Internetbasierte geleitete Selbsthilfeansätze bei Angststörungen und Depressionen

Das Spektrum internetbasierter psychologischer Behandlungsangebote bei psychischen Problemen und Erkrankungen bewegt sich zwischen webbasierten Selbsthilfeprogrammen, die das Internet als Informationsmedium verwenden, und Email-, Chat- und Video-Therapien, in welchen das Internet zu Kommunikationszwecken zwischen Hilfesuchenden und Professionellen genutzt wird. Dieser Beitrag fokussiert auf eine Beratungs- und Therapieform, die die Möglichkeiten des Internets als Informations- und Kommunikationsmedium in sogenannten geleiteten Selbsthilfeansätzen kombiniert. Internetbasierte geleitete Selbsthilfeansätze, in welchen Klienten während der Bearbeitung eines Selbsthilfeprogramms von Therapeuten via Internet (z.B. Email) unterstützt werden, wurden in den letzten Jahren intensiv erforscht. Im Bereich von Angststörungen und Depressionen liegen besonders viele Studien vor. Verschiedene Forschergruppen haben hier in der Regel große Behandlungseffekte gefunden, die mit der Wirkung von Face-to-Face-Therapien vergleichbar sind. In diesem Beitrag wird der geleitete Selbsthilfeansatz dargestellt und die empirische Evidenz diskutiert.

The processing of human pro-tumor necrosis factor

Human pro-TNF-$\alpha$ is a 26 kd type II transmembrane protein, and it is the precursor of 17 kd mature TNF. Pro-TNF release mature from its extracellular domain by proteolytic cleavage between resideu Ava ($-$1) and Val (+1). Both forms of TNF are biologically active and the native form of mature TNF is a bell-shaped trimer. The structure of pro-TNF was studied both in intact cell system and in an in vitro translation system by chemical crosslinking. We found that human pro-TNF protein exist as a trimer in intact cells (LPS-induced THP-1 cells and TNF cDNA transfected COS-3 cells) and this trimeric structure is assembled intracellularly, possibly in the ER. By analysis several deletion mutants, we observed a correlation between expression of pro-TNF cytotoxicity in a juxtacrine fashion and detection of the trimer, suggesting the trimeric structure is very important for its biologic activity. With a series of deletion mutants in the linking domain, we found that the small deletion did not block the cleavage and large deletion did regardless of the presence or absence of the native cleavage site, suggesting that the length of the residues between the plasma membrane and the base of the trimer determines the rate of the cleavage, possibly by blocking the accessibility of the cleavage enzyme to its action site. Our data also suggest that the native cleavage site is not sufficient for the release of mature TNF and alternative cleavage site(s) exists. ^

Internet-based individually versus group guided self-help treatment for social anxiety disorder: protocol of a randomized controlled trial

BACKGROUND: Social anxiety disorder (SAD) is one of the most common mental disorders and causes subjective suffering and economic burden worldwide. Although effective treatments are available, a lot of cases go untreated. Internet-based self-help is a low-threshold and flexible treatment alternative for SAD. Various studies have already shown that internet-based self-help can be effective to reduce social phobic symptoms significantly. Most of the interventions tested include therapist support, whereas the role of peer support within internet-based self-help has not yet been fully understood. There is evidence suggesting that patients' mutual exchange via integrated discussion forums can increase the efficacy of internet-based treatments. This study aims at investigating the added value of therapist-guided group support on the treatment outcome of internet-based self-help for SAD. METHODS/DESIGN: The study is conducted as a randomized controlled trial. A total of 150 adults with a diagnosis of SAD are randomly assigned to either a waiting-list control group or one of the active conditions. The participants in the two active conditions use the same internet-based self-help program, either with individual support by a psychologist or therapist-guided group support. In the group guided condition, participants can communicate with each other via an integrated, protected discussion forum. Subjects are recruited via topic related websites and links; diagnostic status will be assessed with a telephone interview. The primary outcome variables are symptoms of SAD and diagnostic status after the intervention. Secondary endpoints are general symptomology, depression, quality of life, as well as the primary outcome variables 6 months later. Furthermore, process variables such as group processes, the change in symptoms and working alliance will be studied. DISCUSSION: The results of this study should indicate whether group-guided support could enhance the efficacy of an internet-based self-help treatment for SAD. This novel treatment format, if shown effective, could represent a cost-effective option and could further be modified to treat other conditions, as well.

Assessment of low-flow, low-gradient, severe aortic stenosis: an invasive evaluation is required for decision making.

Low-flow, low-gradient severe aortic stenosis (AS) is characterised by a small aortic valve area (AVA) and low mean gradient (MG) secondary to a low cardiac output and may occur in patients with either a preserved or reduced left ventricular ejection fraction (LVEF). Symptomatic patients presenting with low-flow, low-gradient severe AS have a dismal prognosis independent of baseline LVEF if managed conservatively and should therefore undergo aortic valve replacement if feasible. Transthoracic echocardiography (TTE) is the first-line investigation for the assessment of AS haemodynamic severity. However, when confronted with guideline-discordant AVA (small) and MG (low) values, there are several reasons other than severe AS combined with a low cardiac output which may lead to such a situation, including erroneous measurements, small body size, inherent inconsistencies in the guidelines' criteria, prolonged ejection time and aortic pseudostenosis. The distinction between these various entities poses a diagnostic challenge. However, it is important to make a distinction because each has very different implications in terms of risk stratification and therapeutic management. In such instances, cardiac catheterisation forms an integral part of the work-up of these patients in order to confirm or refute the echocardiographic findings to guide management decisions appropriately.

