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Institute
- Department Sport- und Gesundheitswissenschaften (66) (remove)
Background: To handle the competition demands, sparring drills are used for specific technical–tactical training as well as physical–physiological conditioning in combat sports. While the effects of different area sizes and number of within-round sparring partners on physiological and perceptive responses in combats sports were examined in previous studies, technical and tactical aspects were not investigated. This study investigated the effect of different within-round sparring partners number (i.e., at a time; 1 vs. 1, 1 vs. 2, and 1 vs. 4) and area sizes (2 m × 2 m, 4 m × 4 m, and 6 m × 6 m) variation on the technical–tactical aspects of small combat games in kickboxing.
Method: Twenty male kickboxers (mean ± standard deviation, age: 20.3 ± 0.9 years), regularly competing in regional and national events randomly performed nine different kickboxing combats, lasting 2 min each. All combats were video recorded and analyzed using the software Dartfish.
Results: Results showed that the total number of punches was significantly higher in 1 versus 4 compared with 1 versus 1 (p = 0.011, d = 0.83). Further, the total number of kicks was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 0.99 and d = 0.83, respectively). Moreover, the total number of kick combinations was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 1.05 and d = 0.95, respectively). The same outcome was significantly lower in 2 m × 2 m compared with 4 m × 4 m and 6 m × 6 m areas (p = 0.010 and d = − 0.45; p < 0.001 and d = − 0.6, respectively). The number of block-and-parry was significantly higher in 1 versus 4 compared with 1 versus 1 (p < 0.001, d = 1.45) and 1 versus 2 (p = 0.046, d = 0.61) and in 2 m × 2 m compared with 4 m × 4 m and 6 × 6 m areas (p < 0.001; d = 0.47 and d = 0.66, respectively). Backwards lean actions occurred more often in 2 m × 2 m compared with 4 m × 4 m (p = 0.009, d = 0.53) and 6 m × 6 m (p = 0.003, d = 0.60). However, the number of foot defenses was significantly lower in 2 m × 2 m compared with 6 m × 6 m (p < 0.001, d = 1.04) and 4 m × 4 m (p = 0.004, d = 0.63). Additionally, the number of clinches was significantly higher in 1 versus 1 compared with 1 versus 2 (p = 0.002, d = 0.7) and 1 versus 4 (p = 0.034, d = 0.45).
Conclusions: This study provides practical insights into how to manipulate within-round sparring partners’ number and/or area size to train specific kickboxing technical–tactical fundamentals.
Background/Purpose
Muscular reflex responses of the lower extremities to sudden gait disturbances are related to postural stability and injury risk. Chronic ankle instability (CAI) has shown to affect activities related to the distal leg muscles while walking. Its effects on proximal muscle activities of the leg, both for the injured- (IN) and uninjured-side (NON), remain unclear. Therefore, the aim was to compare the difference of the motor control strategy in ipsilateral and contralateral proximal joints while unperturbed walking and perturbed walking between individuals with CAI and matched controls.
Materials and methods
In a cross-sectional study, 13 participants with unilateral CAI and 13 controls (CON) walked on a split-belt treadmill with and without random left- and right-sided perturbations. EMG amplitudes of muscles at lower extremities were analyzed 200 ms after perturbations, 200 ms before, and 100 ms after (Post100) heel contact while walking. Onset latencies were analyzed at heel contacts and after perturbations. Statistical significance was set at alpha≤0.05 and 95% confidence intervals were applied to determine group differences. Cohen’s d effect sizes were calculated to evaluate the extent of differences.
Results
Participants with CAI showed increased EMG amplitudes for NON-rectus abdominus at Post100 and shorter latencies for IN-gluteus maximus after heel contact compared to CON (p<0.05). Overall, leg muscles (rectus femoris, biceps femoris, and gluteus medius) activated earlier and less bilaterally (d = 0.30–0.88) and trunk muscles (bilateral rectus abdominus and NON-erector spinae) activated earlier and more for the CAI group than CON group (d = 0.33–1.09).
Conclusion
Unilateral CAI alters the pattern of the motor control strategy around proximal joints bilaterally. Neuromuscular training for the muscles, which alters motor control strategy because of CAI, could be taken into consideration when planning rehabilitation for CAI.
Schomoller, A, Schugardt, M, Kotsch, P, and Mayer, F. The effect of body composition on cycling power during an incremental test in young athletes. J Strength Cond Res 35(11): 3225-3231, 2021-As body composition (BC) is a modifiable factor influencing sports performance, it is of interest for athletes and coaches to optimize BC to fulfill the specific physical demands of one sport discipline. The purpose of this study is to test the impact of body fat (BF) and fat-free mass (FFM) on aerobic performance in young athletes. Body composition parameters were evaluated among gender and age groups of young athletes undergoing their mandatory health examination. The maximal power (in Watts per kilogram body mass) of a stepwise incremental ergometer test was compared between 6 BC types: high BF, high FFM, high BF and high FFM, normal BC values, low BF, and low FFM. With increasing age (11-13 vs. 14-16 years) BF decreased and FFM increased in both genders. Both BC parameters, as well as body mass, correlated moderately with performance output (r = 0.36-0.6). Subjects with high BF or high FFM or both had significantly lower ergometer test results compared with those with low BF and FFM in all age and gender groups (p < 0.05). The finding that high levels of BF and FFM are detrimental for cycle power output is important to consider in disciplines that demand high levels of aerobic and anaerobic performance.
Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
Objective: To assess the reliability of measurements of paraspinal muscle transverse relaxation times (T2 times) between two observers and within one observer on different time points. <br /> Methods: 14 participants (9f/5m, 33 +/- 5 years, 176 +/- 10 cm, 73 +/- 12 kg) underwent 2 consecutive MRI scans (M1,M2) on the same day, followed by 1 MRI scan 13-14 days later (M3) in a mobile 1.5 Tesla MRI. T2 times were calculated in T-2 weighted turbo spin- echo-sequences at the spinal level of the third lumbar vertebrae (11 slices, 2 mm slice thickness, 1 mm interslice gap, echo times: 20, 40, 60, 80, 100 ms) for M. erector spinae (ES) and M. multifidius (MF). The following reliability parameter were calculated for the agreement of T2 times between two different investigators (OBS1 & OBS2) on the same MRI (inter rater reliability, IR) and by one investigator between different MRI of the same participant (intersession variability, IS): Test-Retest Variability (TRV, Differences/Mean*100); Coefficient of Variation (CV, Standard deviation/Mean*100); Bland-Altman Analysis (systematic bias = Mean of the Differences; Upper/Lower Limits of Agreement = Bias+/-1.96*SD); Intraclass Correlation Coefficient 3.1 (ICC) with absolute agreement, as well as its 95% confidence interval. <br /> Results: Mean TRV for IR was 2.6% for ES and 4.2% for MF. Mean TRV for IS was 3.5% (ES) and 5.1% (MF). Mean CV for IR was 1.9 (ES) and 3.0 (MF). Mean CV for IS was 2.5% (ES) and 3.6% (MF). A systematic bias of 1.3 ms (ES) and 2.1 ms (MF) were detected for IR and a systematic bias of 0.4 ms (ES) and 0.07 ms (MF) for IS. ICC for IR was 0.94 (ES) and 0.87 (MF). ICC for IS was 0.88 (ES) and 0.82 (MF). <br /> Conclusion: Reliable assessment of paraspinal muscle T2 time justifies its use for scientific purposes. The applied technique could be recommended to use for future studies that aim to assess changes of T2 times, e.g. after an intense bout of eccentric exercises.
Einleitung
Ältere Patienten mit Herzklappenerkrankungen werden zunehmend häufig mit der kathetergestützten Aortenklappenimplantation (Transcatheter Aortic Valve Implantation, TAVI) oder dem MitraClip®-Verfahren behandelt. In der kardiologischen Rehabilitation nimmt infolgedessen die Patientenpopulation der Hochbetagten stetig zu. Die funktionale Gesundheit dieser Patienten wird durch häufig auftretende, sogenannte geriatrische Syndrome wie Multimorbidität, Mangelernährung, Gebrechlichkeit oder Sturzereignisse beeinflusst. Insbesondere die eingeschränkte Mobilität und Mangelernährung sind wichtige Prädiktoren für die Prognose der Patienten nach TAVI.
Etablierte Verfahren, um die körperliche Leistungsfähigkeit von kardiologischen Rehabilitanden zu beurteilen, sind die Belastungsergometrie und der 6-Minuten-Gehtest. Allerdings ist nahezu die Hälfte der hochbetagten Patienten nicht in der Lage, eine Belastungsergometrie durchzuführen. Bislang erfolgt in der kardiologischen Rehabilitation keine differenzierte Erfassung des funktionellen Status hinsichtlich Mobilität, Kraft und Gleichgewicht, um die geriatrischen Syndrome individuell zu beurteilen. Darüber hinaus werden keine Assessments zur Erfassung des Ernährungsstatus eingesetzt.
Daher war es das Ziel der vorliegenden Arbeit, die Ausprägung des funktionellen und nutritiven Status älterer Patienten anhand geeigneter Assessments in der kardiologischen Rehabilitation zu ermitteln.
Methode
Zwischen Oktober 2018 und Juni 2019 nahmen Patienten im Alter von 75 Jahren oder älter nach TAVI, atrioventrikulärer Intervention mittels MitraClip®-Verfahren (AVI) oder perkutaner Koronarintervention (PCI) an der Studie teil. Zu Beginn der kardiologischen Rehabilitation wurden soziodemografische Daten, echokardiografische Parameter (z. B. links und rechtsventrikuläre Ejektionsfraktion, Herzrhythmus) und Komorbiditäten (z. B. Diabetes mellitus, Niereninsuffizienz, orthopädische Erkrankungen) erhoben, um die Patientenpopulation zu beschreiben. Zusätzlich wurde die Gebrechlichkeit der Rehabilitanden mit dem Index von Stortecky et al., bestehend aus den Komponenten Kognition, Mobilität, Ernährung und Aktivitäten des täglichen Lebens, beurteilt.
Der 6-Minuten-Gehtest diente zur Ermittlung der körperlichen Leistungsfähigkeit der Patienten. Die Mobilität wurde mit Hilfe des Timed-Up-and-Go-Tests, die Ganggeschwindigkeit mit dem Gait Speed Test und die Handkraft mit dem Hand Grip Test erfasst.
Für die Objektivierung des Gleichgewichts wurde eine Kraftmessplatte (uni- und bipedaler Stand mit geöffneten und geschlossenen Augen) erprobt, die bislang bei älteren Rehabilitanden noch nicht eingesetzt wurde.
Der Ernährungsstatus wurde mit dem Mini Nutritional Assessment-Short Form und den ernährungsbezogenen Laborparametern (Hämoglobin, Serumalbumin, Eiweißkonzentration) erfasst.
Die Eignung der Assessments bewerteten wir anhand folgender Kriterien: Durchführbarkeit (bei ≥ 95 % der Patienten durchführbar), Sicherheit (< 95 % Stürze oder andere unerwünschte Ereignisse) und der Pearson-Korrelationen zwischen den funktionellen Tests und dem Goldstandard 6-Minuten-Gehtest sowie den Laborparametern und dem Mini Nutritional Assessment-Short Form.
Ergebnisse
Es wurden 124 Patienten (82 ± 4 Jahre, 48 % Frauen, 5 ± 2 Komorbiditäten, 9 ± 3 Medikamente) nach TAVI (n = 59), AVI (n = 21) und PCI (n = 44) konsekutiv in die Studie eingeschlossen.
