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Biomedical subjects

B Saletu

Publications and source records attributed to B Saletu.

At least 37 records · Page 2Linked to original sources
PubMed2001

Treatment of idiopathic restless legs syndrome (RLS) with gabapentin.

Nine patients with idiopathic restless legs syndrome (RLS) were treated with 300 mg of gabapentin as an initial dose and an up-titration until relief of symptoms for 4 weeks. Subjective symptoms improved significantly. Polysomnographic data showed a reduction of periodic leg movements during sleep (PLMS) (p = 0.003) and PLMS index (p = 0.001). The authors conclude that gabapentin provides a well-tolerated and effective treatment of idiopathic RLS.

Acetates↗
PubMed2001

[Relationship between symptoms of depression and anxiety and the quality of life in multiple sclerosis].

BACKGROUND: Health-related Quality of Life (QoL) is gaining increasing influence as a relevant evaluation criterium in clinical research. Several studies have investigated QoL in patients suffering from multiple sclerosis (MS) and the impact of therapeutic interventions on QoL. However, the influence of psychiatric complications, which occur frequently in MS (e.g. depression and anxiety disorders), on the autoassessment of QoL are hardly ever considered. METHODS: Symptoms of depression and anxiety were rated in 74 outpatients with definite MS. The health-related QoL was assessed and set into relation to physical disability (measured with the Expanded Disability Status Scale) and duration of the disease. The results were compared with 74 normal controls of the same age. RESULTS: A highly significant relationship between emotional state (Zerssen-scale), depression (Zung-depression-scale), anxiety (Zung anxiety scale) and Quality of Life was evident. CONCLUSIONS: Clinical trials assessing Quality of Life in MS patients should consider the frequency of psychiatric comorbidity and the influence of depression and anxiety disorders on self-rated Quality of Life.

Adult↗
PubMed2001

[Fatigue and stress sensitivity of physicians after 16 hours on duty at the emergency department].

In addition to their 40-hour working week (Mon-Fri, 8 a.m.-4 p.m.) residents at the emergency department of the General Hospital of Vienna have to do approximately six 24-hour duties. The reasons for conducting the present field study were physicians' complaints about tiring night duties. 11 residents (4 women, 7 men; aged between 28 and 43 years, x = 33.5 +/- 4.9 years; working at the emergency department for 4-50 months, x = 31 +/- 20 months) were tested on an ordinary working day at 9 a.m. and midnight. Self-rating concerning sleep duration, perception of stress and workload on the days of the investigations were found to be representative of other prolonged duties. Subjects reported a usual nocturnal sleep duration of only 6-7 hours. Stress was regarded as moderate by most of the volunteers. Blood pressure and pulse rates did not show diurnal changes. Generally, residents felt significantly (p < 0.01) less awake at night than in the morning, but reported only slight vegetative and somatic stress reactions or annoyances as assessed by the Fahrenberg self-rating scale. Interindividual differences were found; residents who had been working at the emergency department for a longer period experienced a more pronounced impairment. Further studies are required in order to objectify a nocturnal decrease in vigilance (by means of computer-assisted EEG) and to evaluate potential performance deficits (by means of psychometric tests).

Adult↗
PubMed2001

[Nonorganic hypersomnia: epidemiology, diagnosis, and therapy].

Daytime tiredness and daytime sleepiness are frequent complaints occurring in 29% and 14% of the Austrian population. Epidemiological studies demonstrate a high comorbidity between nonorganic hypersomnia and mental disorders. Especially comorbidity with affective disorders increases steadily from the general population over primary to tertiary care settings. Diagnostic criteria of nonorganic hypersomnia have been described in the International Classification of Diseases (ICD-10). Nonorganic hypersomnia can be primary or associated with a number of psychiatric disorders such as reaction to severe stress or adjustment disorders, affective disorders, other functional disorders, tolerance to or withdrawal of CNS-stimulating substances and chronic use of CNS-sedating substances. Diagnostic procedures comprise case history and symptom evaluation, sleep-specific and supplementary investigations. Concerning the latter, this article will focus on sleep questionnaires, vigilance and psychological tests as well as CNS investigations. Therapy of nonorganic hypersomnia rests on 3 pillars: psychological, somatic and pharmacological treatment. In view of the wide variety of psychiatric causes, resulting in a number of therapeutic options, it seems desirable that apart from subjective clinical assessment also objective methods be used in diagnosis and treatment. On the neurophysiological level objective measures can be obtained by means of EEG mapping during the day and polysomnography at night. Different mental disorder patients show different brain activity patterns as compared with normal controls and different classes of psychotropic substances cause different changes in neurophysiological variables. The fact that the changes in electrophysiological brain activity caused by mental disorders are exactly opposite to those induced by the psychotropic drugs used for their treatment suggests a key-lock principle in the diagnosis and treatment of nonorganic hypersomnia.

