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Search Results: 1 - 10 of 23630 matches for " Paul Enck "
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The placebo response in gastroenterology and beyond
Sibylle Klosterhalfen,Paul Enck
Polish Gastroenterology , 2009,
Abstract: The placebo literature has substantially increased in the last decade, and more and more medical and psychological subspecialties have added empirical data to our knowledge. The theoretical framework of our understanding of the placebo response needs extension to account for findings that cannot be attributed to (Pavlovian) conditioning or expectancies alone. Gender aspects have been demonstrated for the placebo and nocebo response. It has been shown that nocebo research needs a methodological and ethical framework that allows its exploration. Finally, analyses of clinical trial data, either as meta-analyses or as reanalyses of trial raw data may allow identifying factors that subsequently can be used in experimental work. This has fostered the development of novel and alternative ways to test drugs against placebo that better control for placebo mechanisms without ignoring them.
Novel study designs to investigate the placebo response
Paul Enck, Sibylle Klosterhalfen, Stephan Zipfel
BMC Medical Research Methodology , 2011, DOI: 10.1186/1471-2288-11-90
Abstract: We reviewed the respective literature for trials designs that may be used to elucidate the size of the placebo response and the mechanisms associated with it.In general, this can be done by either manipulation the information provided to the subjects, or by manipulation the timing of the drug applied. Two examples of each strategy are discussed: the "balanced placebo design" (BDP) and the "balanced cross-over design" (BCD) and their variants are based on false information, while the "hidden treatment" (HT) and the ""delayed response test" (DRT) are based on manipulating the time of drug action. Since most such approaches include deception or incomplete information of the subjects they are suitable for patient only with authorized deception.Both manipulating the information provided to subjects (BDP, DCD) or manipulating the timing of drug application (HT, DRT) allows overcoming some of the restrictions of conventional drug trials in the assessment of the placebo response, but they are feasible mostly in healthy subjects for ethical reasons.Ever since the dawn of the first randomized placebo-controlled trials testing new drugs and treatments in the middle of the last century, and even before [1], placebo responses in clinical trials have given rise to discussion and concern regarding their mechanisms, and have usually been regarded as a nuisance or a barrier to a rational approach in modern drug development. High placebo responses have induced false expectations regarding drug efficacy and resulted in the refusal or withdrawal of drugs in some cases, e.g. neurokinins in the treatment of depression.Not only do placebo responses in clinical trials impose significant limits to the testing of new compounds, but they are also linked to the drug adherence and compliance of patients in such trials in a paradoxical way. Patients that adhered to medication instructions by more than 80% showed better survival in a coronary disease study, and poor drug adherence in a myocardial
Sleep Duration and Sleep Problems in a Representative Sample of German Children and Adolescents  [PDF]
Angelika A. Schlarb, Marco D. Gulewitsch, Victoria Weltzer, Ute Ellert, Paul Enck
Health (Health) , 2015, DOI: 10.4236/health.2015.711154
Abstract: Objective: The main purpose of the present study was to evaluate sleep duration for nighttime sleep from early infancy to late adolescence in a German sample to illustrate the developmental course and age-specific variability of these variables among subjects. Methods: A total of 17,641 subjects from the KiGGS study were evaluated. The questionnaires contained questions about physical health, living circumstances, health behavior and risks, health supply, mental health, health-related quality of life and sleep. KiGGS assessed sleep by using parent questionnaire of children aged 0 to 10 years (n = 9944) and self-reports of adolescents (n = 7697) aged 11 to 17 years. Results: Total sleep duration decreased from 14.28 hours (SD = 2.33) at the ages 0 - 0.5 to 9.50 hours (SD = 0.82) at the ages of 10.5 - 11. Above the age of 11 adolescents report a decrease of sleep at night from 9.41 hours (SD = 1.33) at the age of 11 - 11.5 to 7.42 (SD = 1.73) at the age of 17.5 - 18 years. Unspecified sleep problems were reported of 19.5%, 13.0% of the children had difficulties falling asleep, difficulties sleeping through the night showed 8.8% of the children, whereas 3.0% report both symptoms—difficulties falling asleep and difficulties sleeping through the night. Conclusions: Age-specific variability of sleep duration is reported as well as sleep difficulties from infancy to adolescence. This is important knowledge for the health care professional who deals with sleep problems in pediatric practice.