Etwa zwei Drittel aller Patienten der Gesamtpopulation waren als gebrechlich zu klassifizieren, bei einer mittleren Punktzahl von 2,9 ± 1,4. Annähernd die Hälfte der Patienten zeigte eine eingeschränkte körperliche Leistungsfähigkeit aufgrund einer reduzierten 6-Minuten-Gehstrecke (48 % < 350 m) sowie eine eingeschränkte Mobilität im Timed-Up-and-Go-Test (55 % > 10 s). Es wurden eine mittlere Gehstrecke von 339 ± 131 m und eine durchschnittliche Zeit im Timed-Up-and-Go-Test von 11,4 ± 6,3 s erzielt. Darüber hinaus wies ein Viertel der Patienten eine eingeschränkte Ganggeschwindigkeit (< 0,8 m/s) auf und etwa 35 % von Ihnen zeigten eine reduzierte Handkraft (Frauen/Männer < 16/27 kg). Im Mittel wurde eine Geschwindigkeit von 1,0 ± 0,2 m/s im Gait Speed Test sowie eine Handkraft von 24 ± 9 kg im Hand Grip Test erreicht. Ein Risiko einer Mangelernährung konnte bei 38 % (< 12 Punkte) der Patienten nachgewiesen werden bei einer mittleren Punktzahl von 11,8 ± 2,2 im Mini Nutritional Assessment-Short Form.
Im Vergleich zwischen den einzelnen Subpopulationen bestanden keine statistisch signifikanten Unterschiede in den Ergebnissen der funktionellen Assessments. Bezüglich des Ernährungsstatus wiesen allerdings die Patienten nach AVI einen statistisch signifikant niedrigeren Punktewert im Mini Nutritional Assessment-Short Form (10,3 ± 3,0 Punkte) auf als die Patienten nach TAVI (12,0 ± 1,8 Punkte) und PCI (12,1 ± 2,1 Punkte), wobei etwa 57 % der Patienten nach AVI, 38 % nach TAVI und 50 % nach PCI ein Risiko einer Mangelernährung zeigten.
Mit Ausnahme der Tests auf der Kraftmessplatte waren alle Assessments durchführbar und sicher. Während 86 % der Patienten den bipedalen Stand mit geschlossenen Augen auf der Kraftmessplatte durchführen konnten und damit nahezu den Grenzwert von 95 % erreichten, war der unipedale Stand mit 12 % an durchführbaren Messungen weit von diesem entfernt.
Der Gait Speed Test (r = 0,79), Timed-Up-and-Go-Test (r = 0,68) und Hand Grip Test (r = 0,33) korrelierten signifikant mit dem 6-Minuten-Gehtest, Hämoglobin (r = 0,20) und Albumin (r = 0,24) korrelierten mit dem Mini Nutritional Assessment-Short Form.
Schlussfolgerung
Über die bestehende Multimorbidität und Multimedikation hinaus wiesen die untersuchten Patienten vor allem eine eingeschränkte Mobilität und ein Risiko einer Mangelernährung auf, wobei die Subpopulation nach AVI besonders betroffen war.
Um den Bedürfnissen hochbetagter Rehabilitanden nach kathetergestützer Intervention gerecht zu werden, ist eine individuelle Behandlung der einzelnen Defizite erforderlich, mit besonderer Berücksichtigung der Komorbiditäten sowie der geriatrischen Kofaktoren. Aufgrund des multidisziplinären Ansatzes erfüllt die kardiologische Rehabilitation bereits die Voraussetzung, hochbetagte Patienten bedarfsgerecht zu behandeln, jedoch mangelt es an Assessments, um die individuellen Defizite der Patienten zu identifizieren
Der Gait Speed Test, der Timed-Up-and-Go-Test und der Hand Grip Test sollten daher in den klinischen Alltag der kardiologischen Rehabilitation implementiert werden, um die körperliche Funktion und Leistungsfähigkeit älterer Patienten detailliert zu beurteilen. In Kombination dieser Assessments mit dem Mini Nutritional Assessment-Short Form können die individuellen funktionellen und nutritiven Bedürfnisse der Patienten während der Rehabilitation erkannt und mit geeigneten Maßnahmen die weitere Ausbildung geriatrischer Syndrome gemindert werden.
Background
Artificial intelligence (AI) is one of the most promising areas in medicine with many possibilities for improving health and wellness. Already today, diagnostic decision support systems may help patients to estimate the severity of their complaints. This fictional case study aimed to test the diagnostic potential of an AI algorithm for common sports injuries and pathologies.
Methods
Based on a literature review and clinical expert experience, five fictional “common” cases of acute, and subacute injuries or chronic sport-related pathologies were created: Concussion, ankle sprain, muscle pain, chronic knee instability (after ACL rupture) and tennis elbow. The symptoms of these cases were entered into a freely available chatbot-guided AI app and its diagnoses were compared to the pre-defined injuries and pathologies.
Results
A mean of 25–36 questions were asked by the app per patient, with optional explanations of certain questions or illustrative photos on demand. It was stressed, that the symptom analysis would not replace a doctor’s consultation. A 23-yr-old male patient case with a mild concussion was correctly diagnosed. An ankle sprain of a 27-yr-old female without ligament or bony lesions was also detected and an ER visit was suggested. Muscle pain in the thigh of a 19-yr-old male was correctly diagnosed. In the case of a 26-yr-old male with chronic ACL instability, the algorithm did not sufficiently cover the chronic aspect of the pathology, but the given recommendation of seeing a doctor would have helped the patient. Finally, the condition of the chronic epicondylitis in a 41-yr-old male was correctly detected.