Austria↗
PubMed2001

Activity monitoring in sleep research, medicine and psychopharmacology.

Motor activity as a diagnostic parameter has become an important feature in many fields of medicine and psychology. The concept of mobility and immobility implies the assumption that mental and behaviour disorders involve abnormal activity that can be measured to characterise the disorder itself, to diagnose its presence and to document the impact of treatment. In sleep research, activity monitoring by wrist actigraphs has proven its usefulness as an efficient method to assess the rest-activity cycle over long time periods and to estimate sleep-related features such as sleep efficiency and total sleep time. But like many other techniques and devices, activity monitoring has some limitations and drawbacks. This paper describes the basic features of wrist actigraphy in measuring nocturnal and daytime motor activity.

Chronobiology Phenomena↗
PubMed2001

Low-resolution brain electromagnetic tomography revealed simultaneously active frontal and parietal sleep spindle sources in the human cortex.

Analyses of scalp-recorded sleep spindles have demonstrated topographically distinct slow and fast spindle waves. In the present paper, the electrical activity in the brain corresponding to different types of sleep spindles was estimated by means of low-resolution electromagnetic tomography. In its new implementation, this method is based on realistic head geometry and solution space is restricted to the cortical gray matter and hippocampus. In multichannel all-night electroencephalographic recordings, 10-20 artifact-free 1.25-s epochs with frontally, parietally and approximately equally distributed spindles were marked visually in 10 normal healthy subjects aged 20-35years. As a control condition, artifact-free non-spindle epochs 1-3s before or after the corresponding spindle episodes were marked. Low-resolution electromagnetic tomography demonstrated, independent of the scalp distribution, a distributed spindle source in the prefrontal cortex (Brodmann areas 9 and 10), oscillating with a frequency below 13Hz, and in the precuneus (Brodmann area 7), oscillating with a frequency above 13Hz. In extremely rare cases only the prefrontal or the parietal source was active. Brodmann areas 9 and 10 have principal connections to the dorsomedial thalamic nucleus; Brodmann area 7 is connected to the lateroposterior, laterodorsal and rostral intralaminar centrolateral thalamic nuclei. Thus, the localized cortical brain regions are directly connected with adjacent parts of the dorsal thalamus, where sleep spindles are generated. The results demonstrated simultaneously active cortical spindle sources which differed in frequency by approximately 2Hz and were located in brain regions known to be critically involved in the processing of sensory input, which is in line with the assumed functional role of sleep spindles.

Adult↗
PubMed2001

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD): acute placebo-controlled sleep laboratory studies with clonazepam.

Restless legs syndrome (RLS) - a common sensorimotor disorder - and periodic limb movement disorder (PLMD) are currently treated with substances of four classes: dopaminergic agents, which are considered the drugs of choice, benzodiazepines, opioids and anticonvulsants. As their effects on sleep variables differ considerably, the aim of the present placebo-controlled sleep laboratory study was to measure the acute effects of 1 mg clonazepam on objective and subjective sleep and awakening quality in ten RLS and 16 PLMD patients, utilizing polysomnography (PSG) and psychometry. Descriptive data analysis demonstrated at the confirmatory level concerning three target variables that - as compared with placebo - clonazepam significantly improved objective sleep efficiency and subjective sleep quality in both patient groups, but failed to reduce the index PLM/h of sleep. At the descriptive level, in PLMD clonazepam improved PLM during time in bed, REM and wakefulness and showed more significant changes in various sleep and awakening measures than in RLS patients, though there were no significant inter-group differences. In conclusion, in both PLMD and RLS clonazepam exhibited acute therapeutic efficacy regarding insomnia, which is quite different from the mode of action of dopamine agonists.

