Queer im Übergangssystem Maria Bitzan, Jasmin Brück, Susanne Dern, Thomas Nestler, Utan Schirmer, Bettina Staudenmeyer, Ulrike Zöller / Maria Bitzan, Jasmin Brück, Susanne Dern, Thomas Nestler, Utan Schirmer, Bettina Staudenmeyer, Ulrike Zöller
2022, 20221220
eBook
Junge queere Menschen erleben nach wie vor erhebliche Diskriminierungen und sind mit besonderen Herausforderungen konfrontiert. Fachkräfte im Arbeitsfeld des Übergangssystems zwischen Schule und ...Ausbildung bzw. Erwerbsarbeit sind gefordert, diverse Lebenslagen wahrzunehmen und in ihrem gesellschaftlichen Kontext zu reflektieren, um angemessene Unterstützung leisten zu können. Die Beiträger*innen bündeln Erkenntnisse aus aktuellen Studien zu Erfahrungen von Fachkräften und jungen queeren Menschen im Übergangssystem und in angrenzenden Bereichen. Dies wird verbunden mit Einführungen in institutionelle Logiken des Feldes und theoretische Zugänge sowie Impulsen für eine emanzipatorische Praxis.
Background
Exercise training has now become established practice in patients with chronic heart failure. Women are often under-represented in intervention studies compared to men. For this reason it ...was our aim to conduct a combined endurance and muscle strength training program to evaluate its effect on clinical performance data and health-related psychosocial factors in women and men.
Methods
One hundred and sixteen women, mean age 69 ± 9 years, body mass index (BMI) 25.8 ± 4.9, and 169 men, mean age 66 ± 9 years, BMI 26.6 ± 3.6 underwent combined endurance/resistance training. The training program lasted 29 ± 7 days and comprised bicycle ergometer training, a 6-min walk test as a training unit and muscle strength training for the lower and upper extremities.
Results
Differences between women and men were found in clinical parameters. In particular, statistically significant differences were revealed between the women and men with regard to cardiopulmonary performance. Quality of life was significantly improved on discharge with regard to both physical and mental health, whereas anxiety and depression showed no significant alteration.
Conclusion
A specialized in-hospital program for women and men combining endurance/resistance training and education is feasible. But our program revealed a very low level of cardiopulmonary performance in women. Women need to be encouraged and motivated to participate in such programs.
Chronic heart failure (CHF) will become one of the greatest medical challenges during the next decades. This is especially true with regard to elderly patients. Besides medical diagnostics and drug ...therapy, efficient treatment of CHF must also include exercise training.
The purpose of our study was 1) to record health-related quality of life (QOL) in elderly patients with CHF and 2) to assess the efficacy of a training program, as well as to evaluate any changes detected during a six month follow-up.
In our non-randomized study, 116 patients, divided according to age into Group 1 (>70 years) and Group 2 (<70 years), took part in a 4-week training program.
There were differences in the clinical parameters and the QOL between the older and the younger patients both after 4 weeks and at the follow-up. After six months, however, the older patients again recorded having an inferior QOL to that of the younger patients.
Elderly patients can also benefit from physical exercise training, with improvement in clinical parameters and QOL. In order to maintain the subjectively improved QOL in the long term, however, continued special heart failure education and support is required.
Abstract
A subset of patients has long-lasting symptoms after mild to moderate Coronavirus disease 2019 (COVID-19). In a prospective observational cohort study, we analyze clinical and laboratory ...parameters in 42 post-COVID-19 syndrome patients (29 female/13 male, median age 36.5 years) with persistent moderate to severe fatigue and exertion intolerance six months following COVID-19. Further we evaluate an age- and sex-matched postinfectious non-COVID-19 myalgic encephalomyelitis/chronic fatigue syndrome cohort comparatively. Most post-COVID-19 syndrome patients are moderately to severely impaired in daily live. 19 post-COVID-19 syndrome patients fulfill the 2003 Canadian Consensus Criteria for myalgic encephalomyelitis/chronic fatigue syndrome. Disease severity and symptom burden is similar in post-COVID-19 syndrome/myalgic encephalomyelitis/chronic fatigue syndrome and non-COVID-19/myalgic encephalomyelitis/chronic fatigue syndrome patients. Hand grip strength is diminished in most patients compared to normal values in healthy. Association of hand grip strength with hemoglobin, interleukin 8 and C-reactive protein in post-COVID-19 syndrome/non-myalgic encephalomyelitis/chronic fatigue syndrome and with hemoglobin, N-terminal prohormone of brain natriuretic peptide, bilirubin, and ferritin in post-COVID-19 syndrome/myalgic encephalomyelitis/chronic fatigue syndrome may indicate low level inflammation and hypoperfusion as potential pathomechanisms.