Recurrent abdominal pain in children and adolescents – a survey among paediatricians
Angelika A. Schlarb,Marco D. Gulewitsch,Inga Bock genannt Kasten,Paul Enck
GMS Psycho-Social-Medicine , 2011,
Abstract: Objective: Little is known about prevalence and usual treatment of childhood and adolescent recurrent abdominal pain (RAP) in outpatient paediatricians’ practice. This study’s primary objective was to acquire insights into the usual paediatricians’ treatment and their estimation of prevalence, age and gender of RAP patients. Further objectives were to assess to which extent family members of patients report similar symptoms, how paediatricians rate the strain of parents of affected children and adolescents and how paediatricians estimate the demand for psychological support. Methods: Provided by a medical register, 437 outpatient paediatricians received a questionnaire to assess their perception of several psychosomatic problems and disorders including recurrent abdominal pain. Results: According to paediatricians’ estimation, 15% of all visits are caused by patients with RAP. In 22% of these cases of RAP, at least one family member has similar problems. In about 15% of all RAP cases, parents ask for professional psychological support concerning their children’s issues, whereas 40% of paediatricians wish for psychological support considering this group of patients. Conclusions: Estimated frequencies and paediatricians’ demands show the need for evidence-based psychological interventions in RAP to support usual medical treatment.
Emotion through Locomotion: Gender Impact
Samuel Krüger, Alexander N. Sokolov, Paul Enck, Ingeborg Kr?geloh-Mann, Marina A. Pavlova
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081716
Abstract: Body language reading is of significance for daily life social cognition and successful social interaction, and constitutes a core component of social competence. Yet it is unclear whether our ability for body language reading is gender specific. In the present work, female and male observers had to visually recognize emotions through point-light human locomotion performed by female and male actors with different emotional expressions. For subtle emotional expressions only, males surpass females in recognition accuracy and readiness to respond to happy walking portrayed by female actors, whereas females exhibit a tendency to be better in recognition of hostile angry locomotion expressed by male actors. In contrast to widespread beliefs about female superiority in social cognition, the findings suggest that gender effects in recognition of emotions from human locomotion are modulated by emotional content of actions and opposite actor gender. In a nutshell, the study makes a further step in elucidation of gender impact on body language reading and on neurodevelopmental and psychiatric deficits in visual social cognition.
Mental Strain and Chronic Stress among University Students with Symptoms of Irritable Bowel Syndrome
Marco D. Gulewitsch,Paul Enck,Juliane Schwille-Kiuntke,Katja Weimer,Angelika A. Schlarb
Gastroenterology Research and Practice , 2013, DOI: 10.1155/2013/206574
Abstract: Aim. To investigate the degree of mental strain and chronic stress in a German community sample of students with IBS-like symptoms. Methods and Materials. Following an internet-based survey about stress, this study recruited 176 German university students ( years; 48.3% males) with IBS-like symptoms according to Rome III and 181 students without IBS ( years; 50.3% males) and compared them regarding current mental strain (SCL-90-R) and the extend of chronic stress. Beyond this, IBS subtypes, IBS severity, and health care utilization were assessed. Results. Students fulfilling IBS criteria showed significantly elevated values of mental strain and chronic stress. Nearly 40% of the IBS group (versus 20% of the controls) reached a clinically relevant value on the SCL-90-R global severity scale. IBS subtypes did not differ in terms of mental distress or chronic stress. Somatization, anxiety, and the chronic stressors “work overload,” “social tension,” and “dissatisfaction with job” were most closely connected to IBS symptom severity. Regarding health care utilization, our results show that consulting a physician frequently was not associated significantly with elevated mental strain or chronic stress but with IBS symptom severity. Conclusion. Our data contribute additional evidence to the distinct association between psychological stress and IBS in community samples. 1. Introduction Irritable bowel syndrome (IBS) is a frequent functional gastrointestinal disorder which is characterized by recurrent abdominal pain or discomfort and altered bowel function without an explanatory organic etiology. Despite constipation and/or diarrhea, additional gastrointestinal symptoms like bloating and sensation of incomplete evacuation are experienced quite often. Epidemiologic data on this disorder vary a lot depending on the examined sample and the diagnostic criteria used. The prevalence of IBS in the general population is estimated to be in the range between 10% and 20% [1–5]. Our previous study has shown that the prevalence of Rome III IBS symptoms among German university students is 18.1% with a significant difference between males (15.2%) and females (21.0%) [6]. IBS, especially in a moderate or severe manifestation, has a considerable impact on health-related quality of life and daily functioning [7–9]. The pathogenic mechanisms of IBS are not fully known. There is strong evidence of altered physiologic features of persons suffering from IBS such as abnormal gastrointestinal motility [10–12] and heightened visceral sensitivity [13–15]. Gastrointestinal infections have
Effects of Ginger and Expectations on Symptoms of Nausea in a Balanced Placebo Design
Katja Weimer, J?rg Schulte, Annamaria Maichle, Eric R. Muth, Jenna L. Scisco, Bj?rn Horing, Paul Enck, Sibylle Klosterhalfen
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0049031
Abstract: Objective Ginger effects on (experimental) nausea have been described, but also strong placebo effects and sex differences when nausea is involved. The “balanced placebo design” has been proposed to allow better separation of drug and placebo effects. Methods Sixty-four healthy participants (32 women) were randomly assigned to receive an antiemetic ginger preparation or placebo, and half of each group was told to have received drug or placebo. They were exposed to 5×2 min body rotations to induce nausea. Subjective symptoms and behavioral (rotation tolerance, head movements) and physiological measures (electrogastrogram, cortisol) were recorded. Groups were balanced for sex of participants and experimenters. Results Ginger and the information given did not affect any outcome measure, and previous sex differences could not be confirmed. Adding the experimenters revealed a significant four-factorial interaction on behavioral but not on subjective or physiological measures Men who received placebo responded to placebo information when provided by the male experimenter, and to ginger information when provided by the female experimenter. This effect was not significant in women. Conclusion The effects of an antiemetic drug and provided information interact with psychosocial variables of participants and experimenters in reports of nausea.
