Marco Lehmann

The "Open-Earedness" Hypothesis and the Development of Age-Related Aesthetic Reactions to Music in Elementary School Children.

This study investigates age-related changes in musical preference in elementary school children. The tolerance towards unconventional musical styles has been called ‘openearedness’ (Hargreaves, 1982a), and it is assumed to decline with increasing age. Musical preferences of 186 students from grade 1 to 4 (age range: 6–10 years) were measured by using a 5-point iconographic rating scale. Eight sound examples were presented in a sound questionnaire. Results showed a decline of open-earedness for unconventional music (classical, ethnic and avant-garde music) from grade 1 to 2 (age: 7–8 years). However, this effect disappeared when classical music was excluded from data analysis. Only a few absolute rejections of unconventional musical styles were found, and the mean preference ratings did not exceed the neutral mean range. Future studies will have to consider additional factors of influence to make clear predictions about the point in time when this transition occurs.

Ebola and Psychological Stress of Health Care Professionals

To the Editor: Providing medical care for Ebola virus–infected patients entails physical and psychological stress, extended shift times, and risk for infection. In addition, the wearing of personal protective equipment impairs communication and performance of diagnostic and therapeutic procedures. Lessons learned from outbreaks of other infectious diseases indicate that such challenging treatment environments require the monitoring of health care professionals for psychological distress (e.g., anxiety, depression, fatigue, and social isolation) to prevent personal exhaustion and reduced job performance (1). In August 2014, the first patient in Germany known to have Ebola virus disease was admitted to the University Medical Center Hamburg-Eppendorf (2) and received treatment in the isolation facility for 18 days. We hypothesized that health care professionals working in the isolation unit who had direct contact with the Ebola patient would show more signs of psychological distress than those not working in the isolation unit. To test our hypothesis, we conducted a cross-sectional controlled study by using validated self-report scales (1,3–5) and open-response questions. Seven days after the Ebola patient was admitted, we distributed questionnaires to the 46 health care professionals (17 physicians, 29 nurses) who had direct contact with the patient (Table). Table Demographic characteristics, self-reported symptoms, and evaluation of working conditions of health care professionals with and without direct contact with an Ebola patient, Germany, 2014* Of the 46 health care professionals, 30 participated in the study. During patient contact, these staff members wore Astro-Protect pressurized suits (Asatex, Bergheim, Germany). As a control group, 40 health care professionals from other wards in the same department were recruited and participated in the study. Providers in the control group cared for terminally ill patients and for patients with reduced consciousness, but they had no direct contact with the Ebola patient. The control participants were not recruited from intensive care units because, at the time of the study, the patient was not receiving intensive care treatment. The 2 groups were balanced with respect to age and occupational characteristics (Table). There was no special psychological support service for health care workers in this hospital. Staff members had received mandatory biweekly training, which included decontamination procedures, technical aspects of diagnostic procedures, and emergency care. In contrast to our hypothesis, no significant differences emerged between the 2 groups with respect to the severity of somatic symptoms, anxiety, depression, and fatigue (Table). Moreover, mean total scores for both groups were at a comparable level to mean scores for the general population (3–5). However, health care professionals who had direct contact with the Ebola patient reported significantly greater social isolation and felt significantly more need for shorter shift hours. The open responses of participants who experienced social isolation suggested that their spouses, children, and other relatives had infection-related concerns. Additionally, half of the participants who did not have direct patient contact reported feeling a need for psychological preparation (Table). Nevertheless, almost all health care professionals (97% of those with direct patient contact, 93% of those without direct patient contact) believed that the health care facilities of the hospital were safe. Our investigation of the psychological stress of health care professionals in a Western tertiary care center showed that a well-trained and dedicated team can cope well with the stress of caring for a severely ill Ebola patient. Of note, the direct patient contact group tended to comprise more male participants and more participants living with partners, which may have influenced the experience of psychological stress. No staff member refused to participate in the treatment of the Ebola patient, which underlines the high level of motivation within the team and may render direct comparison to other centers difficult. While the patient was in the isolation unit, working shifts lasted up to 12 hours, consisting of 2 periods with 3–4 hours of work while wearing personal protective equipment in addition to time spent disinfecting. Most respondents felt that these shifts were too long. We therefore suggest that shift durations should be decreased to 8 hours comprising 2 blocks of 2 hours each for direct patient contact. Shorter shifts should improve staff satisfaction with the working conditions and potentially increase the personal safety of all health care personnel involved in direct patient contact.

