Objective:
Group health education is an important aspect of medical rehabilitation. While interaction and active involvement are important characteristics of group health education, little is known ...about patients’ understanding of their role in this form of education. This study explored patients’ understanding of their role in group health education as part of inpatient rehabilitation.
Design:
Qualitative, in-depth study.
Setting:
Six orthopaedic rehabilitation facilities in Germany.
Methods:
A total of 30 patients participated in six focus groups, and data were analysed using interpretative phenomenological analysis.
Results:
Findings reveal a complex picture concerning patient role both during and after group health education. Participants expected that patients should fulfil an active patient role and be good patients, but also said that some patients did not always comply with these expectations. Participants perceived that personal, group health education–related and environmental factors can affect the fulfilment of their role.
Conclusion:
Group health education should not be seen in isolation but in the context of the complex network of personal, group health education–related and environmental factors. Engagement with these factors can contribute to patients’ fulfilment of an active patient role and sustainable success after rehabilitation.
This chapter gives an overview of the application of SWAT for ecohydrological modelling in Germany. Because of its importance related to the application of Soil and Water Assessment Tool (SWAT) in ...Europe and Germany, the next section gives an overview on the WFD programme, followed by the introduction of the SWAT model. After an overview of studies on the simulation of land management and tillage on hydrology and river water quality, the following section describes the results and challenges of model-based scenario simulations for river basin management. The two studies that are presented were carried out within the context of the WFD: one is a 3500 km agricultural river basin known as the Upper Ems River Basin; the other is a 50 km lowland catchment in northern Germany (Kielstau catchment). The following section includes supporting studies in which the work on sensitivity analyses of management parameters in SWAT and on the impact of water quality monitoring strategies and load-estimation methods on model calibration and evaluation is presented.
Context:
The chemoattractant protein chemerin has recently been shown to be expressed in adipose tissue.
Objective:
We aimed to evaluate the association of chemerin with obesity and early-onset ...metabolic and vascular sequelae in children.
Design:
We quantified chemerin serum levels in 69 lean and 105 obese children and assessed associations with metabolic and cardiovascular parameters. In addition, a potential direct effect of chemerin on the expression of endothelial adhesion molecules and cell viability was assessed in human coronary artery endothelial cells in vitro.
Results:
Chemerin concentrations were significantly higher in obese compared to lean children and correlated with obesity-related parameters such as body mass index sd score, leptin, and skinfold thickness. Moreover, we identified significant associations with the measures of inflammation high-sensitivity C-reactive protein and white blood cell count, as well as with the markers of endothelial activation intercellular adhesion molecule-1 (ICAM-1) and E-selectin. Multiple regression analyses confirmed chemerin as the strongest predictor of ICAM-1 and E-selectin independent of body mass index sd score. Likewise, on the cellular level, chemerin induced ICAM-1 and E-selectin expression in endothelial cells in vitro, whereas VCAM-1 and eNOS expression and endothelial cell viability were unaffected.
Conclusion:
Our results suggest an association of chemerin with obesity and inflammatory and endothelial activation markers and support a role for chemerin as a molecular link between increasing fat mass and an early atherogenic risk profile in obese children.
Anti-neutrophil cytoplasmic autoantibodies (ANCA) targeting proteinase 3 (PR3) and myeloperoxidase expressed by innate immune cells (neutrophils and monocytes) are salient diagnostic and pathogenic ...features of small vessel vasculitis, comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA. Genetic studies suggest that ANCA-associated vasculitides (AAV) constitute separate diseases, which share common immunological and pathological features, but are otherwise heterogeneous. The successful therapeutic use of anti-CD20 antibodies emphasizes the prominent role of ANCA and possibly other autoantibodies in the pathogenesis of AAV. However, to elucidate causal effects in AAV, a better understanding of the complex interplay leading to the emergence of B lymphocytes that produce pathogenic ANCA remains a challenge. Different scenarios seem possible; e.g., the break of tolerance induced by a shift from non-pathogenic toward pathogenic autoantigen epitopes in inflamed tissue. This review gives a brief overview on current knowledge about genetic and epigenetic factors, barrier dysfunction and chronic non-resolving inflammation, necro-inflammatory auto-amplification of cellular death and inflammation, altered autoantigen presentation, alternative complement pathway activation, alterations within peripheral and inflamed tissue-residing T- and B-cell populations, ectopic lymphoid tissue neoformation, the characterization of PR3-specific T-cells, properties of ANCA, links between autoimmune disease and infection-triggered pathology, and animal models in AAV.
