GesundF: Angewandte GesundheitswissenschaftenF: Europan Campus Rottal-Inn
Tomorrow is the start of the rest of their life – so who cares about health? Exploring constructions of weight-loss motivations and health using story completion
Qualitative Research in Psychology, vol. 16, no. 1, pp. 54-73
In Western societies, health is closely associated with body weight and weight loss, achieved through individual health behaviour. I examined such associations in constructions of weight-loss motivations and health in stories generated using the novel method of story completion. The story stem featured either a female or male protagonist deciding to lose weight; 148 women and 22 men (ages 18–24) provided stories in response. A social constructionist thematic analysis identified five themes: health as clothing size and means to an end; weight-loss activity as good for every woman; tomorrow is going to be the start of the rest of their life; tell me when I’m okay — it’s not about wellbeing; and weight loss as signifier of the “true self.” Considering the adverse social and psychological consequences reflected in the stories and the longstanding elusiveness of successful weight-loss methods, I support calls to review the dominant weight-focused approach to public health.
GesundF: Angewandte Gesundheitswissenschaften
A. Fringer, Mareike Hechinger, F. Wolfensberger, R. Steiner, W. Schnepp
Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis
BMC Palliative Care, vol. 17, no. Article number 22, pp. 1-15
Background When receiving palliative care, patients and their families experience altered life situations in which they must negotiate challenges in daily life, increased care and new roles. With limited time, they also experience emotional changes that relate to their uncertain future. Transitions experienced in such situations are often studied by focusing on individual aspects, which are synthesized in the following study. The aim was to conduct a qualitative meta-synthesis to explore the experiences patients and their families gain during transitions in palliative care circumstances.
Methods A qualitative meta-synthesis was conducted following an inductive approach as proposed by Sandelowski and Barroso. Inclusion criteria were studies with adult persons in palliative situations and articles published in English or German. Relevant articles were identified by researching the Pubmed and Cinahl databases, as well as by hand searches in journals and reference lists for the period 2000–2015. The findings of each study were analyzed using initial coding, followed by axial and selective coding in this order. Consequently, a conceptual model was derived from the categories.
Results In total 2225 articles were identified in the literature search. Finally, 14 studies were included after the selection process. The central phenomenon observed among palliative care patients and their families was maintaining normality during transitions. Transitions are initially experienced unconsciously until a crisis occurs and responsive actions are necessary, which encourages patients and families to perceive the situation consciously and develop strategies for its negotiation. Patients remain caught between hopelessness and valuing their remaining time alive. As the illness progresses, informal caregivers reprioritize and balance their roles, and after death, family members inevitably find themselves in changed roles.
Conclusions In palliative care situations, transitions are experienced differently by patients and their families in a constant phenomenon that oscillates between unconscious and conscious perceptions of transitions. The derived conceptual model offers an additional perspective to existing models and helps to clarify the phenomenon in practical settings. The study promotes a differentiated conceptual view of transitions and emphasizes patients’ and families’ perspectives.
GesundF: Europan Campus Rottal-Inn
E. Faiola, I. Meyhöfer, M. Steffens, Anna-Maria Kasparbauer, V. Kumari, U. Ettinger
Combining Trait and State Model Systems of Psychosis: The Effect of Sleep Deprivation on Cognitive Functions in Schizotypal Individuals
Psychiatry Research, vol. 270, no. December, pp. 639-648
Model systems of psychosis play an important role in pathophysiology and drug development research. Schizotypal individuals display similar cognitive impairments as schizophrenia patients in several domains. Therefore, schizotypy may be interpreted as a trait model system of psychosis. In addition, experimentally controlled sleep deprivation is a putative state psychosis model that evokes subclinical psychosis-like states. We aimed to further validate these model systems by examining them in relation to central cognitive biomarkers of schizophrenia. Most of all, we were interested in investigating, for the first time, effects of their combination on cognitive function. Healthy subjects with high (N = 17) or low (N = 19) levels of schizotypy performed a cognitive task battery after one night of normal sleep and after 24 h of sleep deprivation. Sleep deprivation impaired performance in the go/nogo and n-back tasks relative to the normal sleep control condition. No differences between groups or interactions of group with sleep condition were found. The role of sleep deprivation as a model of psychosis is thus supported to some extent by impairments in inhibitory control. However, classical measures of cognition may be less able to detect deficits in schizotypy, in line with evidence of more basic information processing dysfunctions in schizotypy.
