Understanding the linkage between slow paced breathing (SPB), slow cortical potentials (SCP) and the human consciousness could help to improve practicing strategies in the field of mental well-being. Providing 25 individuals performing two different breathing cycles (6 s—cycle and 10 s—cycle), which were accompanied by the sound of a humming gong, while measuring a 64-channel EEG, our study provides an insight into the relationship between SPB and SCPs. More importantly, it points out the greater impact of the 10 s—cycle on SCPs than the 6 s—cycle. Breathing with a frequency of 0.1 Hz led to an increased SCP-amplitude ratio as well as to a synchronization of SCPs with the breathing rhythm. Also, non-SCP frequencies were considered. Here, the 10 s—cycle showed the increased appearance of delta (ES_t = 3.52), theta (ES_t = 4.11), and alpha 1 (ES_t = 3.47) frequencies, especially in the occipital and central parietal regions. Moreover, subjectively, the SPB intervention has been rated to evoke an increased feeling of “integrity” and “balance” as well as a slightly increased feeling of “vitality”. Demonstrating the relation between SPB, SCPs, and subjective mental feeling, this study contributes to emphasizing the importance of SPB in mental health.

Zusammenfassung Das Post-COVID-Syndrom (PCS) ist weit mehr als anhaltende Erschöpfung (ME/CFS). Hinter Lärm- und Lichtempfindlichkeit, kognitiven Einschränkungen (Brainfog) und Belastungsintoleranz könnte sich auch eine tiefgreifende Störung des inneren Körpersinns, der Propriozeption, verbergen. Ein integrativer therapeutischer Ansatz mit Elementen aus der funktionellen Entspannung eröffnet neue Perspektiven für Stabilisierung und Selbstwirksamkeit.

Introduction: Post-COVID syndrome (PCS) can lead to severe restrictions in the ability to work and participate in society and can lead to the development of depressive symptoms. The aim of this study was to investigate how many PCS patients suffer from clinically relevant depressive symptoms and to what extent PCS rehabilitation can modulate psychological symptoms as well as limitations in functional health. Methods: Prospective multicenter cohort study PoCoRe (N = 1,028). Assessment of depressiveness (PHQ-9, PHQ-2), fatigue (FSMC) and functional health and disability (WHO-DAS2.0). Frequency analyses, mean comparisons. Results: At the start of rehabilitation, 71.4% (n = 734) fulfilled the core symptoms of depressive disorders in general in the PHQ-2. In the screening-positive patients, the PHQ-9 total score was on average M = 23.74 (standard deviation = 4.43). As expected the depressive symptom burden was reduced more in depressed PCS patients (d = 0.50) than in nondepressed PCS patients (d = 0.32). Fatigue symptoms did not change. Functional health (WHO-DAS) improved above all in coping with everyday life (d = 0.71, or 1.04), and in the nondepressed patients also in mobility (d = 0.27). In the sociomedical assessment, 24.7% of the total samples were assessed as having an impaired capacity for the reference occupation and 19.5% as having an impaired capacity for the general labor market. Depressive patients had the worse sociomedical outcome. Conclusion: Depressiveness is common and can be well influenced by PCS rehabilitation. Fatigue is less easily influenced, which indicates that they are independent symptoms. Patients with persistent depression and fatigue have a poorer sociomedical prognosis.

Aims Fracture-related infections (FRIs) are a major concern for patients and healthcare systems, yet their impact on mental health has been largely overlooked. This study aimed to assess the longitudinal impact of FRI on patients’ quality of life. Methods A prospective study was conducted at a level 1 trauma centre between January 2020 and December 2022. In total, 56 patients participated, with quality of life assessed at five timepoints: one week preoperatively, and one, three, six, and 12 months postoperatively. Statistical analysis was performed using repeated measures analysis of variance (ANOVA) with adjusted post-hoc analysis. Results The preoperative Physical Component Summary score on the 36-Item Short-Form Health Survey questionnaire (SF-36) was 26.71, increasing to 30.40 at one month, remaining stable at three months. A modest increase was observed at six months (32.45, p = 0.003), but it decreased to 29.72 at 12 months. The preoperative Mental Component Summary score (SF-36) was 46.48, decreasing to 39.89 at one month (p = 0.027) and to 36.03 at three months (p ≤ 0.001). However, it improved at six (42.74) and 12 months (44.05). Positive changes were seen in EuroQol five-dimension questionnaire (EQ-5D) subdimensions, such as mobility, self-care, usual activities, and pain/discomfort, while anxiety/depression scores decreased over time. The EQ-5D visual analogue scale (VAS) score increased to 62.79 at six months (p ≤ 0.001) and decreased to 58.2 at 12 months (p = 0.011). Conclusion FRIs substantially affect mental health and quality of life, particularly during the initial three months of treatment. This study emphasizes the importance of addressing psychological aspects early in FRI management, advocating for holistic care encompassing both physical and psychological aspects of treatment. Cite this article: Bone Joint Res 2025;14(2):136–142.