Effects of a Transdiagnostic Internet Intervention («velibra») for Anxiety Disorders in Primary Care: Results of a Randomized Controlled Trial

Internet-based cognitive behavioral self-help treatment (ICBT) for anxiety disorders has shown promising results in several trials, but there is yet a lack of studies of ICBT in „real world” primary care settings. In this randomized controlled trial we recruited participants through general practitioners. The aim of the study was to examine whether treatment-as-usual (TAU) in primary care settings plus ICBT is superior to TAU alone in reducing anxiety symptoms and other outcome measures among individuals meeting diagnostic criteria of a least one of three anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, generalized anxiety disorder). 150 adults fulfilling diagnostic criteria for a least one of the anxiety disorders according to a diagnostic interview are randomly assigned to one of the two conditions: TAU plus ICBT versus TAU. Randomization is stratified by primary disorder, medication (yes/no) and concurrent psychotherapy. ICBT consists of a transdiagnostic and tailored Internet-based self-help program for several anxiety disorders which also includes cognitive bias modification for interpretation (CBM-I). Primary outcomes are symptoms of disorder-specific anxiety measures and diagnostic status after the intervention (9 weeks). Secondary outcomes include primary outcomes at 3-month follow-up and secondary measures such as general symptomatology, depression, quality of life, adherence to ICBT and satisfaction with ICBT. The study is currently being completed. Primary results along with results for specific subgroups (e.g. primary diagnosis, concurrent medication and/or psychotherapy) will be presented and discussed.

A sorrow shared is a sorrow halved? Internet-based group therapy versus individual therapy for social anxiety disorder: A randomized controlled trial

Purpose: Social anxiety disorder is one of the most researched conditions in the field of Internet-based self-help. Various studies have shown that cognitive-behavioral treatments can be efficacious to reduce social phobic symptoms. Most of the interventions tested include some form of support, whereas the efficacy of a web-based group format has yet to be investigated. The present study aims at investigating the possible added value of therapist-guided group support in an Internet-based guided self-help treatment for SAD. Methods: A total of 150 adults with a diagnosis of SAD are randomly assigned to either a wait-list control group or one of two active treatment conditions. Participants in the two active conditions use the same Internet-based self-help program, either with individual guidance by a therapist or with the support of a therapist-guided group of 6 individuals. In the group condition, participants communicate with each other via an integrated, protected discussion forum. The primary outcome variables are symptoms of SAD and diagnostic status immediately after the intervention (12 weeks) and at 6-month follow-up. Secondary endpoints are general symptomatology, depression, quality of life and adherence to treatment. Furthermore, process variables such as group processes and the working alliance are studied. Results: Results are currently being analyzed. Results at post-treatment will be presented and discussed. Potential moderating and mediating variables of treatment success will be addressed. Conclusion: The results of this study should indicate whether therapist-guided group support could enhance the efficacy of an internet based self-help treatment for SAD. This novel treatment format, if shown efficacious, could represent a cost-effective option and could be further modified to treat other conditions.

Early identification of symptomatic aortic stenosis using echocardiographic data

Background: Heart failure (CHF) is the most frequent and prognostically severe symptom of aortic stenosis (AS), and the most common indication for surgery. The mainstay of treatment for AS is aortic valve replacement (AVR), and the main indication for an AVR is development of symptomatic disease. ACC/AHA guidelines define severe AS as an aortic valve area (AVA) ≤1cm², but there is little data correlating echocardiogram AVA with the onset of symptomatic CHF. We evaluated the risk of developing CHF with progressively decreasing echocardiographic AVA. We also compared echocardiographic AVA with Jet velocity (V2) and indexed AVA (AVAI) to assess the best predictor of development of symptomatic CHF.^ Methods and Results: This retrospective cohort study evaluated 518 patients with asymptomatic moderate or severe AS from a single community based cardiology practice. A total of 925 echocardiograms were performed over an 11-year period. Each echocardiogram was correlated with concurrent clinical assessments while the investigator was blinded to the echocardiogram severity of AS. The Cox Proportional hazards model was used to analyze the relationship between AVA and the development of CHF. The median age of patients at entry was 76.1 years, with 54% males. A total of 116 patients (21.8%) developed new onset CHF during follow-up. Compared to patients with AVA >1.0cm², patients with lower AVA had an exponentially increasing risk of developing CHF for each 0.2cm² decrement in AVA, becoming statistically significant only at an AVA less than 0.8 cm². Also, compared to V2 and AVAI, AVA added more information to assessing risk for development of CHF (p=0.041). ^ Conclusion: In patients with normal or mildly impaired LVEF, the risk of CHF rises exponentially with decreasing valve area and becomes statistically significant after AVA falls below 0.8cm². AVA is a better predictor of CHF when compared to V2 or AVAI.^