Adult↗
PubMed2001

Depression and quality of life in multiple sclerosis.

OBJECTIVES: Health related quality of life (QoL) has gained increasing influence as a relevant evaluation criterion in multiple sclerosis. The high prevalence of psychiatric comorbidity in MS is, however, hardly ever considered in studies concerning QoL. MATERIALS AND METHODS: In 60 patients of a MS outpatient clinic, symptoms of anxiety (Zung Anxiety Scale) and depression (Zung Depression Scale), as well as the health-related quality of life were rated and set into relation to the EDSS and to the duration of illness, respectively. RESULTS: There was a highly significant correlation between depression as well as anxiety and the self-assessed quality of life. Depression was the by far strongest predictor for reduced QoL. CONCLUSION: Clinical studies, which seek to register the increasingly important evaluation criterion of health-related quality of life in MS, should consider the prevalence of depressive disorders and the decisive effect of depression on the self-assessed quality of life of affected patients.

Adult↗
PubMed2001

Double-blind, placebo-controlled psychometric studies on the effects of a combined estrogen-progestin regimen versus estrogen alone on performance, mood and personality of menopausal syndrome patients.

The influence of a combined estrogen-progestin regimen (Climodien) on noopsyche, thymopsyche, personality and psychophysiological measures of menopausal syndrome patients was investigated in a double-blind, placebo-controlled, comparative, randomized 3-arm trial phase (Climodien 2/3 = estradiol valerate (CAS 979-32-8) 2 mg + the progestin dienogest (CAS 65928-58-7) 3 mg = regimen A, estradiol valerate 2 mg = regimen EV, and placebo = regimen P) followed by an open-label phase in which all patients received Climodien 2/2 (estradiol valerate 2 mg + dienogest 2 mg) = regimen A*. 49 women (16, 17, 16 valid patients per arm) aged between 46 and 67 years (mean 58, 58, 56 years, respectively) with the diagnoses of insomnia (G 47.0) related to postmenopausal syndrome (N 95.1) were included in the analysis of the double-blind phase. Both the double-blind and the open-label phase lasted 2 months. Noopsychic investigations demonstrated an improvement in associative verbal memory after 2 months of regimen A, which was significant as compared with both baseline and placebo. Regarding visual memory, regimen A* induced an improvement, which was significantly different from the decline in correct reproductions in the Benton Test observed under estradiol. Errors in the Benton Test decreased significantly after regimen A* as compared with regimen EV. These findings suggest that hormone replacement therapy with estradiol, and even more in combination with dienogest, improves verbal and visual memory, which is in line with the improvement in information processing speed and capacity objectified by event-related potentials (ERP). Thymopsychic investigations demonstrated a significant improvement in somatic complaints and trait anxiety after both regimen A and regimen EV as compared with baseline. State anxiety decreased significantly under regimen A* as compared with EV. The Freiburger Personality Inventory showed an improvement in aggressivity after regimen A* as compared with the preceding placebo as well as an improvement in striving after dominancy after both regimen A and regimen EV as compared with pre-treatment, but also after regimen A* as compared with regimen EV. Extraversion increased after 2 months of regimen A as compared to regimen P. Psychophysiological findings including pupillary and skin conductance variables were not significant.

Affect↗
PubMed2001

Relationship between depression, anxiety and quality of life: a study of stroke patients compared to chronic low back pain and myocardial ischemia patients.

The prevalence of anxiety disorders and depression is assessed as between 20 and 50% following stroke. Depressive persons tend to give their overall life situation a worse rating than their relatives or physicians because of negative cognitions. Nevertheless, research concerning Quality of Life (QoL) after stroke hardly ever takes into account the methodological bias of assessing QoL only by self-rating. The aim of this study was to point out the important relationship between depression, anxiety and the autoassessment of QoL. QoL was markedly affected in the poststroke patients and in the chronic low back pain and myocardial ischemia patients, and it was rated worst by the most seriously depressed subjects. Clinical studies focusing on the ever more significant evaluation criterion 'health-related QoL' after stroke should take into account the high prevalence of anxiety and depressive symptoms and their major influence on the patients' self-evaluated QoL.

Anxiety Disorders↗
PubMed2001

Insomnia related to dysthymia: polysomnographic and psychometric comparison with normal controls and acute therapeutic trials with trazodone.