Purpose The most common symptoms of PCS are persistent fatigue and cognitive impairment, which significantly affect participation in work and daily life. There is increasing evidence for the effectiveness of rehabilitative treatment approaches. Nevertheless, voices are being raised, especially in the social media, that negatively evaluate rehabilitation for PCS. The aim of this study was to objectify the subjective success of treatment and the satisfaction of inpatients with PCS with the rehabilitation. Methods As part of a prospective multicentre cohort study (n=1028), the subjective treatment success and patient satisfaction (ZUF-8) at the end of PCS rehabilitation were examined (PCS rehabilitation indications: Dual rehabilitation, psychosomatics, neurology and pneumology). Frequency analyses, mean value comparisons, correlation analyses and regression models were used. Results The subjective success of treatment was rated as good to very good across all PCS rehabilitation indications. Approximately 62% of PCS patients experienced improvement in physical symptoms, about 58% improvement in mental well-being. The general State of health and performance improved in 62% and 47% of patients, respectively. If all categories of treatment success are considered together, at least one area improved in 87.5%. Around 90% of PCS patients would recommend rehabilitation to others or return for treatment. Comparable results also showed that the treatment met the patients' needs. The vast majority of PCS patients (around 90%) would recommend the rehabilitation programme to others or return for treatement. Global patient satisfaction correlated to r=-0.727 (p<0.001) with the subjectively experienced psychological relief, but not with the 6-minute walking test (6MWT) as a somatic surrogate parameter. Regression analyses showed that only improvement in depression had a significant influence on patient satisfaction and subjective treatment success, but not improvement in walking distance or the socio-medical assessment (general labour market performance). Conclusion PCS rehabilitants were satisfied with the therapy programme across all indications examined and experienced successful treatment. The vast majority of PCS rehabilitants found a multimodal rehabilitation program to be helpful.

Hypnosis is recognized as an effective non-pharmacological intervention for managing anxiety, pain, and physiological stress during invasive medical procedures. Despite its growing use, variability in techniques and inconsistent outcome measurements have challenged its clinical standardization. This systematic review and meta-analysis evaluated the effectiveness of hypnosis in reducing anxiety, pain, and physiological stress during invasive procedures, while identifying the most effective techniques as well as assessing analgesic use and safety. A comprehensive literature search was conducted in PubMed, Cochrane Library, and Scopus to identify randomized controlled trials (RCTs) evaluating hypnosis in invasive procedures. Eligible studies were assessed for bias using the Revised Cochrane Risk of Bias Tool. Meta-analyses were performed with a random-effects model, and subgroup analyses were conducted based on hypnosis techniques, patient characteristics, and procedure types. Twenty RCTs with 1250 patients were included. Hypnosis significantly reduced anxiety (SMD = -0.43, 95 % CI: -0.58 to -0.28, p < 0.001) and pain (SMD = -0.35, 95 % CI: -0.50 to -0.20, p < 0.001) compared to standard care. Subgroup analyses indicated that virtual reality-enhanced hypnosis and tailored interventions for high-anxiety procedures were most beneficial. Physiological stress markers, including heart rate and blood pressure, were also reduced, supporting the calming effects of hypnosis. Adverse effects were minimal. Hypnosis is effective and safe for reducing anxiety and pain during invasive medical procedures. Standardized protocols and further research are needed to optimize its clinical use and enhance adoption in routine care.

