Mobilität und Sicherheit im Alter (MoSi), ein neues Trainingsprogramm zur Verbesserung der Mobilität und Gangsicherheit bei Senioren

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Einleitung: „Mobilität und Sicherheit im Alter (MoSi)©“ ist ein neues Interventionsprogramm speziell für gangunsichere Menschen im höheren Lebensalter, oder Personen welche bereits Stürze erlitten haben. Methode: An der Studie nahmen 165 selbständig lebende ältere Personen, über 65 Jahre teil.Die Studienteilnehmer wurden vor und nach der 5 wöchigen Intervention untersucht.Das Trainingsprogramm beinhaltete verschiedene Elemente des Kraft- und Gleichgewichttrainings, Stretching, Reaktions- und Koordinationsschulung. Außerdem erhielten die Teilnehmer Informationen wie sie Sturzgefahren erkennen und vermeiden, bzw. wie sie sich nach einem Sturz selbst helfen können. Darüber hinaus wurden sie für das selbstständige Üben zu Hause angeleitet. Das Trainingsprogramm fand ambulant statt und beinhaltete 10 Trainingseinheiten. Ergebnisse: Nach Einschätzung der Teilnehmer verbesserten sich: Gang bei 94 Personen (66%), Gangsicherheit bei 94 Personen (66%), Kraft bei 92 Personen (65%), Gleichgewicht bei 88 Personen (62%), Sicherheitsgefühl bei 87 Personen (61%), Leistungsfähigkeit bei 100 Personen (70%) und Wohlbefinden bei 90 Personen (63%). Auswertungen der „Berg Balance Skala“ und des Balancetest der „Tinetti Balance Skala“ zeigten signifikante (p<0,001) Verbesserungen. Beim „Timed Up and Go Test“ und der Gangprobe der „Tinetti Balance Skala“ ergaben sich nur bei sehr gangunsicheren Personen signifikante Verbesserungen (p<0,05). Beim „Repeated Chair Stands Test“ zeigten sich dagegen keine signifikanten Veränderungen. 137 (95%) der Teilnehmer wollten die Übungen zu Hause fortsetzen, 112 (79%) gerne auch unter therapeutischer Aufsicht. Diskussion: Die Ergebnisse deuten darauf hin, dass das von uns entwickelte Interventionsprogramm die Mobilität und Gangsicherheit von älteren Personen subjektiv und objektiv verbesserte, wobei besonders gangunsichere Personen profitierten. Die Intervention hatte einen sehr guten Motivationseffekt, dies zeigte sich an der hohen Bereitschaft der Teilnehmer zuhause weiter zu üben. Weiterhin führte das Training dazu, dass die Teilnehmer auch andere Faktoren wie die Leistungsfähigkeit und das Wohlbefinden als verbessert ansahen. Schlussfolgerung: Obwohl Endpunkte wie die Reduktion des Sturzrisikos noch nicht belegt sind, kann das von uns entwickelte Trainingsprogramm zur Verbesserung wichtiger Faktoren für einen sicheren Gang für selbstständig lebende ältere Menschen empfohlen werden. Es ist ambulant durchführbar und zeigt bereits nach wenigen Wochen eine signifikante Wirkung. Aufgrund seiner Kompaktheit ist das Training vor allem auch für ältere Personen geeignet, die langdauernde Programme, wie sie in verschiedenen Studien entwickelt wurden, scheuen

Mediators and Cytokines in Persistent Allergic Rhinitis and Nonallergic Rhinitis with Eosinophilia Syndrome

