Higher Mental Burden Research Articles

Needs and Demands for e-Health Interventions in Patients Attending a Psychosomatic Outpatient Clinic: A Baseline Assessment for a User-Centered Design Approach.

Objective: Increased utilization of e-health services can help to meet shortages of psychotherapeutic treatment. e-Health interventions can be effective if tailored according to the individual needs and demands of the target group. To gather comprehensive data for the development of a user-centered e-health intervention, a cross-sectional study was conducted among a heterogeneous cohort of 309 patients seeking treatment or consultation at psychosomatic university hospital in a densely populated region of Germany. Methods: Sociodemographic data, psychometric dimensions of mental burden, as well as needs and demands regarding an e-health intervention were assessed. A descriptive statistical analysis and a cluster analysis were performed to examine distribution of preferences and differences based on level of burden regarding needs and demands for e-health interventions. Results: Two hundred thirty-nine (N = 239) participants were included in the final data analysis. Among this primarily urban target group smartphone availability was favored by 77.8% of the participants. The cluster analysis revealed significant differences dependent on mental burden. 75.2% of participants with a high mental burden preferred longer interventions of 1-4 months compared with 49% in the low burden group, which also considered short interventions of up to 1 month (46%). Differences were also identified for content preferences and daily-life integration and were consistent irrespective of the initial reason for consultation. Conclusion: The findings of this study can provide a foundational framework for developing user-centered psychosomatic interventions. The potential relationship between individual burden and individual needs and demands highlights the crucial role of preliminary research to tailor interventions to effectively address diverse needs and preferences.

Intensive out-of-hospital coaching for frequently hospitalized COPD patients: a before-after feasibility study.

This study assesses whether out-of-hospital coaching of re-hospitalized, severe COPD patients by specialized respiratory nurses is feasible in terms of cost-effectiveness, implementation, and recipient acceptability. The coaching was aimed at improving patients' health management abilities, motivation for healthy behavior, strengthening the professional and informal care network, stimulating physiotherapy treatment and exercise training, improving knowledge on symptom recognition and medication use, and providing safety and support. Cost-effectiveness of 6 months of out-of-hospital coaching was assessed based on a before-after intervention design, with real-life data and one-year follow-up. A total of 170 patients were included. Primary (questionnaires, meeting reports) and secondary data (insurance reimbursement data) were collected in one province in the Netherlands. The implementing and recipient acceptability was assessed based on the number of successfully delivered coaching sessions, questionnaire response rate, Patient Reported Experience Measure, and interviews with coaches. Post-intervention, the COPD-related hospitalization rate was reduced by 24%, and patients improved in terms of health status, anxiety, and nutritional status. Patients with a high mental burden and a poor score for health impairment and wellbeing at the start of the intervention showed the greatest reduction in hospitalizations. The coaching service was successfully implemented and considered acceptable by recipients, based on patient and coach satisfaction and clinical use of patient-reported measures. The study demonstrates the value of coaching patients out-of-hospital, with a strong link to primary care, but with support of hospital expertise, thereby adding to previous studies on disease- or self-management support in either primary or secondary care settings. Patients benefit from personal attention, practical advice, exercise training, and motivational meetings, thereby improving health status and reducing the likelihood of re-hospitalization and its associated costs.

How do spine surgeons cope with psychological distress: results of a cross-sectional study

