fabry disease (2)
- Fabry-associated pain (2)
- MASK (2)
- Medicine (2)
- SARS-CoV-2 (2)
- Stroke (2)
- age (2)
- biomarker (2)
- biomarkers (2)
- blood pressure (2)
- cancer (2)
- cardiac rehabilitation (2)
- cardiac surgery (2)
- cardiovascular events (2)
- childhood asthma (2)
- chronic heart failure (2)
- chronic kidney disease (2)
- disease (2)
- environmental exposure (2)
- factor XI (2)
- factor XII (2)
- food allergy (2)
- guidelines (2)
- health-related quality of life (2)
- implementation (2)
- incidence (2)
- inpatient rehabilitation (2)
- ischaemic stroke (2)
- left ventricular mass (2)
- magnetic resonance imaging (2)
- management (2)
- maternal exposure (2)
- metaanalysis (2)
- metallic trace elements (2)
- mixed methods (2)
- mobile health (2)
- myocardial infarction (2)
- myocardial work (2)
- outcomes (2)
- population-based (2)
- predictors (2)
- prenatal exposure (2)
- primary care (2)
- reliability (2)
- scientific guidelines (2)
- self-help (2)
- thrombolysis (2)
- trial (2)
- troponin (2)
- type 2 diabetes (2)
- unexpressed needs (2)
- urinary tract infections (2)
- 18FDG-PET/CT (1)
- AIRWAYS ICPs (1)
- AKI (1)
- ALAN (1)
- ARDS (acute respiratory distress syndrome) (1)
- Adults (1)
- Akutes Nierenversagen (1)
- Allergic rhinitis (1)
- Apple Watch 7 (1)
- B cells (1)
- BPM (1)
- BPMN (1)
- Barthel-Index (1)
- Business Process Models (1)
- CARAT (1)
- CHRODIS (1)
- COMT (1)
- COVID-19 pandemic (1)
- Cancer (1)
- Cardiovascular risk factors (1)
- Cardiovascular risk prediction (1)
- Carotid intima-media thickness (CIMT) (1)
- Carotid segment (1)
- Carotid ultrasound (1)
- Chronic respiratory diseases (1)
- Chronic rhino‑sinusitis (1)
- Clinical trials (1)
- Clinically silent stroke (1)
- Covid-19 (1)
- Der p 23 (1)
- ECG-recording (1)
- EIP on AHA (1)
- ELISPOT (1)
- EUROASPIRE survey (1)
- English version (1)
- Europe (1)
- European Innovation Partnership on Active and Healthy Ageing (1)
- European countries (1)
- Eye Movement Modeling Examples (1)
- FDG-PET/CT (1)
- Fabry nephropathy (1)
- Fabry patient (1)
- Fatigue (1)
- Fitbit Sense (1)
- Fruits (1)
- GA\(^2\)LEN (1)
- Garmin Fenix 6 Pro (1)
- German Stroke Registers Study Group (1)
- Glatiramer acetate (1)
- Good Practices (1)
- HFpEF (1)
- HFrEF (1)
- HRQL (1)
- Health care service research (1)
- Herzthoraxchirurgie (1)
- Hesse (1)
- HiGHmed (1)
- ICD-CRT (1)
- ICD-coding of CKD (1)
- IgE sensitazion (1)
- Inflammation (1)
- IoT (1)
- IoT-driven processes (1)
- KDIGO (1)
- LV dilatation (1)
- LV mass (1)
- Location-based algorithms (1)
- Long COVID (1)
- MACVIA (1)
- MASLD (1)
- MDR (1)
- MS (1)
- MeDALL (1)
- Metastatic breast cancer (1)
- Meta‑analysis (1)
- Mobile application engineering (1)
- Mobile augmented reality (1)
- Mobile augmented reality game (1)
- Multimorbidity (1)
- Multiple myeloma (1)
- NAFLD (1)
- NAKO (1)
- NOAC (1)
- NSSI (1)
- Neurodegeneration (1)
- PTSD (1)
- Pain questionnaire (1)
- Patient-centered care (1)
- Patient-centered registry (1)
- Patient’s needs (1)
- Prevalence (1)
- Process Model Comprehension (1)
- RCT (1)
- RT-PCR (1)
- Rehabilitation (1)
- Reminder e-mails (1)
- Rhinitis (1)
- SARS-CoV- 2 (1)
- SCORE (1)
- Sars-CoV-2 (1)
- Scaling up (1)
- Serious game (1)
- Social support (1)
- Social work (1)
- Sunfrail (1)
- Supportive therapy (1)
- Systematic review (1)
- TGFβ1 (1)
- Turkish (1)
- Vegetables (1)
- Withings ScanWatch (1)
- Yoga (1)
- accessibility (1)
- acculturation (1)
- accuracy (1)
- acetylsalicylic acid exacerbated respiratory disease (1)