Conclusions
All chosen injuries and pathologies were either correctly diagnosed or at least tagged with the right advice of when it is urgent for seeking a medical specialist. However, the quality of AI-based results could presumably depend on the data-driven experience of these programs as well as on the understanding of their users. Further studies should compare existing AI programs and their diagnostic accuracy for medical injuries and pathologies.
The scapula plays a significant role in efficient shoulder movement. Thus, alterations from typical scapular motion during upper limb movements are thought to be associated with shoulder pathologies. However, a clear understanding of the relationship is not yet obtained.. Scapular alterations may only represent physiological variability as their occurrence can appear equally as frequent in individuals with and without shoulder disorders. Evaluation of scapular motion during increased load might be a beneficial approach to detect clinically relevant alterations. However, functional motion adaptations in response to maximum effort upper extremity loading has not been established yet. Therefore, the overall purpose of this research project was to give further insight in physiological adaptations of scapular kinematics and their underlying scapular muscle activity in response to high demanding shoulder movements in healthy asymptomatic individuals. Prior to the investigation of the effect of various load situation, the reproducibility of scapular kinematics and scapular muscle activity were evaluated under maximum effort arm movements. Healthy asymptomatic adults performed unloaded and maximal loaded concentric and eccentric isokinetic shoulder flexion and extension movements in the scapular plane while scapular kinematics and scapular muscle activity were simultaneously assessed. A 3D motion capture system (infra-red cameras & reflective markers) was utilized to track scapular and humerus motion in relation to the thorax. 3D scapular position angles were given for arm raising and lowering between humerus positions of 20° and 120° flexion. To further characterize the scapular pattern, the scapular motion extent and scapulohumeral rhythm (ratio of scapular and humerus motion extent) were determined. Muscle activity of the upper and lower trapezius and the serratus anterior were assessed with surface electromyography. Amplitudes were calculated for the whole ROM and four equidistant movement phases. Reliability was characterized by overall moderate to good reproducibility across the load conditions. Irrespective of applied load, scapular kinematics followed a motion pattern of continuous upward rotation, posterior tilt and external rotation during arm elevation and a continuous downward rotation, anterior tilt and internal rotation during arm lowering. However, kinematics were altered between maximal loaded and unloaded conditions showing increased upward rotation, reduced posterior tilt and external rotation. Further, the scapulohumeral rhythm was decreased and scapular motion extent increased under maximal loaded movements. Muscle activity during maximum effort were of greater magnitude and differed in their pattern in comparison to the continuous increase and decrease of activity during unloaded shoulder flexion and extension. Relationships between scapular kinematics and their underlying scapular muscle activity could only be identified for a few isolated combinations, whereas the majority showed no associations. Scapular kinematics and scapular muscle activity pattern alter according to the applied load. Alterations between the load conditions comply in magnitude and partially in direction with differences seen between symptomatic and asymptomatic individuals. Even though long-term effects of identified adaptations in response to maximum load are so far unclear, deviations from typical scapular motion or muscle activation should not per se be seen as indicators of shoulder impairment. However, evaluation of alterations in scapular motion and activation in response to maximum effort may have the potential to identify individuals that are unable to cope with increased upper limb demands. Findings further challenge the understanding of scapular motion and stabilization by the trapezius and serratus anterior muscles, as clear relationships between the underlying scapular muscle activity and scapular kinematics were neither observed during unloaded nor maximal loaded shoulder movements.
Extracellular vesicles: potential mediators of psychosocial stress contribution to osteoporosis?
(2021)
Osteoporosis is characterized by low bone mass and damage to the bone tissue’s microarchitecture, leading to increased fracture risk. Several studies have provided evidence for associations between psychosocial stress and osteoporosis through various pathways, including the hypothalamic-pituitary-adrenocortical axis, the sympathetic nervous system, and other endocrine factors. As psychosocial stress provokes oxidative cellular stress with consequences for mitochondrial function and cell signaling (e.g., gene expression, inflammation), it is of interest whether extracellular vesicles (EVs) may be a relevant biomarker in this context or act by transporting substances. EVs are intercellular communicators, transfer substances encapsulated in them, modify the phenotype and function of target cells, mediate cell-cell communication, and, therefore, have critical applications in disease progression and clinical diagnosis and therapy. This review summarizes the characteristics of EVs, their role in stress and osteoporosis, and their benefit as biological markers. We demonstrate that EVs are potential mediators of psychosocial stress and osteoporosis and may be beneficial in innovative research settings.
With the 2012 EU guidelines on dual careers (DC), DC research gained increasing awareness in Europe focussing particularly on student-athletes' motivation. The Student Athletes' Motivation toward Sports and Academics Questionnaire (SAMSAQ), arguably the most prominent instrument in this research area, has been used in various cross-cultural studies assessing DC motivation. The present investigation contributes to the cross-cultural discourse aiming to (1) adapt the SAMSAQ for the German context and adolescent secondary school student-athletes, and (2) evaluate the German pre-version. A sample of 208 student-athletes (52.4% females, mean age = 17.4 years, 49.5% at squad level) at three German Elite Sport Schools participated in the study. The investigation was split into two parts. First, the SAMSAQ was adapted to the German context and tested. In the second part, the first pre-version was revised. A series of exploratory factor analyses were applied to verify the factor structure of both German SAMSAQ pre-versions. Eight different factor models based on item removal were compared. Neither model demonstrated good results for the replication of previous findings or a meaningful solution in terms of content. Reasons for the deviations between the original and target SAMSAQ factor structures can be found in the different target groups and the culturally different approaches to career assistant programmes as well as in the theoretical background of the instrument. Since neither model was identified as acceptable, the findings indicate that a new instrument needs to be developed for assessing student-athletes' DC motivation along their pathways in different cross-cultural contexts.