Cross Sectional Study/Online Survey. In this study, we sought to assess stress, psychological distress, resilience, and coping strategies among spine surgeons in German-speaking countries. Recent studies have reported high rates of stress and burnout among surgeons. A survey via Survey Monkey™ was conducted among spine surgeons practicing in German-speaking countries using validated questionnaires for perceived stress, mental burden, resilience, and quality of life. Data on working situation and demographics were also collected. 582 surgeons responded to the survey, representing 15% of those surveyed. 79% of respondents were satisfied with their professional success. Mental burden was higher than in the general population, as was perceived stress. Chairpersons were exposed to the lowest levels of perceived stress and mental burden. Mental distress was high (GHQ ≥ 12) in 59% of residents and 27% chairpersons. Self-reported psychological resilience was higher than levels found in the general population and highest among chairpersons. Quality of life was comparable to levels reported in the general population. There were statistically significant correlations between perceived stress and mental burden scores (r s = 0.65, p < 0.001). Career level (senior physicians vs. residents, OR 0.26; 95% CI 0.10-0.66), perceived stress (OR 1.54; 95% CI 1.33-1.77), self-reported resilience (OR 0.53; 95% CI 0.33-0.84), and mental composite score (SOR 0.86; 95% CI 0.83-0.90) were predictors of high mental burden. There was no interaction between perceived stress and resilience on mental burden (p = 0.835). Spine surgeons are exposed to higher levels of stress than the general population, which are associated with higher mental distress. More professional experience and higher levels of psychological resilience are associated with lower levels of stress.

The Mental Workload Analysis on Female Educators During Covid-19 Pandemic Using Nasa-TLX Method

The fate of women workers during the pandemic is quite worrying. The role of women's triple burden in these times is getting heavier. Mental workload is a multidimensional construct that demands attention, performance, and skills of workers according to their work environment. This study aims to find out the mental burden felt by female workers during the pandemic. The subjects of this study were female educators at the University of Balikpapan. Five subjects feel a Very high mental burden on work activities during a pandemic, namely subjects 06, 14, 19, 23, and 25. There are 18 subjects who feel a high mental burden including subjects 3, 4, 5, 7, 8, 10, 12, 13, 16, 17, 18, 20, 21, 26, 28, 29, 30, and 31. Then, 3 subjects felt a moderate mental load, and 2 subjects felt a low mental load. If average, then the mental workload of female educators at the University of Balikpapan is 56.623 categorized as high. This study also seeks to investigate the correlation between the perceived workload of the subjects and several factors including age, marital status, education level, address, family size, income, COVID-19 survivor status, and family members who are COVID-19 survivors. The result showed that the number of family members is the only significant factor that influences the mental workload.

Text-mining of children's answers to national web-survey questions on parental status during COVID-19

Objectives Behavior at school has been restricted due to infection control during the COVID-19 pandemic. This study aimed to clarify children's opinions by examining the structure of their text responses to open-ended web survey questions, as well as how they differed to the psychological and socio-economic status of their parents.Method From September to October 2020, approximately six months after the temporary closure of schools in Japan due to COVID-19, 2,111 respondents (elementary, junior high, and high school students) answered a questionnaire on "The third wave of CORONA-CODOMO project" website. The text data of 1,140 students who provided free-text answers to open-ended questions such as, "what are you concerned about and what do you want to say?" (comments) and "how should I get them to understand?" (proposals) were analyzed. Results were stratified by parental demographics such as age, employment status, the Kessler Psychological Distress Scale (K6), and financial status. The text mining assessed the frequency of word appearances, analyzed characteristic words, and showed a term network (word-relationship diagram).Results The total number of lines (number of respondents) of comments and proposal texts were 531 and 1,017, respectively, and the average line length (number of characters) was 21.5 and 31.5, respectively. In the dependency relations frequency analysis, the actions of proposals and comments such as "speaking-listening", "event-disappearing", and "mask-removing" appeared. In the word network, words such as "moving" and "speaking" formed a strong co-occurrence network to "I", which had the largest node in proposals, while "COVID-19" in the comments strongly co-occurred with "end+?" (predicate attribute: question) and "I+want to disappear" (predicate attribute: aspirations). According to the parent attributes, in the proposals, the characteristic words (complementary similarity measure) were "talk" (35.9) in the employed group, "talk" (26.6) in the K6 lower score group, and "understand+not" (23.5/17.3, predicate attribute: negation) in the K6 higher score group/bad economic status. In the comments, it was "COVID-19" (28.1, 27.5) in the employed group and the high mental health group.Conclusions While children displayed discomfort and fear of COVID-19 when asked about proposals, the children were willing to talk directly, also, they wanted someone to listen to them. The characteristics of the proposals in their answers were "I don't know" in both the high mental burden group and the bad economic status group of the parents.