Utilizing polysomnography (PSG) and psychometry, objective and subjective sleep and awakening quality was investigated in 11 patients (mean age 50 +/- 14) with nonorganic insomnia (F 51.0) related to dysthymia (F 34.1) as compared with 11 age- and sex-matched normal controls. Patients demonstrated decreased sleep efficiency and sleep stage S2 as well as increased sleep latency to S1, S2 and S3, wakefulness within the total sleep period, number of awakenings, S1 and REM sleep. There was no intergroup difference in REM latency. Subjective sleep quality and the total score of the Self-Assessment Scale for Sleep and Awakening Quality (SSA) were deteriorated as were evening and morning well-being, mood, affectivity and drowsiness. Noopsychic measures showed deteriorated numerical memory, fine motor activity and reaction time variability. In a placebo-controlled crossover design study, the acute effects of 100 mg trazodone, a serotonin reuptake inhibitor with a sedative action due to 5HT(2) and alpha(1) receptor blockade, were investigated in the patients. As compared with placebo, trazodone induced an increase in slow-wave sleep (S3 + 4), a lengthening of REM latency, a decrease in REM sleep and a normalization of the periodic leg movement (PLM) index. In the morning, there was a minimal increase in somatic complaints and a decrease in critical flicker frequency and systolic blood pressure. In conclusion, our study demonstrated that dysthymia induced significant changes in objective and subjective sleep and awakening quality, which were counteracted by 100 mg trazodone, thus suggesting a key-lock principle in the treatment of nonorganic insomnia related to dysthymia with this drug.

Adult↗
PubMed2000

Paclitaxel does not cause central nervous adverse effects: a prospective vigilance-controlled EEG mapping study in ovarian cancer patients.

BACKGROUND: The objective of this study was to evaluate potential adverse effects of paclitaxel-containing chemotherapy on the central nervous system in women with ovarian cancer. METHODS: Twenty-eight women with histologically confirmed epithelial ovarian carcinoma and treated with combination chemotherapy consisting of paclitaxel and carboplatin were entered into the study. Patients were tested with vigilance-controlled EEG before and after chemotherapy. Additionally, a battery of neuropsychologic tests before, after 3 cycles and at the end of the chemotherapy were performed. RESULTS: Twenty of the 28 patients responded to chemotherapy (71%). Eleven patients (39%) developed peripheral neurotoxicity. A reduced vigilance in patients with ovarian cancer prior to chemotherapy compared to healthy controls was observed (clearly demonstrated by an attenuated total power, a decrease in fast alpha and slow beta activity, an increase in delta and theta activity as well as a deceleration of the centroid of the total power spectrum). On the other hand, an improved vigilance in patients with ovarian cancer treated with paclitaxel/carboplatin was observed (demonstrated by an increase in total power and an increase in beta power, being more pronounced in the right than in the left hemisphere, between pre- and post-treatment). The results of EEG mapping concurred with those of psychometric tests. The test results did not deteriorate during chemotherapy. A statistically significant improvement in the alphabetical crossout test from the first to the third measurement was observed, indicating an improvement in short-term attention, concentration and the constancy of work during chemotherapy. CONCLUSIONS: Combination chemotherapy consisting of paclitaxel and carboplatin does not cause encephalopathy, but a trend towards an improved vigilance and an improvement of short-term attention and concentration was observed in patients with ovarian cancer after chemotherapy.

Adult↗
PubMed2000

Effect of the 5-HT(1A) partial agonist buspirone on regional brain electrical activity in man: a functional neuroimaging study using low-resolution electromagnetic tomography (LORETA).

