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Biomedical subjects

J Kupfer

Publications and source records attributed to J Kupfer.

At least 19 recordsLinked to original sources
PubMed2007

[Health-related quality of life in dermatologists compared to other physicians].

BACKGROUND: According to recent studies, there may be differences in quality of life for physicians depending on gender and field of medicine. Presently, there are hardly any data with respect to health-related quality of life in dermatologists. METHODS: Using the SF-36 Health Survey, 112 dermatologists and 113 physicians in other fields of medicine were studied in a cross-sectional study. RESULTS: Dermatologists' mental health level averaged lower than their physical health level (chi2=28.49; p<.001). The mental and physical health level were higher in female dermatologists than in their male colleagues (e.g., GH: chi2=6.15; p<.05 and MH: chi2=6.83; p<.05). These findings are the opposite of results in other medical specialists. The differences between mental and physical health dimensions on the one hand, and between women and men on the other hand, were found in all age groups. CONCLUSIONS: In comparison to other medical specialists, dermatologists differ only slightly in their health-related quality of life. Therefore, it may be advisable to implement preventive measures concerning their comparatively low mental health status.

Adult↗
PubMed2005

Atopic dermatitis -- topical therapy: do patients apply much too little?

BACKGROUND: The treatment of atopic dermatitis still remains a challenge. Little research has been done on the issue of the extent to which patients correctly use prescribed topical preparations under everyday conditions. AIMS: To investigate what quantity of topical preparations is applied by outpatients in daily routine treatment over a 26-week period and to what extent this consumption is related to the course of the severity of patients' skin conditions. METHODS: Thirty adult outpatients (20 female and 10 male) with atopic dermatitis were examined at four different times during 26 weeks. For treatment and skin care these patients were given a topical glucocorticoid preparation (prednicarbate) and the corresponding emollient. RESULTS: The average severity rating (SCORAD) was 29.6 (before therapy 33.9, after 26 weeks 27.4). The SCORAD indices improved by a mean of 6.5 points (p<0.05). CONCLUSION: Patients who applied the correct amount of the prednicarbate-containing preparations (not less than 90% of 0.5 g/dm(2)) to the areas of affected skin showed a significant improvement in SCORAD indices across the four measuring times.

Administration, Topical↗
PubMed2002

[Prevalence of psychosomatic disorders in dermatologic patients. Experiences in 2 dermatology clinics with a liaison therapy model].

INTRODUCTION: The prevalences and differences of biopsychosocial disorders were investigated in the dermatologic clinics of Erfurt and Giessen, where a liaison-therapy model has been established. Different dermatological diseases were compared by a variety of psychological tests, and patients with the same diagnosis were compared between the two clinics. PATIENTS AND METHODS: We examined 406 patients for psychosomatic problems with diagnostic interviews and psychometric tests. The coping of skin disease questionnaire (CSD) and the Symptom Checklist (SCL-90R) served as diagnostic measures. Between 1995-2000, 71 patients were seen in Erfurt and 335 in Giessen. The distribution of skin diseases and the psychosomatic disorders are shown by ICD-10 diagnoses. RESULTS: The comparison of an East and a West German city showed no significant differences in the whole group or the parallel groups using the CSD and SCL-90R. There was only a tendency to a greater reduction of quality of life in Erfurt. Patients with glossodynia evaluated themselves in all psychometric tests as very "normal". By contrast, patients suffering from alopecia and acne felt very helpless and seemed to have a need of greater psychosocial care. CONCLUSIONS: The biopsychosocial characteristics of the patients treated in the dermato-psychosomatic units in Erfurt and Giessen show no significant differences. Patients with diseases such as alopecia and acne are underestimated in regard to the need for additional psychosocial care. The liaison therapy model is an effective approach to diagnose psychosomatic-dermatological disorders and decide if further psychosomatic treatment is indicated.

Adolescent↗
PubMed2002

Psychological factors associated with hand dermatoses: which subgroup needs additional psychological care?