Socio-labor, health, and organizational factors as predictors of perceived high mental load in healthcare personnel during the COVID-19 pandemic

Health care personnel providing direct care to COVID-19 patients may perceive high mental load. In this study, we aimed to determine the mental workload perceived by the workers during the COVID-19 pandemic and its relationship with different variables. Cross-sectional study carried out in Chile that included 411 health care professionals. The following data were collected by means of an on-line questionnaire: sociodemographic, work-related, health, and psychological mediators and perception of the organizational conditions. The Subjective Mental Workload Scale (SCAM) -a 1 to 5 rating instrument- was applied. Scores >3 indicated high perceived mental load. We determined the independent predictors of perceived high mental load. Health care workers perceived medium-high mental load, 3.69 (IQR = 3.35-4.05); 78.4% of these professionals perceived high mental load. Several variables, mainly related to the organizational conditions of their job, acted as independent predictors for high mental load: being a nurse, having been in the job <6 years, had been working in hospital care, had had symptoms of stress and inadequate sleep, having a low perception regarding access to personal protection equipment and psychological support at their work site. In the context of the COVID-19 pandemic, health care workers perceive high mental burden, mainly associated to the organizational conditions of their job.

Understanding Mental Burden and Factors Associated With Study Worries Among Undergraduate Medical Students During the COVID-19 Pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic is affecting many areas of life and has led to major changes in undergraduate medical education. Even before the COVID-19 pandemic, high mental burden of medical students has frequently been reported in the literature. Additional pandemic-specific stressors could exacerbate this situation. This study aimed to assess mental health outcomes among medical students during the first semester after the COVID-19 outbreak and perception of the students on how the learning environment has changed. In May 2020, we conducted a cross-sectional survey among undergraduate medical students at a large medical school in Germany. The survey included validated mental health instruments (Distress Thermometer, Patient Health Questionnaire 4) and self-developed items to examine the perception of the study situation during the COVID-19 pandemic. Open-ended questions were analyzed by conventional content analyses. The response rate was 59.2% (914/1,545). Overall, 61.9% of the students reported distress levels above the cutoff. Year 1 students reported significantly higher levels of distress, anxiety and depression than students during their second to fourth year of studies. 48.3% of the students indicated a decrease in their study motivation since the beginning of the COVID-19 pandemic with significant differences between study years. The binary logistic regression model showed that male gender, being in study year 2, higher distress scores and higher symptoms of depression were significantly associated with a higher likelihood for experiencing serious worries. In the open-ended questions on current concerns related to the impact of the COVID-19 pandemic on their studies, students most frequently reported concerns about missing relevant practical learning experience, difficulties with self-regulated learning and self motivation as well as study-related worries. Year 4 students reported significantly more worries about the lack of practical training than students from study years 1 to 3. Analysis of gender differences showed that female students reported more frequently diverse worries. In contrast, female students shared more frequently helpful strategies in all the categories compared to male students. Our findings suggest that medical students experience significant levels of distress and mental burden during the COVID-19 pandemic and highlight the need for ongoing psychological and educational support for medical students during the COVID-19 pandemic and after.

Psoriasis and addiction: assessing mental health based on a cross-sectional study in Germany.

Psoriasis is a chronic skin disease with a high mental burden. Well-known comorbidities include depression, anxiety, as well as alcohol and tobacco addiction, however, there is barely any evidence on other addictions. The aim of this study was to estimate the prevalence of the six most common addictions among psoriasis patients in Germany and to determine associated clinical factors. Dermatologists working in four dermatological clinics and 32 practices across Germany recruited patients between September 2018 and November 2019. This cross-sectional study contained questionnaires on six addictions, depression, anxiety, and the Dermatology Life Quality Index (DLQI). In addition, scores for the Psoriasis Area and Severity Index (PASI) were obtained by physicians. Overall, 502 patients (43.4% women; mean age: 49.7 ± 14.6 years) were included. Positive addictions were found in 30.3% for daily smoking, 8.6% for alcohol, 1.2% for gambling, 3.8% for internet use, 3.6% for food, and 6.0% for drugs. Younger age was associated with a higher probability of addiction except for alcohol dependency. The PASI was only significantly associated with smoking. Addictions seem to be common among psoriasis patients. Further research should include comprehensive data and control groups, furthermore, standardised screenings and early referrals could represent first steps to improve people-centred healthcare for patients with psoriasis.