Prospective and longitudinal data on pulmonary injury over one year after acute coronavirus disease 2019 (COVID-19) are sparse. We aim to determine reductions in pulmonary function and respiratory ...related quality of life up to 12 months after acute COVID-19.
Patients with acute COVID-19 were enrolled into an ongoing single-centre, prospective observational study and prospectively examined 6 weeks, 3, 6 and 12 months after onset of COVID-19 symptoms. Chest CT-scans, pulmonary function and symptoms assessed by St. Georges Respiratory Questionnaire were used to evaluate respiratory limitations. Patients were stratified according to severity of acute COVID-19.
Median age of all patients was 57 years, 37.8% were female. Higher age, male sex and higher BMI were associated with acute-COVID-19 severity (p < 0.0001, 0.001 and 0.004 respectively). Also, pulmonary restriction and reduced carbon monoxide diffusion capacity was associated with disease severity. In patients with restriction and impaired diffusion capacity, FVC improved over 12 months from 61.32 to 71.82, TLC from 68.92 to 76.95, DLCO from 60.18 to 68.98 and KCO from 81.28 to 87.80 (percent predicted values; p = 0.002, 0.045, 0.0002 and 0.0005). The CT-score of lung involvement in the acute phase was associated with restriction and reduction in diffusion capacity in follow-up. Respiratory symptoms improved for patients in higher severity groups during follow-up, but not for patients with initially mild disease.
Severity of respiratory failure during COVID-19 correlates with the degree of pulmonary function impairment and respiratory quality of life in the year after acute infection.
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•Adverse pulmonary outcome is associated with initial COVID-19 disease severity.•Pulmonary restriction and reduced DLCO are the main pulmonary sequelae after COVID-19.•Pulmonary restriction at follow-up correlates with initial COVID-19 disease severity.•Quality of life remains compromised in patients even with initially mild COVID-19.
Cardiopulmonary Exercise Testing (CPET) provides a comprehensive assessment of pulmonary, cardiovascular and musculosceletal function. Reduced CPET performance could be an indicator for chronic ...morbidity after COVID-19.
Patients ≥18 years with confirmed PCR positive SARS-CoV-2 infection were offered to participate in a prospective observational study of clinical course and outcomes of COVID-19. 54 patients completed CPET, questionnaires on respiratory quality of life and performed pulmonary function tests 12 months after SARS-CoV-2 infection.
At 12 months after SARS-CoV-2 infection, 46.3% of participants had a peak performance and 33.3% a peak oxygen uptake of <80% of the predicted values, respectively. Further impairments were observed in diffusion capacity and ventilatory efficiency. Functional limitations were particularly pronounced in patients after invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. Ventilatory capacity was reduced <80% of predicted values in 55.6% of participants, independent from initial clinical severity. Patient reported dyspnea and respiratory quality of life after COVID-19 correlated with CPET performance and parameters of gas exchange. Risk factors for reduced CPET performance 12 months after COVID-19 were prior intensive care treatment (OR 5.58, p = 0.004), SGRQ outcome >25 points (OR 3.48, p = 0.03) and reduced DLCO (OR 3.01, p = 0.054).
Functional limitations causing chronic morbidity in COVID-19 survivors persist over 12 months after SARS-CoV-2 infection. These limitations were particularly seen in parameters of overall performance and gas exchange resulting from muscular deconditioning and lung parenchymal changes. Patient reported reduced respiratory quality of life was a risk factor for adverse CPET performance.
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•Functional limitations 12 months after SARS-CoV-2 infection are associated with initial COVID-19 severity.•Cardiopulmonary performance is reduced in 46% of patients 12 months after acute COVID-19.•Gas exchange remains impaired 12 months after ICU treatment.•Functional limitations improve between month 6 and 12 in some patients.
•Subjects initiated braking significant earlier in the field than in driving simulator.•Subjects in driving simulator showed significantly higher speed and braked distinctly more intensively than in ...the field.•In driving simulator, the subjects appeared to have reduced risk awareness.•Caution is required when using a driving simulator for designing intersection assistance systems.
Introduction: The majority of accidents involving personal injury occur in urban intersections. As human error is the primary cause of these accidents, it seems reasonable to support drivers by intersection assistants. Studies to evaluate such systems are usually performed in driving simulators. However, this implies driver behaviour validity, which cannot always be taken for granted due to the artificial nature of simulated environments. The paper pays special attention to the validity of braking behaviour in urban intersections. In particular, the effect of the test scenario and selected driving simulator design parameters is considered. Method: The Time to Intersection (TTI) time interval between field and simulator study was evaluated at five simple urban intersections. Results: Independently of the type of intersection and the parameter configuration of the simulator, subjects initiated braking in preparation for a turning manoeuvre significantly earlier in the field than in the driving simulator. In particular, the results of both tests differed more at intersections where the driver did not have right of way than at intersections with other layouts, confirming the impact of the test scenario. Some differences were also found when the driving simulator parameter set was varied. Conclusions: The braking behaviour near urban intersections differs between real and simulated experimental environments. From these results, we conclude that caution is required when designing intersection assistance systems based solely on the braking behaviour of subjects in simulated environments. The test scenario and the design parameters must be considered as factors which influence the results. Practical applications: Depending on the current traffic situation and interactions, multiple different kinds of accident can occur at the considered types of intersection, meaning that closely investigating the driver behaviour validity at these junctions is highly important for further intersection assistance systems. Validity of TTI is for example important when determining the best choice of warning interval for a turning assistance system.
