43 research outputs found
Panik und komorbide Depression und ihre Assoziationen mit Stressreagibilität, interozeptiver Sensibilität und interozeptiver Wahrnehmungsgenauigkeit bei verschiedenen peripherphysiologischen Parametern
No full textBackground: While current theories on perception of interoceptive signals suggest impaired interoceptive processing in psychiatric disorders such as panic disorder or Depression, heart-rate (HR) interoceptive accuracy (IAc)of panic patients under resting conditions is superior to that of healthy controls. Thus, in this study, we chose to assess further physiological parameters and comorbid depression in order to get information on how these potentially conflicting findings are linked together.Design: We used a quasi-experimental laboratory design which included multi-parametric physiological data collection of 40 panic subjects and 53 matched no-panic controls, as well as experimental induction of stress and relaxation over a time-course. Methods: Stress reactivity, interoceptive awareness (IAw; from the Body Perception Questionnaire (BPQ)) and IAc (as correlation between self-estimation and physiological data) were major outcome variables. Self-estimation of bioparametrical change was measured via numeric rating scales. Results: Panic subjects had stronger HR-reaction and more accurate HR-interoception. Concurrently, though, their IAc of skin conductance level, pulse amplitude and breathing amplitude was significantly lower than that of the control group. Interestingly, comorbid depression was found to be associated with increased IAw but attenuated IAc. Limitations: Demand characteristics and a categorical approach to panic confine the results. Conclusion: The potentially conflicting findings coalesce, as panic was associated with an increase of the ability to perceive the fear-related parameter and a simultaneous decrease of the ability to perceive other parameters. The superordinate integration of afferent signals might be impaired.Hintergrund und Ziele:
Theorien zur Entwicklung und Aufrechterhaltung der Panikstörung postulieren teufelskreisähnliche Prozesse (z.B. Clark, 1986, Margraf und Ehlers, 1989), in welchen Betroffene sensibel kleinste körperliche Veränderungen (z.B. beschleunigter Herzschlag) registrieren und diese dann katastrophisierend bewerten. Forscher beschäftigt die Frage, ob veränderte interozeptive Wahrnehmung überhaupt eine Rolle spielt und nicht die kognitiven Prozesse allein zur Erklärung von Panik ausreichen (z.B. Hartl, 1995, Pauli et al., 1991) und - falls die Interozeption doch bedeutsam ist - welcher Art die interozeptiven Veränderungen sind. Während jüngere theoretische Modelle eine ungenaue Wahrnehmung von peripherphysiologischen Afferenzen im Zusammenhang mit Panik und Depression vorhersagen (z.B. Paulus und Stein, 2010), zeigten Herzratenwahrnehmungsstudien wiederholt eine signifikant erhöhte Interozeptionsgenauigkeit bei Panik (z.B. Domschke et al., 2010). Dies ist erklärungsbedürftig. In der vorliegenden Studie wurde deshalb untersucht, welche Zusammenhänge zwischen einem diagnostizierten Paniksyndrom und den Stressreaktionen, deren subjektiver Wahrnehmung und der Genauigkeit der Wahrnehmung bestehen. Da sich bisherige Studien hauptsächlich auf Herzrateninterozeption beschränkten, sollten jetzt simultan eine Reihe weiterer Bioparameter untersucht werden. Außerdem sollte getestet werden, ob und welchen zusätzlichen Einfluss eine komorbide depressive Symptomatik hat.
Methoden (Patienten, Material und Untersuchungsmethoden):
Eingeschlossen in die Untersuchung wurden insgesamt 94 Probanden, 40 von ihnen erfüllten zum Zeitpunkt des Einschlusses die Kriterien für eine Panikstörung (mit/ohne Agoraphobie), gemäß PHQ-D und zusätzlicher klinischer Interviews. Die 54 Kontrollgruppenteilnehmer wurden alters- und geschlechtsgematcht. Zusätzlich wurden Depressivität via BDI und Somatisierung via PHQ-D erhoben und als Kontrollvariablen berücksichtigt. In einem quasi-experimentellen Versuchsdesign durchliefen die Probanden Phasen von induzierter Entspannung und Stress (arithmetischer Stressor) und sie sollten jeweils nachfolgend den Verlauf der peripherphysiologischen Parameter auf Numerischen Ratingskalen einschätzen. Gleichzeitig wurden die physiologischen Reaktionen mittels eines Biofeedbacksystems (Insight Instruments, Softmed, Hallein, A) objektiv erfasst. Zusätzlich wurde eine Reihe von Daten mittels Fragebogen erhoben, unter anderem die Körperwahrnehmung (mittels BPQ, Porges, 1993) als ein Maß für die subjektive Empfänglichkeit für körperliche Veränderungen.