Das Hauptziel der Bachelorarbeit stellt eine theoretische Auseinandersetzung mit dem Thema Wassergewöhnung im eigenen Zuhause dar. Ausgehend von dieser Ausführung erstellt die Autorin als Theorie-Praxis-Transfer eine Handreichung für Erziehungsberechtigte mit den relevantesten Informationen ihrer Qualifikationsarbeit in komprimierter Form. Damit die Erziehungsberechtigten ihren Kindern proaktiv zur Seite stehen können, soll die Handreichung adressat*innengerecht und prägnant sein, ohne den Erziehungsberechtigten essenzielle Details vorzuenthalten. Die Erziehungsberechtigten erhalten eine Handreichung, welche die bedeutendsten Informationen rund um die Wassergewöhnung zu Hause enthält. Sie erfahren unter anderem etwas über die höchstmögliche Aufenthaltsdauer der Kinder im Wasser und die optimale Temperatur des Badewassers. Außerdem erhalten sie wichtige Informationen rund um die Körperreaktionen, welche durch oder im Wasser auftreten können. Das sind bspw. der Lidschlussreflex oder der Kältereiz. Sie werden über essenzielle Sicherheitsaspekte informiert und erhalten eine kompakte Darstellung über Verhaltensregeln, den sogenannten do’s and dont‘s. Die Übungen/Spiele werden nach den aktuellen Vorgaben der DGUV (2019) für die Inhalte der Wassergewöhnung ausgewählt und nach den heimischen Voraussetzungen strukturiert sein. In der Handreichung werden zudem auch Übungen/Spiele zu finden sein, bei welchen keine Eigenschaften oder Wirkungen des Wassers kennengelernt werden. Atem- und Tauchübungen werden in der Handreichung ebenso beschrieben. Die Angst vor dem Wasser stellt, sobald sie sich manifestiert, bekanntlich das größte Hindernis der Nichtschwimmer*innen dar (DGUV, 2019). Darum möchte die Autorin mit der Aufklärung über diese Angst in ihrer Qualifikationsarbeit und der Handreichung bewirken, dass die Erziehungsberechtigten in der Lage sind, den Kindern das Angstgefühl gegenüber dem Wasser zu nehmen oder ihre Angstfreiheit beizubehalten und um daran anschließend den Kindern Freude an der Bewegung im Wasser zu ermöglichen. „Je mehr Freude die Kinder im Kleinkindalter am Baden haben, je weniger Angst sie mit dem Medium verbinden, umso schneller erlernen sie später das Schwimmen“ (DGUV, 2016, S. 6).
Die theoretischen Grundlagen der Handreichungen stellen die zentralen Aspekte und Ziele der Wassergewöhnung dar. Diese werden der, im Rahmen Schule, bedeutsamen Publikation der Deutschen Gesetzlichen Unfallversicherung aus dem Jahr 2019 entnommen. Hierbei handelt es sich um die Wahrnehmung der spezifischen Voraussetzungen des Wassers sowie deren Annäherung und Gewöhnung. Die Kinder erfahren die Eigenschaften Dichte, Druck und Temperatur des Elements und den Einfluss des Wassers auf den Körper. Das sind Wasserwiderstand, Auftrieb und die Wasserkraft. So werden die Übungen, in denen die Kinder das Wasser kennenlernen, beziehungsweise zum ersten Mal intensiv in Berührung mit diesem kommen, zu Beginn erwähnt. Anschließend folgen Übungen, überwiegend in Spielformen, bei denen die Freude geweckt werden soll. Als letzte Phase folgen Übungen, bei welchen der spezifische Umgang mit dem Wassers vonnöten ist. Diese Struktur ist an den ersten drei Phasen nach Baumeisters (1984) Methodik zur Wassergewöhnung orientiert. So wird zudem das methodische Prinzip vom Einfachen zum Komplexen als theoretische Grundlage verwendet. Legahn (2007) beschreibt einige Lernmodelle, die je nach Alter und Entwicklungsstand bei der Wassergewöhnung angewendet werden können. In der Handreichung wird die Autorin auf diese zurückgreifen und passende Lerntechniken ausführen. Beispiele hierfür sind unter anderem das Lernen am Modell (Nachahmung von Personen, Tieren oder Puppen) oder das Aktive Lernen (ein spielerischer Bewegungsaufbau verbessert die Fertigkeiten). Die benötigten Materialien werden in der Handreichung unter der Überschrift der Übungen/Spiele ausgeführt und dienen als erste Information. Neben der Überschrift werden die möglichen Eigenschaften und Wirkungen des Wassers, welche in dieser spezifischen Übung kennengelernt werden, benannt. Das sind beispielsweise Druck und Auftrieb für Wasserdruck und Wasserauftrieb. Darunter wird die jeweilige Übung beschrieben. Als Visualisierung erstellt die Autorin selbstständig gezeichnete Bilder. Unterhalb dieser Bilder befindet sich oft auch eine passende Spielvariante, um mit dieser Übung noch zusätzlich Freude zu wecken. Ebenso werden auch mehrmals passende Übungsformen oder Tipps erwähnt.
Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
Background: To handle the competition demands, sparring drills are used for specific technical–tactical training as well as physical–physiological conditioning in combat sports. While the effects of different area sizes and number of within-round sparring partners on physiological and perceptive responses in combats sports were examined in previous studies, technical and tactical aspects were not investigated. This study investigated the effect of different within-round sparring partners number (i.e., at a time; 1 vs. 1, 1 vs. 2, and 1 vs. 4) and area sizes (2 m × 2 m, 4 m × 4 m, and 6 m × 6 m) variation on the technical–tactical aspects of small combat games in kickboxing.
Method: Twenty male kickboxers (mean ± standard deviation, age: 20.3 ± 0.9 years), regularly competing in regional and national events randomly performed nine different kickboxing combats, lasting 2 min each. All combats were video recorded and analyzed using the software Dartfish.