Mental burden and perception of the study situation among undergraduate students during the COVID-19 pandemic: a cross-sectional study and comparison of dental and medical students

ObjectivesTo investigate levels of distress, depression, anxiety, stress and perception of their current study situation during the COVID-19 pandemic among undergraduate dental and medical students.DesignObservational, cross-sectional study including two consecutive...

Internal Locus of Control and Sense of Coherence Decrease During the COVID-19 Pandemic: A Survey of Students and Professionals in Social Work.

Mental health is severely challenged by the COVID-19 pandemic due to a variety of restrictions in public and private life. Students in particular may face additional and unique stressors: face-to-face classes have been largely replaced by digital formats, leading to further reduced social contacts, thus facilitating the development of psychological symptoms. In this study, we aimed to assess the impact of the current peri-pandemic situation on students’ 1) locus of control and 2) sense of coherence, both of which have been linked to mental health in previous work. A total of 403 social work students from Germany participated, providing both retrospective (pre-pandemic) and current (February/March 2021) ratings. Furthermore, 324 social work professionals were included to analyze differences between both groups. Locus of control shifted significantly from internal to external during the pandemic for students and professionals. Furthermore, high mental burden correlated with increased external and decreased internal locus of control. Sense of coherence decreased during the pandemic for the entire sample and correlated with high mental burden. Overall, students showed a stronger drop compared to professionals, primarily due to a more pronounced decrease in perceived meaningfulness (all p < 0.001). In summary, students and professionals responded with increased feelings of powerlessness in the absence of sufficient coping strategies—this could lead to further deterioration of mental health as the pandemic continues. In this context, students appear to be particularly vulnerable to a reduction in sense of coherence. We conclude that interventions to improve coping strategies are urgently needed.

Does Subclinical Hypothyroidism Add Any Symptoms? Evidence from a Danish Population-Based Study

BackgroundFew studies have scrutinized the spectrum of symptoms in subclinical hypothyroidism. MethodsFrom 3 Danish Investigation on Iodine Intake and Thyroid Diseases (DanThyr) cross-sectional surveys performed in the period 1997 to 2005, a total of 8903 subjects participated in a comprehensive investigation including blood samples and questionnaires on previous diseases, smoking habits, alcohol intake, and education. From the 3 surveys we included patients with subclinical hypothyroidism (n = 376) and euthyroid controls (n = 7619). We explored to what extent patients with subclinical hypothyroidism reported 13 previously identified hypothyroidism-associated symptoms (tiredness, dry skin, mood lability, constipation, palpitations, restlessness, shortness of breath, wheezing, globus sensation, difficulty swallowing, hair loss, dizziness/vertigo, and anterior neck pain). In various uni- and multivariate regression models we searched for circumstances predicting why some patients have more complaints than others. ResultsSubclinically hypothyroid patients did not report higher hypothyroidism score [(median, interquartile range), 2 (0-4) vs 2 (0-4), P = .25] compared with euthyroid controls. Within the group of subclinical hypothyroid patients, comorbidity had the highest impact on symptoms (tiredness, shortness of breath, wheezing; all P < .001); TSH level had no impact on symptom score; and younger age was accompanied by higher mental burden (tiredness, P < .001; mood lability, P < .001; restlessness, P = .012), whereas shortness of breath was associated with high body mass index (P < .001) and smoking (P = .007). ConclusionPatients with a thyroid function test suggesting subclinical hypothyroidism do not experience thyroid disease-related symptoms more often than euthyroid subjects. In subclinical hypothyroidism, clinicians should focus on concomitant diseases rather than expecting symptomatic relief following levothyroxine substitution.

