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Auswirkungen des Zweiten Weltkrieges auf Psychopathologie und Therapie bei psychischen Erkrankungen
(2009)
In der vorliegenden Arbeit wurden die Auswirkungen des Zweiten Weltkrieges auf die Psychopathologien und Therapien psychischer Erkrankungen am Beispiel der Heil- und Pflegeanstalt Klingenmünster aufgezeigt. Als Quellenmaterial dienten 186 Patientenakten. Die Auswertung der Krankenberichte erfolgte zum einen nach soziodemographischen Merkmalen (wie z.B. Alter, Geschlecht, Wohnort, Beruf usw.), zum anderen nach Diagnose und Therapie. Der Schwerpunkt wurde auf die Auswertung der Diagnosen und die damit verbundenen Psychopathologien gelegt. Dafür wurden die Akten vor dem Zweiten Weltkrieg (1932) und nach dem Zweiten Weltkrieg (1948) miteinander verglichen. Dabei erhob sich auch die Frage, ob die Behandlung, die den Patienten in Klingenmünster zuteil wurde, dem Stand der zeitgenössischen Wissenschaft entsprach. Bei den Diagnosen gab es Unterschiede dergestalt, dass 1932 die Diagnose Progressive Paralyse und Schizophrenie signifikant häufiger gestellt wurde als 1948. Nach dem Zweiten Weltkrieg wurde dafür der angeborene Schwachsinnszustand und die Psychische Störung des höheren Lebensalters signifikant häufiger diagnostiziert. Die Progressive Paralyse trat 1948 wahrscheinlich deshalb seltener auf, weil in den 30er Jahren mit der wirksamen Malariakur und Salvarsantherapie eine recht hohe Remissionsrate erzielt wurde und sie deshalb Ende der 40er Jahre allgemein seltener auftrat. 1948 wurden Patienten mit Schizophrenie seltener aufgenommen als 1932. Es ist denkbar, dass der Anteil der Schizophrenen aufgrund der bereits 1933 laufenden rassenhygienischen Maßnahmen sowie der frühen Deportation und Tötung dieser Patienten abgesunken sein könnte. Patienten mit der Diagnose einer Störung des höheren Lebensalters fielen der Euthanasie wahrscheinlich nicht zum Opfer, da sie ihr Leben lang dem Gemeinwesen genutzt hatten und nicht erbkrank waren. Die Ermordung von "sozial Wertvollen", jetzt jedoch alt gewordenen Menschen wäre auf großen öffentlichen Widerstand gestoßen. Für diese Menschen gab es keinen anderen Ort mehr, denn die Pflege- oder Altenheime waren ausgebombt. Die Versorgung der alten und hinfälligen Menschen wurde im ganzen Land immer schwieriger. Diese Entwicklung der letzten Kriegsjahre und Nachkriegsjahre in Deutschland könnte eine Erklärung dafür sein, dass diese Patienten die größte Patientengruppe 1948 in Klingenmünster bildeten. Das galt sicherlich nicht für Patienten mit angeborenem Schwachsinn, die als erbkrank galten und somit den rassenhygienischen Maßnahmen zum Opfer fielen. In den 40-er Jahren war auch die Öffentlichkeit so weitgehend über die mit einem Klinikaufenthalt verbundene Gefahr der Tötung informiert, dass weniger Patienten einer stationären Behandlung zugeführt worden sein dürften. Diese Patienten wurden während des Krieges wahrscheinlich von ihren Angehörigen nicht in eine Anstalt gebracht. Ziel der vorliegenden Arbeit war es auch zu klären, ob der Zweite Weltkrieg Auswirkungen auf psychiatrische Krankheitsbilder im Sinne einer Kriegsneurose hatte. Es zeigte sich, dass der Zweite Weltkrieg keine Auswirkungen auf die Prävalenz des Krankheitsbildes Kriegsneurose in der Heil- und Pflegeanstalt Klingenmünster hatte. Neben den Krankheitsbildern und den Psychopathologien wurden auch die Therapieformen der beiden Jahrgänge miteinander verglichen. Aber auch hier gab es keine kriegsbedingten Unterschiede. Betrachtet man die Therapieformen zur Zeit der Weimarer Republik und der Nachkriegszeit vor dem Hintergrund der gängigen Therapien zu dieser Zeit, so war Klingenmünster auf dem aktuellen wissenschaftlichen Stand. Die am häufigsten eingesetzten Behandlungsmethoden waren zum einen die Arbeitstherapie, zum anderen die medikamentöse Therapie. Der Rückgang der Arbeitstherapie von 1932 auf 1948 könnte mit dem Personalmangel in den Nachkriegsjahren in den Kliniken zu tun haben, wonach unzureichend qualifiziertes Pflegepersonal vorhanden war, die die Kranken bei der Arbeit anleiten und beaufsichtigen konnten. Die medikamentöse Therapie war die führende Therapieform, die in der Heil- und Pflegeanstalt Klingenmünster eingesetzt wurde. Zwischen den beiden Jahrgängen gab es hinsichtlich der Häufigkeit keine Unterschiede. Doch die Art der Therapie hatte sich im Verlauf der Jahre durch die Einführung der Insulinkomatherapie 1933, der Cardiazolkrampftherapie 1934 und der Elektrokrampftherapie 1938 verändert.
