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Aufgrund von diagnostischen und therapeutischen Fortschritten in der Hämatologie und Onkologie und entsprechend steigenden Überlebensaussichten ist ein stetiger Zuwachs der Gruppe von Langzeitüberlebenden mit und nach Krebs (Cancer Survivor) in Deutschland zu verzeichnen. Obwohl das bereits vorhandene deutsche Gesundheitswesen vielfältige Versorgungsangebote vorhält, die auch für Langzeitüberlebende verfügbar sind, ist die Versorgungssituation dieser Gruppe nicht zufriedenstellend. So bedarf es zum einen der Entwicklung von Orientierungshilfen für Langzeitüberlebende, zum anderen sollten neue und innovative Versorgungsprogramme für Überlebende (Survivorship-Programme) entwickelt werden. Der Beitrag gibt einen Überblick über die Problematik, definiert relevante Begrifflichkeiten und formuliert Kernaspekte für die Ausgestaltung von Survivorship-Programmen für Langzeitüberlebende nach Krebserkrankung.
Background
Fear of abandonment and aloneness play a key role in the clinical understanding interpersonal and attachment-specific problems in patients with borderline personality disorder (BPD) and has been investigated in previous functional Magnet Resonance Imaging (fMRI) studies. The aim of the present study was to examine how different aspects of attachment representations are processed in BPD, by using for the first time an fMRI attachment paradigm including personalized core sentences from the participants’ own attachment stories. We hypothesized that BPD patients would show increased functional involvement of limbic brain regions associated with fear and pain (e.g., the amygdala and the anterior cingulate cortex) when presented personalized attachment relevant stimuli representing loneliness compared to healthy controls (HC).
Methods
We examined the attachment classifications of 26 female BPD patients and 26 female HC using the Adult Attachment Projective Picture System (AAP). We used an fMRI-adapted attachment paradigm to investigate the neural correlates of attachment. All participants were presented three personalized (vs. neutral) sentences extracted from their AAP attachment narrative, combined with standardized AAP pictures representing being alone (monadic) or in interactive (dyadic) attachment situations.
Results
As expected, the classification of unresolved attachment was significantly greater in BPD compared to HC. BPD patients showed increased fMRI-activation in brain areas associated with fear, pain, and hyperarousal than HC when presented with personalized attachment-relevant alone stimuli. In particular, pictures with monadic attachment situations induced greater anterior medial cingulate cortex, anterior insula, amygdala, thalamus and superior temporal gyrus activation in the patient group.
Conclusion
The results point to increased fMRI-activation in areas processing emotional distress and painful experiences in BPD patients. In particular, the emotional cascade reflecting attachment distress was evoked by combining monadic pictures, representing abandonment and aloneness, with the patients’ personalized narrative material. Our results confirmed and replicated previous results that illustrate once again the high relevance of aloneness and feelings of abandonment for BPD in the context of attachment trauma. Moreover, our results support the hypothesis of hypermentalization in response to attachment distress as a core feature of social-cognitive impairment in BPD associated with common treatment implications across different therapeutic orientations.
APOE ε4 in Depression-Associated Memory Impairment—Evidence from Genetic and MicroRNA Analyses
(2022)
(1) Background: The aim of this study was to replicate a reported interaction between APOE ε4 status and depression on memory function in two independent, nondemented samples from the general population and to examine the potential role of circulating plasma miRNAs. (2) Methods: The impact of the APOE ε4 allele on verbal memory and the interaction with depression is investigated in two large general-population cohorts from the Study of Health in Pomerania (SHIP, total n = 6286). Additionally, biological insights are gained by examining the potential role of circulating plasma miRNAs as potential epigenetic regulators. Analyses are performed using linear regression models adjusted for relevant biological and environmental covariates. (3) Results: Current depression as well as carrying the APOE ε4 allele were associated with impaired memory performance, with increasing effect for subjects with both risk factors. In a subcohort with available miRNA data subjects with current depressive symptoms and carrying APOE e4 revealed reduced levels of hsa-miR-107, a prominent risk marker for early Alzheimer’s Disease. (4) Conclusions: Our results confirm the effect of depressive symptoms and APOE ε4 status on memory performance. Additionally, miRNA analysis identified hsa-miR-107 as a possible biological link between APOE ε4, depressive symptoms, and cognitive impairment.