Take care or "German Angst"? Lessons from cancer care during COVID-19 pandemic in spring 2020.

ObjectiveWhile the second wave of COVID-19 has started in Europe, data are still missing on the consequences of the first one for patients with cancer. The aim of our study was to learn more about the experiences of German patients and staff in the oncology services.Materials and methodsAn anonymous online survey was conducted among cancer patients and their therapists (physicians, medical staff, psychologists, spiritual care givers) in Germany between April and May 2020 asking about burden, fears, and perceived changes in German oncology service system. Besides answer frequencies of different stakeholders, uni- and multivariate analyses were performed for selected items to identify areas of high impact.ResultsIn total 752 participants were included. All groups have identified high mental burden as central problem. A majority was confused about varying information policies and strategies against the pandemic. Patient reported restricted visits, isolation and delay of treatment as central fears and problems. The majority of fears could be coped by the health care workers. The patients describe processes at the oncology services during the first wave. Personal experiences with COVID-19 have had no influence on the felt burden of the patients. Physicians, medical staff, psychologists and spiritual care givers were extremely stressed but repressed their own burden. They await financial, physical and mental problems for their own future.ConclusionsThe presented personal views and experiences allow focusing the discussions about heath care systems during the on-going pandemic. Support for health care workers, as much routine as possible in oncology services, and transparency in information will be the keys for good management in futural situations of crisis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00432-020-03492-4.

Riesgos psicosociales y estrés laboral en tiempos de COVID-19: instrumentos para su evaluación.

En el mundo, casi tres millones de personas mueren al año por accidentes o enfermedades relacionadas con el trabajo, más de quinientos sufren enfermedades ocupacionales o lesiones. En 2019, el estrés laboral causó el 30% de las bajas en España, con un alto coste y reducción de la productividad. La COVID-19 presenta nuevos retos, casi cuatro millones de parados, otros cuatro con un ERTE y una recuperación incierta y lenta que provoca inestabilidad. También nuevos riesgos relacionados con el trabajo y el estrés. Distintos organismos defienden la importancia de la salud y bienestar laboral en todos los aspectos, físicos, mentales y sociales. Ante esta situación es imprescindible la detección de factores psicosociales de riesgo que afectan a la salud en entornos laborales para crear planes de prevención eficaces y adaptados a las situaciones cambiantes. Algunos autores destacan la dificultad de esta evaluación por metodologías insuficientes a nivel conceptual y técnico o faltos de estandarización. El objetivo de este trabajo es identificar distintas herramientas, dimensiones, fiabilidad, validez, análisis psicométrico y uso, que sirvan de referentes para la investigación en PRL. Se realizó un análisis descriptico documental de revisión bibliográfica en buscadores y páginas de organismos especializados. Se ofrecen algunos instrumentos de medición con alta confiabilidad para la detección de factores psicosociales en diversos contextos. Se recomienda complementar estas herramientas con otras que tengan en cuenta otras variables como la incertidumbre, la ansiedad o el estado mental.

Perioperative telemonitoring of older adults with cancer: Can we connect them all?

ObjectivesAlthough the increasing cancer incidence in older patients is widely recognised, older patients remain underrepresented in clinical cancer trials and eHealth studies. The aim of this research is to identify technological and patient-related barriers to inclusion of this population in a clinical eHealth study. Material and MethodsThis is a retrospective analysis of a prospective cohort study with older patients (≥ 65 years) undergoing cancer-related surgery, who were identified for a perioperative telemonitoring study. Reasons for ineligibility and refusal had been prospectively registered. Characteristics and postoperative outcomes were compared between participants and non-participants. ResultsBetween May 2018 and March 2020, 151 patients were assessed for eligibility, resulting in 65 participants and 86 non-participants. The main reason for ineligibility was lack of internet access at home (n = 16), while main reasons for refusal were perceived high mental burden (n = 46) and insufficient digital skills (n = 12). Compared with participants, non-participants were significantly older (mean age 75 vs. 73, p = 0.01); more often female (64% vs. 35%, p = 0.00), unmarried (42% vs. 8%, p = 0.01) living alone (38% vs. 19%, p = 0.02); had a higher ASA classification (43% vs. 19%, p = 0.00); often had polypharmacy (67% vs. 43%, p = 0.00); and were more often discharged to skilled nursing facilities (0% vs. 15%, p = 0.00). ConclusionOur results confirm the underrepresentation of older female patients with little support from a partner and higher comorbidity. We should be aware of technological and patient-related barriers to including older adults with cancer, in order to avoid further dividing patients with low and high digital health literacy.

