TY - JOUR A1 - Sebold, Miriam A1 - Schad, Daniel A1 - Nebe, Stephan A1 - Garbusow, Maria A1 - Juenger, Elisabeth A1 - Kroemer, Nils B. A1 - Kathmann, Norbert A1 - Zimmermann, Ulrich S. A1 - Smolka, Michael N. A1 - Rapp, Michael A. A1 - Heinz, Andreas A1 - Huys, Quentin J. M. T1 - Pavlovian-to-Instrumental Transfer Effects Rely Less on Model-based Reinforcement Learning JF - Journal of cognitive neuroscience N2 - Behavioral choice can be characterized along two axes. One axis distinguishes reflexive, model-free systems that slowly accumulate values through experience and a model-based system that uses knowledge to reason prospectively. The second axis distinguishes Pavlovian valuation of stimuli from instrumental valuation of actions or stimulus–action pairs. This results in four values and many possible interactions between them, with important consequences for accounts of individual variation. We here explored whether individual variation along one axis was related to individual variation along the other. Specifically, we asked whether individuals' balance between model-based and model-free learning was related to their tendency to show Pavlovian interferences with instrumental decisions. In two independent samples with a total of 243 participants, Pavlovian–instrumental transfer effects were negatively correlated with the strength of model-based reasoning in a two-step task. This suggests a potential common underlying substrate predisposing individuals to both have strong Pavlovian interference and be less model-based and provides a framework within which to interpret the observation of both effects in addiction. Y1 - 2016 U6 - https://doi.org/10.1162/jocn_a_00945 SN - 0898-929X SN - 1530-8898 VL - 28 SP - 985 EP - 995 PB - MIT Press CY - Cambridge ER - TY - JOUR A1 - Kuschpel, Maxim S. A1 - Liu, Shuyan A1 - Schad, Daniel A1 - Heinzel, Stephan A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Differential effects of wakeful rest, music and video game playing on working memory performance in the n-back task JF - Frontiers in psychology N2 - The interruption of learning processes by breaks filled with diverse activities is common in everyday life. We investigated the effects of active computer gaming and passive relaxation (rest and music) breaks on working memory performance. Young adults were exposed to breaks involving (i) eyes-open resting, (ii) listening to music and (iii) playing the video game “Angry Birds” before performing the n-back working memory task. Based on linear mixed-effects modeling, we found that playing the “Angry Birds” video game during a short learning break led to a decline in task performance over the course of the task as compared to eyes-open resting and listening to music, although overall task performance was not impaired. This effect was associated with high levels of daily mind wandering and low self-reported ability to concentrate. These findings indicate that video games can negatively affect working memory performance over time when played in between learning tasks. We suggest further investigation of these effects because of their relevance to everyday activity. KW - break interventions KW - computer games KW - mozart effect KW - working memory KW - attention KW - cognitive resources KW - mind wandering Y1 - 2015 U6 - https://doi.org/10.3389/fpsyg.2015.01683 SN - 1664-1078 IS - 6 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Sánchez, Alba A1 - Thomas, Christine A1 - Deeken, Friederike A1 - Wagner, Sören A1 - Klöppel, Stefan A1 - Kentischer, Felix A1 - von Arnim, Chrstine A. F. A1 - Denkinger, Michael A1 - Conzelmann, Lars O. A1 - Biermann-Stallwitz, Janine A1 - Joos, Stefanie A1 - Sturm, Heidrun A1 - Metz, Brigitte A1 - Auer, Ramona A1 - Skrobik, Yoanna A1 - Eschweiler, Gerhard W. A1 - Rapp, Michael A. T1 - Patient safety, cost-effectiveness, and quality of life BT - reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults—study protocol for a stepped-wedge cluster randomized trial (PAWEL Study) JF - Trials N2 - Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective. Methods The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures. Discussion Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances. Trial registration German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017. KW - Cross-sectoral care KW - Delirium prevention KW - Postoperative cognitive dysfunction KW - Dementia KW - Older patients KW - Elective surgery KW - Quality of life KW - Cost-effectiveness Y1 - 2019 U6 - https://doi.org/10.1186/s13063-018-3148-8 SN - 1468-6694 SN - 1745-6215 SN - 1468-6708 VL - 20 IS - 71 PB - BioMed Central CY - London ER - TY - JOUR A1 - Pérez Chaparro, Camilo Germán Alberto A1 - Zech, Philipp A1 - Schuch, Felipe A1 - Wolfarth, Bernd A1 - Rapp, Michael A. A1 - Heiβel, Andreas T1 - Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV BT - A meta-analysis JF - PLOS One N2 - Background: Infection with human immunodeficiency virus (HIV) affects muscle mass, altering independent activities of people living with HIV (PLWH). Resistance training alone (RT) or combined with aerobic exercise (AE) is linked to improved muscle mass and strength maintenance in PLWH. These exercise benefits have been the focus of different meta-analyses, although only a limited number of studies have been