Validation of the Scale for the Assessment of Illness Behavior (SAIB) in a community sample of elderly people.

The aim of this study was to evaluate the construct validity of the SAIB in a community sample of elderly people. The SAIB was administered to a large community sample representative of the German population aged 60-85 years (n=1593). The original model was assessed and then refined through confirmatory and exploratory factor analyses. Criterion validity was evaluated by comparing SAIB scores with external criteria in 3 categories: subjective health, chronic illness and health care utilization. The originally suggested five factor structure of the SAIB yielded a comparative fit index (CFI) of 0.70 and the weighted root mean square residual (WRMR) was 3.68. A shortened questionnaire with 13 items and four factors resulted in better model fit (CFI 0.97 and WRMR 1.3). Correlations between subjective health and the new scales ranged from 0.06 to 0.33. Effect sizes (Cohens d) of mean differences in factor scores between those with and without healthcare system contact varied by healthcare type, ranging from 0.05 to 0.94; effect sizes were largest in relation to contact with psychotherapy and alternative medicine practitioners. We propose a shortened version of the SAIB with a different scale structure, which resulted in better model fit with our data. Neither the original nor revised SAIB appeared to discriminate well in terms of health care use, suggesting that the illness behavior as currently conceptualized may not fully explain the increased use of healthcare in the elderly

Posttraumatische Belastungsstörungen in Deutschland: Ergebnisse einer gesamtdeutschen epidemiologischen Untersuchung

Zusammenfassung: In einer repräsentativen Bevölkerungsstichprobe (n=2426) über ein breites Alterspektrum (14-93Jahre) wurden die Prävalenz traumatischer Ereignisse, des Vollbildes der posttraumatische Belastungsstörung (PTBS) und partieller PTBS-Syndrome geschätzt. Ein standardisiertes Interview mit einer Traumaliste des Composite International Diagnostic Interviews (CIDI) und eine PTSD-Symptomliste nach DSM-IV (modifizierte PTSD-Symptomskala) wurden eingesetzt. Die Einmonatsprävalenzrate lag bei 2,3% für das PTBS-Vollbild sowie 2,7% für die partiellen PTBS-Syndrome. Während sich keine Geschlechtsunterschiede hinsichtlich der Prävalenz ergaben, zeigten sich Altersgruppenunterschiede: Die über 60-Jährigen hatten eine Prävalenz bez. des PTBS-Vollbildes von 3,4%, während diese bei den 14- bis 29-Jährigen 1,3% und bei den 30- bis 59-Jährigen 1,9% betrug. Die partiellen PTBS-Syndrome zeigten ebenfalls einen Altersgipfel mit 3,8% in der Gruppe der Älteren sowie 2,4% bei Mittelalten und 1,3% bei jungen Erwachsenen. Die Ergebnisse entsprechen weitgehend denen anderer internationaler Studien, wenn Kriegsauswirkungen für bestimmte Altersgruppen als nationale Besonderheiten berücksichtigt werden. Erstmals konnte unsere repräsentative Studie eine - wahrscheinlich durch den 2.Weltkrieg mitbedingte - relativ hohe Prävalenz der PTBS in der höchsten Altersgruppe der deutschen Bevölkerung aufzeige

Risk perception and emergency experience: comparing a representative German sample with German emergency survivors

People’s perception of risk and its influencing factors has become an important element of research in past decades. The present paper investigated the influence of emergency experiences on risk perception and the impact of experience and gender on the accuracy of risk perception. A representative sample of the German population was subdivided into a general survivor group who had experienced at least one emergency previously (N = 165) and a general public group with no prior emergency experiences (N = 2248), which were compared to a German sample of survivors from the EU-funded Behavior, Security, and Culture (BeSeCu) international study of human behavior in emergency situations and evacuations (N = 201). The perceived risk of different emergencies – including larger-scale events like floods and other important but often overlooked events like domestic fires – was assessed with a questionnaire. Objective risk was also calculated for different emergencies and compared to the risk perceptions of each group to provide a measure of accuracy. The results of this study showed that emergency experiences increase perceived risk, for the experienced event in particular, and this outcome was evident regardless of whether the event was a large-scale one like a natural disaster or a smaller-scale one like a fire in one’s home. Additional data from the BeSeCu survivors identified several pre-, peri-, and post-event factors that might have influenced this outcome. Further results included the finding that gender is an important factor that moderates the accuracy of risk estimations but researchers should be mindful that the presence and pattern of any gender difference in perceived risk accuracy may vary across different types of event. Possible reasons and implications of the results are discussed

