Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 14/19 Archiv

The primary aim of the study was to investigate the predictive value of patients´ characteris-tics for treatment outcome in outpatient and inpatient settings. Study took place between 2003 and 2006. It was a prospective observational study with par-ticipation of 290 alcohol-dependent patients. Patients entered an outpatient treatment (12 months duration), short term inpatient treatment with duration of 8 weeks, or long term inpa-tient treatment (duration between 12 and 16 weeks). Analyzes implied patients´ characteristics and characteristics of mental illness. Assessments were made using medical basic documenta-tion, European Addiction Severity Index (EuropASI), Timeline Followback Interview, Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), and Obsessive-Compulsive Drinking Scale (OCDS). Higher secondary school qualifications, finished professional training, onset of alcohol de-pendence at a later time, longer duration of alcohol dependence, less previous treatments for somatic problems, and a history without or of less attempted suicide were found to be predic-tive for a preferable treatment outcome. Furthermore, family satisfaction and employment were variables which differed between treatments with respect to the treatment outcome. As-sociation between craving and treatment outcome were found as follows: In the short term, patients who reported less craving had better treatment outcome than patients with a larger extent of craving.

As it is commonly known and confirmed by several studies, adolescence is the time in life that goes along with being the latest chronotype in community. This implies that physiologically adolescents tend to go to sleep later and get up later than other age groups. At the same time adolescents are the age group who spend the highest amount of time studying (at school), in order to prepare for their later (working) life. Since the usually requested school start times in Germany around 8:00 a.m. rather meet the needs of earlier chronotypes than those of normal- and later ones, adolescents and shift workers belong to the groups with the largest sleep deficit. There is a recognition that healthy sleep (adjacent to healthy nutrition and physical exercise) states one pillar of health and wellbeing, as well as playing a role in the consolidation of memory. For this reason it appears worthwhile to aim at optimising sleep behaviour and –circumstances in adolescents. Consequently the relations between chronotype and sleep should be understood, in order to gain new insights for the conductance of health prevention programs; especially in schools. The aim was to create one building block for such research. Thus the present study aspired to finding a method of examining the sleep of adolescents “in real life” via a field study with a mainly explorative approach. In order to do so, a simple and cost-effective method was sought, to obtain hypnograms of students in a mobile sleep lab at their school. The mobile, automated and easy to use EEG “Zeo” was elected since it appeared to be an ideal tool for meeting the requests of the present study. This device consists of a headband with three frontal electrodes and a base station that records, inter alia, the following sleep parameters: total sleep, sleep latency, time awake after falling asleep, light sleep (stage 1 and 2), deep sleep (stage 3 and 4) and REM sleep. These are interpreted automatically so that no more manual evaluation of raw EEG-data has to be performed. After hypnograms were obtained, their data were assessed in relation with the students’ chronotypes. To do so, the total duration of the respective named sleep parameters were correlated with the chronotypes. Total durations of the respective sleep phases were also correlated with each other. Prior to deducing EEGs on two consecutive nights per student, the chronotype of each participant was determined via the Munich Chronotype Questionnaire. In order to validate the obtained data and gain further insights into the individual sleeping-behaviour of participants, these were asked to fill in sleep logs for two weeks during the test-phase. The main question of this thesis was weather common chronobiological expectations about sleep timing and –phases could be replicated in the sleep-mobile-setting, using Zeo. In opposition to the usual observance in sleep-labs, no first night effect was seen between the first- and second nights in repeated measures ANOVA. For this reason both nights were used for further analysis in this study. The first hypothesis was that later chronotypes would be observed to fall asleep later in the sleep mobile, and wake up later. This hypothesis could not be confirmed. Similarly the second hypothesis, which expected later chronotypes to be observed to spend more time overall sleeping in the sleep mobile than earlier types, because they would have to catch up on their accumulated sleep deficit throughout the week, could not be approved. Both outcomes may be influenced by the study’s set-up in which respectively four students slept in the sleep mobile at the same time. Thus there hardly was a possibility for one student to get up or go to sleep without waking up the others. No correlation was seen between chronotype and the total duration of the above named sleep parameters. Sleep onset and sleep end were compared to an MCTQ- and sleep-log-deduced 24-h-sleep window. While sleep onset, as measured by Zeo was correlated with the calculated value, no such correlation could be shown between calculated- and measured values for sleep end. An unexpected finding in half of the hypnograms was that students were observed to have fallen asleep via a REM-phase rather than via a light sleep phase, as usual. Testing for correlations between the total durations of sleep phases, the following observations were made: • Total sleep showed a positive correlation with light sleep. • Total sleep showed a positive correlation with REM sleep. • Time awake after falling asleep showed a negative correlation with REM sleep The latter discovery was unexpected, since there is no explanation as to why wake-up phases throughout the night might lead to a decline in REM-sleep. Due to the named unexpected findings regarding REM sleep, a post-hoc hypothesis was generated. This hypothesis assumes that Zeo tends to confound wakefulness with states of REM. Further literature research showed a high probability of this hypothesis being correct, since 1) the frontal EEG-deductions during REM-sleep are rather similar to those deducted during wakefulness, whereas alpha-waves that can be observed in relaxed, awake test-persons with closed eyes are ideally deducted in the dorsal regions of the head. 2) all studies in which Zeo’s output is claimed to have a high correlation with classical polysomnography exist only as abstracts and have not yet been published completely. Furthermore, towards the end of the present study, oral communication with Zeo approved that the device’s hardware could not facilitate a perfect evaluation of REM-phases. In retrospection the setting of measuring student’s sleep profiles in school on weekends within the sleep mobile was accepted well by students and can be recommended for further research. A limitation in this regard is the analysis of total sleep, sleep onset and sleep end that are being de-individualised by the collective residence of students in the sleep mobile. A further use of Zeo for scientific purposes cannot be advised, while a repetition of the present study with classical EEGs is regarded to be commendable. Although such proceeding would include a higher workload in applying and manually evaluating EEGs, the reliability of data would be considerably higher. Moreover, the raw, unevaluated data that would be obtained could be used for a refined evaluation. In the meantime Zeo may well serve for use in health care programs, where it could be applied for individuals to gain insights into their own sleep, its structure and importance.