Background: Patients with nonallergic rhinitis with eosinophilia syndrome (NARES) show typical symptoms of persistent allergic rhinitis (PAR). The aim of the present study was to compare nasal cytokine patterns between NARES and PAR. Methods: Nasal secretions of 31 patients suffering from NARES, 20 patients with PAR to house dust mite and 21 healthy controls were collected using the cotton wool method and analyzed for interleukin (IL)-1 beta, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1 beta (MIP-1 beta) by Bio-Plex Cytokine Assay as well as eosinophil cationic protein (ECP) and tryptase by UniCAP-FEIA. Results: NARES and PAR presented elevated levels of tryptase, while ECP was markedly increased solely in NARES compared to both the controls and PAR. Elevated levels of IL-1 beta, IL-17, IFN-gamma, TNF-alpha and MCP-1 were found in NARES compared to the controls as well as PAR. MIP-1 beta was elevated in NARES and PAR, while IL-4, IL-6 and G-CSF showed increased levels in NARES, and IL-5 was elevated in PAR only. Conclusions: In patients with NARES and PAR, eosinophils and mast cells appear to be the pivotal cells of inflammation, reflected by high levels of tryptase and ECP as well as IL-5 and GM-CSF as factors for eosinophil migration and survival. The elevated levels of proinflammatory cytokines in NARES may indicate the chronic, self-perpetuating process of inflammation in NARES which seems to be more pronounced than in PAR. IL-17 might be a factor for neutrophilic infiltration or be responsible for remodeling processes in NARES. Copyright (C) 2012 S. Karger AG, Base

Cytokine patterns in nasal secretion of non-atopic patients distinguish between chronic rhinosinusitis with or without nasal polys

Background: Being one of the most common nasal diseases, chronic rhinosinusitis (CRS) is subdivided into CRS with nasal polyps (NP) and CRS without nasal polyps (CRSsNP). CRSsNP presents itself with a T(H)1 milieu and neutrophil infiltration, while NP is characterised by a mixed T(H)1/T(H)2 profile and an influx of predominantly eosinophils, plasma cells and mast cells. For the purpose of discovering disease-specific cytokine profiles, the present study compares levels of mediators and cytokines in nasal secretions between CRSsNP, NP, and healthy controls. Methods: The study included 45 participants suffering from NP, 48 suffering from CRSsNP and 48 healthy controls. Allergic rhinitis constituted an exclusion criterion. Nasal secretions, sampled using the cotton wool method, were analysed for IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, IL-8, GM-CSF, G-CSF, IFN-gamma, MCP-1, MIP-1 alpha, MIP-1 beta, eotaxin, and RANTES, and for ECP and tryptase, using Bio-Plex Cytokine assay or ELISA, respectively. Results: Elevated levels of IL-5, IL-17, G-CSF, MCP-1, MIP-1 alpha, MIP-1 beta, ECP, and tryptase, as well as decreased levels of IL-10, IL-12, IL-13, and IFN-gamma were detected in NP. CRSsNP presented increased levels of RANTES and MIP-1 beta while IL-13 was decreased. No differences between the three groups were found for IL-4, IL-8, GM-CSF, and eotaxin. Conclusions: The present work suggests a disequilibrium of T(H)1 and T(H)2, together with a down-regulation of regulatory T lymphocytes and up-regulated T(H)17 in NP. Moreover, elevated levels of diverse mediators represent the activation of various inflammatory cells in this disease entity. The inflammation in CRSsNP, however, is only weakly depicted in nasal secretions. Therefore, cytokines in nasal secretions may provide helpful information for differential diagnosis

Sonderweg oder Königsweg: Ein akteurs- und prozessorientiertes Modell für die Entwicklung weiterbildender Studiengänge

Der Beitrag stellt ein idealtypisches Modell für die Entwicklung weiterbildender Studiengänge vor, das relevante Akteur*innen und zentrale Aufgabenbereiche in Form einer Prozessmatrix darstellt. Dabei wird u.a. an das Modell von Hanft (2014) angeschlossen und durch zentrale Erkenntnisse aus der Umsetzungspraxis ausgewählter Projekte im Rahmen des Bund-Länder-Wettbewerbs „Aufstieg durch Bildung: offene Hochschulen“ erweitert. Hierfür gehen die Autor*innen auf den Stand der Modellbildung und Forschung ein und führen die Ergebnisse in einem Bezugsrahmen für die anschließende Modellableitung zusammen. Die entwickelte Prozessmatrix wird grafisch dargestellt, hinsichtlich ihrer Struktur, der zentralen Rollen bzw. Akteur*innen und Prozessschritte erläutert sowie als idealtypisches Prozessmodell diskutiert. Abschließend werden ausgewählte Nutzungs- und Forschungsperspektiven aufgezeigt und weiterführende Überlegungen zur Bedeutung von weiterbildenden Studiengängen im Kontext der Hochschulentwicklung skizziert. (DIPF/Orig.