Sensitivity and Specificity of Hypnosis Effects on Gastric Myoelectrical Activity
Paul Enck, Jochen Hefner, Beate M. Herbert, Nazar Mazurak, Katja Weimer, Eric R. Muth, Stephan Zipfel, Ute Martens
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083486
Abstract: Objectives The effects of hypnosis on physiological (gastrointestinal) functions are incompletely understood, and it is unknown whether they are hypnosis-specific and gut-specific, or simply unspecific effects of relaxation. Design Sixty-two healthy female volunteers were randomly assigned to either a single session of hypnotic suggestion of ingesting an appetizing meal and an unappetizing meal, or to relax and concentrate on having an appetizing or unappetizing meal, while the electrogastrogram (EGG) was recorded. At the end of the session, participants drank water until they felt full, in order to detect EGG-signal changes after ingestion of a true gastric load. During both conditions participants reported their subjective well-being, hunger and disgust at several time points. Results Imagining eating food induced subjective feelings of hunger and disgust as well as changes in the EGG similar to, but more pronounced than those seen with a real gastric water load during both hypnosis and relaxation conditions. These effects were more pronounced when imagining an appetizing meal than with an unappetizing meal. There was no significant difference between the hypnosis and relaxation conditions. Conclusion Imagination with and without hypnosis exhibits similar changes in subjective and objective measures in response to imagining an appetizing and an unappetizing food, indicating high sensitivity but low specificity.
Cholecystokinin Revisited: CCK and the Hunger Trap in Anorexia Nervosa
Ulrich Cuntz, Paul Enck, Erich Frühauf, Peter Lehnert, Rudolf L. Riepl, Manfred M. Fichter, B?rbel Otto
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0054457
Abstract: Objective Despite a number of studies in the past decades, the role of Cholecystokinin (CCK) in anorexia nervosa (AN) has remained uncertain. In this study a highly specific assay for the biologically active part of CCK was used in patients with bulimic as well as with the restricting type of AN who were followed over the course of weight gain. Methods Ten patients with restricting and 13 with bulimic AN were investigated upon admission (T0), after a weight gain of at least 2 kg on two consecutive weighting dates (T1), and during the last week before discharge (T2) from inpatient treatment in a specialized clinic. Blood samples were drawn under fasting conditions and 20 and 60 minutes following a standard meal (250 kcal). Data were compared to those of eight controls matched for sex and age. Gastrointestinal complaints of patients were measured by a questionnaire at each of the follow-up time points. Results At admission, AN patients exhibited CCK-levels similar to controls both prior to and after a test meal. Pre and post-meal CCK levels increased significantly after an initial weight gain but decreased again with further weight improvement. CCK release was somewhat lower in bulimic than in restricting type AN but both subgroups showed a similar profile. There was no significant association of CCK release to either initial weight or BMI, or their changes, but CCK levels at admission predicted gastrointestinal symptom improvement during therapy. Conclusions Normal CCK profiles in AN at admission indicates hormonal responses adapted to low food intake while change of eating habits and weight gain results in initially increased CCK release (counteracting the attempts to alter eating behavior) that returns towards normal levels with continuous therapy.
An Application Package Configuration Approach to Mitigating Android SSL Vulnerabilities
Vasant Tendulkar,William Enck
Computer Science , 2014,
Abstract: Computing platforms such as smartphones frequently access Web content using many separate applications rather than a single Web browser application. These applications often deal with sensitive user information such as financial data or passwords, and use Secure Sockets Layer (SSL) to protect it from unauthorized eavesdropping. However, recent studies have confirmed a wide-spread misconfiguration of SSL verification in applications. This paper considers the difficulty faced by Android application developers when modifying SSL code for using common features like pinning or using a self-signed SSL certificate. For example, developing an application that accesses a test Web server with a self-signed certificate requires additional code to remove SSL verification; however, this code is not always removed in production versions of the application. To mitigate vulnerabilities introduced because of the complexity of customizing SSL code in Android applications, we propose that common SSL configuration should be specified in the application's package manifest. We provide two concrete suggestions: 1) linking the application's debug state to SSL verification, and 2) pinning certificates and CAs in the manifest. We evaluate the appropriateness of these two suggestions on over 13,000 applications from Google's Play Store, of which 3,302 use SSL in non-advertisement code, and find that 1,889 (57.20%) of these SSL applications would benefit.
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