Background Patients with post COVID-19 condition frequently suffer from chronic dyspnoea. The causes and mechanism for dyspnoea in these patients without evidence of structural lung disease are ...unclear. Methods Patients treated for COVID-19 at Charité University hospital in Berlin received pulmonary function testing including respiratory muscle strength tests and completed health related quality of life questionnaires during follow-up. Patients with post COVID-19 condition during outpatient follow-up with fatigue and exertional intolerance (PCF) were compared to patients with post COVID-19 condition with evidence of chronic pulmonary sequelae (PCR) as well as to patients without post COVID-19 condition (NCF). Results A total of 170 patients presented for follow-up. 36 participants met criteria for PCF, 28 for PCR and 24 for NCF. PCF patients reported dyspnoea in 63.8%. Percent predicted value (ppv) of respiratory muscle strength (median (IQR)) was reduced in PCF (55.8 (41.5–75.9)) compared to NCF and PCR (70.6 (66.3–88.9); 76.8 (63.6–102.2); p=0.011). A pattern of reduced forced vital capacity (FVC), but normal total lung capacity (TLC), termed complex ventilatory dysfunction defined as TLC-FVC>10% (of ppv) was observed and occurred more frequently in PCF (88.9%) compared to NCF and PCR (29.1% and 25.0%; p<0.001). Conclusion Dyspnoea in PCF is characterized by reduced respiratory muscle strength and complex ventilatory dysfunction indicating neuromuscular disturbance as a distinct phenotype among patients with post COVID-19 condition. These observations could be a starting point for developing personalized rehabilitation concepts. Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and resulting coronavirus disease 2019 (COVID-19) has caused serious morbidity and mortality worldwide 1. Acute, subacute and long-term effects of COVID-19 can involve multiple organ systems including vascular endothelial cells, lung, heart, brain, kidney, intestine, liver, pharynx and other tissues, potentially through direct organ damage 2, 3. New and persisting symptoms for more than three months after SARS-CoV-2 infection which cannot be explained by an alternative diagnosis are commonly referred to as long-COVID, and different terms have been introduced by multiple institutions such as post COVID-19 condition 4 or post COVID-19 syndrome 5. An estimated 6% of COVID-19 survivors reported ongoing respiratory problems, cognitive sequelae or fatigue after three months of infection 6. However, all current definitions of post COVID-19 condition are based on broadly defined symptoms and symptom complexes, and their underlying pathophysiology is still not fully understood 7.
Reliable biomarkers for organ quality assessment during normothermic machine perfusion (NMP) are desired. ATP (adenosine triphosphate) production by oxidative phosphorylation plays a crucial role in ...the bioenergetic homeostasis of the liver. Thus, detailed analysis of the aerobic mitochondrial performance may serve as predictive tool towards the outcome after liver transplantation.
In a prospective clinical trial, 50 livers were subjected to NMP (OrganOx Metra) for up to 24 h. Biopsy and perfusate samples were collected at the end of cold storage, at 1 h, 6 h, end of NMP, and 1 h after reperfusion. Mitochondrial function and integrity were characterized by high-resolution respirometry (HRR), AMP, ADP, ATP and glutamate dehydrogenase analysis and correlated with the clinical outcome (L-GrAFT score). Real-time confocal microscopy was performed to assess tissue viability. Structural damage was investigated by histology, immunohistochemistry and transmission electron microscopy.
A considerable variability in tissue viability and mitochondrial respiration between individual livers at the end of cold storage was observed. During NMP, mitochondrial respiration with succinate and tissue viability remained stable. In the multivariate analysis of the 35 transplanted livers (15 were discarded), area under the curve (AUC) of LEAK respiration, cytochrome c control efficiency (mitochondrial outer membrane damage), and efficacy of the mitochondrial ATP production during the first 6 h of NMP correlated with L-GrAFT.
Bioenergetic competence during NMP plays a pivotal role in addition to tissue injury markers. The AUC for markers of outer mitochondrial membrane damage, ATP synthesis efficiency and dissipative respiration (LEAK) predict the clinical outcome upon liver transplantation.
This study was funded by a Grant from the In Memoriam Dr. Gabriel Salzner Stiftung awarded to SS and the Tiroler Wissenschaftsfond granted to TH.
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