Ergebnisse und Beobachtungen:
Panikpatienten reagierten auf den Stressor mit signifikant stärkerer Herzratenaktivierung, sonst zeigten sich keine Unterschiede in den erhobenen physiologischen Parametern im Vergleich zur Kontrollgruppe. Auch die Interozeptionsgenauigkeit war nur bei der Herzwahrnehmung signifikant erhöht. Dem gegenüber war die Interozeptionsgenauigkeit von der Kontrollgruppe in verschiedenen Bereichen (Hautleitfähigkeit, Pulsamplitude, Atemamplitude) signifikant besser, insgesamt gab es einen Trend für höhere Wahrnehmungsgenauigkeit in Abwesenheit von Paniksymptomen. Die subjektive Einschätzung der Veränderung war bei Panikpatienten und Kontrollgruppe nicht signifikant verschieden, beide Gruppen beschrieben geringeres Symptomerleben als depressive Probanden. Depressive schrieben sich auch im Body Perception Questionnaire (BPQ) eine weitaus höhere Sensibilität für körperliche Prozesse zu. Komorbide Depressivität reduzierte die Interozeptionsgenauigkeit von Panikpatienten bei allen untersuchten Parametern, hatte jedoch keinen negativen Einfluss auf die Wahrnehmungsgenauigkeit der Kontrollgruppe. Bei der Hautleitfähigkeit konnte jedoch ein leichter Trend beobachtet werden, dass depressive Symptome (ohne komorbide Panik) auch interozeptionssteigernd wirken können.
Praktische Schlussfolgerungen:
Panikpatienten scheinen im Durchschnitt weder stärker körperlich auf Stress zu reagieren noch eine generelle stärkere Achtsamkeit für interozeptive Reize aufzuweisen. Sie reagieren jedoch intensiver auf dem als bedrohlich erlebten körperlichen Parameter Herzfrequenz und scheinen kompetenter als Kontrollprobanden zu sein, die Veränderung im Fokusbereich richtig zu beurteilen. Dies geht jedoch scheinbar mit einem gleichzeitigen Verlust der Fähigkeit einher, andere Körperparameter korrekt zu beurteilen. Es ist zu vermuten, dass Panikpatienten die verschiedenen afferenten Informationen nicht zu einem stimmigen Gesamtbild integrieren können und damit allein auf die Bedrohung durch die gestiegene Herzrate fokussieren. Dies steht in Einklang mit dem Ansatz von Paulus und Stein (2010), die eine Verschlechterung der Interozeptionsfähigkeit von Panikpatienten postulieren, mit der in der vorliegenden Studie gemessenen Ausnahme einer gesteigerten Wahrnehmungskompetenz bezüglich des Angstfokus. Da nicht alle Panikpatienten auf das Herz fokussieren, sondern z.B. auf Schwindel oder Atmung, wären Anschlussuntersuchungen sinnvoll, ob bei einer größeren Subgruppe dieser Panikunterformen auch entsprechend andere Interozeptionssteigerungen anzutreffen sind. Die Implikation für die Psychotherapie lautet damit, dass Panikpatienten lernen sollten, nicht angstbezogene körperliche Parameter wahrzunehmen (=Fokuswechsel mit Sensibilisierung für positive Information) und damit eine Entkatastrophisierung zu begünstigen. Wichtig für die therapeutische Arbeit scheint auch die reduzierte Interozeptionsleistung von Panikpatienten mit komorbider Depressivität. Da depressive Panikpatienten zu einer deutlichen Überbewertung von körperlichen Prozessen neigen und dadurch unter einem besonders hohen Leidensdruck stehen, wären besonders hier Expositionsübungen (z.B. via Biofeedback) und Psychoedukation angezeigt
Controlling exposure to As and Cd from rice via irrigation management
No full textThis article was originally published in Environmental Geochemistry and Health. The version of record is available at: https://doi.org/10.1007/s10653-024-02116-x. © The Author(s) 2024
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
This research was featured in UDaily on 08/30/2024 at https://www.udel.edu/udaily/2024/august/toxic-metal-leafy-greens-rice-research-angelia-seyfferth-matt-limmer/Irrigation management controls biogeochemical cycles in rice production. Under flooded paddy conditions, arsenic becomes plant-available as iron-reducing conditions ensue, while oxic conditions lead to increased plant availability of Cd in acidic soils. Because Cd enters rice through Mn transporters, we hypothesized that irrigation resulting in intermediate redox could simultaneously limit both As and Cd in rice grain due to As retention in soil and Mn competition for Cd uptake. In a 2 year field study, we used 6 irrigation managements that varied in extent and frequency of inundation, and we observed strong effects of irrigation management on porewater chemistry, soil redox potentials, plant As and Cd concentrations, plant nutrient concentrations, and methane emissions. Plant As decreased with drier irrigation management, but in the grain this effect was stronger for organic As than for inorganic As. Grain organic As, but not inorganic As, was strongly and positively correlated with cumulative methane emissions. Conversely, plant Cd increased under more aerobic irrigation management and grain Cd was negatively correlated with porewater Mn. A hazard index approach showed that in the tested soil with low levels of As and Cd (5.4 and 0.072 mg/kg, respectively), irrigation management could not simultaneously decrease grain As and Cd. Many soil properties, such as reducible As, available Cd, soil pH, available S, and soil organic matter should be considered when attempting to optimize irrigation management when the goal is decreasing the risk of As and Cd in rice grain.This work was funded by the National Science Foundation (grant #1930806)