BACKGROUND: The aetiology of hand dermatoses (HD) is very heterogeneous. Psychological influences on severity and coping in hand eczema have been only rarely investigated. OBJECTIVES: To investigate whether psychological factors correlate with somatic factors, in order to be able to estimate the possible need for psychosocial treatment of these patients. METHODS: In a cross-sectional study 101 hand dermatosis patients (49F, 52M) with psoriasis (n = 26), vesicular hand eczema (n = 33) or contact dermatitis (n = 42) were examined with regard to dermatological [diagnosis, severity, Erlanger Atopy Score (EAS)], allergic (patch test) and psychological aspects [Coping with Chronic Skin Diseases questionnaire (CSD), Allover Depression Scale (ADS), Social Readjustment Rating Scale (SRRS), questionnaire for measuring Factors of Aggression (FAF)],and Visual Analogue Scales (VAS) concerning itching, scratching and impairment. Subgroups of high stress responders (high-SR) vs. low stress responders (low-SR) were also examined. RESULTS: Of the patients with HD, 47.52% are convinced that 'stress' influences the course of their disease. Analysis of variance shows that the subjective reaction to stress (high-SR) correlates with higher severity scores, more itching, higher depression scores and more life events. High-SRs were younger and the onset of the disease was earlier compared with patients without a subjective reaction to stress (low-SR). In the CSD those with especially high-SR but negative patch-test results stated significantly higher values for itching, helplessness and search for information. CONCLUSIONS: Psychological factors should be taken into consideration in the treatment of patients with HD. High-SR patients with a negative patch-test seem to require more adjuvant psychological care.

Adaptation, Psychological↗
PubMed2001

[Psychosomatic dermatology in Germany: a survey of 69 dermatologic clinics].

BACKGROUND AND OBJECTIVE: A questionnaire study of German dermatological clinics was designed to show the situation and development of psychosomatic dermatology 10 years after a similar study. PATIENTS/METHODS: A questionnaire was sent to 170 dermatological clinics. 76 were send back; 69 of them (40.6%) were evaluable. The questionnaires were mostly answered by the heads of the dermatological clinics (38/69 = 55.1%). RESULTS: Nearly 85% of the dermatological clinics answered that they take psychosomatic aspects into consideration in the therapy. 5.1% of the dermatologists working in clinics have additional psychotherapeutic certification. The improvement of coping behaviour seems to be the main goal of psychosomatic interventions. The importance of psychic factors increased in the last 10 years in comparison to a former study in regard to most of the dermatological diseases. CONCLUSIONS: Psychosomatic aspects seem to be an obligatory part of inpatient dermatological therapy. The frequency of some diseases was underestimated in comparison with results from literature.

Behavior Therapy↗
PubMed2001

[Symptoms of prostatitis in German. The Giessen Prostatitis Symptom Score].

In cases of chronic prostatitis, a systematic case history of subjective complaints is crucial. In addition to the urological diagnosis, a special symptom questionnaire can be utilized. The objective of this study was to develop a standardized and valid questionnaire to assess prostata-specific complaints in an economic way. Independently from the evaluation of this questionnaire, a similar instrument (CPSI) was developed in the United States with several similar items. The Giessener prostatitis symptom score (GPSS) comprises 12 items. Thirty-three patients suffering from prostatitis and 770 representatively selected German males filled in the questionnaire. A sum score of 6 points proved to best suited to differentiate between the patient and the representative group. Values of 6 and above indicate the corresponding diagnosis, i.e., it can be assumed that prostata-specific symptoms occur at least occasionally. In the representative sample, 7.8% of the males showed prostata-specific complaints with a score of 6 or above. A comparison between the GPSS and the CPSI concerning their diagnostic validity has not yet been performed. This comparison will show which of the instruments is better suited for prostatitis screening.

Adolescent↗
PubMed2001

"Amalgam disease"--poisoning, allergy, or psychic disorder?

Frequently, patients in environmental health out-patient units relate various complaints to their amalgam fillings. However, an association between the toxic exposure and the reported complaints appears plausible only in few cases. We investigated toxicological, allergological and psychological parameters in patients with amalgam-associated complaints and compared them to controls with similar numbers of amalgam fillings. Forty patients with health disturbances related to amalgam were compared to a control group without amalgam-associated complaints (n = 40), carefully matched for age, sex, and dental status. Mercury concentrations were analyzed in blood, saliva, and 24-h-urine. Atopic predisposition, determination of IgE, patch testing with amalgam and amalgam-associated metals and a psychometric assessment were performed in all participants. Mercury concentrations in blood or urine were similar in patients and controls. Atopic predisposition was markedly enhanced in patients (11/40) as compared to controls (5/40). Only one patient with a lichen ruber of the oral mucosa showed a contact sensitization to amalgam. Patients reported more psychic strain and higher depression scores than controls. Somatization disorders were found in 10 patients (25%) and in one control. Eighteen patients (45%) neither showed an atopic predisposition nor an influence of psychosocial factors. Toxic exposure to mercury does not appear to play a role in "amalgam disease". Since many of these patients are atopic without an "amalgam allergy", but with more psychic strain and notably more depression, the treatment should be focused on allergologic and psychological factors.

Adult↗
PubMed2001

The "Dorian Gray Syndrome": psychodynamic need for hair growth restorers and other "fountains of youth.".

