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Biomedical subjects

E Heim

Publications and source records attributed to E Heim.

At least 19 recordsLinked to original sources
PubMed1992

[Stressors in health occupations. Do females have a greater health risk?].

Stressors and health risks in medical professions are still largely ignored. A survey on different studies in nurses, students, doctors and dentists by this author is compared to results of other authors. Special attention is given to role-strain and health risks of women in health jobs. In nursing attention and care for patients is the most important stressor, followed by team conflicts, insecurity, lack of autonomy, workload and authority conflicts. Burnout is the most important shortterm health risk, longterm consequences are scarcely researched. Where direct comparison was studied nurses named higher stress values than doctors. The stressors mentioned by the latter concern great responsibility and decision-making under time pressure, workload, increasing criticism by the public combined with a demanding attitude. Female doctors in addition complain about the strain of emergency services. They especially suffer from the role-strain between job stressors and family responsibilities. Early signs of this stress combination can already be found in female students, but the whole career of female doctors is marked by it. Overall mortality of doctors decreased during the last decade when compared with the general population, but is still worse than that of other professionals of comparable education. Especially suicide-rates are high, for males 2-3 times, for females even 5-6 times that of the general population. This may be explained by a high toll of psychiatric diseases, particularly addiction and depression. All these facts are surprisingly little observed and reflected by the medical community when compared with increasing preventive activities in other job situations.

Female↗
PubMed1992

[Integration or polarization of psychiatry].

Integration vs. polarization is an issue which presents in various aspects of psychiatry. Its position within medicine is still insecure, partly because of a one-sided preoccupation at times with psychodynamic or social factors. The same divisive tendencies are evident within psychiatry itself. Biological science can make an essential contribution to psychiatry, as recent research on depression demonstrates. But only by combining pharmacotherapy with psychosocial interventions can optimal treatment results be achieved. Within psychotherapy there is an ever stronger trend towards integration of schools and methods. Research in outcome could not demonstrate any clear superiority of one single method over the other approximately 200 methods now known. Consequences for research and practice are discussed. The relationship of psychiatry with society is rather tense, being largely based on prejudice. This should be understood less as a global criticism than as an attempt of individuals and society at large to cope with the potential threat of mental illness. Psychiatry must take its responsibility towards society seriously, especially with regard to economic and ethical issues, and afford priority in care to those in the urgent need.

Biological Psychiatry↗
PubMed1991

Prognostic importance of collateral flow and residual coronary stenosis of the myocardial infarct artery after anterior wall Q-wave acute myocardial infarction.

Residual high-grade coronary stenosis and collateral flow are frequent findings in the chronic phase after a Q-wave acute myocardial infarction (AMI). The prognostic importance of a residual stenosis of the infarct artery and of collateral flow to the infarct area was analyzed in a group of 102 young patients (mean age 35 years, range 22 to 39) who had survived an anterior wall Q-wave AMI. Patients whose only significant lesion (greater than 50% luminal diameter reduction) was in the proximal portion of the left anterior descending artery were enrolled in the study. A 50 to 74% diameter stenosis was present in 33 of 102 patients (32%), 43 (42%) had a 75 to 99% stenosis and 26% had a total occlusion of the infarct vessel. Collateral vessels, which were evaluated by a scoring system, were present in 52 of 102 patients (51%). Four percent had only faint (score 1), 17 of 102 patients (17%) had moderate and 32 patients (31%) had good collateral flow (score greater than 4). The 8-year cumulative mortality was 15.2%--an eightfold increase compared with the age-matched general population. No patient with less than 75% stenosis died during follow-up, whereas the cumulative 8-year mortality was 23 and 17% in patients with a 75 to 99% stenosis or total occlusion, respectively (p less than 0.01). Patients with at least moderate collateral flow had a mortality rate of 21%, versus 8% for patients without or with faint collateral flow (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Acute and chronic neuroborreliosis with and without CNS involvement: a clinical, MRI, and HLA study of 27 cases.

Of the 96 serologically confirmed neuroborreliosis cases seen in our clinic between 1983 and 1988, 11 patients had mild to moderate and 4 patients had serious cerebral and/or spinal cord symptoms. Nine of these 15 patients with CNS involvement exhibited a primary chronic course of the illness. After high-dose intravenous therapy with penicillin, doxycycline or cefotaxime, given mostly in combination with cortisone, gradual recovery occurred with normalization of CSF findings characteristic of neuroborreliosis, and normalization of significantly elevated Borrelia burgdorferi IgG antibody titres in CSF and serum. Brain MRI and CT showed evidence of or were suggestive of vascular involvement which correlated with clinical symptoms in 11 of the 15 patients with CNS involvement. Brain MRI changes that were similar but much slighter in number and intensity were seen in 5 of 12 neuroborreliosis patients without clinical signs of CNS involvement (lymphocytic meningoradiculitis; Bannwarth's syndrome). The frequencies of the HLA-DR7 (75%), HLA-B44 (50%) and HLA-A29 (33%) antigens in 12 neuroborreliosis patients with clinical symptoms of CNS involvement were significantly different from the frequencies in 12 neuroborreliosis patients without CNS involvement and in 100 control subjects. Diagnostic criteria of active neuroborreliosis are proposed.

