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Biomedical subjects

U Gieler

Publications and source records attributed to U Gieler.

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↗
PubMed2006

[The educational program for the management of psoriasis vulgaris according to the rules of the Task Force on Dermatological Prevention: current status].

BACKGROUND: Psoriasis vulgaris is a chronic inflammatory skin disease with a substantial impairment of quality of life. Interdisciplinary outpatient educational programs are an innovative supplementary therapy form for the management of this disorder. SUBJECTS AND METHODS: The Task Force on Dermatological Prevention developed a concept for outpatient instruction of psoriasis patients. Five 2-hour classes by dermatologists, psychotherapists/psychologists and dieticians focus on central topics relevant for the patients and the management of the disease. RESULTS: The results presented are based on own experiences with this educational program. The interdisciplinary program is accepted very well and seen as helpful by the concerned. A structure analysis of the effects in a greater number of cases is a current goal. In some areas, health insurance companies are paying for the classes. CONCLUSION: The educational program for the management of psoriasis vulgaris according to the rules of the Task Force on Dermatological Prevention is a supplement of the treatment of patients with this chronic skin disease. Broader implementation in Germany is desirable.

Ambulatory Care↗
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↗
PubMed2003

[Education programs on atopic eczema. Design and first results of the German Randomized Intervention Multicenter Study].

Atopic eczema (AE) is a common, chronically relapsing, inflammatory skin disease with an early onset during infancy associated with a high loss of quality of life and socioeconomic burden. In the past few years, an Atopic Eczema Prevention Program was established to improve disease management and the quality of life of patients with atopic eczema. In Germany, the Task Force on Education Programs for Atopic Eczema (AGNES = Arbeitsgemeinschaft Neurodermitis Schulung) for children, youths, and parents was founded as well as the Task Force on Dermatological Prevention (ADP) for adults. These groups ensure structure and process quality of the prevention programs and organize train-the-trainer workshops. In a randomized prospective controlled trial (the German Randomized Intervention Multicenter Study = GRIMS), we are currently comparing the effectiveness of an atopic eczema group intervention program in (1) parents of atopic eczema children aged 0-7 years, (2) parents and children 7-12 years old, and (3) youths with AE aged between 13 and 18 years. The groups were randomized and compared with a waiting control group. The design and first results will be reported.

Adolescent↗
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

[Phobic neuroses presenting as "intolerance reaction of the skin"].

Intolerance reaction of the skin refers to multiple reaction patterns, including toxic, allergic, pseudo-allergic and even psychiatric mechanisms. In our case, a patient was diagnosed for years as having "multiple allergies", but except for a documented contact allergy to a local anesthetic, her underlying disease was panic disorder with multiple phobias. Using this case study with one year follow-up, hypotheses are discussed about effective psychotherapy in patients with intolerance reactions of the skin. Differential indications are explored with reference to the latest investigative results in psychoneuroimmunology. In this patient, psychotherapy helped the phobias and eliminated her conviction that she had multiple allergies. In addition, the positive pre-therapy allergy testing was not reproducible. The dermatologist should not expect such patients to present with phobias, because they frequently shift their phobic anxiety into the fear of allergic reactions to escape from the label of having psychiatric disease. Such patients should receive psychotherapy if they begin to generalize their avoidance behavior and limit their social contacts.

Diagnosis, Differential↗
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↗
PubMed2001

[Psychosomatic dermatology - state of the art].

Based on the current literature, the paper gives an overview of the state of knowledge in psychosomatic dermatology. The authors propose the following classification: (1.) Dermatologic problems as a consequence of psychic disorders (e.g. factitious disorder, trichotillomania, dysmorphophobia, delusions of parasitosis etc.); (2.) Multifactorial dermatologic disorders, which can be substantially influenced by psychological factors (e.g. atopic dermatitis, psoriasis, chronic urticaria etc.); (3.) Psychic disorders developing as a consequence of disfiguring or life-threatening dermatoses (e.g. adjustment disorder, depressive disorder, anxiety disorder); (4.) Comorbidity with other psychiatric disorders. Psychosomatic dermatology developed from an anecdotal initial stage to more systematic research with larger numbers of patients, employing control groups and psychometric instruments. During the last decade, research focused on psychophysiological and psychoneuroimmunological mechanisms which influence dermatologic disorders. This course of development and the current state of knowledge are presented for atopic dermatitis and psoriasis.

Anxiety Disorders↗
PubMed2000

[Current status of the interdisciplinary model project "Neurodermatitis Education for Children and Adolescents"].

With the help of the German Ministry of Health and the health insurance companies a national interdisciplinary project for children and adolescents with atopic eczema will be developed. The aim of the project is to generate standardized teaching concepts for parents and children covering medical, psychological and social aspect of the disease. 800 children and adolescents of different age groups will be enrolled in this project. Furthermore, during the three years of the study the efficacy of the teaching concept will be evaluated.

Adaptation, Psychological↗
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↗