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R Schwarz

Publications and source records attributed to R Schwarz.

At least 37 records · Page 2Linked to original sources
PubMed2002

A new rapid landmark-based regional MRI segmentation method of the brain.

BACKGROUND: Neurodegenerative and cerebrovascular diseases show a distinct distribution of regional atrophy and subcortical lesions. OBJECTIVE: To develop an easily applicable landmark-based method for segmentation of the brain into the four cerebral lobes from MRI images. METHOD: The segmentation method relies on a combination of anatomical landmarks and geometrical definitions. It is applied on the surface reconstruction of the MRI volume. The internal borders between the lobes are defined on the axial slices of the brain. The reliability of this method was determined from MRI scans of 10 subjects. To illustrate the use of the method, it was applied to MRI scans of an independent group of 10 healthy elderly subjects and 10 patients with vascular dementia to determine the regional distribution of white matter hyperintensities (WMH). RESULTS: The intra-rater relative error (and intra-class correlation coefficient) of the lobe segmentation ranged from 1.6% to 6.9% (from 0.91 to 0.99). The inter-rater relative error (and intra-class correlation coefficient) ranged from 1.4% to 5.2% (from 0.96 to 0.99). Density of WMH was significantly higher in all four lobes in VD patients compared to controls (p<0.05). Within each group, WMH density was significantly higher in frontal and parietal than in temporal and occipital lobes (p<0.05). CONCLUSION: This landmark based method can accommodate age and disease-related changes in brain morphology. It may be particularly useful for the study of neurodegenerative and cerebrovascular disease and for the validation of template-based automated techniques.

Aged↗
PubMed2002

Complaints of the ageing male based on a representative community study.

OBJECTIVES: To determine (a) the relationship between physical and somatoform complaints, distress and life satisfaction and ageing in the male community and (b) their psychosocial determinants. METHODS: Two stratified random samples of the German male population (total of 2,182 men) were investigated by standardised questionnaires of complaints (MFI-20, GBB), distress (HADS) and life satisfaction. RESULTS: When participants were grouped into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, >70 years), we found a continuous increase of physical, mental and general fatigue, and a reduced activity and motivation associated with age. Exhaustion, cardiovascular and musculoskeletal complaints also increased. This was accompanied by a reduced health satisfaction and increased depression scores. Marked increases of certain complaints occurred in specific age groups. CONCLUSIONS: Community data provide important reference points in evaluating the ageing male. Based on regression analyses we could also demonstrate the contribution of psychosocial vulnerability and protective factors to the development of age-related symptoms.

Activities of Daily Living↗
PubMed2002

Alcohol dependence and gender-role orientation.

OBJECTIVE: The overall increase of female alcoholism is supposed to be associated with the change of the traditional female role, and it is especially seen as a consequence of role convergence or gender-role conflicts. The aim of the present pilot study is to explore whether the approach of gender-role orientation would be empirically useful in contributing to these hypotheses. METHOD: One hundred twelve patients with alcohol dependence meeting DSM-III-R criteria were explored after detoxification; gender-role orientation was measured by a German version of the "Extended Personal Attributes Questionnaire", categorising gender-role orientation into four subgroups: masculine, feminine, androgynous, and undifferentiated. RESULTS: In comparison with a population-based sample, there are significant differences in the distribution of the four subgroups of gender-role orientation, showing a predominance of the undifferentiated self-concept in the alcoholic sample (49%). Alcoholic females describe themselves as rather undifferentiated, and rather feminine than masculine. Low masculinity and low femininity, as well as high femininity, correlate positively with distress, depressiveness, social anxiety, insecurity and concomitant personality disorders. CONCLUSION: Our data do not support the convergence hypothesis related to gender-role orientation, but support the traditional feminine self-concept as an unspecific risk factor for vulnerability. The question whether an undifferentiated self-concept could be a specific risk factor for alcoholism is discussed.

Adult↗
PubMed2002

Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years.

OBJECTIVE: The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined. METHOD: A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years. RESULTS: Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders. CONCLUSION: Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients.