This Thesis contributes by reporting on the current state of diffusion of collaboration information technology (CIT). The investigation concludes, with a high degree of certainty, that today we have a "satisfactory" diffusion level of some level-A CITs (mostly e-Mail, distantly followed by Audio Conferencing), and a "dissatisfactory" diffusion level of higher-level CITs (i.e. those requiring significant collaboration and cooperation among users, like Meeting Support Systems, Group Decision Support Systems, etc.). The potential benefits of the latter seem to be far from fully realised due to lack of user acceptance. This conclusion has gradually developed along the research cycle " it was suggested by Empirical Study I, and tested through Empirical Studies II and III. An additional, unplanned and rather interesting, finding from this study has been the recognition of large [mostly business] reporting on numerous Web 2.0 user-community produced collaboration technologies (most of them belonging to the category of "social software") and their metamorphosis from autonomous, "bottom-up" solutions into enterprise-supported infrastructures. Another contribution of this Thesis " again suggested by Empirical Study I, and tested through Empirical Studies II and III " pertains to the "process structure" of CIT diffusion. I have found that collaboration technology has historically diffused following two distinct (interdependent but orthogonal) diffusion paths " top-down (authority-based) and bottom-up. The authority-based diffusion path seems to be characterised by efforts aimed at "imposing" technologies on employees, the primary concern being to make sure that technology seamlessly and easily integrates into the organisational IT infrastructure. On the other hand, the bottom-up diffusion trail seems to be successful. The contribution of this investigation may be summarised as threefold: 1. This investigation consolidates most of the findings to date, pertaining to CIT adoption and diffusion, which have been produced by the CIT research community. Thus, it tells a coherent story of the dynamics of the community focus and the collective wisdom gathered over a period of (at least) one decade. 2. This work offers a meaningful framework within which to analyse existing knowledge " and indeed extends that knowledge base by identifying persistent problems of collaboration technology acceptance, adoption and diffusion. These problems have been repeatedly observed in practice, though the pattern does not seem to have been recognised and internalised by the community. Many of these problems have been observed in cases of CIT use one decade ago, five years ago, three years ago, and continue to be observed today in structurally the same form despite what is unarguably "rapid technological development". This gives me reason to believe that, at least some of the persistent problems of CIT diffusion can be hypothesised as "determining factors". My contribution here is to identify these factors, discuss them in detail, and thus tackle the theme of CIT diffusion through a structured historical narrative. 3. Through my contribution (2) above, I characterise a "knowledge-action gap" in the field of CIT and illuminate a potential path through which the research community might hope to bridge this gap. The gap may be operationalised as cognitive distance between CIT "knowledge" and CIT "action".