Acute Ebola virus disease patient treatment and health-related quality of life in health care professionals: A controlled study

OBJECTIVE This study aimed to identify predictors of health-related quality of life (HrQoL) and to investigate infection-related concerns in health professionals during the acute treatment episode for one Ebola virus disease (EVD) patient in tertiary care. METHODS In a cross-sectional controlled study, validated self-report questionnaires were completed by three groups of health care professionals: (1) staff from standard internal medicine inpatient wards of a tertiary care center, (2) staff from the isolation unit of the same center responsible for Ebola patient treatment, and (3) staff from a research laboratory with contact to the Ebola virus and other highly infectious pathogens. Outcomes were HrQoL (SF-12), infection-related concerns, global health status, fatigue (FACIT), depression (PHQ-9), anxiety (GAD-7), and somatic symptoms (SSS-8). RESULTS Comparisons between groups (n1=42, n2=32, n3=12) yielded no significant differences in HrQoL, subjective risk of infection, and most other psychosocial variables. However, the Ebola patient treatment group experienced significantly higher levels of social isolation than both other groups. The best predictors of poor physical and mental HrQoL were perceived lack of knowledge about the Ebola virus disease (physical: B=-1.2, p=0.05; mental: B=-1.3, p=0.03) and fatigue (physical: B=-0.3, p=0.02; mental: B=-0.53, p<0.001). CONCLUSION Ebola patient treatment in tertiary care does not seem to be associated with lower HrQoL and enhanced subjective risk of infection, but seems to yield feelings of social isolation in health-care professionals.

The influence of on-stage behavior on the subjective evaluation of rock guitar performances

Show elements are indispensable in live rock performances and have an impact on the recipients’ performance evaluations. We conducted two studies on the persuasive function of show elements (e.g., multi-finger tapping, over-under techniques, or playing with the tongue) in rock guitar solo performances. In Experiment 1 professional guitarists (N = 12) classified performance features, such as show elements, playing difficulty in terms of academic standards, tempo and visible engagement of the performer based on a selection of 15 audio-visual performances by popular virtuosos. In Experiment 2 these features were then used to obtain evaluations of perceived playing difficulty and impressiveness of the solos from subjects differing in musical competence (N = 59). Results revealed interactions between subjects’ musical competence and evaluations of show elements: (a) Music students gave higher ratings than did musically untrained subjects for the perceived playing difficulty and impressiveness of solos played in fast tempo; (b) surprisingly, solos with show elements were rated as more impressive – but only by the music students; (c) the visible engagement of the performer resulted in high ratings for playing difficulty – but only from the musically untrained subjects. We conclude that the technical difficulty of a performance is not self-evident to the recipient and depends on the rater’s degree of musical competence. The evaluations of a guitar performance by the majority of musically untrained recipients rely more on visible cues of engagement than on virtuosic playing (i.e., fast tempo, difficult techniques).

Typikalität, Musiker-Image und die Musikbewertung durch Jugendliche

This study investigates the relationship between typicality, a musician’s image and music evaluation by adolescents. We pay particular attention to adolescents’ sensitivity to the (un-)conventionality of the music and the musicians. First, in the theoretical part, we reveal the variable “typicality” (with the extremes conventional vs. unconventional) as an important parameter for the development of adolescents’ evaluation of music. Second, in the experimental part, we investigate the influence of a conventional and unconventional image of a musician on music evaluation by using an unknown piece of pop music. The image is introduced via two different cover stories about a fictitious band and compared to a control condition without cover story. The evaluation of music is used as the dependent variable. Results show a medium effect size (d = 0.67) for a positive value judgement by an unconventional musician image. Accordingly we give a preview of further research methods and designs. The consequences of our findings for identity formation are discussed in the context of the theories of social identity and self-categorization. We assume that group processes of distinction and identification control music perception and evaluation. In this process, in-groups are characterized by shared norms and attitudes and enable the evaluation of unknown music to be predicted. We suggest that the processes of music perception and evaluation are affected by the image of a musician.