Adult↗
PubMed2002

[Psychosocial aftercare of patients with endometrial or cervical cancer].

INTRODUCTION: Research in psychooncology focuses primarily on the impact of cancer, less on psychosocial causes of cancer. Recent tendencies in clinical practice are shown. PSYCHOSOCIAL PROBLEMS: Original papers show that anxiety, depression, postmenopausal symptoms, fatigue, sexuell issues, relationship and family become important problem areas for the patients. Anxiety and depression are independent of the state of the disease but, instead, depend on the extension of treatment. For unmarried single women sexual issues become a problem earlier whereas the problem develops later for married women. Women with cervical carcinoma are more affected than others. INTERVENTION: There is a high need for psychosocial counselling which is not considered enough in the daily clinical practice. Psychosocial aftercare is, regardless to different focuses, the task of the entire team. Good precare is just as important as good aftercare to reduce anxiety, pain and increase well-being. Addressing information and support in a timely fashion is important in providing success to psychosocial aftercare.

Adaptation, Psychological↗
PubMed2001

Alloreactivity of natural killer cells in allogeneic liver transplantation.

BACKGROUND: The cytolytic attack of natural killer (NK) cells is blocked by recognition of the idiotypic phenotype of certain polymorphisms in HLA class I molecules, specifically by HLA-C alleles (Asn77, Lys80 or Ser77, Asn80) or HLA-Bw4 allotypes. Because liver allograft rejection is associated closer with mismatch in HLA class I than class II, we investigated the role of NK cells in acute hepatic allograft rejection in vivo/in vitro. METHODS: The HLA pattern was typed with serological and polymerase chain reaction (PCR) techniques. In 31 liver transplantations, mononuclear cells from donor spleen and peripheral blood of recipients (before/after transplantation) were cultured in mixed lymphocyte cultures (MLC). MLC-derived effector cells were analyzed by flow cytometry and tested in 51Cr-release assays. RESULTS: Patients with NK allospecific constellations tended to have higher numbers of NK cells in peripheral blood during the first 4 weeks after transplantation, and patients' lymphocytes stimulated with donor cells had a significantly higher cytotoxic activity on days 14 and 21 compared with patients without NK allospecificity. However, acute rejection occurred with similar frequency in both groups (31% with allospecific constellations vs. 40% without). Moreover, acute rejection episodes were not associated with an increase in NK cells in vivo or enhanced cytotoxicity of NK cells to donor target cells. CONCLUSIONS: Under standard immunosuppressive therapy, NK allospecific constellations did not seem play a major role in acute hepatic allograft rejection. Strategies to prevent or treat NK allospecific constellations after liver transplantation are not likely to reduce the incidence or severity of acute allograft rejection.

Acute Disease↗
PubMed2001

[Anxiety and depression in the general population over 60 years old].

BACKGROUND: Anxiety and depression lead to extensive utilization of the health service. Frequency and extent of symptoms of anxiety and depression were assessed in the elderly general population. PARTICIPANTS AND METHOD: In a random community sample of 622 elderly persons aged above 60 years (mean age 69.55 years; 56.1% women), the frequency of anxiety and depression was assessed by means of the Hospital Anxiety and Depression Scale. RESULTS: Probable anxiety was found in 7.6% of the elderly, probable depression in 27.5%. Negative affectivity (based on the total scale) was found in 31.7% of the elderly. Self-reported anxiety and depression symptoms correlated to a considerable extent (r = 0.69). There were higher rates of probable anxiety and depression in women than in men. However, a significant effect of the sex on anxiety and depression scores was not found. There was a significant effect of age, with higher depression rates with increasing age. Anxiety and depression correlate significantly positively with the fatigue syndrome and with subjective bodily complaints and significantly negatively with different aspects of quality of life. CONCLUSIONS: Physical complaints in the elderly cannot be directly traced back to age-correlated multimorbidity. Rather, elderly persons with nonspecific bodily complaints and fatigue should also be screened for anxiety and depression.