THE PACKAGING SECTION EMPLOYEE MENTAL WORKLOADS ANALYSIS USING NASA-TLX METHODS IN CHRUNCHY PEANUTS PRODUCTION

This research was conducted at a food industry that processed peanuts raw materials into snacks such as crunchy peanuts. The qualities of the peanuts are divide into two levels of quality specifically, first grade quality and medium grade quality. The large amount of production that is carried out every day affected the employee’s mental pressure on both the packaging quality process. The purpose of this research is to measure the level of mental workloads of employees, knowing which type of work that the mental workloads level is highest, knowing the work categories that have higher mental workload, knowing which indicators that affect the level of mental workloads of employees, and to recommend solutions in forms of improvements to reduce employee mental workloads using NASA - TLX method. The results of this research show that the mental workloads experienced by employees of crunchy peanuts production in both first grade and medium grade packaging sections are having high mental workloads. Work that has the highest mental workloads on both packaging first grade quality and medium grade quality is the transit process with a score of 79.2. A work group with a higher mental burden is in packaging first grade quality with a score of 60.2. The indicator that most influences the level of a mental workloads of employees of crunchy peanuts production in packaging first grade section is the effort indicator (EF) with a score of 17.2, followed with the mental demand indicator (MD) with a score of 16.4 in the medium grade packaging section. Recommendations for improvements that can made to reduce the mental workloads of employees are to increase the number of employees especially in the transit section, provide safety equipment such as free masks, create reward systems and give out promotions to the employees with excellent work performances.

703 Implicit associations towards pornographic stimuli in hypersexual disorder

Hypersexual disorder describes extremely frequent sexual fantasies, sexual urges or sexual behaviors that often constitute a high mental burden. There is an ongoing debate whether hypersexual behavior should be classified as obsessive compulsive disorder, impulse control disorder or behavioral addiction. In substance dependencies implicit associations towards addiction related stimuli can be seen as result of neural sensitization leading to automatic approach behavior. Positive implicit associations may explain why problematic pornography users have difficulties resisting their automatically triggered impulses to consume pornography despite negative consequences. Patients with hypersexual disorder (N=47) and healthy controls (N=38) matched regarding age and education completed an implicit association task. This neuropsychological test indicates the strength of automatic associations. The performed implicit association task measures performance speed in a classification tasks. Participants had to categorize pictorial stimuli along different dimensions (positive vs. negative or jogging vs. pornographic) as fast as possible while the pairing of the dimensions with the response (either positive and porn share the same response or negative and porn) changes. Furthermore, hypersexual behavior was assessed.

COPD-related fatigue: Impact on daily life and treatment opportunities from the patient's perspective.

Fatigue is a highly prevalent, challenging and understudied symptom of COPD, which influences the quality of life of patients. This study addresses the patient's perspective on the impact of fatigue on their daily lives and explores possible treatment options to tackle the burden of fatigue. Twenty semi-structured interviews were conducted with ten patients hospitalised for a COPD exacerbation and ten outpatients with COPD. Data were transcribed verbatim and coded in an iterative (deductive and inductive) coding process. Patients perceived severe negative impact of fatigue on their daily lives and emphasized that they were limited in physical, emotional, cognitive and social functioning. These limitations caused a high mental burden which challenged patients' coping resources and making fatigue a symptom difficult to accept. The majority of patients mentioned that they had, to some degree, lost the joy in life or in some cases, even lost the will to live. Patients reported the need for effective treatment and recommended a multidisciplinary approach and blended care, in which an online treatment to improve fatigue management is combined with face-to-face contact with a healthcare professional to increase social support. These findings indicate that patients perceive the impact of fatigue on their daily lives to be a key factor in decreasing their quality of life. To increase awareness of fatigue in healthcare professionals and patients and to facilitate early fatigue self-management, a pro-active approach by healthcare professionals might be the best way to realize effective tailored treatment.