GesundF: Europan Campus Rottal-Inn
M. Steffens, C. Neumann, Anna-Maria Kasparbauer, B. Becker, B. Weber, M. Mehta, R. Hurlemann, U. Ettinger
Effects of ketamine on brain function during response inhibition
Psychopharmacology, vol. 235, pp. 3559-3571
The uncompetitive N-methyl-D-aspartate (NMDA) receptor (NMDAR) antagonist ketamine has been proposed to model symptoms of psychosis. Inhibitory deficits in the schizophrenia spectrum have been reliably reported using the antisaccade task. Interestingly, although similar antisaccade deficits have been reported following ketamine in non-human primates, ketamine-induced deficits have not been observed in healthy human volunteers.
To investigate the effects of ketamine on brain function during an antisaccade task, we conducted a double-blind, placebo-controlled, within-subjects study on n = 15 healthy males. We measured the blood oxygen level dependent (BOLD) response and eye movements during a mixed antisaccade/prosaccade task while participants received a subanesthetic dose of intravenous ketamine (target plasma level 100 ng/ml) on one occasion and placebo on the other occasion.
While ketamine significantly increased self-ratings of psychosis-like experiences, it did not induce antisaccade or prosaccade performance deficits. At the level of BOLD, we observed an interaction between treatment and task condition in somatosensory cortex, suggesting recruitment of additional neural resources in the antisaccade condition under NMDAR blockage.
Given the robust evidence of antisaccade deficits in schizophrenia spectrum populations, the current findings suggest that ketamine may not mimic all features of psychosis at the dose used in this study. Our findings underline the importance of a more detailed research to further understand and define effects of NMDAR hypofunction on human brain function and behavior, with a view to applying ketamine administration as a model system of psychosis. Future studies with varying doses will be of importance in this context.
GesundF: Europan Campus Rottal-Inn
A. Kupferberg, M. Iacoboni, V. Flanagin, M. Huber, Anna-Maria Kasparbauer, T. Baumgartner, G. Hasler, F. Schmidt, C. Borst, S. Glasauer
Fronto-parietal Coding of Goal-Directed Actions Performed by Artificial Agents
Human Brain Mapping, vol. 33, no. 3, pp. 1145-1162
With advances in technology, artificial agents such as humanoid robots will soon become a part of our daily lives. For safe and intuitive collaboration, it is important to understand the goals behind their motor actions. In humans, this process is mediated by changes in activity in fronto-parietal brain areas. The extent to which these areas are activated when observing artificial agents indicates the naturalness and easiness of interaction. Previous studies indicated that fronto-parietal activity does not depend on whether the agent is human or artificial. However, it is unknown whether this activity is modulated by observing grasping (self-related action) and pointing actions (other-related action) performed by an artificial agent depending on the action goal. Therefore, we designed an experiment in which subjects observed human and artificial agents perform pointing and grasping actions aimed at two different object categories suggesting different goals. We found a signal increase in the bilateral inferior parietal lobule and the premotor cortex when tool versus food items were pointed to or grasped by both agents, probably reflecting the association of hand actions with the functional use of tools. Our results show that goal attribution engages the fronto-parietal network not only for observing a human but also a robotic agent for both self-related and social actions. The debriefing after the experiment has shown that actions of human-like artificial agents can be perceived as being goal-directed. Therefore, humans will be able to interact with service robots intuitively in various domains such as education, healthcare, public service, and entertainment.
GesundF: Angewandte GesundheitswissenschaftenI: Institut Betriebliches Gesundheitsmanagement u. Arbeitssicherheit
Dieter Melchart, A. Eustachi, Stephan Gronwald, Erich Wühr, K. Wifling, B. Bachmeier
Introduction of a web portal for an Individual Health Management and observational health data sciences
Patient Related Outcome Measures (PROM), vol. 9, no. June, pp. 183-196
There is a global trend to a stronger active involvement of persons in the maintenance and restoring of health. The Competence Centre for Complementary Medicine and Naturopathy (CoCoNat) of the Technical University of Munich (TUM) has developed a lifestyle concept to enable each individual to manage his or her health – Individual Health Management (IHM) – and a web-based health portal named Virtual Tool for Education, Reporting, Information and Outcomes (VITERIO®), which addresses these needs for practice and research.
The objectives of this study were to establish a core set of questionnaires for a self-assessment program on certain risk indications and comprehensive protection factors of health and to develop and enhance 1) tools for individual feedback, longitudinal self-monitoring, self-assessment, and (self-)care-planning; 2) training packages; 3) open notes and records for provider and patient; and 4) tools for monitoring groups and single participants in various indicators for individual coaching and scientific evaluation.