Age Factors↗
PubMed2001

Observation of high-energy neutrinos using Cerenkov detectors embedded deep in Antarctic ice.

Neutrinos are elementary particles that carry no electric charge and have little mass. As they interact only weakly with other particles, they can penetrate enormous amounts of matter, and therefore have the potential to directly convey astrophysical information from the edge of the Universe and from deep inside the most cataclysmic high-energy regions. The neutrino's great penetrating power, however, also makes this particle difficult to detect. Underground detectors have observed low-energy neutrinos from the Sun and a nearby supernova, as well as neutrinos generated in the Earth's atmosphere. But the very low fluxes of high-energy neutrinos from cosmic sources can be observed only by much larger, expandable detectors in, for example, deep water or ice. Here we report the detection of upwardly propagating atmospheric neutrinos by the ice-based Antarctic muon and neutrino detector array (AMANDA). These results establish a technology with which to build a kilometre-scale neutrino observatory necessary for astrophysical observations.

Journal Article↗
PubMed2001

Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population.

The objective of this study was to obtain age- and sex-specific reference values for the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30. A randomly selected sample of the German adult population (3015 subjects) was used, 2081 subjects agreed to take part in the investigation. Most of the scales and symptom items of the questionnaire proved to be dependent on age and sex. Men reported fewer symptoms than women. Age differences were even more pronounced. Younger people reported better functioning and fewer symptoms. Compared with the results of a similar Norwegian study (Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Health related quality of life in the general Norwegian population assessed by the European Organization for research and treatment of cancer core quality-of-life questionnaire: The QLQ-C30(+3). J Clin Oncol 1998, 16, 1188-1196) the prevalence of some symptoms was markedly less. Norm values for age and sex groups are given and regression analyses are performed which help to calculate expected mean scores. The results show that age and sex differences must be taken into consideration when different groups of cancer patients are compared. The norm values help to interpret quality of life data for clinicians.

Adolescent↗
PubMed2001

Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments.

OBJECTIVE: We investigated whether alcoholic patients with comorbid personality disorders and those with cognitive impairments would benefit in a different way from different behaviour therapy strategies. METHOD: After detoxification, 120 alcoholics were assigned randomly to one of three out-patient treatment programmes comprising 'coping skills training', 'cognitive behaviour therapy' or unspecific supportive control therapy. Personality disorders and cognitive impairments were assessed at the beginning of the 6-month treatment period. RESULTS: The impact of concomitant personality disorders or cognitive impairments was generally only moderate and mainly independent from treatment condition. However, alcoholic patients relapsing within 6 months after detoxification showed a higher rate of personality disorders (especially antisocial and borderline) and slightly more cognitive deficits (especially in verbal memory and visuomotor functions) than abstainers even before therapy. CONCLUSION: The high amount of early relapses and drop-outs probably hindered larger differentiated treatment effects. Hypotheses will be retested in treatment completers using forthcoming follow-up data.

Alcoholism↗
PubMed2001

Out-patient behaviour therapy in alcoholism: relapse rates after 6 months.

OBJECTIVE: In spite of the increasing interest in out-patient treatment programmes for alcoholics, there still exist only a few experimental studies on this issue. In this still ongoing study the efficacy of different behaviour therapy strategies is to be examined. METHOD: One hundred and twenty patients were assigned randomly to non-specific supportive therapy or to two forms of behavioural therapy (coping skills training and cognitive therapy). Behavioural treatment comprised 26 weekly sessions; follow-up examinations will take place every 6 months over 2 years. RESULTS: Patients undergoing behavioural therapy showed less drop-outs and significantly higher rates of abstinence compared with supportive treatment. Nevertheless, statistically significant differences between the two behavioural therapy strategies could not be established so far. CONCLUSION: Preliminary results demonstrate the feasibility and efficacy of behaviour therapy programmes in the out-patient treatment of alcoholism. Furthermore, they stress the importance of professional psychiatric and psychotherapeutic engagement in the field of addiction.