- action versus state orientation (1)
- activated receptor-1 (1)
- acupressure (1)
- acute ischemic stroke (1)
- acute kidney injury (1)
- acute stroke (1)
- adolescence (1)
- adult (1)
- adult-onset (1)
- adults with congenital heart disease (1)
- age differences (1)
- aggression (1)
- aldosterone (1)
- allergic rhinitis (1)
- allergy (1)
- anemia (1)
- anomaly detection (1)
- antibiotic resistance (1)
- antigen testing (1)
- anxiety (1)
- aortic valve replacement (1)
- apoptosis (1)
- app (1)
- architectural design (1)
- areas (1)
- arterial stiffening (1)
- artificial light at night (1)
- aspirin sensitivity (1)
- aspirin-induced asthma (1)
- asymptomatic screening (1)
- atherosclerosis (1)
- atherothrombosis (1)
- atopic dermatitis (1)
- atopic-dermatitis (1)
- autoimmune (1)
- awareness (1)
- balance (1)
- beta-blockers (1)
- bibliometric analysis (1)
- bioelectronics (1)
- biological rapid deployment aortic valve (1)
- biological rhythm (1)
- birth cohort study (1)
- blood (1)
- blood lipids (1)
- blood sampling (1)
- blood-glucose (1)
- brain edema (1)
- brain endothelium (1)
- breast cancer (1)
- breastfeeding (1)
- bullous pemphigoid (1)
- calcification (1)
- cardiac arrhythmia (1)
- cardiac hypertrophy (1)
- cardiac rehabilitation standards (1)
- cardiopulmonary bypass (1)
- cardiovascular diseases (1)
- care tempis (1)
- carotid artery (1)
- carotid artery disease (1)
- carotid atherosclerosis (1)
- carotid stenosis (1)
- carotid ultrasound (1)
- caspase activation (1)
- catastrophizing (1)
- cbt (1)
- cerebral microbleeds (1)
- cerebrovascular diseases (1)
- childhood (1)
- children (1)
- chromosome 11Q13 (1)
- chronic cerebrovascular disease (1)
- chronic disorders (1)
- chronic low back pain (1)
- chronic respiratory-diseases (1)
- chronic urticaria (1)
- circadian rhythm (1)
- circulating micrornas (1)
- clinical measurement in health technology (1)
- clinical practice (1)
- clinical risk score (1)
- clinical routine data (1)
- clinical trial (1)
- clinical-practice (1)
- cloud-native (1)
- coagulation (1)
- cognition (1)
- cohort study (1)
- colorectal cancer (1)
- community detection (1)
- comorbid diseases (1)
- comparability (1)
- comprehension (1)
- computer science (1)
- condition prediction (1)
- cornea verticillata (1)
- coronavirus (1)
- cortisol (1)
- course of recovery (1)
- crantiectomy (1)
- cross-sectional studies (1)
- crowdsourcing (1)
- cyber-physical systems (1)
- data collection (1)
- data stream processing (1)
- death (1)
- decompressive surgery (1)
- degree of stenosis (1)
- delivery mode (1)
- demography (1)
- dependency (1)
- deployment (1)
- dermatitis (1)
- diabetes (1)
- diabetic mouse (1)
- diagnosis (1)
- dialysis (1)
- digital transformation of health and care (1)
- disease score (1)
- disease severity (1)
- drug therapies (1)
- drug therapy (1)
- dual guidance (1)
- dysphagia (1)
- early-life (1)
- early-onset gastric cancer patients (1)
- echocardiography (1)
- ecological momentary assessments (1)
- ecological momentary assessments (EMA) (1)
- education (1)
- ehealth (1)
- ejection fraction (1)
- elderly (1)
- electrodermal activity (1)
- emotion regulation (1)
- end-user programming (1)
- endoglin (1)
- endovascular treatment (1)
- environmental sound (1)
- enzyme replacement therapy (1)
- erythropoietin (1)
- euroaspire (1)
- european birth cohorts (1)
- event rates (1)
- evidence‐based medicine (1)
- exacebrated respiratory-disease (1)
- exercise (1)
- exercise program (1)