Outbreak of cryptosporidium hominis following river flooding in the city of Halle (Saale), Germany, August 2013

Background: During weeks 32–33, 2013, 24 cases of cryptosporidiosis were notified in the city of Halle (annual mean 2008–2012: 9 cases). We investigated the outbreak to identify the source and recommend control measures, considering that between weeks 23–25 the river Saale which flows through the city centre overflowed the floodplain, parts of the city centre and damaged sewage systems. Methods: We defined a case as a resident of Halle with gastroenteritis, Cryptosporidium-positive stool and disease onset weeks 27 through 47. In a case–control study among kindergarten children, we compared cases and controls regarding environmental exposure, use of swimming pools, zoo visits and tap water consumption 14 days pre-onset or a corresponding 14-days-period (controls) and adjusted for residence. Stool specimens were tested by microscopy and PCR, and Cryptosporidium DNA was sequenced. Samples from public water system, swimming pools and river Saale were examined for Cryptosporidium oocysts (microscopy and PCR). Results: Overall, 167 cases were detected, 40/167 (24%) were classified as secondary cases. First disease onsets occurred during week 29, numbers peaked in week 34 and started to decrease in week 36. Median age was 8 years (range: 0–77). Compared to controls (n = 61), cases (n = 20) were more likely to report visits to previously flooded areas (OR: 4.9; 95%-CI: 1.4-18) and the zoo (OR: 2.6; 95%-CI: 0.9-7.6). In multivariable analysis visits to the floodplain remained the sole risk factor (OR: 5.5; 95%-CI: 1.4-22). Only C.hominis of a single genotype (IbA9G2) was detected in stools. Oocysts were detected in samples from the river, two local lakes and three public swimming pools by microscopy, but not in the public water supply. Conclusions: Evidence suggests that activities in the dried out floodplain led to infection among children. Secondary transmissions may be involved. Consequently, authorities recommended to avoid playing, swimming and having picnics in the flood-affected area. Health authorities should consider the potential health risks of long-term surviving parasites persisting on flooded grounds and in open waters even several weeks after the flooding and of bathing places close to sewage spill-overs. Preventive measures comprise water sampling (involving parasites), information of the public and prolonged closures of potentially contaminated sites

Cytokine profiles in nasal fluid of patients with seasonal or persistent allergic rhinitis.

Background New therapeutic approaches with biologic agents such as anti-cytokine antibodies are currently on trial for the treatment of asthma, rhinosinusitis or allergic diseases necessitating patient selection by biomarkers. Allergic rhinitis (AR), affecting about 20 % of the Canadian population, is an inflammatory disease characterised by a disequilibrium of T-lymphocytes and tissue eosinophilia. Aim of the present study was to describe distinct cytokine patterns in nasal secretion between seasonal and perennial AR (SAR/PAR), and healthy controls by comparing cytokines regulating T-cells or stimulating inflammatory cells, and chemokines. Methods Nasal secretions of 44 participants suffering from SAR, 45 participants with PAR and 48 healthy controls were gained using the cotton wool method, and analysed for IL-1β, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, IL-17, GM-CSF, G-CSF, IFN-γ, MCP-1, MIP-1α, MIP-1β, eotaxin, and RANTES by Bio-Plex Cytokine Assay as well as for ECP and tryptase by UniCAP-FEIA. Results Participants with SAR or PAR presented elevated levels of tryptase, ECP, MCP-1, and MIP-1β, while values of GM-CSF, G-CSF, IL-1β, and IL-6 did not differ from the controls. Increased levels of IL-5, eotaxin, MIP-1α, and IL-17 and decreased levels of IFN-γ, IL-12 and IL-10 were found in SAR only. RANTES was elevated in SAR in comparison to PAR. Interestingly, we found reduced levels of IL-4 in PAR and of IL-13 in SAR. Conclusions Elevated levels of proinflammatory cytokines were seen in both disease entities. They were, however, more pronounced in SAR, indicating a higher degree of inflammation. This study suggests a downregulation of T H 1 and T reg -lymphocytes and an upregulation of T H 17 in SAR. Moreover, the results display a prominent role of eosinophils and mast cells in AR. The observed distinct cytokine profiles in nasal secretion may prove useful as a diagnostic tool helping to match patients to antibody therapies