In a double-blind, placebo-controlled study, the effects of 20 mg buspirone - a 5-HT(1A) partial agonist - on regional electrical generators within the human brain were investigated utilizing three-dimensional EEG tomography. Nineteen-channel vigilance-controlled EEG recordings were carried out in 20 healthy subjects before and 1, 2, 4, 6 and 8 h after drug intake. Low-resolution electromagnetic tomography (LORETA; Key Institute for Brain-Mind Research, software: http://www.keyinst.unizh.ch) was computed from spectrally analyzed EEG data, and differences between drug- and placebo-induced changes were displayed as statistical parametric maps. Data were registered to the Talairach-Tournoux human brain atlas available as a digitized MRI (McConnell Brain Imaging Centre: http://www.bic.mni.mcgill.ca). At the pharmacodynamic peak (1st hour), buspirone increased theta and decreased fast alpha and beta sources. Areas of theta increase were mainly the left temporo-occipito-parietal and left prefrontal cortices, which is consistent with PET studies on buspirone-induced decreases in regional cerebral blood flow and fenfluramine-induced serotonin activation demonstrated by changes in regional cerebral glucose metabolism. In later hours (8th hour) with lower buspirone plasma levels, delta, theta, slow alpha and fast beta decreased, predominantly in the prefrontal and anterior limbic lobe. Whereas the results of the 1st hour speak for a slight CNS sedation (more in the sense of relaxation), those obtained in the 8th hour indicate activation. Thus, LORETA may provide useful and direct information on drug-induced changes in central nervous system function in man.

Adult↗
PubMed2000

[Daytime tiredness correlated with nocturnal respiratory and arousal variables in patients with sleep apnea: polysomnographic and EEG mapping studies].

There is evidence that daytime tiredness is caused by apnea/hypopnea with oxygen desaturation and/or by sleep fragmentation due to arousals. The aim of this study was to investigate objective and subjective sleep and awakening quality and daytime vigilance--objectified by midmorning mapping of vigilance-controlled EEG (V-EEG)--in sleep apnea patients (N: 18), as compared with age- and sex-matched normal controls (N: 18) as well as to correlate nocturnal respiratory distress and arousals to daytime brain function. Statistical analyses demonstrated a deterioration in subjective and objective sleep and awakening quality in apnea patients. Midmorning V-EEG mapping in apnea patients exhibited less total power, more delta and theta, less alpha and beta activity, as well as a slower dominant frequency and centroid of the total activity compared to controls, which suggests a vigilance decrement. The Spearman rank correlation between 6 polysomnographically registered respiratory variables and 36 diurnal quantitative EEG measures demonstrated the following: the higher the apnea, apnea-hypopnea, snoring and desaturation indices and the lower the minimum and average low oxygen saturation, the more pronounced was diurnal tiredness. Eleven arousal measures based on ASDA criteria showed the following significant correlations: the higher the nocturnal arousal index and the more arousals due to hypopneas, the greater was daytime tiredness. On the other hand, the greater the average frequency change during arousals and the more spontaneous arousals, the better was daytime vigilance. Our findings show that, in contrast to the lengthy Multiple Sleep Latency (MSLT) and Maintenance of Wakefulness (MWT) tests which evaluate sleep pressure under resting conditions conducive to sleep, V-EEG mapping provides a brief objective measure of a sleep apnea patient's daytime tiredness under conditions of wakefulness more appropriate to reflect the patient's everyday life.

Adult↗
PubMed2000

Decrease of vigilance assessed by EEG-mapping in type I diabetic patients with history of recurrent severe hypoglycaemia.

In Type I diabetic patients with history of recurrent severe hypoglycaemia, a more rapid decrease in vigilance (slowing of brain function) during hypoglycaemia in comparison to patients without history of such events was found. Our aims were: (1) to study EEG parameters of vigilance in non-hypoglycaemic state in representative groups of Type I diabetic patients with and without previous recurrent severe hypoglycaemia; and (2) to compare them with non-diabetic controls. A vigilance-controlled EEG mapping (10-20 system, significance probability maps) was performed in a non-hypoglycaemic state (blood glucose 4.0-10.0 mmol/l) in a group of 13 Type I diabetic patients with a history of recurrent severe hypoglycaemia and compared to that of 14 Type I diabetic patients without history of severe hypoglycaemia, matched for HbA1c, age and gender, and to age- and gender-matched non-diabetic controls. When compared to non-diabetic controls, hypoglycaemia patients demonstrated a reduction in absolute power in beta band (13-35 Hz) and slowing of centroid frequencies of beta and total frequency bands (1.3-35 Hz) (up to P < 0.01), whereas patients without history of severe hypoglycaemia showed only a borderline reduction of absolute power in delta (1.3-3.5 Hz) band. Deceleration in hypoglycaemia patients versus those without recurrent hypoglycaemia was most remarkable (P < .01) in centroid frequency of total frequency band. Patients with history of recurrent severe hypoglycaemia demonstrated in non-hypoglycaemic state significantly reduced vigilance when compared to the group without hypoglycaemia history and to the controls, as well. Lower vigilance may be at least in part responsible for impaired hypoglycaemia perception in these patients, but, as it resembles EEG patterns seen in pathologic ageing, it might also represent a consequence of recurrent episodes of severe hypoglycaemia.