identified up to the year 2013/4. An up-to-date systematic review and meta-analysis concerning the effect of RT alone or combined with AE on strength parameters and hormones is of high value, since more and recent studies dealing with these types of exercise in PLWH have been published. Methods: Randomized controlled trials evaluating the effects of RT alone, AE alone or the combination of both (AERT) on PLWH was performed through five web-databases up to December 2017. Risk of bias and study quality was attained using the PEDro scale. Weighted mean difference (WMD) from baseline to post-intervention changes was calculated. The I2 statistics for heterogeneity was calculated. Results: Thirteen studies reported strength outcomes. Eight studies presented a low risk of bias. The overall change in upper body strength was 19.3 Kg (95% CI: 9.8±28.8, p< 0.001) after AERT and 17.5 Kg (95% CI: 16±19.1, p< 0.001) for RT. Lower body change was 29.4 Kg (95% CI: 18.1±40.8, p< 0.001) after RT and 10.2 Kg (95% CI: 6.7±13.8, p< 0.001) for AERT. Changes were higher after controlling for the risk of bias in upper and lower body strength and for supervised exercise in lower body strength. A significant change towards lower levels of IL-6 was found (-2.4 ng/dl (95% CI: -2.6, -2.1, p< 0.001). Conclusion: Both resistance training alone and combined with aerobic exercise showed a positive change when studies with low risk of bias and professional supervision were analyzed, improving upper and, more critically, lower body muscle strength. Also, this study found that exercise had a lowering effect on IL-6 levels in PLWH. KW - Human-immunodeficiency-virus KW - Quality-of-life KW - Randomized controlled-trails KW - Infected patients KW - Muscle strength KW - Body-composition KW - Nandrolone decanoate KW - Cardiovascular risk KW - Style modification KW - Metabolic syndrome Y1 - 2018 U6 - https://doi.org/10.1371/journal.pone.0203384 SN - 1932-6203 VL - 13 IS - 9 SP - 1 EP - 12 PB - PLOS CY - San Francisco ER - TY - JOUR A1 - Aichberger, Marion Christina A1 - Montesinos, Amanda Heredia A1 - Bromand, Zohra A1 - Yesil, Rahsan A1 - Temur-Erman, Selver A1 - Rapp, Michael A. A1 - Heinz, Andreas A1 - Schouler-Ocak, Meryam T1 - Suicide attempt rates and intervention effects in women of Turkish origin in Berlin JF - European psychiatry : the journal of the Association of European Psychiatrists N2 - Purpose: Ethnic minority groups show elevated suicide attempt rates across Europe. Evidence suggests a similar trend for women of Turkish origin in Germany, yet data on suicidal behaviour in minorities in Germany is scarce. The objective was to examine rates of suicidal behaviour, underlying motives, and to explore the effectiveness of an intervention program. Methods: From 05/2009-09/2011, data on all suicide attempts among women of Turkish origin who presented at a hospital-based emergency unit in Berlin, Germany, were collected. A multi-modal intervention was conducted in 2010 and the effects of age, generation and the intervention on suicide attempt rates were examined. Results: At the start, the highest rate was found in women aged 18-24 years with 225.4 (95% CI = 208.8-242.0)/100,000. Adjustment disorder was the most prevalent diagnosis with 49.7% (n = 79), being more common in second-generation women (P = .004). Further analyses suggested an effect of the intervention in the youngest age group (trend change of beta = -1.25; P = .017). Conclusion: Our findings suggest a particularly high rate of suicide attempts by 18-24-year-old, second-generation women of Turkish origin in Berlin. Furthermore, our results suggest a trend change in suicide attempts in women aged 18-24 years related to a population-based intervention program. (C) 2015 Elsevier Masson SAS. All rights reserved. KW - Suicide attempt KW - Incidence rates KW - Turkish migrants KW - Intervention study Y1 - 2015 U6 - https://doi.org/10.1016/j.eurpsy.2014.12.003 SN - 0924-9338 SN - 1778-3585 VL - 30 IS - 4 SP - 480 EP - 485 PB - Elsevier CY - Paris ER - TY - JOUR A1 - Konrad, Marcel A1 - Bohlken, Jens A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Depression risk in patients with heart failure in primary care practices in Germany JF - International psychogeriatrics N2 - Background: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. Methods: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. Results: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. Conclusions: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany. KW - depression KW - primary care KW - risk factors KW - antidepressants Y1 - 2016 U6 - https://doi.org/10.1017/S1041610216000867 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1889 EP - 1894 PB - Cambridge Univ. Press CY - New York ER - TY - JOUR A1 - Häusler, Andreas A1 - Sánchez, Alba A1 - Gellert, Paul A1 - Deeken, Friederike A1 - Rapp, Michael A. A1 - Nordheim, Johanna T1 - Perceived stress and quality of life in dementia patients and their caregiving spouses: does dyadic coping matter? JF - International psychogeriatrics N2 - Background: Given the well-established association between perceived stress and quality of life (QoL) in dementia patients and their partners, our goal was to identify whether relationship quality and dyadic coping would operate as mediators between perceived