Cytokine patterns in nasal secretion of non-atopic patients distinguish between chronic rhinosinusitis with or without nasal polys

Background: Being one of the most common nasal diseases, chronic rhinosinusitis (CRS) is subdivided into CRS with nasal polyps (NP) and CRS without nasal polyps (CRSsNP). CRSsNP presents itself with a T(H)1 milieu and neutrophil infiltration, while NP is characterised by a mixed T(H)1/T(H)2 profile and an influx of predominantly eosinophils, plasma cells and mast cells. For the purpose of discovering disease-specific cytokine profiles, the present study compares levels of mediators and cytokines in nasal secretions between CRSsNP, NP, and healthy controls. Methods: The study included 45 participants suffering from NP, 48 suffering from CRSsNP and 48 healthy controls. Allergic rhinitis constituted an exclusion criterion. Nasal secretions, sampled using the cotton wool method, were analysed for IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, IL-8, GM-CSF, G-CSF, IFN-gamma, MCP-1, MIP-1 alpha, MIP-1 beta, eotaxin, and RANTES, and for ECP and tryptase, using Bio-Plex Cytokine assay or ELISA, respectively. Results: Elevated levels of IL-5, IL-17, G-CSF, MCP-1, MIP-1 alpha, MIP-1 beta, ECP, and tryptase, as well as decreased levels of IL-10, IL-12, IL-13, and IFN-gamma were detected in NP. CRSsNP presented increased levels of RANTES and MIP-1 beta while IL-13 was decreased. No differences between the three groups were found for IL-4, IL-8, GM-CSF, and eotaxin. Conclusions: The present work suggests a disequilibrium of T(H)1 and T(H)2, together with a down-regulation of regulatory T lymphocytes and up-regulated T(H)17 in NP. Moreover, elevated levels of diverse mediators represent the activation of various inflammatory cells in this disease entity. The inflammation in CRSsNP, however, is only weakly depicted in nasal secretions. Therefore, cytokines in nasal secretions may provide helpful information for differential diagnosis

Cytokine profiles in nasal fluid of patients with seasonal or persistent allergic rhinitis.

Background New therapeutic approaches with biologic agents such as anti-cytokine antibodies are currently on trial for the treatment of asthma, rhinosinusitis or allergic diseases necessitating patient selection by biomarkers. Allergic rhinitis (AR), affecting about 20 % of the Canadian population, is an inflammatory disease characterised by a disequilibrium of T-lymphocytes and tissue eosinophilia. Aim of the present study was to describe distinct cytokine patterns in nasal secretion between seasonal and perennial AR (SAR/PAR), and healthy controls by comparing cytokines regulating T-cells or stimulating inflammatory cells, and chemokines. Methods Nasal secretions of 44 participants suffering from SAR, 45 participants with PAR and 48 healthy controls were gained using the cotton wool method, and analysed for IL-1β, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, IL-17, GM-CSF, G-CSF, IFN-γ, MCP-1, MIP-1α, MIP-1β, eotaxin, and RANTES by Bio-Plex Cytokine Assay as well as for ECP and tryptase by UniCAP-FEIA. Results Participants with SAR or PAR presented elevated levels of tryptase, ECP, MCP-1, and MIP-1β, while values of GM-CSF, G-CSF, IL-1β, and IL-6 did not differ from the controls. Increased levels of IL-5, eotaxin, MIP-1α, and IL-17 and decreased levels of IFN-γ, IL-12 and IL-10 were found in SAR only. RANTES was elevated in SAR in comparison to PAR. Interestingly, we found reduced levels of IL-4 in PAR and of IL-13 in SAR. Conclusions Elevated levels of proinflammatory cytokines were seen in both disease entities. They were, however, more pronounced in SAR, indicating a higher degree of inflammation. This study suggests a downregulation of T H 1 and T reg -lymphocytes and an upregulation of T H 17 in SAR. Moreover, the results display a prominent role of eosinophils and mast cells in AR. The observed distinct cytokine profiles in nasal secretion may prove useful as a diagnostic tool helping to match patients to antibody therapies