The CoCoNat of TUM, Faculty for Applied Health Science of Technische Hochschule Deggendorf, VITERIO® company, IHM campus network, and Erich Rothenfußer Foundation, Munich, provide a consortium responsible for content, research strategy, technical production and implication, postgraduate education for IHM coaches, implementation of IHM in various settings, and funding resources.
A data set of indicators for health screening and self-monitoring of findings, symptoms, health behavior, and attitudes are integrated into a web-based health portal named VITERIO®. The article introduces some implemented graphical solutions of developed tools and gives examples for daily use.
Behavioral change and adaptation in attitudes and personal values are difficult issues of health education and lifestyle medicine. To address this problem best, the implementation of a patient-centric, performance measures-based program including open records and a blended learning concept were elaborated. The combination of an individual web-based health portal with personal coaching allows the implementation of IHM in everyday practice.
GesundF: Angewandte Gesundheitswissenschaften
Energetic Profile of the Basketball Exercise Simulation Test in Junior Elite Players
International Journal of Sports Physiology and Performance (IJSPP), vol. 13, no. 6, pp. 810-815
Purpose: To analyze the energetic profile of the Basketball Exercise Simulation Test (BEST). Methods: Ten male elite junior basketball players (age 15.5 [0.6] y, height 180  cm, and body mass 66.1 [11.2] kg) performed a modified BEST (20 circuits consisting of jumping, sprinting, jogging, shuffling, and short breaks) simulating professional basketball game play. Circuit time, sprint time, sprint decrement, oxygen uptake (VO2), heart rate, and blood lactate concentration (blc) were obtained. Metabolic energy and metabolic power above rest (Wtot and Ptot), as well as energy share in terms of aerobic (Waer), glycolytic (Wblc), and high-energy phosphates (WPCr), were calculated from VO2 during exercise, net lactate production, and the fast component of postexercise VO2 kinetics, respectively. Results: Waer, Wblc, and WPCr reflect 89% (2%), 5% (1%), and 6% (1%) of total energy needed, respectively. Assuming an aerobic replenishment of PCr energy stores during short breaks, the adjusted energy share yielded Waer 66% (4%), Wblc 5% (1%), and WPCr 29% (1%). Waer and WPCr were negatively correlated (−0.72 and −0.59) with sprint time, which was not the case for Wblc. Conclusions: Consistent with general findings on energy system interaction during repeated high-intensity exercise bouts, the intermittent profile of the BEST relies primarily on aerobic energy combined with repetitive supplementation by anaerobic utilization of high-energy phosphates.
GesundI: Zentrum für Akademische Weiterbildung
Matthew White, H. Braund, D. Howes, R. Egan, Andreas Gegenfurtner, J.J.G. van Merriënboer, A. Szulewski
Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations
Annals of emergency medicine, vol. 72, no. 3, pp. 289-298
Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases.
During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter.
Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors.
The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.
GesundI: Zentrum für Akademische Weiterbildung
E. Kok, De Bruin, A. B., K. van Geel, Andreas Gegenfurtner, I. Heyligers, B. Sorger
The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System: An fMRI Study
Frontiers in Human Neuroscience, vol. 12
Motor expertise is an important aspect of high-level performance in professional tasks such as surgery. While recently it has been shown that brain activation as measured by functional magnetic resonance imaging (fMRI) within the mirror-neuron system (MNS) is modulated by expertise in sports and music, little is known about the neural underpinnings of professional, e.g., surgical expertise. Here, we investigated whether and (if so) how surgical expertise is implemented in the MNS in medical professionals across three levels of surgical qualification. In order to answer the more specific research question, namely, if the neural implementation of motor expertise develops in a linear or non-linear fashion, the study compares not only brain activation within the MNS related to action observation of novices and experts, but also intermediates. Ten novices (medical students), ten intermediates (residents in orthopedic surgery) and ten experts (orthopedic surgeons) watched 60 video clips (5 s each) of daily-life activities and surgical procedures each while their brain activation was measured using a 3-T fMRI scanner. An established localization procedure was followed to functionally define the MNS for each participant individually. A 2 (video type: daily-life activities, surgical procedures) × 3 (expertise level: novice, intermediate, expert) ANOVA yielded a non-significant interaction. Furthermore, separate analyses of the precentral and parietal part of the MNS also yielded non-significant interactions. However, post hoc comparisons showed that intermediates displayed marginally significantly lower brain activation in response to surgery-related videos within the MNS than novices. No other significant differences were found. We did not find evidence for the hypothesis that the brain-activation level in the MNS evoked by observing surgical videos reflects the level of surgical expertise in the professional task of (orthopedic) surgery. However, the results suggest a potential non-linear relationship between expertise level and MNS-activation level.