Pilot study examining a profession-oriented rehabilitation concept for nursing professionsObjectives: Nursing professions are associated with high levels of psychological distress, high numbers of absent days and premature retirement. To achieve higher return-to-work rates, psychosomatic rehabilitation is expected to offer treatments tailored to workplace demands. This pilot study is the first to examine the effects of a new workplace-oriented medical rehabilitation program for nursing professions. Methods: A total of N = 145 depressed patients in nursing occupations (86.9 % female; 50.9 ± 7.34 years) took part in a workplace-oriented rehabilitation program for nursing professions. At admission they were compared to N = 147 depressed patients (63.27 % female; 49.36 ± 7.58 years) in non-nursing professions regarding patterns of work-related experience and behaviour (AVEM) using a MANOVA with follow-up ANOVAs for individual subscales. Changes in workrelated attitudes among the nursing professions following completion of the intervention were assessed using a MANOVA followed by repeated measures ANOVAs. The effect of the workplace-oriented intervention on depressiveness (BDI-II) was compared to a treatment program for depression using a mixed model after taking potentially confounding variables into account. Results: At entry, depressed patients in nursing professions scored significantly higher on AVEM scale willingness to work to exhaustion and lower on AVEM scale distancing ability compared to depressed patients in other professions. Following completion of the workplaceoriented intervention program for nursing professions, participants showed a significant reduction on AVEM scales subjective importance of work, willingness to work to exhaustion, and striving for perfection. Increasing scores were observed on the distancing ability and life satisfaction scales. Depression scores had significantly improved at discharge in both participants of the work-oriented intervention and the disorder-specific intervention for depressive disorders, whereas neither group differences nor interaction effects were found. Conclusions: The work-oriented intervention for nursing professions successfully induced changes in maladaptive work-related attitudes. Improvements in depressiveness did not significantly differ from an intervention targeting depression specifically.

Background: Cushing’s disease (CD) is caused by adrenocorticotropic hormone (ACTH)-secreting pituitary tumours. They express high levels of heat shock protein 90 and heat shock factor 1 (HSF1) in comparison to the normal tissue counterpart, indicating activated cellular stress. Aims: Our objectives were: (1) to correlate HSF1 expression with clinical features and hormonal/radiological findings of CD, and (2) to investigate the effects of HSF1 inhibition as a target for CD treatment. Patients/Methods: We examined the expression of total and pSer326HSF1 (marker for its transcriptional activation) by Western blot on eight human CD tumours and compared to the HSF1 status of normal pituitary. We screened a cohort of 45 patients with CD for HSF1 by immunohistochemistry and correlated the HSF1 immunoreactivity score with the available clinical data. We evaluated the effects of HSF1 silencing with RNA interference and the HSF1 inhibitor KRIBB11 in AtT-20 cells and four primary cultures of human corticotroph tumours. Results: We show that HSF1 protein is highly expressed and transcriptionally active in CD tumours in comparison to normal pituitary. The immunoreactivity score for HSF1 did not correlate with the typical clinical features of the disease. HSF1 inhibition reduced proopiomelanocortin (Pomc) transcription in AtT-20 cells. The HSF1 inhibitor KRIBB11 suppressed ACTH synthesis from 75% of human CD tumours in primary cell culture. This inhibitory action on Pomc transcription was mediated by increased glucocorticoid receptor and suppressed Nurr77/Nurr1 and AP-1 transcriptional activities. Conclusions: These data show that HSF1 regulates POMC transcription. Pharmacological targeting of HSF1 may be a promising treatment option for the control of excess ACTH secretion in CD.

Psychiatric disorders increasingly contribute to disability and early retirement. This study was conducted to investigate whether machine learning can contribute to a better understanding and assessment of such a reduced earning capacity. It analyzed whether impaired earning capacity is reflected in missing treatment effects, and which interventions drive treatment effects during psychosomatic rehabilitation. Analyses were based on routine clinical data encompassing demographics, diagnoses, psychological questionnaires before, and after treatment, interventions, and an interdisciplinary assessment of earning capacity for N = 1,054 patients undergoing psychosomatic rehabilitation in 2019. Classification of patients by changes in self-reported mental health and interventions predictive of changes were analyzed by gradient boosted model. Clustering results revealed three major groups, one of which was comprised almost exclusively of patients with full earning capacity, one of patients with reduced or lost earning capacity and a third group with mixed assessments. Classification results (Kappa = 0.22) indicated that patients experienced modestly divergent changes over the course of rehabilitation. Relative variable influence in the best model was highest for changes in psychological wellbeing (HEALTH-49). Regression analysis identified intervention A620 (physical exercise therapy with psychological goal setting) as most influential variable predicting changes in psychological wellbeing with a model fit of R2 = 0.05 (SD = 0.007). Results suggest that disability due to psychiatric disorders does associate with distinct demographic and clinical characteristics but may be less clear-cut in a subgroup of patients. Trajectories of treatment response show moderately divergent paths between patient groups. Moreover, results support both physical exercise therapy as efficient intervention in reducing disability-associated impairments and the complementarity of a multimodal treatment plan.

No abstract