The psychic-dynamic factors underlying the hypochondriac disorder involving an obsessive preoccupation with physical attractiveness (dysmorphophobia) and the treatment possibilities for some manifestations of this syndrome have been examined. This psychosomatic illness frequently leads to the taking of finasteride, a medication that halts the balding process in cases of androgenetic alopecia or even stimulates renewed hair growth. The nosological demarcation of the disorder requires the differential diagnosis of depressive, hypochondriac and delusionary disorders. The psychodynamics involved, as deduced from 2 case studies, takes the form of an expansion of the patients' reductionist perspective, characterized by an emphasis on external types extending to a psychogenetic attitude with regression into narcissistic fixation. The authors seek eternal youth which is a "leitmotif' of the disorder, and they apply the term "Dorian Gray Syndrome" after Oscar Wilde's novel. The treatment recommended is a course of intensive psychotherapy; often the topic of "life-style medication" must be introduced before the specific narcissistic conflicts behind the current symptoms can be treated.

Adult↗
PubMed2000

Relation between mercury concentrations in saliva, blood, and urine in subjects with amalgam restorations.

The aim was to determine the relationship between mercury content of resting and stimulated saliva, and blood and urine. Eighty subjects participated; 40 of them attributed their self-reported complaints to dental amalgam (patients), the others were matched with respect to age, sex and amalgam restorations (controls). Serum, 24-h urine, resting and chewing stimulated saliva were analyzed for mercury using the ASS-technique. Quality, number, surfaces and total area of amalgam fillings were recorded clinically and using study models. Median (range) mercury levels in serum were 0.67 (0.1-1.52) microgram/l for patients and 0.60 (0.1-1.3) for controls. In urine levels were found to be 0.77 (0.11-5.16) and 0.94 (0.17-3.01) microgram/g creatinine respectively. No significant differences were found between the groups. Resting saliva contained 2.97 (0.10-45.46) micrograms/l in patients and 3.69 (0.34-55.41) in controls (not significant). Chewing mobilized an additional amount of 16.78 (-6.97 to 149.78) micrograms/l in patients and 49.49 (-1.36 to 504.63) in controls (P < or = 0.01). Only a weak correlation was found between mobilized mercury in saliva and serum (r = 0.27; P < or = 0.05) or urine (r = 0.47; P < or = 0.001). For resting saliva the respective values were r = 0.45 (P < or = 0.001) and r = 0.60 (P < or = 0.001). Saliva testing is not an appropriate measure for estimating the mercury burden derived from dental amalgam.

Adult↗
PubMed1999

[From neuropeptides and cytokines to psychotherapy. Skin diseases between psychoneuroimmunology research and psychosomatic treatment].

Most therapists recognize that emotional factors influence the course of neurodermitis (ND). Most studies concerning the influence of experimental, acute stressors brought only inconsistent results in ND. Most likely, the experimental stressors chosen thus far were only able to poorly simulate the reactions to real stressors in neurodermitis patients. More recent articles, however, were able to demonstrate changes in psychoimmunological parameters under experimental stress conditions in ND in comparison with a control group of persons with healthy skin. Retrospective studies, serial analyses over time and psychotherapeutic evaluation studies were able to demonstrate even more clearly that emotional factors influence the course of ND.

Complementary Therapies↗
PubMed1999

Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI.

The purposes of the study were to compare treatment-related stresses of couples undergoing IVF or ICSI treatment (ejaculated, epididymal or testicular spermatozoa) and to identify sex differences and risk factors for depression. A one-year cohort of couples was retrospectively sent questionnaires on infertility and treatment-related distress and depression (Depression Scale, D-S). Two hundred and eighty-one women and 281 men (61% of those eligible) were included. As determined by analysis of the medical charts, successful couples were more likely to participate. Treatment-related distress was generally higher for women than for men. Treatment by ICSI carried additional burdens for the men: they reported a greater subjective responsibility for the infertility, impact of childlessness on daily life, treatment-related stresses (particularly for MESA/TESE) and time demands. Even when clinical differences between treatments (e.g. age, previous treatments) were controlled statistically, depression scores did not differ. Independent of the treatment, women were significantly more depressed than their age-matched female controls from the general population and their husbands. The men only reported marginally elevated depression scores compared to their controls. Meaningful characteristics were identified that could guide clinicians to give psychological support to those couples at risk for depression, e.g. an unsuccessful treatment outcome, repeated treatment cycles, a low socioeconomic status, foreign nationality, or, for women, a lack of partner support.

Adult↗
PubMed1998

Rapid extension of left adrenocortical carcinoma into the right atrium.