BackgroundPost COVID-19 condition (PCC) is increasingly recognized as a debilitating condition characterized by persistent symptoms following SARS-CoV-2 infection. Neuropsychological deficits, including cognitive impairments and fatigue, are prevalent in individuals with PCC. The PoCoRe study aimed to evaluate the burden of neuropsychological deficits in PCC patients undergoing multidisciplinary indoor rehabilitation and to describe possible changes in this symptomatology.MethodsThe PoCoRe study, a prospective, non-randomized, controlled longitudinal study, recruited PCC patients from six German indoor rehabilitation centers. Eligible participants underwent comprehensive neuropsychological assessments at admission and discharge. Various measures were employed, including the fatigue scale for motor functioning and cognition (FSMC), the Test Battery for Attention (TAP) and the Montreal Cognitive Assessment (MoCA).ResultsOut of the 1,086 recruited participants, a total of N = 701 participants were included in the main data analysis. The prevalence of fatigue on admission was high (84.6%) and decreased significantly by discharge (77.4%), with a mild effect size. Reaction times on the alertness subtest were abnormal in 70% of patients on admission and 50% on discharge. Sustained attention was abnormal in 55% of patients on admission, decreasing to 43% on discharge. These differences were significant with mild effect sizes. Furthermore, of the 27% of participants with pathological MoCA scores at admission, 63% improved to normative levels during rehabilitation, indicating a significant treatment effect (p ≤ 0.001). However, the MoCA demonstrated limited sensitivity in detecting attention deficits.ConclusionThe PoCoRe study highlights the high prevalence of neuropsychological deficits and fatigue in PCC patients, with notable improvements observed following multidisciplinary rehabilitation. Challenges remain in accurately identifying and addressing these deficits, underscoring the importance of comprehensive neuropsychological assessment and tailored rehabilitation interventions. Further research is warranted to optimize screening tools and enhance neuropsychological care for PCC patients in both rehabilitation and outpatient settings.

Aims Fracture-related infections (FRIs) are a major concern for patients and healthcare systems, yet their impact on mental health has been largely overlooked. This study aimed to assess the longitudinal impact of FRI on patients' quality of life. Methods A prospective study was conducted at a level 1 trauma centre between January 2020 and December 2022. In total, 56 patients participated, with quality of life assessed at five timepoints: one week preoperatively, and one, three, six, and 12 months postoperatively. Statistical analysis was performed using repeated measures analysis of variance (ANOVA) with adjusted post-hoc analysis. Results The preoperative Physical Component Summary score on the 36-Item Short-Form Health Survey questionnaire (SF-36) was 26.71, increasing to 30.40 at one month, remaining stable at three months. A modest increase was observed at six months (32.45, p = 0.003), but it decreased to 29.72 at 12 months. The preoperative Mental Component Summary score (SF-36) was 46.48, decreasing to 39.89 at one month (p = 0.027) and to 36.03 at three months (p = 0.001). However, it improved at six (42.74) and 12 months (44.05). Positive changes were seen in EuroQol five-dimension questionnaire (EQ-5D) subdimensions, such as mobility, self-care, usual activities, and pain/discomfort, while anxiety/depression scores decreased over time. The EQ-5D visual analogue scale (VAS) score increased to 62.79 at six months (p = 0.001) and decreased to 58.2 at 12 months (p = 0.011). Conclusion FRIs substantially affect mental health and quality of life, particularly during the initial three months of treatment. This study emphasizes the importance of addressing psychological aspects early in FRI management, advocating for holistic care encompassing both physical and psychological aspects of treatment.

Introduction: In the context of SARS-CoV-2 infections, the significance of NO production in the nasal mucosa as an endogenous activator of immune function is in discussion, especially how the endogenous metabolism can be empowered. E.g., humming is been discovered to increase NO release. From another point of view, forest bathing seen as a source of relaxation for body and soul, may have an influence on nasal NO levels, due to the aerosols produced by the trees. In this trial interested, whether the exposition to a fresh felled pine induces endogenous NOx production. As control condition, humming having a verifiable emission of NO was chosen. Methods: In a RCT 16 volunteers in a randomized cross over design either inhaled fresh pine scent or were humming each for 5 min. Nasal fractional exhaled nitric oxide was measured before and after the exposition respectively the control procedure. A simply subjective relaxation test was taken in parallel. Results: Before-after comparison revealed an impressing increase of NO concentrations, but were not significant, just as intra-individual differences (pre-post) between the two groups (Wilcoxon Test). Positive changes with the scent of the felled tree were observed in 44% of the subjects, with humming 48%. Almost 70% of the study participants could profit at least from one of the both stimuli, only 25% showed no increase. Discussion: The old Germanic/Celtic tradition to put trees in the living rooms and light candles which was transferred to Christian customs could have a more serious background than only a pleasant scent and lights to modulate moods in a positive manner. Unconscious knowledge about the immunomodulatory effects could be another important aspect. Conclusion: Perhaps this may be the reason why singing/humming nearby the Christmas tree is so common: So there's something for everyone! Happy holidays!

