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We have conducted an extensive study of the scaling properties of small scale turbulence using both numerical and experimental data of a flow in the same von Kármán geometry. We have computed the wavelet structure functions, and the structure functions of the vortical part of the flow and of the local energy transfers. We find that the latter obey a generalized extended scaling, similar to that already observed for the wavelet structure functions. We compute the multi-fractal spectra of all the structure functions and show that they all coincide with each other, providing a local refined hypothesis. We find that both areas of strong vorticity and strong local energy transfer are highly intermittent and are correlated. For most cases, the location of local maximum of the energy transfer is shifted with respect to the location of local maximum of the vorticity. We, however, observe a much stronger correlation between vorticity and local energy transfer in the shear layer, that may be an indication of a self-similar quasi-singular structure that may dominate the scaling properties of large order structure functions.

In this study, we examined the conditional indirect and direct relations of pain-related cognitions to depression. Subjective helplessness was included as presumably mediating the relations of catastrophizing and thought suppression to depression due to motivational deficits. In addition, moderating effects of dispositional action versus state orientation were analyzed, whereby state orientation indicates volitional deficits in coping with distress . The study was based on self-report data from 536 patients with chronic non-specific low back pain at the beginning of inpatient rehabilitation. Moderated mediation analyses were performed. The indirect catastrophizing- and thought suppression-depression relations were (partially) mediated by subjective helplessness; and moderated by failure-related action versus state orientation. Moreover, action versus state orientation moderated the direct relation of thought suppression to depression. Results suggest that catastrophizing, thought suppression, and subjective helplessness do not lead to depression unless associated with self-regulatory inability (i.e., state orientation). In contrast, action-oriented patients more effectively self-regulate pain-related emotions, disengage from rumination, and distract from pain and thus better avoid the debilitating effects of negative pain-related cognitions on depression. Future research and treatment may more strongly focus on the role of motivational and volitional deficits underlying learned helplessness and depression in chronic pain.

Although inflammatory bowel disease (IBD) affects patients’ psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months. The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects.

Abstract The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen’s d = 0.45, 95% CI = 0.27–0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.

Purpose Although therapy and psychosocial care for patients with breast cancer and gynaecological cancer has improved in the last years, there are still many issues that require further investigation. Unmet supportive care needs can lead to a lower adherence to treatment and a lower quality of life. Patients’ needs seem to be highest during the time of treatment. Thus, this study investigated needs and quality of life. Methods In this German prospective study, we enrolled 292 patients with breast cancer and gynaecological cancer during the time of treatment. Data on needs were assessed using instruments that had proven feasible in earlier studies. Data on quality of life (QoL) were assessed using the European Organization for Research and Treatment of Cancer QoL Core Questionnaire (EORTC QLQ-C30). We investigated correlations between needs and sociodemographic data as well as quality of life. Results Among all cancer entities we observed that 150 patients (51.5%) showed unmet information needs, 221 patients (75.7%) showed at least one high supportive care need, and 91 patients (31.2%) had psychological care needs. Data showed statistically significant correlations between these needs and sociodemographic data as well as quality of life. These correlations generally showed small to medium effect sizes. Older women showed less supportive care needs (r = − 0.24; p < 0.001), (r = − 0.15; p = 0.010). Furthermore, recruitment after surgery was associated with statistically significant higher information needs (r = 0.14; p = 0.015), whereas recruitment during chemotherapy was associated with statistically significant less information needs (r = − 0.15; p = 0.013). Positive correlations were shown for the level of received information and physical functioning (r = 0.12; p = 0.047), social functioning (r = 0.16; p = 0.009) and global quality of life (r = 0.19, p = 0.002) as well as satisfaction with information and physical (r = 0.16; p = 0.006), social (r = 0.24; p < 0.001), cognitive functioning (r = 0.14; p = 0.017) as well as global quality of life (r = 0.25; p < 0.001). Negative correlations were reported for information needs and emotional functioning (r = − 0.12; p = 0.035) and global quality of life (r = − 0.15; p = 0.011). Supportive care needs also correlated negatively with physical (r = − 0.23; p < 0.001), role (r = − 0.23; p < 0.001), emotional (r = − 0.35; p < 0.001), cognitive (r = − 0.24; p < 0.001), social functioning (r = − 0.30; p < 0.001), and global quality of life (r = − 0.35; p < 0.001). Also, patients with at least one high supportive care need correlated negatively with role (r = − 0.15; p = 0.014), emotional (r = − 0.23; p < 0.001), social functioning (r = − 0.30; p = 0.001), and global quality of life (r = − 0.35; p < 0.001). There was no statistical significance concerning cancer side. Thus, both groups are reported together. Furthermore, there was no statistical significance concerning disease status. Conclusion Overall, this study highlights the importance of tailored information and supportive care interventions. Addressing these needs, particularly in terms of information provision and psychosocial support, could lead to improved quality of life and better overall patient outcomes.