Results: Results showed that the total number of punches was significantly higher in 1 versus 4 compared with 1 versus 1 (p = 0.011, d = 0.83). Further, the total number of kicks was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 0.99 and d = 0.83, respectively). Moreover, the total number of kick combinations was significantly higher in 1 versus 4 compared with 1 versus 1 and 1 versus 2 (p < 0.001; d = 1.05 and d = 0.95, respectively). The same outcome was significantly lower in 2 m × 2 m compared with 4 m × 4 m and 6 m × 6 m areas (p = 0.010 and d = − 0.45; p < 0.001 and d = − 0.6, respectively). The number of block-and-parry was significantly higher in 1 versus 4 compared with 1 versus 1 (p < 0.001, d = 1.45) and 1 versus 2 (p = 0.046, d = 0.61) and in 2 m × 2 m compared with 4 m × 4 m and 6 × 6 m areas (p < 0.001; d = 0.47 and d = 0.66, respectively). Backwards lean actions occurred more often in 2 m × 2 m compared with 4 m × 4 m (p = 0.009, d = 0.53) and 6 m × 6 m (p = 0.003, d = 0.60). However, the number of foot defenses was significantly lower in 2 m × 2 m compared with 6 m × 6 m (p < 0.001, d = 1.04) and 4 m × 4 m (p = 0.004, d = 0.63). Additionally, the number of clinches was significantly higher in 1 versus 1 compared with 1 versus 2 (p = 0.002, d = 0.7) and 1 versus 4 (p = 0.034, d = 0.45).
Conclusions: This study provides practical insights into how to manipulate within-round sparring partners’ number and/or area size to train specific kickboxing technical–tactical fundamentals.
The survey of the prevalence of chronic ankle instability in elite Taiwanese basketball athletes
(2021)
BACKGROUND: Ankle sprains are common in basketball. It could develop into Chronic Ankle Instability (CAI) causing decreased quality of life, functional performance, early osteoarthritis, and increased risk of other injuries. To develop a strategy of CAI prevention, localized epidemiology data and a valid/reliable tool are essential. However, the epidemiological data of CAI is not conclusive from previous studies and the prevalence of CAI in Taiwanese basketball athletes are not clear. In addition, a valid and reliable tool among the Taiwan-Chinese version to evaluate ankle instability is missing.
PURPOSE: The aims were to have an overview of the prevalence of CAI in sports population using a systematic review, to develop a valid and reliable cross-cultural adapted Cumberland Ankle Instability Tool Questionnaire (CAIT) in Taiwan-Chinese (CAIT-TW), and to survey the prevalence of CAI in elite basketball athletes in Taiwan using CAIT-TW.
METHODS: Firstly, a systematic search was conducted. Research articles applying CAI related questionnaires in order to survey the prevalence of CAI were included in the review. Second, the English version of CAIT was translated and cross-culturally adapted into the CAIT-TW. The construct validity, test-retest reliability, internal consistency, and cutoff score of CAIT-TW were evaluated in an athletic population (N=135). Finally, the cross-sectional data of CAI prevalence in 388 elite Taiwanese basketball athletes were presented. Demographics, presence of CAI, and difference of prevalence between gender, different competitive levels and play positions were evaluated.
RESULTS: The prevalence of CAI was 25%, ranging between 7% and 53%. The prevalence of CAI among participants with a history of ankle sprains was 46%, ranging between 9% and 76%. In addition, the cross-cultural adapted CAIT-TW showed a moderate to strong construct validity, an excellent test-retest reliability, a good internal consistency, and a cutoff score of 21.5 for the Taiwanese athletic population. Finally, 26% of Taiwanese basketball athletes had unilateral CAI while 50% of them had bilateral CAI. In addition, women athletes in the investigated cohort had a higher prevalence of CAI than men. There was no difference in prevalence between competitive levels and among play positions.
CONCLUSION: The systematic review shows that the prevalence of CAI has a wide range among included studies. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of CAI are required. The CAI epidemiological study should be prospective. Factors affecting the prevalence of CAI ability should be investigated and described. The translated CAIT-TW is a valid and reliable tool to differentiate between stable and unstable ankles in athletes and may further apply for research or daily practice in Taiwan. In the Taiwanese basketball population, CAI is highly prevalent. This might relate to the research method, preexisting ankle instability, and training-related issues. Women showed a higher prevalence of CAI than men. When applying the preventive measure, gender should be taken into consideration.
Das Therapiemanagement bei Lipödem stellt auf Grund unzureichenden Wissensstandes in entscheidenden Aspekten eine besondere Herausforderung dar. Da die Pathogenese der Erkrankung nicht hinreichend geklärt ist und bislang kein pathognomonisches Diagnostikkriterium definiert wurde, beklagen viele Betroffene einen langjährigen Leidensweg bis zur Einleitung von Therapiemaßnahmen. Durch Steigerung der Awareness der Erkrankung in den letzten Jahren konnten die Intervalle bis zur korrekten Diagnose erfreulicherweise erheblich verkürzt werden. Obwohl die Zuordnung der Beschwerden zu einer klar definierten Erkrankung für viele Patientinnen eine Erleichterung ist, stellt die Erkenntnis über begrenzte Therapiemöglichkeiten häufig eine neuerliche Belastung dar.