Acute Disease↗
PubMed1991

Job stressors and coping in health professions.

In spite of their knowledge about stressors, health hazards and coping, health professionals are in general not aware of their own health risks. In an attempt to clarify the issue results of our own studies are compared to the relevant literature. A survey on 1,248 Swiss nurses confirmed the major stressors known: ethical conflicts about appropriate patient care, team conflicts, role ambiguity, workload and organizational deficits. In doctors workload and shortage of time, combined with specific responsibility in decision making, are most prominent. Nevertheless, job satisfaction is still high in both professions. Health hazards in doctors are considerable, although life expectancy has improved and is comparable to the general public, but still lower as compared to other professionals. Depression and substance abuse are related to higher suicide rates. The specific role strain of female doctors is responsible for health risks with an alarming 10 years lower life expectancy than in the general population. Little is known about specific health hazards in nurses, except for burnout. A lack of coping research in the field makes conclusions difficult. Our own studies show limited coping skills in nurses, but good buffering effect in 1,700 Swiss dentists.

Adaptation, Psychological↗
PubMed1990

Teaching problem-oriented therapy.

The therapeutic concept is problem- and patient-oriented. In analogy to it the didactic concept is problem- and therapist-oriented. The essential point is learning in groups from practical cases. Problem-oriented in this context means that the problems-solving process in which the patient and the therapist are engaged is supported by the observer group. Therapist-oriented means that the learning process should take account of the different preferences and experiences of the therapists. That can only be accomplished by problem-oriented learning. Each psychotherapy training group consists of 4 assistant doctors and a supervisor and stays together about 1 year. The strongly structured concept of problem-oriented therapy (POT) [Blaser et al., 1988] offers the beginner a framework by which he can guide the dialogue with the patient. The eclecticism of POT allows the more experienced therapist to try out new methods without losing track of the problem. The constantly changing role of being observer or therapist supports the group coherence, and furthermore it promotes an important element of therapeutic competence, the ability to get into a close relation with the patient and at the same time being able to observe oneself, the patient and the therapeutic process from a more distant view. In addition to the POT training group tutorials in special psychotherapy methods and single supervision sessions are offered.

Clinical Competence↗
PubMed1990

Theory and technique of problem-oriented therapy.

Problem-oriented therapy (POT) features the following essentials: problem orientation, eclecticism, patient orientation and brevity. These ingredients, above all the eclecticism, are detailed: diverse psychotherapeutic interventions are administered to foster awareness, modification of thought patterns, modification of behavior, emotionality, awareness of the body, ability to relax, and support. The required abilities of the therapist are mainly flexibility and transparency of his therapeutic actions. The definition of the problem which is negotiated together with the patient is decisive for the selection of the intervention strategy. An example illustrates the use of POT especially as in contrast to school-consistent traditional therapies.

Combined Modality Therapy↗
PubMed1990

Subjective illness concepts and problem-oriented therapy.

Subjective illness concepts mean the comprehensive psychological explanations about causes and functions of actual problems by the patient. These concepts are related to basic needs and they historically arise from interactions with the social environment. In respect to the actual situation they are constructed in a new way. They aim at reorganizing the needs of the sick individual as well as monitoring his experience of being ill. Often they do not accomplish this aim because they appear to be deficient for many reasons. In the therapeutic situation the patient is confronted with the scientific theories of his therapist. Both concepts represent different perspectives of the same problem. However, both have to be discussed in a cooperative manner and ultimately result in a complementary view which we denote as 'problem definition'.

Adaptation, Psychological↗
PubMed1990

[Overview of brief psychotherapies--a basis for discussion of problem-oriented therapy].

Historical and pragmatic reasons justify short term practice of psychotherapy. Some of the better known methods are discussed in respect to their concept, indication and setting: Malan and the Tavistock-group; Mann: Time limited psychotherapy; Sifneos: STAP, Short term anxiety provoking psychotherapy; Davenloo: Broad focus short term dynamic psychotherapy; Strupp: TLDP, Time limited dynamic psychotherapy; Luborksy: Supportive-expressive psychoanalytic psychotherapy; Klerman: Interpersonal psychotherapy; Beck: Cognitive therapy. After a cross-comparison arguments are given why there is still a need for a more problem- and patient-oriented, eclectic and limited psychotherapy. Besides theoretical reasons there are practical and didactic aspects in favour of such a method.