- exercise training (1)
- explainable machine learning (1)
- expression (1)
- extracorporeal membrane oxygenation (ECMO) (1)
- eye tracking (1)
- factor VIII (1)
- factor-V-Leiden (1)
- family caregiver (1)
- family caregivers (1)
- family physicians (1)
- fatal cardiovascular disease (1)
- fatty liver disease (1)
- feasibility (1)
- ferritin (1)
- fibrosis (1)
- filaggrin mutations (1)
- fitness trackers (1)
- follow up (1)
- follow-up (1)
- form health survey (1)
- frailty (1)
- gastric cancer in young patients (1)
- gastroesophageal reflux (1)
- gastroesophageal reflux disease (1)
- gender (1)
- gene polymorphism (1)
- general practice (1)
- genomewide association (1)
- geographic information science (1)
- geospatial data (1)
- german clinical cancer registry group (1)
- gestational age (1)
- giant intracranial aneurysm (1)
- gingivitis (1)
- glucose control (1)
- glycaemic control (1)
- gradient boosting machine (1)
- guideline implementation (1)
- harmonization (1)
- hay fever (1)
- head and neck cancer (1)
- health care (1)
- health care service research (1)
- health literacy (1)
- health sciences (1)
- health tracker (1)
- healthcare (1)
- healthcare assistants (1)
- heart (1)
- heart rate variability (1)
- heart transplantation (1)
- heart valve prosthesis (1)
- heart valve repair (1)
- helplessness (1)
- heme oxygenase-1 (1)
- hemicraniectomy (1)
- hemoglobin (1)
- hemorrhagic stroke (1)
- home isolation (1)
- home-based-rehabilitation (1)
- hospital medical complications (1)
- hospitalization (1)
- hospitals (1)
- house dust mite allergy (1)
- human behaviour (1)
- human brian endothelium (1)
- human-centered design (1)
- hypertrophic cardiomyopathy (1)
- hypoxia (1)
- illness experience (1)
- immune-responses (1)
- immunoglobulin-e (1)
- immunological reactivity (1)
- impact (1)
- inattention/hyperactivity (1)
- independent marker (1)
- indicators (1)
- infant growth (1)
- infection (1)
- infection surveillance (1)
- inflammation (1)
- informal care (1)
- informal caregiving (1)
- informed consent (1)
- injury (1)
- integraed care (1)
- intelligence (1)
- intensive care medicine (1)
- intensive care unit (1)
- inter-rater reliability (1)
- internal medicine (1)
- internet of things (1)
- intersession experiences (1)
- intersession processes (1)
- intervention (1)
- interview (1)
- intracerebral hemorrhage (1)
- ischemic-stroke (1)
- juvenile myoclonic epilepsy (1)
- kidney disease (1)
- kidney function (1)
- late-onset (1)
- latent change (1)
- left ventricular geometric abnormality (1)
- left ventricular geometry (1)
- left ventricular performance (1)
- left ventricular remodeling (1)
- length of stenosis (1)
- life style (1)
- lifestyle (1)
- loneliness (1)
- long-term survivors (1)
- longitudinal decrease (1)
- longitudinal studies (1)
- low birth weight (1)
- m-Health (1)
- malignant MCA infarct (1)
- marathon running (1)
- mechanical thrombectomy (1)
- mechanisms (1)
- medical analytics (1)
- medical complications (1)
- medical data integration center (1)
- medical device regulation (1)
- medical device software (1)
- medical informatics initiative (1)
- medical rehabilitation (1)
- melatonin (1)
- mellitus (1)
- mental disorders (1)
- mental effort (1)
- mental health monitoring (1)
- mental illness (1)
- metastatic (1)
- meta‐analysis (1)
- miR-122 (1)
- migration (1)
- mineralocorticoid antagonist (1)
- minimally invasive surgery (1)
- mobile app (1)
- mobile application (1)
- mobile apps (1)
- mobile crowdsensing (MCS) (1)