Als Konsequenz der ungeklärten Pathogenese konnte bis dato keine kausale Therapie für das Lipödem definiert werden. Zu Beginn waren die Möglichkeiten konservativer Behandlungsstrategien nur eingeschränkt in den Rahmen eines allgemeingültigen Konzeptes involviert und insbesondere Limitationen nicht klar definiert. Obwohl in diversen Bereichen der Therapie weiterhin keine ausreichende Evidenz besteht, konnten durch eine systematische Aufarbeitung die grundsätzlichen Behandlungsoptionen in Relation zueinander gesetzt werden. Betroffene Patientinnen, sowie die verschiedenen in die Behandlung integrierte medizinische Disziplinen verfügen somit über einen grundsätzlichen Handlungsalgorithmus, deren Empfehlungen über einfache Rezeptierung von Lymphdrainage und Kompressionsbekleidung hinausgehen. Durch kritische Reflexion der geltenden Dogmata wurde ein interdisziplinärer Leitfaden vorgeschlagen, der auf nachvollziehbare Weise im Sinne eines Stufenschemas alle wesentlichen Therapiesäulen in einen allgemeingültigen Behandlungsplan einbindet.
Im vielschichten Management der Erkrankung verbleibt die operative Behandlung, die Liposuktion, allerdings häufig als „ultima ratio“ nach ausbleibender Linderung unter konservativen Therapiemaßnahmen. Die wesentliche Zielstellung der vorliegenden Arbeit konzentriert sich demnach auf die Optimierung des operativen Vorgehens in der Durchführung von Liposuktionen bei Patientinnen mit Lipödem und zeigt sowohl Grenzen der Indikationsstellung, als auch Potenzial des Behandlungserfolges im Langzeitverlauf auf. Langzeitergebnisse zeigen, dass die Liposuktion als sicherer Eingriff mit dem Potenzial einer nachhaltigen Symptomreduktion für Lipödem-Patientinnen angesehen werden kann. Betont werden soll zudem die Notwendigkeit der Verzahnung operativer Maßnahmen mit konservativen Therapien und somit die Integration der Liposuktion als sinnvolle Behandlungsalternative in ein klar umrissenes Therapiekonzept.
Methodisch greift die Arbeit auf insgesamt 10 Publikationen zurück. Die hier postulierte mehrzeitige Megaliposuktion zur Therapie des Lipödems, mit summierten Gesamtaspirationsvolumina über alle Eingriffe von bis zu 66.000 ml, konnte als evidenzbasiertes Therapieverfahren bestätigt und validiert werden. Die beschriebenen niedrigen Komplikationsraten sind unter Anderem Resultat einer differenzierten, individualisierten perioperativen Strategie. Neben der Berücksichtigung grundsätzlicher methodischer Prinzipien existieren allerdings vielfältige Variationen, deren Implikationen auf Komplikationsraten jeweils differenziert zu betrachten sind. Es existiert zwar kein Konsensus für ein allgemeingültiges Standardverfahren der Liposuktion, allerdings konnten zahlreiche Elemente im perioperativen Management definiert werden, die unabhängig von der verwendeten Operationstechnik einen potenziellen positiven Einfluss auf das Outcome haben. Obwohl die Liposuktion bei Lipödem somit zusammenfassend mittlerweile als sicheres Verfahren gelten kann, sind einige Aspekte weiterhin nicht abschließend geklärt. Hierbei stehen vor allem das Volumenmanagement und die standardisierte Festlegung des maximalen Aspirationsvolumens im Fokus.
Die Analyse verschiedener Kovariablen auf die Linderung Lipödem-assoziierter Symptome nach Liposuktion zeigt, dass Alter, Body-Mass-Index (BMI) und präoperatives Stadium der Erkrankung einen signifikanten Einfluss auf das postoperative Ergebnis haben und in der Planung des mehrzeitigen operativen Vorgehens berücksichtigt werden müssen. BMI- oder körpergewichtsabhängige Zielgrößen der Absaugvolumina waren als Prognosefaktor für das postoperative Outcome dagegen nicht relevant. Inwieweit dies möglicherweise an der Überschreitung des „notwendigen“ Volumengrenzwerts für adäquate Symptomlinderung durch reguläre Durchführung von Megaliposuktionen liegen könnte, oder ob dieser Parameter tatsächlich keinen Einfluss auf das Ergebnis nach Operation besitzt, konnte nicht abschließend geklärt werden.
Weiterhin konnte ein positiver Nutzen auf assoziierte Begleiterkrankungen bei Lipödem nachgewiesen werden. Das Spektrum der Behandlungsmethoden kann durch reguläre Integration der Liposuktion in das Therapieschema somit um eine nachhaltige Alternative sinnvoll ergänzt werden. Im Unterschied zur alleinigen konservativen Therapie kann hierdurch ein wesentlicher Schritt weg von der alleinigen symptomatischen Therapie gemacht werden. Zudem die vielfältige Symptomatik der diversen assoziierten Komorbiditäten zu berücksichtigen. Als Konsequenz und für die Notwendigkeit eines ganzheitlichen, interdisziplinären Therapieansatzes wäre der Terminus „Lipödem-Syndrom“ möglicherweise treffender und wird zur Diskussion gestellt.
Für ein gesondertes Patientenklientel wurden zudem basale Grundsätze im perioperativen Vorgehen differenziert aufgearbeitet. Lipödem-Patientinnen mit begleitendem von-Willebrand-Syndrom stellen im Hinblick auf Blutungskomplikationen eine außerordentliche Herausforderung dar. Die vorliegenden evidenzbasierten Empfehlungen zum Therapiemanagement dieser Patientinnen bei Eingriffen ähnlicher Risikoklassifizierung wurden systematisch aufgearbeitet und in Bezug zu den speziellen Anforderungen bei Megaliposuktionen gebracht. Das dabei erarbeitete Therapieschema wird die präoperative Detektion von Koagulopathien im Allgemeinen, sowie die perioperative Komplikationsrate bei von-Willebrand-Patientinnen im Speziellen zukünftig erheblich verbessern.
