@misc{LehnenSchroederHenningsenetal., author = {Lehnen, Nadine and Schr{\"o}der, Lena and Henningsen, Peter and Glasauer, Stefan and Ramaioli, Cecilia}, title = {Deficient head motor control in functional dizziness: Experimental evidence of central sensory-motor dysfunction in persistent physical symptoms}, series = {Progress in Brain Research}, volume = {249}, journal = {Progress in Brain Research}, issn = {1875-7855}, doi = {10.1016/bs.pbr.2019.02.006}, pages = {385 -- 400}, abstract = {Understanding the mechanisms of symptoms that are insufficiently explained by organic dysfunction remains challenging. Recently, it has been proposed that such "functional symptoms" are based on erroneous sensory processing in the central nervous system (CNS), with internal expectations dominating sensory inputs. In a pilot study, we used a head motor control set-up to assess the interplay between sensory input and expectation on the example of patients with functional dizziness. Eight patients and 11 age-matched healthy controls performed large active eye-head gaze shifts towards visual targets in the natural situation and with the head moment of inertia 3.3-fold increased. The latter induces head oscillations and the expected sensory outcome of the movement, estimated in the CNS, does not match the actual sensory input. Head oscillations were assessed in patients and in healthy subjects and compared to prior results from patients with organic disease (vestibular loss and cerebellar ataxia). Head oscillations in patients with functional dizziness were different from those of healthy subjects (F(1,17) = 27.26, P < 0.001, partial η2 = 0.62), and similar to those of patients with cerebellar ataxia, and with vestibular loss (F(2,19) = 0.56, P = 0.58). Even in the natural, unweighted, condition, head oscillations were higher in functional dizziness patients than in healthy subjects (P = 0.001). Since an extensive work-up failed to demonstrate any explanatory peripheral vestibular, motor, or cerebellar organic dysfunction, these motor control deficits are a first indication of erroneous interplay between expectations and sensory input in the CNS that could account for persistent physical symptoms.}, language = {en} } @misc{SchroederHoebelRoicketal., author = {Schr{\"o}der, Sara Lena and Hoebel, Jens and Roick, Julia and Markert, Jenny and Spallek, Jacob and Knesebeck, Olaf von dem and Richter, Matthias}, title = {Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review}, series = {European Journal of Public Health}, volume = {29}, journal = {European Journal of Public Health}, number = {4}, issn = {1101-1262}, doi = {10.1093/eurpub/ckz186.377}, abstract = {Background: The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population. Methods: This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria. Results: The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged. Conclusions: The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians.}, language = {en} } @misc{SchroederHoebelSpalleketal., author = {Schr{\"o}der, Sara Lena and Hoebel, Jens and Spallek, Jacob and Knesebeck, Olaf von dem and Richter, M.}, title = {Sozio{\"o}konomische Unterschiede in der Inanspruchnahme haus- und fach{\"a}rztlicher Versorgung - Ergebnisse einer systematischen Literaturrecherche}, series = {Gesundheitswesen 2019}, volume = {81}, journal = {Gesundheitswesen 2019}, number = {08/09}, publisher = {Georg Thieme Verlag KG}, address = {Stuttgart}, doi = {10.1055/s-0039-1694561}, pages = {730 -- 730}, abstract = {Hintergrund: Sozio{\"o}konomische Ungleichheiten in der gesundheitlichen Versorgung werden h{\"a}ufig krankheitsspezifisch untersucht, w{\"a}hrend die Evidenz zu Unterschieden in der Inanspruchnahme in der Gesamtbev{\"o}lkerung bislang unzureichend ist. Ziel der Arbeit ist es, den internationalen Stand zum Zusammenhang zwischen dem Sozialstatus und der Inanspruchnahme von Haus- und Fach{\"a}rzten systematisch aufzubereiten. Methode: In den Datenbanken Medline und Web of Science wurde eine systematische Literaturrecherche durchgef{\"u}hrt, um quantitative Studien aus den Jahren 2003 bis 2018 zu identifizieren. Von 1214 Treffern werden aktuell 69 Volltexte in Hinblick auf die Einschlusskriterien {\"u}berpr{\"u}ft. Ergebnisse: Die Inanspruchnahme wird entweder als „Anzahl der Arztkontakte" gemessen oder zwischen Nutzung und Nicht-Nutzung eines Haus- oder Facharztes in einem bestimmten Zeitraum unterschieden. Die bisher gesichteten Studien deuten darauf hin, dass sich die sozio{\"o}konomischen Ungleichheiten in der Inanspruchnahme der haus- und fach{\"a}rztlichen Versorgung unterscheiden. W{\"a}hrend Fach{\"a}rzte seltener von Menschen mit niedrigem Sozialstatus aufgesucht werden, sind die Ungleichheiten bei Haus{\"a}rzten geringer und die Studien konnten entweder keine sozio{\"o}konomischen Unterschiede aufzeigen oder fanden, dass Menschen mit niedrigem Sozialstatus h{\"a}ufiger eine Prim{\"a}rversorgung in Anspruch nehmen. Diskussion: Sozio{\"o}konomische Unterschiede zu Ungunsten der sozial benachteiligten Bev{\"o}lkerung bestehen m{\"o}glicherweise deutlicher bei Fach{\"a}rzten im Vergleich zu Haus{\"a}rzten. Gerade in der Inanspruchnahme von Fach{\"a}rzten besteht daher Handlungsbedarf zur Verringerung der Ungleichheiten, um eine bedarfsgerechte Inanspruchnahme der Versorgung zu gew{\"a}hrleisten. M{\"o}gliche Gr{\"u}nde f{\"u}r die Unterschiede sollen bei einem Vergleich der Studien untersucht werden, um Implikationen f{\"u}r eine Verbesserung der Versorgung abzuleiten.