Patienten mit chronisch entzündlichen Darmerkrankungen (CED) weisen ein vergleichsweise erhöhtes Risiko für depressive Episoden auf. Es ist anzunehmen, dass diese den Verlauf der Grunderkrankung ungünstig beeinflussen und das Auftreten neuer Krankheitsschübe provozieren können. Durch gezieltes Vorbeugen dieser Episoden könnte positiv Einfluss auf die Grunderkrankung genommen werden. Im Rahmen der vorliegenden, randomisierten Kontrollgruppenstudie wurde ein Gruppenprogramm zur Prävention depressiver Episoden auf Basis der kognitiven Verhaltenstherapie (KVT) für Patienten mit CED adaptiert und durchgeführt. 71 Teilnehmer wurden in die Studie eingeschlossen. Davon wurden 35 in die Interventionsgruppe (IG) und 36 in die Kontrollgruppe (KG) randomisiert. 18 Teilnehmer beendeten die Intervention. Ziel der Studie war es, dieses für CED-Patienten adaptierte Depressionspräventionsmanual hinsichtlich seiner Wirksamkeit zu überprüfen. Der Erfolg der Intervention wurde anhand der Reduktion der Depressivität auf den Ergebnismaßen Allgemeine Depressionsskala (ADS) und Beckschem Depressionsinventar (BDI) zum Zeitpunkt des 12-Monats-follow-ups überprüft. Ein weiteres Ergebnismaß stellte der Inflammatory bowel disease questionnaire (IBDQ-D) stellte dar. Im Anschluss an die Intervention wurde zusätzlich eine Evaluation durchgeführt. Die Gruppenunterschiede auf genannten Messinstrumenten wurden nicht statistisch signifikant. Es ließen sich jedoch kleine Effektstärken (d [BDI] = 0,189; d [ADS] = 0,271]) nachweisen. Im Rahmen der Evaluation zeigte sich innerhalb des Probandenkollektivs eine durchweg positive Resonanz auf die Intervention in Bezug auf unterschiedliche Teilaspekte. Zusätzlich wurde die Wirksamkeit der Intervention unter Berücksichtigung des Geschlechtes überprüft, wobei sich kein signifikanter Unterschied feststellen ließ. Im Rahmen der Nebenergebnisse zeigte sich wiederum kein signifikanter Unterschied der Diagnosegruppen in Bezug auf die Wirksamkeit. Die Verlaufskontrolle der Depressivität unmittelbar nach der Intervention zeigte für die Interventionsteilnehmer eine deutliche Reduktion im prä-post-Vergleich.
Die Ergebnisse zeigen, dass das Schmerz- und Angsterleben bei ambulanten Eingriffen in Lokalanästhesie durch die Operationsarten beeinflusst wird. Hier sind besonders die „Osteotomie Weisheitszahn“ und die „Wurzelspitzenresektion Seitenzahn“ mit einem hohen Score zu beachten. Weiterhin wird die Ausprägung durch bestimmte Persönlichkeitsmerkmale moduliert, so dass Patienten mit einer hohen Grundängstlichkeit als Persönlicheigenschaft, jüngere Patienten und das weibliche Geschlecht besonders im Fokus stehen sollten.
Background:
Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated.
Objective:
We aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants’ socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed).
Methods:
Patients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89% (345/387) and 83% (292/354) received at least two doses of intervention, and 72% (280/387) and 54% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling.
Results:
The efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps≥.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95% CI 0.24–0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps≥.31).
Conclusions:
Computer-based and in-person BAI worked equally well independent of the patient’s level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status.
The classical secretory renin-a is known to be involved in angiotensin generation, thereby regulating not only blood pressure, but also promoting oxidative stress as well as apoptotic and necrotic cell death. In contrast, another cytosolic renin isoform named renin-b has been described, exerting protective effects under ischemia-related conditions in H9c2 cardiomyoblasts. Using microarray-based transcriptome analyses, we aimed to identify the signaling pathways involved in mediating cardioprotection in H9c2 cells overexpressing renin-b. By transcriptome profiling, we identified increased gene expression of several genes encoding glycolytic enzymes and glucose transporters, while the transcript levels of TCA-cycle enzymes were decreased. Complementing data from metabolic analyses revealed enhanced glucose consumption and lactate accumulation due to renin-b overexpression. Renin-b overexpression further stimulated AKT/mTOR signaling, where numerous genes involved in this pathway showed altered transcript levels. For AKT, we also detected enhanced phosphorylation levels by means of Western blotting, suggesting an activation of this kinase. Moreover, analysis of the ROS levels identified an increase in ROS accumulation in renin-b-overexpressing cells. Altogether, our data demonstrate that renin-b overexpression induces the metabolic remodeling of H9c2 cells similar to that seen under oxygen deprivation. This metabolic phenotype exerting so-called aerobic glycolysis is also known as the Warburg effect.
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.
Objective
To identify and summarise evaluated interventions aiming to improve the communication of palliative care (PC) and end-of-life (EoL) issues in physicians caring for cancer patients. Such interventions are needed with regard to the aim of an earlier communication of those issues in oncology daily practice, which is associated with a range of benefits for patients and caregivers but is often impeded by physicians’ communication insecurities.
Design
Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesRelevant publications were systematically searched in MEDLINE, PsycINFO, CINAHL and Web of Science databases in September 2020 with an update in July 2021.
Eligibility criteria
We included publications reporting a quantitative evaluation of a communication intervention on one or more PC/EoL issues with a communication-related main outcome. Target group had to be physicians caring for cancer patients non-specialist in PC.
Data extraction and synthesis
Two independent raters extracted intervention characteristics, publication characteristics and publication quality. Results were narratively synthesised.
Results
24 publications reporting 22 interventions were included. 13 publications reported randomised controlled trials. A majority of the interventions addressed one specific PC/EoL issue, most often breaking bad news. Teaching strategies mostly involved role-plays. Target group were mainly oncologists. In addition to self-reported outcome measurements for evaluation, most publications also reported the use of external rating data. All but one publication reported significant intervention effects on at least one outcome parameter. Publication quality was overall moderate.
Conclusions
The empirically tested communication interventions on PC/EoL issues seem to effectively improve physicians’ communication. Future interventions should focus on other issues than breaking bad news, such as preparing for the future. Target group should also be organ-specific oncologists, as all primary caring physicians are responsible for timely communication. Our risk-of-bias assessment revealed some weaknesses, indicating that more high-quality studies for evaluation are needed.
PROSPERO registration number CRD42020191054.