Diagnostic barriers for somatic symptom disorders in primary care: study protocol for a mixed methods study in Germany

Introduction Somatoform or somatic symptom disorders ((S)SD) are common and have a negative impact on the patients’ health-related quality of life, healthcare use and costs. In primary care, which is central to the management of (S)SD, diagnosis and treatment tend to be delayed. There is a significant lack of evidence regarding the barriers in the diagnostic process of (S)SD in primary care and how interventions should be tailored to address them. The aim of this study is to analyse the diagnostic process in primary care that results in the diagnosis or non-diagnosis of a (S)SD. Methods and analysis This mixed methods study will investigate the topic with qualitative methods, subsequently proceeding to a quantitative phase where the initial results will be validated and/or generalised. First, focus groups will explore meanings and patterns, inconsistencies and conflicts in general practitioners’ (GPs) thoughts and behaviours when diagnosing (S)SD. Second, the results of these focus groups will be used to develop interview guidelines for subsequent face-to-face interviews. Patients and their treating GPs will be interviewed separately on how they experience the history of illness, the diagnostic process and treatment. Third, based on the results of the first two study parts, a questionnaire will be derived and a nationwide survey among German GPs will be conducted, quantifying the barriers and difficulties identified before. Ethics and dissemination Ethics approval was obtained from the Ethics Committee of the Hamburg Medical Association, Germany (approval number PV4763). The results of this study will be disseminated through conference presentation and publications in peer-reviewed journals. Trial registration number The study is registered in the German Clinical Trial Register (DRKS), DRKS-ID DRKS00009736.

Base Rates of Depressive Symptoms in Patients with Coronary Heart Disease: An Individual Symptom Analysis.

Background Major depression is common in coronary heart disease (CHD) but challenging to diagnose. Instead of focusing on the overall diagnosis of depression, base rates of depressive symptoms could facilitate screening and management of psychopathology in CHD. The present study investigates the frequency of individual depressive symptoms in CHD and their impact on cardiac and subjective health. Methods In total, 1337 in- and outpatients with CHD were screened for depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9) at three different cardiac treatment sites. Tables stratified by age and gender were designed to illustrate base rates of depressive symptoms. Multiple regression analyses adjusted for sociodemographic and clinical data were conducted to test associations between individual depressive symptoms and quality of life as well impairment caused angina pectoris and dyspnea. Results During the last 14 days, more than half of patients reported a loss of energy (74.9%, 95% Confidence Interval (CI): 70.6–79.2), sleeping problems (69.4%, 95% CI: 64.9–74.0), loss of interest (55.7%, 95% CI: 50.8–60.7). In contrast, psychomotor change (25.6%, 95%CI: 21.3–30.0), feelings of failure (21.9%, 95%CI: 17.7–26.0), suicidal ideations (14.1%, 95%CI: 10.7–17.6) were less frequently reported. Depending on the outcome, only particular depressive symptoms were highly associated with low quality of life and impairment caused by angina pectoris and dyspnea. Loss of energy was the only depressive symptom that reliably predicted all three outcomes. Conclusions Depressive symptoms in CHD are frequent but vary widely in terms of frequency. Findings underline the differential effects of individual depressive symptoms on cardiac health. Presented base rates of depressive symptoms offer clinicians a new way to judge the severity of individual depressive symptoms and to communicate individual PHQ-9 profiles with patients with respect to gender, age, cardiac symptoms and quality of life.

A European research network to improve diagnosis, treatment and care for patients with persistent somatic symptoms : Work report of the EURONET-SOMA conference series