Adult↗
PubMed2000

Sleep and quality of life in the Austrian population.

PURPOSE: To compare the self-reported estimation of sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) and life quality assessed by the Quality of Life Index (QLI). BACKGROUND: The PSQI comprised 19 questions and assessed a wide variety of factors relating to sleep quality. The QLI consisted of 10 items for self assessment of different dimensions of life quality. SUBJECTS: A representative Austrian sample (n = 1049) aged above 15 years. PROCEDURE: Interviews in the homes of the participants. RESULTS: 32.1% could be classified as poor sleepers (37% females, 26.5% males). Sleep quality decreased with increasing age, especially in women. Overall quality of life was highest in younger (15-29 years) and lowest in elderly subjects (over 50 years). Life quality decreased with increasing age. Between subjective sleep quality and quality of life a moderate, significant correlation was found (r2= 0.6721). CONCLUSIONS: Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).

Adolescent↗
PubMed2000

Placebo-controlled sleep laboratory studies on the acute effects of zolpidem on objective and subjective sleep and awakening quality in nonorganic insomnia related to neurotic and stress-related disorder.

UNLABELLED: Recent investigations in our sleep outpatient clinic demonstrated that 30% of patients exhibited organic and 70% nonorganic sleep disorders, with 41% showing as an additional diagnosis neurotic, stress-related, and somatoform disorders, 31% affective disorders and 15% mental and behavioral disorders due to psychoactive substance use. Thus, the aim of the study was to investigate the acute effects of the imidazopyridine zolpidem on objective and subjective sleep and awakening quality in the largest of the above-mentioned groups. In this single-blind, placebo-controlled cross-over study, 15 patients (9 females and 6 males aged 51.1 + 11. 3 years) diagnosed as having nonorganic insomnia (ICD-10: F 51.0) related to neurotic and stress-related disorders (F 1.1:12, F 41.2:2 and F 43.2:1) were included. Objective and subjective sleep and awakening quality measures were investigated in 3 subsequent nights in the sleep laboratory (adaptation, baseline/placebo and zolpidem 10 mg night), utilizing clinical, polysomnographic, psychometric and psychophysiological methods. The drug-free patients were matched according to age and sex with 15 normal healthy controls (age 51.2 + 11.8 years). Statistical analysis of polysomnographic variables demonstrated a significant lengthening of the total sleep period (TSP) and total sleep time (TST), an improvement in sleep efficiency and a shortening of sleep latencies after zolpidem as compared with placebo. These changes were opposite to the differences between patients and controls. Concerning sleep architecture, zolpidem increased the length of S4 and S3 + S4 as compared with placebo. Subjective sleep and awakening quality and the thymopsychic variables drive, mood, affectivity and wakefulness in the morning showed no significant changes, as a significant improvement had already occurred from the adaptation to the baseline/placebo night. Noopsychic variables (attention, concentration, attention variability, numerical memory, fine motor activity, reaction time measures) showed similar findings. Moreover, subjective sleep and awakening quality, thymopsychic and noopsychic measures during baseline/placebo recordings did not differ significantly from normative data (except for fine motor activity). Psychophysiological measures did not show any significant alterations either, except for a decrease in systolic blood pressure in the evening. CONCLUSION: As compared with placebo, zolpidem induced a significant improvement in objective sleep quality, mainly by increasing TSP, TST and sleep efficiency and shortening sleep latencies, thereby normalizing the disorder of initiating and maintaining sleep. Deep sleep stages S3 + S4 increased (although at baseline/placebo these stages did not differ from controls), while S1, S2 and SREM did not change significantly. Subjective sleep and awakening quality as well as thymopsychic and noopsychic performance in the morning mainly showed a placebo and 'first- night effect' phenomenon in these patients. Thus, the changes induced by zolpidem were somewhat different from those after classical benzodiazepines.

Cross-Over Studies↗