Royal Commission on Human Relationships
No full textThis controversial Royal Commission from the 1970s found that many Australian families were failing to protect their most valuable members, and helped change the shape of public discussion around families, gender and sexuality.
This is the first time a digitised version of the Royal Commission on Human Relationships\u27 five-volume final report has been made publically available.
The Royal Commission was initiated in 1974, following a failed attempt by the Whitlam government to reform abortion law. The terms of reference were:
To inquire into and report upon the family, social, educational, legal and sexual aspects of male and female relationships, so far as those matters are relevant to the powers and functions of the Australian Parliament and Government, including powers and functions in relation to the Territories:
To give particular emphasis to the concept of responsible parenthood, to have regard to experience in other countries and to include in your inquiry the following aspects of the said matters:
(a) the extent of relevant existing education programs, including sex education programs, and their effectiveness in promoting responsible sexual behaviour and providing a sound basis in the fundamentals of male and female relationships in the Australian social environment;
(b) the extent of relevant existing programs in medical schools and their adequacy to provide comprehensive medical training in contraceptive techniques, in the physical, psychological and sexual problems experienced by women in adapting to marriage and before, during and after menstruation and in matters relating to pregnancy, fertility control, spontaneous and induced abortions and childbirth and to encourage acceptance by the medical profession of its responsibilities in the field of contraceptive counselling;
(c) the provision, adequacy and effectiveness of existing family planning facilities, educational and activational information on family planning and methods of evaluation of all family planning techniques;
(d) the social, economic, psychological and medical pressures on women in determining whether to proceed with unplanned or unwanted pregnancies, having regard to:
(i) the adequacy of housing, child-minding centres, pre-school centres, domestic assistance for families and working mothers, assistance to single parent families, other forms of assistance for mothers employed in industry, and adoption procedures;
(ii) the disabilities of families with handicapped children; and
(iii) the social status of women in the community; the social, psychological and medical results of termination of, or and failure to terminate such pregnancies;
(e) the adequacy and effectiveness of existing medico-legal determinations in relation to termination of pregnancy, the incidence of such terminations, the factors influencing their occurrence, the adequacy of medical training in an evaluation of methods of termination, consultative rights of the family or other persons concerned and the adequacy and effectiveness of pregnancy support services; and
(f) any other matters in relation to the family, social, educational, legal and sexual aspects of male and female relationships to which the attention of the Commission is directed by the Prime Minister in the course of the inquiry.
To make recommendations as to measures that are desirable with respect to the foregoing matters under existing or future laws of the Australian Parliament or of the Territories (including laws providing for grants to the States) and to indicate whether these measures should be implemented through existing bodies or through government instrumentalities to be created.
The final report, presented to Governor-General John Kerr in 1977, contained over 500 recommendations relating to "contraception (access and use), unwanted pregnancies, childbirth, attitudes to sexuality, sexual knowledge, sex education, domestic violence, rape and the police and courts’ treatment of rape victims, the changing roles of women, child care, child abuse, and homosexuality – especially discrimination faced by gays and lesbians."