Persistent somatic symptoms are common and complex phenomena which pose major challenges to psychosomatics and many other medical specialties across Europe. They are frequent and can affect every organ system [1], individuals of all ages, ethnic groups and socioeconomic strata [2]. Chronic courses of disorders are common [3] and significantly impair quality of life [4,5] and increase health care use [6] as well as health care costs [7]. The different concepts of persistent somatic symptoms across medical specialties, clinical psychology and in psychosomatic medicine itself impede an early diagnosis and treatment initiation. Practitioners in psychosomatic medicine are faced with the new diagnosis of “Somatic Symptom Disorder” in DSM-5 [8] and the suggested “Bodily Distress Disorder” in ICD-11 [9,10] which both no longer exclude the existence of underlying medical conditions. Etiological concepts of persistent somatic symptoms differ substantially between medical specialties. The lack of medical guidelines or specialized treatment options for persistent somatic symptoms in some European countries present additional challenges for practitioners and affected patients [11,12]. Available clinical guidelines (e.g., from Germany or the Netherlands) suggest a stepped-care approach for patients with persistent somatic symptoms [13,14] which often remains unimplemented in favor of medication use actually intended for the treatment of anxiety, depression, and other mental health problems [15]. Given that research efforts on persistent somatic symptoms would largely benefit from a more coordinated and collaborative approach across Europe, we have come to recognize the urgent need to establish a European research network. By bringing researchers from all over Europe to take a seat at the table, we sought to develop a joint research agenda to address the pressing needs for improvement in the recognition, diagnosis, explanation and treatment of patients with persistent somatic symptoms.

Public stigma towards individuals with somatic symptom disorders – Survey results from Germany

OBJECTIVE The study aims to investigate (1) the magnitude of public stigma towards individuals with somatic symptom disorder (SSD), (2) differences in public stigma between SSD and depression, and (3) predictors of social distance towards individuals with SSD. METHODS Analyses are based on a national telephone survey in Germany (N = 1004). Two vignettes with symptoms of SSD were used. Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Stigma was measured by stereotypes, negative emotional reactions, and desire for social distance. RESULTS There were no significant differences in public stigma regarding type of symptom and existence of an earlier somatic disease. Two of three components of public stigma under study (stereotypes and desire for social distance) showed higher values in case of depression compared to SSD (both vignettes pooled). Age and negative emotional reactions were positively associated with desire for social distance in case of both SSD vignettes, whereas associations with stereotypes and experience (own affliction and contact to persons afflicted) were inconsistent. Education was not associated with social distance towards people with SSD. CONCLUSIONS Results indicated public stigma towards people affected by SSD in Germany. Compared with depression, SSD stigma was lower in most components. Magnitude of SSD stigma was similar, irrespective of main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Reducing SSD stigma could help to improve illness behaviour and prevent chronification.

Coding of medically unexplained symptoms and somatoform disorders by general practitioners - an exploratory focus group study

BackgroundMedically unexplained symptoms (MUS) and somatoform disorders are common in general practices, but there is evidence that general practitioners (GPs) rarely use these codes. Assuming that correct classification and coding of symptoms and diseases are important for adequate management and treatment, insights into these processes could reveal problematic areas and possible solutions. Our study aims at exploring general practitioners’ views on coding and reasons for not coding MUS/somatoform disorders.MethodsWe invited GPs to participate in six focus groups (N = 42). Patient vignettes and a semi-structured guideline were used by two moderators to facilitate the discussions. Recordings were transcribed verbatim. Two researchers analyzed the data using structuring content analysis with deductive and inductive category building.ResultsThree main categories turned out to be most relevant. For category a) “benefits of coding” GPs described that coding is seen as being done for reimbursement purposes and is not necessarily linked to the content of their reference files for a specific patient. Others reported to code specific diagnoses only if longer consultations to explore psychosomatic symptoms or psychotherapy are intended to be billed. Reasons for b) “restrained coding” were attempting to protect the patient from stigma through certain diagnoses and the preference for tentative diagnoses and functional coding. Some GPs admitted to c) “code inaccurately” attributing this to insufficient knowledge of ICD-10-criteria, time constraints or using “rules of thumb” for coding.ConclusionsThere seem to be challenges in the process of coding of MUS and somatoform disorders, but GPs appear not to contest the patients’ suffering and accept uncertainty (about diagnoses) as an elementary part of their work. From GPs’ points of view ICD-10-coding does not appear to be a necessary requirement for treating patients and coding might be avoided to protect the patients from stigma and other negative consequences. Our findings supply a possible explanation for the commonly seen difference between routine and epidemiological data. The recent developments in the DSM-5 and the upcoming ICD-11 will supposedly change acceptance and handling of these diagnoses for GPs and patients. Either way, consequences for GPs’ diagnosing and coding behavior are not yet foreseeable.