Das Ziel unserer Studie war die Evaluierung der Veränderungen von Lebensqualität, Körpererleben und sozialer Unterstützung von Mammakarzinom-Patientinnen während des ersten Jahres nach Primärdiagnose und die Testung prädikativer Variablen. Methodik: Prospektive, klinische Verlaufsstudie (n=236) mit Meßzeitpunkten zum Zeitpunkt der Primärdiagnose, sowie nach sechs und zwölf Monaten. Als standardisierte Messinstrumente wurden Quality of Life Questionnaire (EORTC-QLQ-C30), Breast Cancer Specific Quality of Life Questionnaire Module (QLQ-BR23), der Fragebogen zur Belastung von Krebspatienten (FBK-R23) und der Fragebogen zur Lebenszufriedenheit (FLZ) verwendet. Ergebnisse: Die meisten Lebensqualitäts- und Symptomskalen verbesserten sich bereits innerhalb der ersten sechs Monate und blieben auch nach zwölf Monaten stabil. Körpererleben und soziale Belastung veränderten sich im Zeitverlauf nicht. Die Variable Primäroperation korrelierte lediglich mit dem Körpererleben. Adjuvante Chemotherapie zeigte eine negative Korrelation mit der Lebensqualität und der sozialen Funktion. Unter den soziodemographischen Faktoren zeigte sich nur die Variable Aller prädiktiv für die Lebensqualität, das Körpererleben und die soziale Funktion. Schlussfolgerung: Mammakarzinom Patientinnen sollten besonders während der ersten sechs Monate psychologisch betreut und begleitet werden. Hierzu sind interdisziplinäre Therapiekonzepte nötig. Besonderer Betreuungsbedarf besteht bei jüngeren Patientinnen und Patientinnen unter Chemotherapie.