Adaptation, Psychological↗
PubMed1990

[Problem oriented therapy. A new therapeutic and didactic concept].

Problem Oriented Therapy (POT) is a short-term therapy concept that is characterized by the following essentials: Problem orientation, patient orientation, eclecticism and process-structuring. These essentials will be explained and their therapeutic and didactic implications shown. POT is not committed to a certain psychotherapeutic school but uses selectively reliable methods from different therapeutic approaches. The indication to specific therapeutic strategies is made from a pragmatic point of view on the level of problem definition and takes account of the patient's own comprehension of the problem. Transparency and flexibility of therapeutic thinking and acting are essential in POT. This will be illustrated by a case report. The training-settings of POT will also be briefly described.

Adaptation, Psychological↗
PubMed1990

[The value of subjective illness theories in problem oriented therapy].

Subjective illness concepts mean the more or less comprehensive psychological explanations about causes and functions of actual psychosocial problems by the patient. These concepts historically arise from interactions with the social environment. In respect to the actual situation they are constructed in a new way. They aim at monitoring the individuals' experience of being ill or healthy. Often they don't accomplish this aim because they are deficient for many reasons. In the therapeutic situation the patient is confronted with the scientific theories of his therapist. Both concepts represent different perspectives of the same problem. However, both have to be discussed in a cooperative manner and ultimately result in a complementary view which we denote as an important issue for our problemoriented therapy.

Adult↗
PubMed1989

[Psychogenic impaired consciousness].

Until not too long ago, psychogenic trance was considered to be a 'conversion hysteria'. But clinical syndromes and personality disorders are now seen as separate entities; therefore, psychogenic trance is part of the so-called 'dissociative disorders'. Here, the integrative functions of the psyche are reduced and control of memory, identity, sensoric and motoric functions are impaired. As a consequence, certain disorders are observed, which have common characteristics, such as onset (psychogenic trauma), course (initial panic or belle indifference) and psychodynamics (repression of an unbearable reality). The following disorders can be distinguished: --psychogenic amnesia: partial or complete loss of memory --psychogenic trance: temporary loss of habitual identity with more or less full awareness of surroundings --psychogenic fugue: apparently purposeful journey away from home with psychogenic amnesia --psychogenic stupor: profound diminuation or absence of voluntary movement and no responsiveness to external stimuli.

Accidents, Aviation↗
PubMed1988

The outcome of surgery for lumbar disc herniation. II. A 4-17 years' follow-up with emphasis on psychosocial aspects.

We propose that the operated patients without complaints, patients with complaints and pensioned patients with complaints differ in their psychosocial situation. Thus, the first group show the best and the third the worst psychosocial condition. A sample of 135 patients after disc surgery was chosen at random from the patient population (n = 435) responding to a questionnaire. The patients were divided into three groups: no pain (n = 51), pain, no pension (n = 40), pain and a disability pension (n = 44). All have attended a psychosocial screening. They filled in the MMPI and were interviewed on some aspects of their social life, and reported on the coping modes they used in order to subdue their low-back complaints before or after the operation. Independent from the preoperative low-back pain condition and the immediate postoperative results, the operated patients showed, several years after the operation, traceable differences in several psychosocial factors according to the socially and personally defined illness career and its stages. The difference is particularly strong between the patients without complaints and the pensioned patients. The patients with complaints, mainly those receiving a pension, showed more psychopathological features as monitored on MMPI than the patients without complaints. They also reported substantially less satisfactory occupational, family and social life than the patients considered to be complaint-free. Finally, they also differed in their modes of coping with their back problems.

Adaptation, Psychological↗
PubMed1987

Coping with breast cancer--a longitudinal prospective study.

In a prospective longitudinal study over several years, 58 patients with breast cancer are compared to 52 patients with fibrocystic disease and 24 patients with mastodynia. Results of coping (as assessed with the Bernese Coping Modes) are presented for the illness course of the first 6 months: (1) There is considerable variation of coping depending on illness situation and illness state. A core group of coping modes is predominant in most situations: 'attention & care', 'problem analysis', and 'Tackling'. In average 10 different coping modes were used by patients per given illness situation. (2) The different aspects of illness (in the same organ) ask for different coping. In the initial evaluation phase, however, the possibly fatal diagnosis overrides these differences. (3) Change over time (first 6 months) is net. Besides the core group of coping modes mentioned above, there is more variability in coping; in cancer a trend from a more fighting to a more accepting attitude is obvious; in fibrocystic disease more restricted coping is observed. Interdependence of coping with emotional stability and social adaptation will be studied as well.

Adaptation, Psychological↗