The report was highly controversial when released and many of its recommendations were not acted on. However, the Royal Commission had a lasting influence. It was said to have brought taboo topics like abortion, rape and child abuse into public discussion, and to have opened up conversations about private life to this day.
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Part of the Policy History Collection. Digitisation of this report has been supported by the National Library of Australia.
Reproduced with permission of the Department of Prime Minister and Cabinet
Spectacular listening: Music and disability in the digital age (McDaniel)
No full textThis is a review of the book "Spectacular listening: Music and disability in the digital age" authored by Byrd McDaniel.
Title: Spectacular listening: Music and disability in the digital age Author: Byrd McDaniel Publication Year: 2024 Publisher: Oxford University Press Pages: 216 ISBN: 978019762046
Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation
No full textCaecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient’s caecum was decompressed in the emergency department using a needle under local anaesthetic. The patient subsequently underwent laparoscopic hernia repair and had an uncomplicated recovery. When conducted safely and with precision in an appropriate patient, percutaneous needle caecostomy can provide immediate symptom relief, reduce risk of caecal perforation, and allow a laparoscopic surgical approach
Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters
No full textAbstractBackgroundWhile current theories on perception of interoceptive signals suggest impaired interoceptive processing in psychiatric disorders such as panic disorder or depression, heart-rate (HR) interoceptive accuracy (IAc) of panic patients under resting conditions is superior to that of healthy controls. Thus, in this study, we chose to assess further physiological parameters and comorbid depression in order to get information on how these potentially conflicting findings are linked together.DesignWe used a quasi-experimental laboratory design which included multi-parametric physiological data collection of 40 panic subjects and 53 matched no-panic controls, as well as experimental induction of stress and relaxation over a time-course.MethodsStress reactivity, interoceptive awareness (IAw; from the Body Perception Questionnaire (BPQ)) and IAc (as correlation between self-estimation and physiological data) were major outcome variables. Self-estimation of bioparametrical change was measured via numeric rating scales.ResultPanic subjects had stronger HR-reaction and more accurate HR-interoception. Concurrently, though, their IAc of skin conductance level, pulse amplitude and breathing amplitude was significantly lower than that of the control group. Interestingly, comorbid depression was found to be associated with increased IAw but attenuated IAc.LimitationsDemand characteristics and a categorical approach to panic confine the results.ConclusionThe potentially conflicting findings coalesce, as panic was associated with an increase of the ability to perceive the fear-related parameter and a simultaneous decrease of the ability to perceive other parameters. The superordinate integration of afferent signals might be impaire
Corrigendum to “Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters” [J. Affect. Disord. 185 (2015) 170–179]
No full textInterhospital transfer delays emergency abdominal surgery and prolongs stay
No full textBackground: Interhospital transfer of patients requiring emergency surgery is common practice. It has the potential to delay surgical intervention, increase rate of complications and thus length of hospital stay. Methods: A retrospective cohort study was conducted of adult patients who underwent emergency surgery for abdominal pain at a large metropolitan hospital in New South Wales (Hospital A) in 2013. The impact of interhospital transfer on time to surgical intervention, post-operative length of stay and overall length of stay was assessed. Results: Of the 910 adult patients who underwent emergency surgery for abdominal pain at Hospital A in 2013, 31.9% (n=290) were transferred by road ambulance from a local district hospital (Hospital B). The leading surgical procedures performed were appendicectomy (n=299, 32.9%), cholecystectomy (n=174, 19.1%), gastrointestinal endoscopy (n=95, 10.4%), cystoscopy (n=86, 9.5%), hernia repair (n=45, 4.9%), salpingectomy (n=19, 2.1%) and oversewing of perforated peptic ulcer (n=13, 1.4%). Overall, interhospital transfer (n=290, 31.9%) was associated with increases in mean time to surgical intervention (14.2h, P<0.001), post-operative length of stay (1.1days, P=0.001) and overall length of stay (1.6days, P<0.001). Delayed surgical intervention was observed across all procedure types except surgery for perforated peptic ulcer, where transferred patients underwent surgery within a comparable timeframe to direct admissions. Conclusion: Interhospital transfer delays surgical intervention and increases length of hospital stay. This mandates attention due to the implications for patient outcomes and added burden to the healthcare system. The system did, however, show capability to appropriately expedite surgery for acutely life-threatening cases