- mobile healthcare application (1)
- mobile operating system differences (1)
- mobile phone (1)
- mobility (1)
- models (1)
- moderate (1)
- molecular imaging (1)
- mortality/survival (1)
- mothers (1)
- multicenter (1)
- multidisciplinary (1)
- multifactorial (1)
- multimodal (1)
- multimodal data (1)
- multimodal intervention (1)
- multimorbidity (1)
- multi‑center cohort study (1)
- muscle strength (1)
- music performance anxiety (1)
- myocardial work efficiency (1)
- myocarditis (1)
- national health survey (1)
- natriuretic peptide levels (1)
- neoadjuvant therapy (1)
- neurological (1)
- noise measurement (1)
- non-cancer controls (1)
- non-personalised tips (1)
- normal values (1)
- nursing home (1)
- offspring (1)
- old patients (1)
- older-adults (1)
- on-site examination (1)
- oncology (1)
- openEHR (1)
- oral hygiene (1)
- organ dysfunktion (1)
- osteopontin (1)
- outcome (1)
- pain questionnaire (1)
- pancreatic cancer (1)
- pancreatic surgery (1)
- pandemia (1)
- parenting stress (1)
- paroxysmal atrial fibrillation (1)
- participation (1)
- passive data (1)
- patient education (1)
- patients' experience (1)
- patients’ awareness (1)
- peer review (1)
- perinatal (1)
- perioperative changes (1)
- perioperative therapy (1)
- peripheral artery disease (1)
- personalized medicine (1)
- pharmacotherapy (1)
- photoplethysmography (1)
- physical activity trajectories (1)
- physical health (1)
- physician feedback (1)
- physicians’ awareness (1)
- pilot project (1)
- platelets (1)
- pneumonia (1)
- point-of-care echocardiography (1)
- polysensitization (1)
- population-based studies (1)
- population-based study (1)
- postoperativ (1)
- power (1)
- prediction (1)
- predictive value (1)
- preschool children (1)
- preserved ejection fraction (1)
- preterm children (1)
- prevention (1)
- primary prevention (1)
- primary-care physicians (1)
- probiotic prophylaxis (1)
- probiotics (1)
- process model (1)
- process model comprehension (1)
- processing pipeline (1)
- production machines (1)
- prognosis (1)
- progressive muscle relaxation (1)
- proteinuria (1)
- psycho-oncology (1)
- psychological burden (1)
- psychological interventions (1)
- psychology (1)
- psychotherapy (1)
- public mental health (1)
- pulmonary hypertension (1)
- pulmonary rehabilitation (1)
- quality (1)
- quality assurance (1)
- quality indicators (1)
- quality of health care (1)
- quality-of-care (1)
- questionnaire assessment (1)
- questionnaire development (1)
- randomized controlled trial (1)
- randomized controlled-trial (1)
- rankin scale (1)
- rare diseases (1)
- reference architecture (1)
- reference data (1)
- register (1)
- registries (1)
- registry (1)
- regression analysis (1)
- rehabilitation (1)
- relapse (1)
- renal disease (1)
- renal fibrosis (1)
- reperfusion injury (1)
- resistance training (1)
- resource (1)
- retention strategies (1)
- review (1)
- risk factor (1)
- risk factor control (1)
- risk prediction scores (1)
- risk-factors (1)
- salt consumption (1)
- salt-intake-related behavior (1)
- sample (1)
- scalability (1)
- scale (1)
- school-based prevention (1)
- second line antibiotics (1)
- sedentary behavior (1)
- self help (1)
- self-efficacy (1)
- self-employed (1)
- self-injury (1)
- self-management (1)
- self-monitoring (1)
- semantic interoperability (1)
- sensor (1)
- sensor data (1)
- sensor networks (1)
- sentiment analysis (1)
- septal hypertrophy (1)
- severe sepsis (1)
- severity (1)
- sex (1)
- sex addiction (1)
- sex differences (1)
- shedding (1)