Los frentes de atracción y la (des)integración de los indios de la nación. En: Avá, nº 17

Este trabajo intenta relacionar los “frentes de atracción de pueblos indígenas” creado por las agencias gubernamentales brasileñas con los programas del indigenismo de las compañías hidroeléctricas para los indígenas Waimiri-Atroari, para interpretarlos como acciones del indigenismo incluidas al paradigma biopolítico moderno según lo definido por Giorgio Agamben. Para sostener tal interpretación, los conceptos de poder soberano y de poder tutelar serán aplicados para aclarar el carácter asimétrico y violento de la territorialización de los pueblos indígenas. Se espera que la articulación teórica de estas nociones demuestre que las tierras o territorios indígenas son muchas veces constituidos como estados de excepción y, como tales, generan la configuración de situaciones extremas para los pueblos indígenas que viven en ella.

Políticas de salud basadas en el concepto de interculturalidad. Los centros de salud intercultural en el altiplano boliviano. En: Avá, n° 14

Actualmente en Bolivia, uno de los mayores problemas en el ámbito de la salud es la incorporación del concepto de cultura a las políticas sanitarias, hecho que hizo que se crearan centros de salud denominados “interculturales”, así como el Modelo de Salud Familiar Comunitario e Intercultural. Este artículo, a través de una investigación realizada en el año 2007 en la zona altiplánica de Bolivia, pretende demostrar como el concepto de cultura está sirviendo de base para implementar políticas que no están ayudando a cambiar los deficientes índices epidemiológicos del país.

"Contemporary Art and Anthropology". De Arnd Schneider y Christopher Wright (Editores). En: Avá, nº 9

Entre Arte e Antropologia: diálogos e apropriações A relação entre Arte e Ciência é um dos temas dos mais complexos e evolutivos, sempre dependendo do contexto histórico e do objetivo desta "relação". Por isto, resolvi começar esta resenha do livro ContemporaryArt and Anthropology com uma visão ampla e clássica deste problema epistemológico .

NARRATIVAS DE EXPERIÊNCIAS VIVIDAS POR DOCENTES E DISCENTES COM USO DE TECNOLOGIA DE INFORMAÇÃO E COMUNICAÇÃO – TDIC NA EDUCAÇÃO BÁSICA

Vivemos um período de transformações políticas, econômicas, sociais e culturais que, a todo instante, nos impõe desafios. Neste contexto, nas últimas décadas, o uso da tecnologia tem sido ampliado na realização de diversas atividades cotidianas, na divulgação de informações, na comunicação, como forma de expressão e organização da sociedade. A escola, enquanto instituição social, precisa reconhecer esta nova realidade, esta diferente possibilidade de aquisição e transformação de saber, para que possa intervir, ressignificar e redirecionar sua ação, a fim de atender as demandas de seu tempo. O objetivo geral desta pesquisa, a partir da apresentação e análise de experiências realizadas com o uso de Tecnologias da Informação e Conhecimento, é o de refletir sobre como inserir estas ferramentas no processo de ensinar e aprender na escola a partir da visão de professores e alunos, visando a formação integral do educando. Deste modo, no desenvolvimento, entendemos como necessário conhecer e considerar o contexto histórico, bem como as perspectivas relacionadas a escola e seus protagonistas (professores e estudantes) na chamada Sociedade da Informação e do Conhecimento. Ressaltamos a importância do docente (sua formação) e seu papel de mediador nos processos de aprendizagem, assim como a recepção à tecnologia, observando função e espaço de atuação desta. Destacamos experiências com a utilização de TDIC, realizada por professores e alunos, como a produção de game, revistas científicas, escrita de histórias, produções artísticas, blogs, vlogs, discussões em grupos presentes em redes sociais. A metodologia utilizada nesta pesquisa é qualitativa, na modalidade de pesquisa-ação e narrativa, em função do envolvimento com o grupo e com as atividades desenvolvidas, nas quais os participantes compartilham com o pesquisador suas histórias pessoais e de aprendizagem relacionadas às ações ou às atividades que realiza, fornecendo informações e indícios relevantes sobre o seu processo de formação ao longo do tempo. A revisão de literatura foi realizada por meio de análise bibliográfica e documental em livros, teses, dissertações, periódicos específicos sobre o assunto, além de artigos publicados na Internet. A coleta de dados foi realizada a partir de conversas informais, entrevistas semiestruturadas e filmagem dos relatos. A análise foi realizada a partir da abordagem hermenêutico-fenomenológica, que busca descrever e interpretar fenômenos da experiência humana, a fim de investigar a essência por meio da identificação de temas. Os resultados apontam para a necessidade e possibilidade da ampliação da utilização de TDIC como recurso no processo de ensino e aprendizagem, por meio de formação, diálogo, interação, intencionalidade, expectativas, esperança e seus desdobramentos.