A Small Conductance Calcium-Activated K⁺ Channel in C. elegans, KCNL-2, Plays a Role in the Regulation of the Rate of Egg-Laying

In the nervous system of mice, small conductance calcium-activated potassium (SK) channels function to regulate neuronal excitability through the generation of a component of the medium afterhyperpolarization that follows action potentials. In humans, irregular action potential firing frequency underlies diseases such as ataxia, epilepsy, schizophrenia and Parkinson's disease. Due to the complexity of studying protein function in the mammalian nervous system, we sought to characterize an SK channel homologue, KCNL-2, in C. elegans, a genetically tractable system in which the lineage of individual neurons was mapped from their early developmental stages. Sequence analysis of the KCNL-2 protein reveals that the six transmembrane domains, the potassium-selective pore and the calmodulin binding domain are highly conserved with the mammalian homologues. We used widefield and confocal fluorescent imaging to show that a fusion construct of KCNL-2 with GFP in transgenic lines is expressed in the nervous system of C. elegans. We also show that a KCNL-2 null strain, kcnl-2(tm1885), demonstrates a mild egg-laying defective phenotype, a phenotype that is rescued in a KCNL-2-dependent manner. Conversely, we show that transgenic lines that overexpress KCNL-2 demonstrate a hyperactive egg-laying phenotype. In this study, we show that the vulva of transgenic hermaphrodites is highly innervated by neuronal processes and by the VC4 and VC5 neurons that express GFP-tagged KCNL-2. We propose that KCNL-2 functions in the nervous system of C. elegans to regulate the rate of egg-laying. © 2013 Chotoo et al

A role for genetic susceptibility in sporadic focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis (FSGS) is a syndrome that involves kidney podocyte dysfunction and causes chronic kidney disease. Multiple factors including chemical toxicity, inflammation, and infection underlie FSGS; however, highly penetrant disease genes have been identified in a small fraction of patients with a family history of FSGS. Variants of apolipoprotein L1 (APOL1) have been linked to FSGS in African Americans with HIV or hypertension, supporting the proposal that genetic factors enhance FSGS susceptibility. Here, we used sequencing to investigate whether genetics plays a role in the majority of FSGS cases that are identified as primary or sporadic FSGS and have no known cause. Given the limited number of biopsy-proven cases with ethnically matched controls, we devised an analytic strategy to identify and rank potential candidate genes and used an animal model for validation. Nine candidate FSGS susceptibility genes were identified in our patient cohort, and three were validated using a high-throughput mouse method that we developed. Specifically, we introduced a podocyte-specific, doxycycline-inducible transactivator into a murine embryonic stem cell line with an FSGS-susceptible genetic background that allows shRNA-mediated targeting of candidate genes in the adult kidney. Our analysis supports a broader role for genetic susceptibility of both sporadic and familial cases of FSGS and provides a tool to rapidly evaluate candidate FSGS-associated genes

Real-world data confirm the effectiveness of caplacizumab in acquired thrombotic thrombocytopenic purpura

Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare but life-threatening condition. In 2018, the nanobody caplacizumab was approved for the treatment of adults experiencing an acute episode of aTTP, in conjunction with plasma exchange (PEX) and immunosuppression for a minimum of 30 days after stopping daily PEX. We performed a retrospective, observational analysis on the use of caplacizumab in 60 patients from 29 medical centers in Germany during acute disease management. Caplacizumab led to a rapid normalization of the platelet count (median, 3 days; mean 3.78 days). One patient died after late treatment initiation due to aTTP-associated complications. In 2 patients with initial disease presentation and in 4 additional patients with laboratory signs of an exacerbation or relapse after the initial therapy, PEX-free treatment regimens could be established with overall favorable outcome. Caplacizumab is efficacious in the treatment of aTTP independent of timing and ancillary treatment modalities. Based on this real-world experience and published literature, we propose to administer caplacizumab immediately to all patients with an acute episode of aTTP. Treatment decisions regarding the use of PEX should be based on the severity of the clinical presentation and known risk factors. PEX might be dispensable in some patients