- signs and symptoms (1)
- small business (1)
- smart mobile devices (1)
- smart-phone (1)
- smartphone app (1)
- smartphone communication (1)
- smartwatch (1)
- smoking-cessation (1)
- social media use (1)
- social well-being (1)
- soldiers (1)
- steatotic liver disease (1)
- stream processing (1)
- strength and difficulties (1)
- stress (1)
- stress factors (1)
- stroke care (1)
- stroke register (1)
- stroke unit (1)
- stroke unit care (1)
- stroke, acute (1)
- stroke-associated pneumonia (1)
- study-group ADSR (1)
- sudden cardiac death (1)
- surgical aneurysm treatment (1)
- survey (1)
- survey instrument (1)
- survival (1)
- symptoms (1)
- system architecture design (1)
- systolic dysfunction (1)
- task force (1)
- tele-medicine (1)
- telehealth (1)
- telemedicine (1)
- telemedicine network (1)
- term (1)
- term mortality (1)
- territory infaction (1)
- thought suppression (1)
- time (1)
- time series (1)
- time trends (1)
- tinnitus research (1)
- tinnitus therapy (1)
- tolerability (1)
- topic modeling (1)
- training curriculum (1)
- transient ischemic attack (1)
- treatment (1)
- under-dosing (1)
- universal prevention (1)
- update (1)
- urinary protein excretion (1)
- usability study (1)
- uveal melanoma (1)
- vascular access (1)
- vascular disease (1)
- venous thrombosis (1)
- ventricular assist device (1)
- violence (1)
- virtual reality exposure therapy (1)
- visual analytics (1)
- wearable (1)
- wheeze (1)
- wheezing (1)
- women (1)
- work capacity evaluation (1)
- young children (1)
- young patients (1)
Institute
- Institut für Klinische Epidemiologie und Biometrie (150) (remove)
Sonstige beteiligte Institutionen
- Clinical Trial Center (CTC) / Zentrale für Klinische Studien Würzburg (ZKSW) (5)
- Klinische Studienzentrale (Universitätsklinikum) (2)
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany (1)
- Servicezentrum Medizin-Informatik (1)
- Servicezentrum Medizin-Informatik (Universitätsklinikum) (1)
In this study, we examined the conditional indirect and direct relations of pain-related cognitions to depression. Subjective helplessness was included as presumably mediating the relations of catastrophizing and thought suppression to depression due to motivational deficits. In addition, moderating effects of dispositional action versus state orientation were analyzed, whereby state orientation indicates volitional deficits in coping with distress. The study was based on self-report data from 536 patients with chronic non-specific low back pain at the beginning of inpatient rehabilitation. Moderated mediation analyses were performed. The indirect catastrophizing- and thought suppression-depression relations were (partially) mediated by subjective helplessness; and moderated by failure-related action versus state orientation. Moreover, action versus state orientation moderated the direct relation of thought suppression to depression. Results suggest that catastrophizing, thought suppression, and subjective helplessness do not lead to depression unless associated with self-regulatory inability (i.e., state orientation). In contrast, action-oriented patients more effectively self-regulate pain-related emotions, disengage from rumination, and distract from pain and thus better avoid the debilitating effects of negative pain-related cognitions on depression. Future research and treatment may more strongly focus on the role of motivational and volitional deficits underlying learned helplessness and depression in chronic pain.