stress and QoL. Results: We found negative correlations between stress and QoL in both partners (QoL-AD: r = -0.62; p < 0.001; WHO-QOL Overall: r = -0.27; p = 0.02). Spousal caregivers had a significantly lower DCI total score than dementia patients (p < 0.001). Dyadic coping was a significant mediator of the relationship between stress and QoL in spousal caregivers (z = 0.28; p = 0.02), but not in dementia patients. Likewise, relationship quality significantly mediated the relationship between stress and QoL in caregivers only (z = -2.41; p = 0.02). Conclusions: This study identified dyadic coping as a mediator on the relationship between stress and QoL in (caregiving) partners of dementia patients. In patients, however, we found a direct negative effect of stress on QoL. The findings suggest the importance of stress reducing and dyadic interventions for dementia patients and their partners, respectively. KW - dementia KW - dyadic coping KW - perceived stress KW - quality of life Y1 - 2016 U6 - https://doi.org/10.1017/S1041610216001046 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1857 EP - 1866 PB - Cambridge Univ. Press CY - New York ER - TY - JOUR A1 - Bookers, Anke A1 - Jacob, Louis A1 - Bohlken, Jens A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Persistence with antipsychotics in dementia patients in Germany JF - International journal of clinical pharmacology and therapeutics N2 - Background/Aims: To analyze the duration of treatment with antipsychotics in German dementia patients. Methods: This study included patients aged 60 years and over with dementia who received a first-time antipsychotic prescription by psychiatrists between 2009 and 2013. The main outcome measure was the treatment rate for more than 6 months following the index date. Results: A total of 12,979 patients with dementia (mean age 82 years, 52.1% living in nursing homes) were included. After 2 years of follow-up, 54.8%, 57.2%, 61.1%, and 65.4% of patients aged 60 - 69, 70 - 79, 80 - 89, and 90 - 99 years, respectively, received antipsychotic prescriptions. 63.9% of subjects living in nursing homes and 55.0% of subjects living at home also continued their treatment (p-value < 0.001). Conclusion: The percentage of dementia patients treated with anti psychotics is very high. KW - persistence KW - antipsychotics KW - dementia Y1 - 2016 U6 - https://doi.org/10.5414/CP202631 SN - 0946-1965 VL - 54 SP - 835 EP - 840 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Schulze, Susanne A1 - Merz, Sibille A1 - Thier, Anne A1 - Tallarek, Marie A1 - König, Franziska A1 - Uhlenbrock, Greta A1 - Nübling, Matthias A1 - Lincke, Hans-Joachim A1 - Rapp, Michael A. A1 - Spallek, Jacob A1 - Holmberg, Christine T1 - Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic BT - a cross-sectional study with quantitative and qualitative data JF - BMC health services research N2 - Background The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic. Methods We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch's t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke). Results Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales 'quantitative demands', 'hiding emotions', 'work-privacy conflicts', 'role conflicts', 'quality of leadership', 'support at work', 'recognition', 'physical demands', 'intention to leave profession', 'burnout', 'presenteeism' and 'inability to relax'. The interviews (n = 15) revealed six main themes related to nurses' psychosocial stress: 'overall working conditions', 'concern for residents', 'management of relatives', 'inability to provide terminal care', 'tensions between being infected and infecting others' and 'technicisation of care'. 'Enhanced community cohesion' (interviews), 'meaning of work' and 'quantity of social relations' (COPSOQ III) were identified as positive effects of the pandemic. Conclusions Results clearly illustrate an aggravation of geriatric nurses' situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses' strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses. KW - COPSOQ KW - Nurses KW - Nursing home KW - Psychosocial burden KW - Mixed-methods study KW - Covid-19 Y1 - 2022 U6 - https://doi.org/10.1186/s12913-022-08333-3 SN - 1472-6963 VL - 22 IS - 1 PB - BMC CY - London ER - TY - JOUR A1 - Hoffmann, Stephanie A1 - Tschorn, Mira A1 - Michalski, Niels A1 - Hoebel, Jens A1 - Förstner, Bernd Rainer A1 - Rapp, Michael A. A1 - Spallek, Jacob T1 - Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood BT - Data from mandatory school entry examinations in Germany JF - Health & place : an international journal ; a social science & medicine publication ; incorporating Geographia medica N2 - Background: From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration. Method: We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children's school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high) Results: Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation. Conclusion: Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course. KW - Health inequalities KW - Spatial analysis KW - Regional deprivation KW - Rurality KW - Developmental delay KW - Children Y1 - 2022 U6 - https://doi.org/10.1016/j.healthplace.2022.102794 SN - 1353-8292 SN - 1873-2054 VL - 75 PB - Elsevier Science CY - Amsterdam [u.a.] ER -