Background Tobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Hence, smoking cessation is considered pivotal in the prevention of CHD. The current study aimed to evaluate smoking cessation patterns and determine factors associated with smoking cessation in patients with established CHD. Methods The fourth European Survey of Cardiovascular Disease Prevention and Diabetes investigated quality of CHD care in 24 countries across Europe in 2012/13. In the German subset, smoking cessation patterns and clinical characteristics were repetitively assessed a) during index event due to CHD by medical record abstraction, b) as part of a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit), and c) by telephone-based follow-up interview two years after the baseline visit. Logistic regression analysis was performed to search for factors determining smoking status at the time of the telephone interview. Results Out of 469 participants available for follow-up, 104 (22.2%) had been classified as current smokers at the index event. Of those, 65 patients (62.5%) had quit smoking at the time of the telephone interview, i.e., after a median observation period of 3.5 years (quartiles 3.0, 4.1). Depressed mood at baseline visit and higher education level were less prevalent amongst quitters vs non-quitters (17.2% vs 35.9%, p  = 0.03 and 15.4% vs 33.3%, p = 0.03), cardiac rehabilitation programs were more frequently attended by quitters (83.1% vs 48.7%, p  < 0.001), and there was a trend for a higher prevalence of diabetes at baseline visit in quitters (37.5% vs 20.5%, p  = 0.07). In the final multivariable model, cardiac rehabilitation was associated with smoking cessation (OR 5.19; 95%CI 1.87 to 14.46; p  = 0.002). Discussion Attending a cardiac rehabilitation program after a cardiovascular event was associated with smoking cessation supporting its use as a platform for smoking cessation counseling and relapse prevention.

Background Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. Methods The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15–39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. Discussion CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. Trial registration Registered at the German Clinical Trial Register (ID: DRKS00012504 , registration date: 19th January 2018).

Little is known about the psychological burden patients are left with after successful allogeneic hematopoietic SCT (HSCT). With the main focus on physical condition and common transplant complications, psychological symptoms often remain neglected in daily practice. To assess the prevalence of distress in patients who have undergone allogeneic HSCT, we conducted a cross-sectional pilot study in 50 consecutive patients from our outpatient transplant clinic using standardized questionnaires. Distress was categorized by symptoms of anxiety, fear of progression, depression and post-traumatic stress disorder (PTSD). Forty-one patients completed self-administered questionnaires. The median age was 53 years (21–74 years) and the mean time after transplantation was 614 days (25–2070 days). In total, 18 patients (44%) showed symptoms of distress. Among these 18 patients, 11 patients reported symptoms of anxiety, 12 patients suffered from fear of progression, 11 patients showed symptoms of depression and 6 patients of PTSD. Age below 55 years was significantly associated with fear of progression ( P =0.004). This study demonstrates the high prevalence of distress in patients who have undergone allogeneic HSCT. Our results suggest an unmet need for professional support and intervention. These findings may be relevant as distress could have an influence on the outcome after HSCT.

Patient education is an essential part of the treatment of coronary heart disease in cardiac rehabilitation. In Germany, no standardized and evaluated patient education programs for coronary heart disease have been available so far. In this article, we report the evaluation of a patient-oriented program. A multicenter quasi-experimental, sequential cohort design study of patients with coronary heart disease (n = 434) in inpatient cardiac rehabilitation was conducted. Intervention patients received the new patient-oriented program, control patients a traditional lecture-based program (usual care). Primary outcome illness knowledge and secondary behavioral and health outcomes were assessed at admission, discharge and 6- and 12-months follow-up. We found a significant, small between-group intervention effect in both patients' medical illness and treatment knowledge and behavior change knowledge at discharge (medical: ?[superscript 2] = 0.013; behavior change: ?[superscript 2] = 0.011) and after 12 months (medical: ?[superscript 2] = 0.015). Furthermore, a significant, small effect was observed for physical activity after 12 months (?[superscript 2] = 0.011), but no effects on healthy diet and medication adherence emerged. Superiority of the patient-oriented educational program for patients with coronary heart disease was partially confirmed. The program produced improved illness knowledge and physical activity compared with usual care after 1 year.

Purpose To assess stable effects of self-management programs, measurement instruments should primarily capture the attributes of interest, for example, the self-management skills of the measured persons. However, measurements of psychological constructs are always influenced by both aspects of the situation (states) and aspects of the person (traits). This study tests whether the Health Education Impact Questionnaire (heiQ™), an instrument assessing a wide range of proximal outcomes of self-management programs, is primarily influenced by person factors instead of situational factors. Furthermore, measurement invariance over time, changes in traits and predictors of change for each heiQ™ scale were examined. Methods Subjects were N = 580 patients with rheumatism, asthma, orthopedic conditions or inflammatory bowel disease, who filled out the heiQ™ at the beginning, the end of and 3 months after a disease-specific inpatient rehabilitation program in Germany. Structural equation modeling techniques were used to estimate latent trait-change models and test for measurement invariance in each heiQ™ scale. Coefficients of consistency, occasion specificity and reliability were computed. Results All scales showed scalar invariance over time. Reliability coefficients were high (0.80–0.94), and consistency coefficients (0.49–0.79) were always substantially higher than occasion specificity coefficients (0.14–0.38), indicating that the heiQ™ scales primarily capture person factors. Trait-changes with small to medium effect sizes were shown in five scales and were affected by sex, age and diagnostic group. Conclusion The heiQ™ can be used to assess stable effects in important outcomes of self-management programs over time, e.g., changes in self-management skills or emotional well-being.