Strategies to Enhance Retention in a Cohort Study Among Adults of Turkish Descent Living in Berlin
(2022)
Retention is important for statistical power and external validity in long-term cohort studies. The aims of our study were to evaluate different retention strategies within a cohort study of adults of Turkish descent in Berlin, Germany, and to compare participants and non-participants. In 2011–2012, a population-based study was conducted among adults of Turkish descent to primarily examine recruitment strategies. 6 years later, the participants were re-contacted and invited to complete a self-report questionnaire regarding their health status, health care utilization, and satisfaction with medical services. The retention strategy comprised letters in both German and Turkish, phone calls, and home visits (by bilingual staff). We calculated the response rate and retention rate, using definitions of the American Association for Public Opinion Research, as well as the relative retention rate for each level of contact. Associations of baseline recruitment strategy, sociodemographic, migration-related and health-related factors with retention were investigated by logistic regression analysis. Of 557 persons contacted, 249 (44.7%) completed the questionnaire. This was 50.1% of those whose contact information was available. The relative retention rate was lowest for phone calls (8.9%) and highest for home visits (18.4%). Participants were more often non-smokers and German citizens than non-participants. For all remaining factors, no association with retention was found. In this study, among adults of Turkish descent, the retention rate increased considerably with every additional level of contact. Implementation of comprehensive retention strategies provided by culturally matched study personnel may lead to higher validity and statistical power in studies on migrant health issues.
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) imposes a significant burden on Westernized regions. The Western diet, high in salt intake, significantly contributes to disease development. However, there are a lack of data on salt literacy and salt intake among MASLD patients in Germany. Our study aims to analyze daily salt intake and salt-intake-related behavior in MASLD patients. Methods: 234 MASLD patients were prospectively included. Daily salt intake and salt-intake-related behavior were assessed via a food frequency questionnaire (FFQ—DEGS) and a salt questionnaire (SINU). Statistical analyses were performed using SPSS. Results: Mean daily salt intake was higher in men than in women (7.3 ± 5 g/d vs. 5.3 ± 4 g/d; p < 0.001). There was significant agreement between increased daily salt intake (6 g/d) and the behavioral salt index (SI) (p < 0.001). Men exhibited higher SI scores compared to women, indicating lower awareness of salt in everyday life. Multivariate analysis identified specific salt-intake-related behaviors impacting daily salt consumption. Conclusions: Our study reveals a strong link between daily salt intake and salt-intake-related behavior, highlighting sex-specific differences in an MASLD cohort. To enhance patient care in high-cardiovascular-risk populations, specific behavioral approaches may be considered, including salt awareness, to improve adherence to lifestyle changes, particularly in male patients.
Purpose
Over the course of COVID-19 pandemic, evidence has accumulated that SARS-CoV-2 infections may affect multiple organs and have serious clinical sequelae, but on-site clinical examinations with non-hospitalized samples are rare. We, therefore, aimed to systematically assess the long-term health status of samples of hospitalized and non-hospitalized SARS-CoV-2 infected individuals from three regions in Germany.
Methods
The present paper describes the COVIDOM-study within the population-based cohort platform (POP) which has been established under the auspices of the NAPKON infrastructure (German National Pandemic Cohort Network) of the national Network University Medicine (NUM). Comprehensive health assessments among SARS-CoV-2 infected individuals are conducted at least 6 months after the acute infection at the study sites Kiel, Würzburg and Berlin. Potential participants were identified and contacted via the local public health authorities, irrespective of the severity of the initial infection. A harmonized examination protocol has been implemented, consisting of detailed assessments of medical history, physical examinations, and the collection of multiple biosamples (e.g., serum, plasma, saliva, urine) for future analyses. In addition, patient-reported perception of the impact of local pandemic-related measures and infection on quality-of-life are obtained.