ANCA-associated vasculitis (AAV) comprises granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). While systemic vasculitis ...is a hallmark of all AAV, GPA is characterized by extravascular granulomatous inflammation, preferentially affecting the respiratory tract. The mechanisms underlying the emergence of neutrophilic microabscesses; the appearance of multinucleated giant cells; and subsequent granuloma formation, finally leading to scarred or destroyed tissue in GPA, are still incompletely understood. This review summarizes findings describing the presence and function of molecules and cells contributing to granulomatous inflammation in the respiratory tract and to renal inflammation observed in GPA. In addition, factors affecting or promoting the development of granulomatous inflammation such as microbial infections, the nasal microbiome, and the release of damage-associated molecular patterns (DAMP) are discussed. Further, on the basis of numerous results, we argue that, in situ, various ways of exposure linked with a high number of infiltrating proteinase 3 (PR3)- and myeloperoxidase (MPO)-expressing leukocytes lower the threshold for the presentation of an altered PR3 and possibly also of MPO, provoking the local development of ANCA autoimmune responses, aided by the formation of ectopic lymphoid structures. Although extravascular granulomatous inflammation is unique to GPA, similar molecular and cellular patterns can be found in both the respiratory tract and kidney tissue of GPA and MPA patients; for example, the antimicrobial peptide LL37, CD163+ macrophages, or regulatory T cells. Therefore, we postulate that granulomatous inflammation in GPA or PR3-AAV is intertwined with autoimmune and destructive mechanisms also seen at other sites.
The enterobacterium Erwinia amylovora causes fire blight on members of the family Rosaceae, with economic importance on apple and pear. During pathogenesis, the bacterium is exposed to a variety of ...plant-borne antimicrobial compounds. In plants of Rosaceae, many constitutively synthesized isoflavonoids affecting microorganisms were identified. Bacterial multidrug efflux transporters which mediate resistance toward structurally unrelated compounds might confer tolerance to these phytoalexins. To prove this hypothesis, we cloned the acrAB locus from E. amylovora encoding a resistance nodulation division-type transport system. In Escherichia coli, AcrAB of E. amylovora conferred resistance to hydrophobic and amphiphilic toxins. An acrB-deficient E. amylovora mutant was impaired in virulence on apple rootstock MM 106. Furthermore, it was susceptible toward extracts of leaves of MM 106 as well as to the apple phytoalexins phloretin, naringenin, quercetin, and (+)-catechin. The expression of acrAB was determined using the promoterless reporter gene egfp. The acrAB operon was up-regulated in vitro by the addition of phloretin and naringenin. The promoter activity of acrR, encoding a regulatory protein involved in acrAB expression, was increased by naringenin. In planta, an induction of acrAB was proved by confocal laser scanning microscopy. Our results strongly suggest that the AcrAB transport system plays an important role as a protein complex required for virulence of E. amylovora in resistance toward apple phytoalexins and that it is required for successful colonization of a host plant.
Background
Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and ...spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use.
Methods
We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex.
Results
Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM.
Conclusion
The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
It is Not Only the Heart that Hurts Schnabel, Alexander; Brünen, Andreas; Rohlfing, Fabian ...
The Clinical journal of pain,
12/2022, Volume:
38, Issue:
12
Journal Article
PDF