Adult↗
PubMed2001

The impact of high pressure vs low pressure stent implantation on intimal hyperplasia and follow-up lumen dimensions; results of a randomized trial.

AIMS: Histology and retrospective clinical studies have indicated that the amount of neointimal hyperplasia is dependent on the arterial injury induced during stent implantation. This study analysed, prospectively, the impact of high vs low pressure stent implantation techniques using a second generation stent on intimal hyperplasia and follow-up lumen dimensions. METHODS AND RESULTS: Post-intervention and follow-up (mean[+/-SD] 5.5+/-1.3 months) angiographic and intravascular ultrasound studies were performed on 120 Multi-Link HP stents randomized to implantation at either low (8-10 atm) or high (16-20 atm) pressure. Intravascular ultrasound measurements of the external elastic membrane, stent, and lumen cross-sectional area were performed at 1 mm axial increments. Peri-stent plaque+media cross-sectional area (external elastic membrane-stent cross-sectional area, intimal hyperplasia cross-sectional area (stent-lumen cross-sectional area at follow-up), intimal hyperplasia thickness and peri-stent tissue growth cross-sectional area (Deltapersistent plaque+media cross-sectional area) were calculated. Intravascular ultrasound demonstrated a larger minimal lumen cross-sectional area post-intervention in the high pressure group (7.3+/-2.0 vs 6.2+/-1.8 mm(2), P<0.001, high vs low pressure group, respectively). At follow-up, the mean intimal hyperplasia cross-sectional area (1.7+/-0.9 vs 1.5+/-0.8 mm(2), P=0.708), the mean intimal hyperplasia thickness (0.16+/-0.12 vs 0.16+/-0.12 mm, P=0.818) and peri-stent tissue proliferation cross-sectional area were not greater in the high pressure group. Thus, the minimal lumen cross-sectional area at follow-up continued to be greater (5.5+/-2.0 vs 4.7+/-1.7 mm(2), P=0.038) in the high pressure group. CONCLUSIONS: High pressure stent implantation results in greater stent expansion even with the less rigid second generation Multi-Link stent. Larger lumen dimensions persist at follow-up, while intimal hyperplasia is not significantly greater after high pressure implantation compared to the low pressure technique.

Coronary Angiography↗
PubMed2001

[Anxiety and depression in the general population: normal values in the Hospital Anxiety and Depression Scale].

For the Hospital Anxiety and Depression Scale (HADS) psychometric properties were tested and standardised values were calculated on the basis of a representative sample of the German adult population with 2037 persons. The main result was the evidence of age and gender differences for anxiety and depression. Females were more anxious than males. For both dimensions of the HADS a nearly linear age dependency was found which was more pronounced for depression (r = 0.36) than for anxiety (r = 0.14). Standardised values are given for different age and gender groups, and the results of regression analyses are presented. The psychometric properties were satisfying or good, the two-dimensional factorial structure could be replicated. By means of the standardised values and regression coefficients it is now possible to compare patient groups of different age and gender distributions with the general population.

Adolescent↗
PubMed2001

[Outpatient behavioural treatment in alcoholism: alcohol consumption and sociodemographic factors].

In spite of the increasing interest in outpatient treatment programmes for alcohol dependents, there still exist only a few experimental studies on this issue. Moreover, the interaction between abstinence and sociodemographic factors has been only rarely explored. In this study, the efficiency of different behaviour therapy strategies was examined: 120 patients were randomly assigned to nonspecific supportive therapy or to 2 forms of behavioural therapy (coping skills training and cognitive therapy). Behavioural treatment comprised 26 weekly sessions; follow-up examinations took place every 6 months over 2 years. Patients undergoing behavioural therapy showed less drop outs and significantly higher rates of abstinence and also of reemployment and satisfaction with their job situation compared to those under supportive treatment. At the same time, the employment status proved to be a valid predictor of treatment success, whereas there was only a weak (negative) impact of an existing partnership on abstinence. Statistically significant differences between the 2 behavioural therapy strategies could be established in neither respect.

Adult↗