Die häufigsten Symptome des PCS sind anhaltende Fatigue und kognitive Störungen, welche Aktivität und Teilhabe im Beruf und im täglichen Leben erheblich beeinträchtigen. Es gibt zunehmend Evidenz für die Effektivität rehabilitativer Behandlungsansätze. Nichtsdestotrotz werden v. a. in den sozialen Medien Stimmen laut, die die Rehabilitation beim PCS negativ bewerten und über teilweise gravierende subjektive Verschlechterungen berichten. Ziel dieser Studie ist es, den subjektiven Behandlungserfolg und die Zufriedenheit stationärer PCS-Patienten mit der Rehabilitation zu objektivieren. Im Rahmen einer prospektiven Multicenter-Kohortenstudie (N=1028) wurden der subjektive Behandlungserfolg und die Patientenzufriedenheit (ZUF-8) am Ende der PCS-Rehabilitation untersucht (PCS-Reha-Indikationen: Duale Reha, Psychosomatik, Neurologie und Pneumologie). Häufigkeitsanalysen, Mittelwertvergleichen, Korrelationsanalysen und Regressionsmodelle kamen zum Einsatz. Der subjektive Behandlungserfolg wird über alle PCS-Reha Indikationen hinweg als gut bis sehr gut eingeschätzt. Ca. 62% der PCS-Patienten erleben eine Besserung der körperlichen Beschwerden, ca. 58% eine Besserung des psychischen Wohlbefindens. Der Allgemeinzustand und die Leistungsfähigkeit besserten sich bei 62% und 47% der Patienten. Werden alle Kategorien des Behandlungserfolges in der Zusammenschau betrachtet, so besserten sich bei 87.5% mindestens ein Bereich. Die Behandlungsqualität wurde über alle Indikationen hinweg zu ca. 90% mit gut bis ausgezeichnet bewertet. Etwa 90% der PCS-Patienten würden die Rehabilitation weiterempfehlen bzw. wiederkommen. Die globale Patientenzufriedenheit korreliert zu r=–0,727 (p<0,001) mit der subjektiv erlebten psychischen Entlastung, nicht aber mit dem 6-Minuten-Gehtest (6MWT) als somatischem Surrogatparameter. Die Regressionsanalysen zeigten, dass lediglich die Verbesserung der Depressivität signifikant Einfluss auf die Patientenzufriedenheit und den subjektiven Behandlungserfolg hat, nicht aber die Verbesserung der Gehstrecke oder die sozialmedizinische Beurteilung (Leistungsvermögen allgemeiner Arbeitsmarkt). PCS- Rehabilitanden waren über alle untersuchten Indikationen hinweg mit dem Therapieprogramm zufrieden und erlebten einen Behandlungserfolg. Von der ganz überwiegenden Mehrzahl der PCS-Rehabilitanden wird eine multimodale Rehabilitation als hilfreich empfunden.

BackgroundThe relationship between spirituality and mental health has garnered attention, fostering overall well-being. Spirituality, posited as a protective factor, may enhance resilience and provide meaning, thus benefiting mental health. This study aims to identify spirituality-associated factors influencing clinical outcomes in psychosomatic inpatients and validate the Transpersonal Spirituality Inventory (TSI).MethodsThe study involved 4952 psychosomatic inpatients completing the Transpersonales Vertrauen (TPV) and 7739 patients completing the TSI, with assessments conducted at admission and discharge. Additional instruments included the ISR for symptom rating and the LK-18 for life skills. Factor analysis and Spearman’s rank correlation were used to evaluate the validity of TSI and the relationship between spirituality and clinical outcomes.ResultsFactor analysis confirmed the TSI’s two-factor structure: “centered connectedness” (F1) and “transcendent orientation” (F2), with satisfactory internal consistency (Cronbach’s α = 0.824 for F1 and 0.644 for F2). Higher spirituality levels, particularly in transpersonal trust and centered connectedness, correlated with lower depression and psychosomatic symptoms (ISR). Although these correlations were generally weak, significant associations were found between spirituality and life competences, particularly in meaning, belief, and values (r = .595 for TPV and .598 for TSI F1).ConclusionDespite correlations between psychosomatic health and spirituality as measured with TPV and TSI were rather small several spirituality items could be identified which seem to have a prominent connection to the diagnosis and development of psychosomatic health. Specific spiritual attitudes, such as access to inner stillness and connection to a greater whole, were linked to positive treatment responses and reduced symptom burden. These findings suggest potential benefits in incorporating spirituality into psychosomatic treatments, though its complex and multifaceted nature warrants further investigation.