Gender and leprosy-related stigma in endemic areas: A systematic review

Background: The social impact of leprosy is said to exacerbate existing gender inequalities, but what is the evidence for this? What are the differences and similarities in leprosy-related stigma experiences between men and women? Methods: A systematic search was done in PubMed, Web of Science, PsycInfo and CINAHL databases, using the web-based version of Mendeley and following PRISMA guidelines. Search terms used in the search syntaxes involved synonyms for leprosy, stigma, and sex or gender. Criteria for eligibility were articles providing data on leprosy-related stigma separate for men and/or women, Dutch or English language, access to full-text copy, information based on primary data (excluding reviews), and a sample group of leprosy-affected subjects above 15 years old, living in leprosy-endemic areas. Case reports were excluded. Findings: 18 articles met the criteria and were reviewed. They demonstrated a female gender disadvantage, in the social, health and/or psychological domain. This was evidenced by a higher percentage of women experiencing stigma, a lower quality of life score for women, and a higher mental burden among women compared to controls. Only one article indicated higher perceived stigma in men compared to women, in society and in social institutions. Overall, it was found that womens inferior position results in more rejection at family and community level, more difficulties in their marital position, more social avoidance, more concealment and treatment delay, and more self-stigmatisation. All these factors and the lower female social status mutually reinforce each other. It is argued that this gender inequality is the case in other neglected tropical diseases and stigmatising conditions as well. Conclusion: The consensus that female leprosy patients are more severely affected by leprosy-related stigma than male patients is supported by 12 of the 18 reviewed articles, and by other literature. These findings highlight a need for gender sensitivity in leprosy interventions to reduce leprosy-related stigma and its impact, especially among women and girls.

Trauma-Associated Tinnitus: Audiological, Demographic and Clinical Characteristics

BackgroundTinnitus can result from different etiologies. Frequently, patients report the development of tinnitus after traumatic injuries. However, to which extent this specific etiologic factor plays a role for the phenomenology of tinnitus is still incompletely understood. Additionally, it remains a matter of debate whether the etiology of tinnitus constitutes a relevant criterion for defining tinnitus subtypes.ObjectiveBy investigating a worldwide sample of tinnitus patients derived from the Tinnitus Research Initiative (TRI) Database, we aimed to identify differences in demographic, clinical and audiological characteristics between tinnitus patients with and without preceding trauma.MaterialsA total of 1,604 patients were investigated. Assessment included demographic data, tinnitus related clinical data, audiological data, the Tinnitus Handicap Inventory, the Tinnitus Questionnaire, the Beck Depression Inventory, various numeric tinnitus rating scales, and the World Health Organisation Quality of Life Scale (WHOQoL).ResultsOur data clearly indicate differences between tinnitus patients with and without trauma at tinnitus onset. Patients suffering from trauma-associated tinnitus suffer from a higher mental burden than tinnitus patients presenting with phantom perceptions based on other or unknown etiologic factors. This is especially the case for patients with whiplash and head trauma. Patients with posttraumatic noise-related tinnitus experience more frequently hyperacousis, were younger, had longer tinnitus duration, and were more frequently of male gender.ConclusionsTrauma before tinnitus onset seems to represent a relevant criterion for subtypization of tinnitus. Patients with posttraumatic tinnitus may require specific diagnostic and therapeutic management. A more systematic and – at best - standardized assessment for hearing related sequelae of trauma is needed for a better understanding of the underlying pathophysiology and for developing more tailored treatment approaches as well.