Zusammenfassend konnte somit ein allgemeingültiger Algorithmus für die moderne und langfristig erfolgreiche Therapie von Lipödem-Patientinnen mit besonderem Fokus auf die Megaliposuktion erarbeitet werden. Bei adäquatem perioperativem Management und Berücksichtigung der großen Volumenverschiebungen kann der Eingriff komplikationsarm und sicher durchgeführt werden. Nicht abschließend geklärt ist derzeit die Pathophysiologie der Erkrankung wobei eine immunologische Genese sowie die primäre Pathologie des Lymphgefäßsystems bzw. der Fett(vorläufer)zellen als Erklärungmodelle favorisiert werden. Die Entwicklung diagnostischer Biomarker sollte dabei verfolgt werden.
Background: Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations.
Methods: An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle
Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method.
Results: After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias.
Conclusions: The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of
CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.
Objective:
Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome.
Method:
Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions.
Results:
(a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy.
Conclusion:
Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome.
What is the public health significance of this article? This study suggests the substantial value of systematic competence feedback for improving therapist competence in the psychotherapy of depression. No significant effect of competence feedback on the reduction of reported depressive symptoms was found.
Background
The metabolic syndrome (MetS) is a risk cluster for a number of secondary diseases. The implementation of prevention programs requires early detection of individuals at risk. However, access to health care providers is limited in structurally weak regions. Brandenburg, a rural federal state in Germany, has an especially high MetS prevalence and disease burden. This study aims to validate and test the feasibility of a setup for mobile diagnostics of MetS and its secondary diseases, to evaluate the MetS prevalence and its association with moderating factors in Brandenburg and to identify new ways of early prevention, while establishing a “Mobile Brandenburg Cohort” to reveal new causes and risk factors for MetS.
Methods
In a pilot study, setups for mobile diagnostics of MetS and secondary diseases will be developed and validated. A van will be equipped as an examination room using point-of-care blood analyzers and by mobilizing standard methods. In study part A, these mobile diagnostic units will be placed at different locations in Brandenburg to locally recruit 5000 participants aged 40-70 years. They will be examined for MetS and advice on nutrition and physical activity will be provided. Questionnaires will be used to evaluate sociodemographics, stress perception, and physical activity. In study part B, participants with MetS, but without known secondary diseases, will receive a detailed mobile medical examination, including MetS diagnostics, medical history, clinical examinations, and instrumental diagnostics for internal, cardiovascular, musculoskeletal, and cognitive disorders. Participants will receive advice on nutrition and an exercise program will be demonstrated on site. People unable to participate in these mobile examinations will be interviewed by telephone. If necessary, participants will be referred to general practitioners for further diagnosis.
Discussion
The mobile diagnostics approach enables early detection of individuals at risk, and their targeted referral to local health care providers. Evaluation of the MetS prevalence, its relation to risk-increasing factors, and the “Mobile Brandenburg Cohort” create a unique database for further longitudinal studies on the implementation of home-based prevention programs to reduce mortality, especially in rural regions.
Trial registration
German Clinical Trials Register, DRKS00022764; registered 07 October 2020—retrospectively registered.
Background
Depression is one of the key factors contributing to difficulties in one’s ability to work, and serves as one of the major reasons why employees apply for psychotherapy and receive insurance subsidization of treatments. Hence, an increasing and growing number of studies rely on workability assessment scales as their primary outcome measure. The Work and Social Assessment Scale (WSAS) has been documented as one of the most psychometrically reliable and valid tools especially developed to assess workability and social functioning in patients with mental health problems. Yet, the application of the WSAS in Germany has been limited due to the paucity of a valid questionnaire in the German language. The objective of the present study was to translate the WSAS, as a brief and easy administrable tool into German and test its psychometric properties in a sample of adults with depression.
Methods
Two hundred seventy-seven patients (M = 48.3 years, SD = 11.1) with mild to moderately severe depression were recruited. A multistep translation from English into the German language was performed and the factorial validity, criterion validity, convergent validity, discriminant validity, internal consistency, and floor and ceiling effects were examined.
Results
The confirmatory factor analysis results confirmed the one-factor structure of the WSAS. Significant correlations with the WHODAS 2–0 questionnaire, a measure of functionality, demonstrated good convergent validity. Significant correlations with depression and quality of life demonstrated good criterion validity. The WSAS also demonstrated strong internal consistency (α = .89), and the absence of floor and ceiling effects indicated good sensitivity of the instrument.
Conclusions
The results of the present study demonstrated that the German version of the WSAS has good psychometric properties comparable to other international versions of this scale. The findings recommend a global assessment of psychosocial functioning with the sum score of the WSAS.
Background
Recent research emphasized the role of inflammatory processes in the pathophysiology of depression. Theories hypothesizes that life events (LE) can affect the immune system and trigger depressive symptoms. LE are also considered as one of the best predictors for the onset and course of depressive disorders.
Methods
Observational study across three treatment settings: n=208 depressive patients (75.5%f, M 46.6 y) were examined on depression (BDI-II), life events (ILE) and inflammatory markers (IL-6, CRP, fibrinogen, ICAM-1, TNF-alpha, E-selectin) at baseline (t0), 5-week(t1) and 5-month(t2) follow-up. Effects and interactions were analyzed with regression models.
Results
LE were associated with depressive symptoms at t0 (beta=.209; p=.002) and both follow-ups. Except for CRP, which was linked to depression symptoms at t2 (betai=-.190; p=.032), there were no effects of inflammatory markers on depressive symptoms. At t1, an interaction between CRP and LE in total (beta=-.249; p=.041) was found as well as for LE in the past five years (beta=-.122; p=.027). Similar interactions were found between cumulative LE and ICAM-1 (beta=-.197; p=.003) and IL-6 (beta=-.425; p=.001).
Conclusion
The cumulative burden of LE effects symptoms and treatment outcome in depressive patients. There is some evidence that inflammatory marker may have long-term effects on treatment outcome as they seem to weaken the determining relation between LE and depression.