}, language = {de} } @misc{SchroederWerderRamaiolietal., author = {Schr{\"o}der, Lena and Werder, Dina von and Ramaioli, Cecilia and Wachtler, Thomas and Henningsen, Peter and Glasauer, Stefan and Lehnen, Nadine}, title = {Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders}, series = {Frontiers in Neuroscience}, volume = {15}, journal = {Frontiers in Neuroscience}, issn = {1662-453X}, doi = {10.3389/fnins.2021.685590}, abstract = {Objective: We are still lacking a pathophysiological mechanism for functional disorders explaining the emergence and manifestation of characteristic, severely impairing bodily symptoms like chest pain or dizziness. A recent hypothesis based on the predictive coding theory of brain function suggests that in functional disorders, internal expectations do not match the actual sensory body states, leading to perceptual dysregulation and symptom perception. To test this hypothesis, we investigated the account of internal expectations and sensory input on gaze stabilization, a physiologically relevant parameter of gaze shifts, in functional dizziness. Methods: We assessed gaze stabilization in eight functional dizziness patients and 11 healthy controls during two distinct epochs of large gaze shifts: during a counter- rotation epoch (CR epoch), where the brain can use internal models, motor planning, and resulting internal expectations to achieve internally driven gaze stabilization; and during an oscillation epoch (OSC epoch), where, due to terminated motor planning, no movement expectations are present, and gaze is stabilized by sensory input alone. Results: Gaze stabilization differed between functional patients and healthy controls only when internal movement expectations were involved [F(1,17) = 14.63, p = 0.001, and partial η2 = 0.463]: functional dizziness patients showed reduced gaze stabilization during the CR (p = 0.036) but not OSC epoch (p = 0.26). Conclusion: While sensory-driven gaze stabilization is intact, there are marked, well- measurable deficits in internally-driven gaze stabilization in functional dizziness pointing at internal expectations that do not match actual body states. This experimental evidence supports the perceptual dysregulation hypothesis of functional disorders and is an important step toward understanding the underlying pathophysiology.}, language = {en} } @misc{SchroederRegnathGlasaueretal., author = {Schr{\"o}der, Lena and Regnath, Franziska and Glasauer, Stefan and Hackenberg, Anna and Hente, Juliane and Weilenmann, Sonja and Pohl, Daniel and K{\"a}nel, Roland von and Lehnen, Nadine}, title = {Altered sensorimotor processing in irritable bowel syndrome: Evidence for a transdiagnostic pathomechanism in functional somatic disorders}, series = {Frontiers in Neuroscience}, volume = {16}, journal = {Frontiers in Neuroscience}, issn = {1662-453X}, doi = {10.3389/fnins.2022.1029126}, abstract = {Objective A recent hypothesis suggests that functional somatic symptoms are due to altered information processing in the brain, with rigid expectations biasing sensorimotor signal processing. First experimental results confirmed such altered processing within the affected symptom modality, e.g., deficient eye-head coordination in patients with functional dizziness. Studies in patients with functional somatic symptoms looking at general, trans-symptomatic processing deficits are sparse. Here, we investigate sensorimotor processing during eye-head gaze shifts in irritable bowel syndrome (IBS) to test whether processing deficits exist across symptom modalities. Methods Study participants were seven patients suffering from IBS and seven age- and gender-matched healthy controls who performed large gaze shifts toward visual targets. Participants performed combined eye-head gaze shifts in the natural condition and with experimentally increased head moment of inertia. Head oscillations as a marker for sensorimotor processing deficits were assessed. Bayes statistics was used to assess evidence for the presence or absence of processing differences between IBS patients and healthy controls. Results With the head moment of inertia increased, IBS patients displayed more pronounced head oscillations than healthy controls (Bayes Factor 10 = 56.4, corresponding to strong evidence). Conclusion Patients with IBS show sensorimotor processing deficits, reflected by increased head oscillations during large gaze shifts to visual targets. In particular, patients with IBS have difficulties to adapt to the context of altered head moment of inertia. Our results suggest general transdiagnostic processing deficits in functional somatic disorders.}, language = {en} }