Adrenocortical carcinoma is a rare tumor which can extend into the right heart via the inferior vena cava. We describe a case of a 26-year-old woman who had progressive shortness of breath, intermittent chest pain, and peripheral edema. A two-dimensional echocardiogram on hospital admission showed a large multinodular mass in the right atrium which extended into the inferior vena cava. Further studies showed that this mass was adrenocortical carcinoma. An echocardiogram performed 3 weeks before admission was completely normal. It appears that an adrenocortical carcinoma is capable of rapid growth up the inferior vena cava and into the right atrium.

Adrenal Cortex Neoplasms↗
PubMed1998

Coping with acne vulgaris. Evaluation of the chronic skin disorder questionnaire in patients with acne.

The present study investigated how patients with acne vulgaris cope with their disease. By means of questionnaires, relations and interactions between acne and psyche were evaluated. In addition to the evaluation of a specific questionnaire for patients with chronic skin disorders (CSD), assessing psychosocial impairment by the disease, depression and social anxiety were investigated in patients with acne. The study included 50 patients with acne. The CSD showed significant correlations with Beck's depression inventory, the interaction-anxiety questionnaire and the health locus of control scale. The CSD revealed significant differences compared to a control group of 33 patients with healthy skin. Furthermore the patients' attitudes towards triggering factors and disease-related limitations in everyday life are presented. The results of the study demonstrate that patients with acne suffer from emotional distress and psychosocial problems caused by their disease; however, impairment is not correlated with the objective severity of acne.

Acne Vulgaris↗
PubMed1997

Load weight determination during dynamic working procedures using the pedar foot pressure distribution measuring system.

INTRODUCTION:: In 1994 a new BIA research project was launched, which deals with the development of a portable measuring system for recording of external stress parameters (e.g. body postures and handled load weights) at different places of employment. The investigations are carried out against the background of a newly recognized occupational disease (since 1993), which is that of damage of the spine following long-term repetitive lifting and carrying of heavy loads as well as working in an extreme trunk bending posture. As a part of the study it should be clarified if the worker's handled load weight can be determined by using a foot pressure distribution measuring system. METHODS:: In the case of a static working posture the handled load weight can simply be calculated by taking the difference of the measured weight and the known body rest weight of the worker. In dynamic situations the measured total foot reaction force consists of a static and a dynamic component, which is caused by the body movement and which is normally bigger than the load gravitational force. For load weight determination it is important to separate the dynamic forces from the measured total force to get an idea about its gravitational rest part. Therefore the body dynamics are measured synchronously to the foot pressure by using angle and angular velocity sensors. The herewith received data are used as input values for a developed biomechanical link segment model, with which it is possible to predict the foot reaction force. So even in dynamic situations an estimation of the handled load weight can be made by comparison of the predicted with the measured foot reaction force. RESULTS AND DISCUSSION:: In laboratory tests the load weight could be determinated reliably for different working processes over a total measuring time of 40 seconds. During the measurements the Pedar insoles were placed directly under the foot so that the accuracy of the static force measurement was reasonably high (with a maximal deviation of 5% to the real force). When the insoles were put in shoes, additional forces resulting from the bent shoe leather complicate the load weight determination. This effect still has to be analysed to compensate for it in future measurements. CONCLUSION:: The laboratory results encourage us for future measurements at places of employment. Currently our work focuses on an increase of the total measuring time and on a modification of the measuring system to a portable system without any connection to a computer. A field study is in preparation.

Journal Article↗
PubMed1997

Effectiveness of valproic acid on destructive and aggressive behaviours in patients with acquired brain injury.

Valproic acid, a primary anticonvulsant drug, has recently been studied for purported effectiveness in disparate disorders of mood and behaviour. The psychopharmacological treatment of patients with acquired brain injury frequently includes numerous trials of psychotherapeutic drugs such as antipsychotics, benzodiazepines, antidepressants, and lithium, in an effort towards affective and behavioural improvement. In this report we describe and graphically depict the striking efficacy of valproic acid in reducing and improving destructive and aggressive behaviours in five patients with acquired brain injury. In all cases valproic acid was effective after other pharmacological interventions were not. Also, the addition of valproic acid was followed by neurobehavioural improvement rather quickly, often within 1-2 weeks. Advantages of valproic acid, in addition to its possible unique efficacy, include a lower propensity towards sedation and cognitive impairment, and thus a more robust potential for rehabilitation participation. Behaviours associated with affective disorders ranging along the affective spectrum from depression to dysphoric mania may be particularly amenable to valproic acid. The drug may also be beneficial in some cases in which another psychotropic anticonvulsant, carbamazepine, was not.

Activities of Daily Living↗