A prospective, population-based study was carried out from 1980 to 1984 and again from 1991 to 1995 to determine the incidence of ulcerative colitis in an urban area in Germany. Patients with ...proctitis were excluded from this analysis. 74 (1980-84) and 76 (1991-95) patients newly diagnosed with ulcerative colitis were identified. A slight rise in the age- and sex-standardized incidence rate from 2.4/10(5) in 1980-84 (95% CI 1.8/10(5) to 3.0/10(5)) to 3.0 (95% CI 2.4/10(5) to 3.7/10(5)) in 1991-95 was primarily due to a significant increase of the disease in young woman. A male preponderance in the earlier time period was hereby leveled out. There were no differences in the extent of the disease and the severity of symptoms. However, the time from onset of symptoms to diagnosis was reduced from a median of nine months in the 1980s to two months in the more recent period.
Smoking is not only a risk factor for Crohn's disease, but ongoing smoking is associated with a poorer disease course. Therefore, smoking cessation should be an important treatment strategy for ...Crohn's disease patients who smoke tobacco. Recent improvements in understanding how people quit smoking and the development of pharmacological interventions, such as nicotine patches and bupropion, have improved cessation rates. In this article, we first briefly review the evidence supporting the adverse effects of smoking on the disease course. We next review the current understanding of how people change addictive behaviors, such as smoking. We then describe how the gastroenterologist can aid the patient with Crohn's disease to quit smoking, including appropriate and brief counseling strategies and the use of adjunctive treatments. Given the improvements in smoking cessation strategies, all patients with Crohn's disease should be strongly advised to quit smoking and be aided in doing so.
The growing relevance of continuous medical education is evident. Also information retrieval helping to solve clinical problems yet at the patient's bedside becomes more and more important. This ...study challenges common and coming methods of information retrieval applied by German physicians. It helps answering the question which advantage or disadvantage due to the chosen method of information acquisition may arise. It also shows which practical relevance and which grade of quality the information seeking doctor may anticipate.
A questionnaire was sent out to all registered clinicians in hospital and practice in Germany. Not only traditional means of information retrieval were analyzed. Also, a lot of the questions posed focused on the acceptance and use of new media in the professional context. About 16,000 colleagues answered by filling in the complete form therewith allowing a deep insight into their informational needs and habits.
While traditional media like books and scientific papers enjoy wide public confidence, the acceptance and estimated reliability of virtual sources of information today still remain restrained. The lack of transparency of the virtual sources and ways of information within the web according to often imprecise rules for quality assurance lead to major complaint. Information offered directly by the industry has a very low rate of acceptance.
To gain higher confidence in electronic media presenting professional knowledge and advanced medical training, the development of technological advantages today seems to be less relevant. Work on the transparency of the informational structures including clear definition of resources and clear indication of possible conflicts of interest are just as important as a comprehensible quality of forthcoming medical content.
Knowledge of clinical-epidemiological methods is indispensable for scientifically informed clinical decisions and understanding clinical research. These skills gain particular relevance in a medical ...curriculum committed to science and scientific evidence, as reflected in the German national competence-based catalog of learning objectives for medicine (NKLM). It is expected that knowledge of clinical-epidemiological methods will also be part of the new licensing regulations and national subject catalogs (GK) for the state examinations (STEX) in Germany. Clinical epidemiology content is, however, not explicitly marked in these catalogs. Furthermore, teaching goals related to epidemiology and related subjects are distributed over all phases of the curriculum and several topic areas. Consequently, teaching in the new curriculum poses particular challenges even for experienced instructors.The German translation of the book “Clinical Epidemiology: The Essentials“ by Fletcher et al. follows the priorities set for the new curriculum. Besides a scientific approach to medicine, this concerns consideration of the requirements of everyday medical practice (graduate profile). The book is, however, not recommended explicitly for medical students.This review critically examines the book’s suitability for the various requirements of the medical curriculum. Epidemiology-related questions from a recent exam, the new subject catalog for STEX II valid from 2022, and relevant chapters of the NKLM are described to contrast book content with curricular requirements.
Among various innate immune receptor families, the role of C-type lectin receptors (CLRs) in lung protective immunity against Streptococcus pneumoniae (S. pneumoniae) is not fully defined. We here ...show that Mincle gene expression was induced in alveolar macrophages and neutrophils in bronchoalveolar lavage fluids of mice and patients with pneumococcal pneumonia. Moreover, S. pneumoniae directly triggered Mincle reporter cell activation in vitro via its glycolipid glucosyl-diacylglycerol (Glc-DAG), which was identified as the ligand recognized by Mincle. Purified Glc-DAG triggered Mincle reporter cell activation and stimulated inflammatory cytokine release by human alveolar macrophages and alveolar macrophages from WT but not Mincle KO mice. Mincle deficiency led to increased bacterial loads and decreased survival together with strongly dysregulated cytokine responses in mice challenged with focal pneumonia inducing S. pneumoniae, all of which was normalized in Mincle KO mice reconstituted with a WT hematopoietic system. In conclusion, the Mincle-Glc-DAG axis is a hitherto unrecognized element of lung protective immunity against focal pneumonia induced by S. pneumoniae.
Stress-related mental disorders are highly prevalent and pose a substantial burden on individuals and society. Improving strategies for the prevention and treatment of mental disorders requires a ...better understanding of their risk and resilience factors. This multicenter study aims to contribute to this endeavor by investigating psychological resilience in healthy but susceptible young adults over 9 months. Resilience is conceptualized in this study as the maintenance of mental health or quick recovery from mental health perturbations upon exposure to stressors, assessed longitudinally via frequent monitoring of stressors and mental health.
This study aims to investigate the factors predicting mental resilience and adaptive processes and mechanisms contributing to mental resilience and to provide a methodological and evidence-based framework for later intervention studies.
In a multicenter setting, across 5 research sites, a sample with a total target size of 250 young male and female adults was assessed longitudinally over 9 months. Participants were included if they reported at least 3 past stressful life events and an elevated level of (internalizing) mental health problems but were not presently affected by any mental disorder other than mild depression. At baseline, sociodemographic, psychological, neuropsychological, structural, and functional brain imaging; salivary cortisol and α-amylase levels; and cardiovascular data were acquired. In a 6-month longitudinal phase 1, stressor exposure, mental health problems, and perceived positive appraisal were monitored biweekly in a web-based environment, while ecological momentary assessments and ecological physiological assessments took place once per month for 1 week, using mobile phones and wristbands. In a subsequent 3-month longitudinal phase 2, web-based monitoring was reduced to once a month, and psychological resilience and risk factors were assessed again at the end of the 9-month period. In addition, samples for genetic, epigenetic, and microbiome analyses were collected at baseline and at months 3 and 6. As an approximation of resilience, an individual stressor reactivity score will be calculated. Using regularized regression methods, network modeling, ordinary differential equations, landmarking methods, and neural net-based methods for imputation and dimension reduction, we will identify the predictors and mechanisms of stressor reactivity and thus be able to identify resilience factors and mechanisms that facilitate adaptation to stressors.
Participant inclusion began in October 2020, and data acquisition was completed in June 2022. A total of 249 participants were assessed at baseline, 209 finished longitudinal phase 1, and 153 finished longitudinal phase 2.
The Dynamic Modelling of Resilience-Observational Study provides a methodological framework and data set to identify predictors and mechanisms of mental resilience, which are intended to serve as an empirical foundation for future intervention studies.
DERR1-10.2196/39817.
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