Results
As of July 2021, in total 6813 individuals infected in 2020 have been invited into the COVIDOM-study. Of these, about 36% wished to participate and 1295 have already been examined at least once.
Conclusion
NAPKON-POP COVIDOM-study complements other Long COVID studies assessing the long-term consequences of an infection with SARS-CoV-2 by providing detailed health data of population-based samples, including individuals with various degrees of disease severity.
Trial registration
Registered at the German registry for clinical studies (DRKS00023742).
Background
Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters.
Methods
This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation.
Discussion
The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects.
Trial registration
This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860)
During the COVID-19 pandemic, the novel coronavirus had an impact not only on public health but also on the mental health of the population. Public sentiment on mental health and depression is often captured only in small, survey-based studies, while work based on Twitter data often only looks at the period during the pandemic and does not make comparisons with the pre-pandemic situation. We collected tweets that included the hashtags #MentalHealth and #Depression from before and during the pandemic (8.5 months each). We used LDA (Latent Dirichlet Allocation) for topic modeling and LIWC, VADER, and NRC for sentiment analysis. We used three machine-learning classifiers to seek evidence regarding an automatically detectable change in tweets before vs. during the pandemic: (1) based on TF-IDF values, (2) based on the values from the sentiment libraries, (3) based on tweet content (deep-learning BERT classifier). Topic modeling revealed that Twitter users who explicitly used the hashtags #Depression and especially #MentalHealth did so to raise awareness. We observed an overall positive sentiment, and in tough times such as during the COVID-19 pandemic, tweets with #MentalHealth were often associated with gratitude. Among the three classification approaches, the BERT classifier showed the best performance, with an accuracy of 81% for #MentalHealth and 79% for #Depression. Although the data may have come from users familiar with mental health, these findings can help gauge public sentiment on the topic. The combination of (1) sentiment analysis, (2) topic modeling, and (3) tweet classification with machine learning proved useful in gaining comprehensive insight into public sentiment and could be applied to other data sources and topics.
Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic
(2023)
Background: At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020.
Methods: From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol.
Results: One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients’ health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources.
Discussion: It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.
Psychosocial factors affect mental health and health-related quality of life (HRQL) in a complex manner, yet gender differences in these interactions remain poorly understood. We investigated whether psychosocial factors such as social support and personal and work-related concerns impact mental health and HRQL differentially in women and men during the first year of the COVID-19 pandemic. Between June and October 2020, the first part of a COVID-19-specific program was conducted within the “Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB)” cohort study, a representative age- and gender-stratified sample of the general population of Würzburg, Germany. Using psychometric networks, we first established the complex relations between personal social support, personal and work-related concerns, and their interactions with anxiety, depression, and HRQL. Second, we tested for gender differences by comparing expected influence, edge weight differences, and stability of the networks. The network comparison revealed a significant difference in the overall network structure. The male (N = 1370) but not the female network (N = 1520) showed a positive link between work-related concern and anxiety. In both networks, anxiety was the most central variable. These findings provide further evidence that the complex interplay of psychosocial factors with mental health and HRQL decisively depends on gender. Our results are relevant for the development of gender-specific interventions to increase resilience in times of pandemic crisis.
Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.
Objectives
To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women.
Design
Parallel, cluster randomised, controlled trial.
Setting
General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022.
Participants
General practitioners from 128 randomly assigned practices.
Interventions
Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention.
Main outcome measures
Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes.
Results
110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was −0.13 (95% confidence interval −0.21 to −0.06, P<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of −0.08 (95% confidence interval −0.15 to −0.02, P<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups.
Conclusions
The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women.
Trial registration
German Clinical Trials Register (DRKS), DRKS00020389