In this work has been examined, how the existing model of the simulation of cables and hoses can be advanced. Therefore an investigation has been made on the main influences to the shape simulation and the factors of constraints and side conditions were analyzed. For the validation of the accuracy, the simulation has to be compared to real specimen behavior. To obtain a very precise digitalization of the shape, the choice was made to use a laser scanner that converts the pointcloud into a .vrml file which can be imported into the simulation environment. The assumption was that the simulation method itself has the highest impact to the simulated shape. This is why the capabilities of the most sophisticated methods have been analyzed. The main criterion for the success of a simulation approach proved not to be accuracy, as expected. Process integration and usability showed to be of higher interest for the efficient exertion. Other factors like the pricing, the functionality and the real-time capability were assayed as well. The analyzed methods are based on the solution of the equations of elasticity with different ways of discetization, finite-elements and a spring-impulse-system. Since the finite-element-system takes several minutes for the computation of the shape and the spring-impulse-system reacts retarded on user manipulation, the competitiveness of these approaches is low. The other methods distinguish more in real-time performance, data interfaces and functionality than in accuracy. For the accuracy of a system, the consideration of other factors proved to be very important. As one of these main factors, the accurate assignment of the material properties was indicated. Until the start of this work, only the finite-element-approach dealt with this factor, but no documentation or validation is provided. In the publications of the other methods, the material properties are estimated to obtain a plausible simulation shape. Therefore the specific material values of real specimen have been measured and assigned to the simulation. With the comparison to the real shape it has been proven that the accuracy is very high with the measured properties. Since these measurements are very costly and time consuming, an investigation on a faster and cheaper way to obtain these values has been made. It has been assumed that with the knowledge of the cross-section it should be possible to compute the specimen behavior. Since the braid distribution changes individually from specimen to specimen, a more general way to obtain the values needed to be found. The program composer has been developed, where only the number of the different braids and the taping is entered. It computes with very high precision the stiffness, the density and the final diameter of the bundle. With the measured values and the fitting to the real shape it has been proven that the simulation approach reflects the precise behavior of cables and hoses. Since the stiffness of the single braids is wasteful to measure, a measurement setup was created where the stiffness has a large impact to the shape. With known density, the stiffness of the specimen can be reconstructed precisely. Thus a fast and beneficial way of obtaining the stiffness of a cable has been invented. The poissons ratio of cables and bundles cannot be measured with a tensile test, since the inner structure is very complex. For hoses, the variation of the inner diameter has been measured during the tensile test as well. The resulting values were reasonable, but their accuracy could not be proven. For cables and hoses, it has been tried to obtain the poissons ratio via the computation of the cross section, but the influence of individual changes and the crosstalk of the braids is very high. Therefore a setup was constructed where the torsion stiffness can be measured. For cables and hoses, the individual cross-sections and taping lead to varying results. For hoses, expected and repeatable good values for the poissons ratio were obtained. The low influence of the poisons ratio in the range between 0 and 0.5 has been proven. Therefore we decided to follow the advice of [Old06] and our own experiences to set the poisons ratio for cables and bundles to 0.25. With the knowledge of the measurability and the capabilities of the developed program composer, a procedure to obtain material properties for bundles has been designed. 1. Measurement of the braid density with via pyknometer or mass, length and diameter. 2. Empirical reconstruction of the stiffness with the designed setup. 3. Composing the bundle with the program composer. 4. Adding a factor for the taping and transfer the values to the simulation. The model of the cable simulation has been improved as follows: The main influences in the simulation of cables and hoses are the simulation method, the material properties and the geometric constraints. To obtain higher accuracy, an investigation on the correct material properties is indispensable. The scientific determination of material properties for the simulation of cables, bundles and hoses has been performed for the first time. The influence of geometrical constraints has been analyzed and documented. The next steps are the analysis of pre-deformation and further investigations to the determination of the poisons ratio with a more precise torsion test. All analysis were made with the simulation approach fleXengine. A comparison to other simulation methods would be of high interest.
Background: Somatoform symptoms are a prevalent and disabling condition in primary practice, causing high medical care utilization. Objective: To compare the short and long term effects of cognitive behavioral outpatient group-therapy to a relaxation-group and a waiting-control-group, on physical symptoms, anxiety, depression, functional health, symptomspecific cognitions and illness-behavior. Methods: 135 subjects were treated and assessed in a randomized control group design. The manualized interventions comprised eight sessions. Results: The cognitive-behavioral group treatment lead to lower levels of somatoform symptoms (SOMS-7) and enhanced mental health (SF-12). There were no differential effects between cognitive-behavioral therapy and relaxation treatment on any of the analysed variables. Conclusions: This brief cognitive-behavioral group therapy has beneficial effects on ambulatory patients with somatoform. To enhance effect sizes and facilitate differential effects, future studies should consider applying increased therapy dosage.