Introduction: Invasive pneumococcal disease is a major cause of morbidity and mortality in infectious diseases. Selective reporting of antibiotic susceptibility test results might lead to a tailored antibiotic therapy and could therefore be an important antibiotic stewardship program intervention. The aim of this study was to analyse whether a switch to selective reporting of antibiotic test results leads to a more focused antibiotic therapy in patients with a bloodstream infection with Streptococcus pneumoniae. Methods: This study was performed as a retrospective cohort study at the University Hospital Regensburg, Germany. All blood cultures positive for Streptococcus pneumoniae between 2006 and 2021 were analysed. In 2014, a switch to selective reporting of antibiotic susceptibility test results omitting sensitivity results for agents not recommended was introduced. Results: Twenty-four hours after final antibiotic susceptibility test results were available, 20.9% before (BI) versus 15.4% after implementation (AI) of selective reporting of antibiotic test results received a narrow-spectrum penicillin, while only 2.3% BI versus 5.8% AI received a narrow-spectrum penicillin from the beginning. Conclusion: Selective reporting of antibiotic susceptibility test results without further antimicrobial stewardship interventions did not lead to a higher use of a narrow-spectrum penicillin in this study.

INTRODUCTION:Affective disorders profoundly affect individuals' emotional well-being and quality of life. This study investigates the epidemiology of affective disorders in Germany from 2011 to 2021, focusing on incidence rates, age- and sex-standardized rates, and developmental trends. METHODS:Using nationwide data of ICD-10 diagnosis codes from 2011 to 2021, this cross-sectional study analyzed inpatient cases of affective disorders in individuals aged 20 years or older. Age- and sex-standardized incidence rates were calculated based on the population size of each birth cohort in the 16 German federal states. Incidence rate ratios (IRRs) for 2011 to 2021 and 2019 to 2021 were compared with a two-sample z-test. RESULTS:Between 2011 and 2021, F30 (manic episode) showed a decline of 42.8 % to an incidence of 4.9 per 100,000 inhabitants, even though not statistically significant (p = 0.322). F31 (bipolar affective disorder) remained relatively stable with a reduction of 15.3 % to an incidence of 13.6 per 100,000 inhabitants in 2021 (p = 0.653). F32 (depressive episode) decreased statistically significant by 25.7 % to an incidence of 64.1 per 100,000 inhabitants (p = 0.072). F33 (recurrent depressive disorder) slightly increased by 18.3 % to an incidence of 94.6 per 100,000 inhabitants (p = 0.267). No statistically significant differences were found when comparing the COVID-19 pandemic year 2021 to 2019 incidences (p ≥ 0.529). CONCLUSION:The study provides valuable insights into the changing landscape of affective disorders in Germany over the past decade. The observed decline in incidence rates underscores the importance of continued efforts to promote mental health awareness and access to care.

BACKGROUND:This study aimed at answering the following research questions: (1) Does the self-reported level of sensory-processing sensitivity (SPS) correlate with complexity, or criticality features of the electroencephalogram (EEG)? (2) Are there significant EEG differences comparing individuals with high and low levels of SPS?METHODS:One hundred fifteen participants were measured with 64-channel EEG during a task-free resting state. The data were analyzed using criticality theory tools (detrended fluctuation analysis, neuronal avalanche analysis) and complexity measures (sample entropy, Higuchi's fractal dimension). Correlations with the 'Highly Sensitive Person Scale' (HSPS-G) scores were determined. Then, the cohort's lowest and the highest 30% were contrasted as opposites. EEG features were compared between the two groups by applying a Wilcoxon signed-rank test.RESULTS:During resting with eyes open, HSPS-G scores correlated significantly positively with the sample entropy and Higuchi's fractal dimension (Spearman's ρ = 0.22, p < 0.05). The highly sensitive group revealed higher sample entropy values (1.83 ± 0.10 vs. 1.77 ± 0.13, p = 0.031). The increased sample entropy in the highly sensitive group was most pronounced in the central, temporal, and parietal regions.CONCLUSION:For the first time, neurophysiological complexity features associated with SPS during a task-free resting state were demonstrated. Evidence is provided that neural processes differ between low- and highly-sensitive persons, whereby the latter displayed increased neural entropy. The findings support the central theoretical assumption of enhanced information processing and could be important for developing biomarkers for clinical diagnostics.