Covid-19 Crisis = care crisis? Changes in care provision and care-givers' well-being during the Covid-19 Pandemic

This chapter examines the situation of individuals providing unpaid support or care for persons suffering from poor health, disability or age-related frailty during the Covid-19 pandemic. The following questions are addressed: Did more people provide support or care for others during the first Covid-19 wave than before the pandemic, or was there a decline? Was there a change in who was being cared for? Did care-givers' well-being change? Did care-givers wish for more help and support during the first Covid-19 wave

Corona-Krise = Krise der Angehörigen-Pflege? Zur veränderten Situation und den Gesundheitsrisiken der informell Unterstützungs- und Pflegeleistenden in Zeiten der Pandemie

Im Juni und Juli 2020 wurde im Rahmen des Deutschen Alterssurveys (DEAS) eine Kurzbefragung zu den Auswirkungen der Corona-Krise durchgeführt. Im Mittelpunkt der Befragung standen Veränderungen in verschiedenen Lebensbereichen, die während der Pandemie bei Menschen in der zweiten Lebenshälfte aufgetreten sind. Die Quote der informell geleisteten Unterstützung und Pflege steigt. Im Jahr 2017 haben 16 Prozent aller 46- bis 90- Jährigen für andere Personen gesundheitsbedingte Unterstützung oder Pflege erbracht. Während der ersten Welle der Corona-Pandemie sind es 19 Prozent. Dieser Anstieg geht vor allem auf die Frauen zurück, deren Unterstützungsquote von 18 Prozent auf 22 Prozent gestiegen ist. Die Unterstützung und Pflege innerhalb der Nachbarschaft nimmt deutlich zu. Der Anteil der Unterstützungs- und Pflegeleistenden, die sich an der Versorgung von Nachbar*innen beteiligen, ist von 7 Prozent (2017) auf 17 Prozent (2020) angestiegen. Aber auch für Freund*innen zeigt sich ein Zuwachs von 7 Prozent (2017) auf 11 Prozent (2020). (Schwieger-)Eltern sind auch 2020 die größte Empfänger*innengruppe von Unterstützung und Pflege (55 Prozent). Lediglich die Partner*innenunterstützung und -pflege ist leicht zurückgegangen. Unterstützungs- und Pflegeleistende schätzen ihre Gesundheit weniger gut ein als vor der Corona-Krise. Unter den Unterstützungs- und Pflegeleistenden ist der Anteil derer, die ihre Gesundheit als gut oder sehr gut bewerten, von 59 Prozent auf 56 Prozent zurückgegangen. Demgegenüber schätzen Personen ohne Unterstützungs- oder Pflegeverpflichtung ihre Gesundheit während der Corona-Krise besser ein als zuvor. Bei Unterstützungs- und Pflegeleistenden zeigt sich eine deutliche Verschlechterung ihrer psychosozialen Gesundheit gegenüber vor der Corona-Krise. Der Anteil der Unterstützungs- und Pflegeleistenden mit depressiven Symptomen hat zwischen 2017 (6 Prozent) und 2020 (15 Prozent) zugenommen. Das Gleiche gilt für den Anteil derer, die sich einsam fühlen: 2017 waren 8 Prozent einsam und 2020 sind es 13 Prozent. Dabei sind Frauen von diesen Negativ-Trends stärker betroffen als Männer. Unterstützungs- und Pflegeleistende berichten von fehlender informeller und professioneller Hilfe. Ein Viertel der Personen, die während der ersten Corona-Welle andere unterstützen oder pflegen, haben sich hierbei mehr Hilfe und Entlastung gewünscht, vor allem aus der Familie

Leveraging mobile health technology and research methodology to optimize patient education and self-management support for advanced cancer pain

Funding: National Institutes of Health [R21 NR017745, PI, Enzinger]; Friends of Dana-Farber Cancer Institute. Availability of data and material: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.Peer reviewedPostprin

Giant silent corticotrope pituitary adenoma in a patient with complicated clinical course

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Fat Mass and Obesity-Associated Gene (FTO) in Eating Disorders: Evidence for Association of the rs9939609 Obesity Risk Allele with Bulimia nervosa and Anorexia nervosa

Objective: The common single nucleotide polymorphism (SNP) rs9939609 in the fat mass and obesity-associated gene (FTO) is associated with obesity. As genetic variants associated with weight regulation might also be implicated in the etiology of eating disorders, we evaluated whether SNP rs9939609 is associated with bulimia nervosa (BN) and anorexia nervosa (AN). Methods: Association of rs9939609 with BN and AN was assessed in 689 patients with AN, 477 patients with BN, 984 healthy non-population-based controls, and 3,951 population-based controls (KORA-S4). Based on the familial and premorbid occurrence of obesity in patients with BN, we hypothesized an association of the obesity risk A-allele with BN. Results: In accordance with our hypothesis, we observed evidence for association of the rs9939609 A-allele with BN when compared to the non-population-based controls (unadjusted odds ratio (OR) = 1.142, one-sided 95% confidence interval (CI) 1.001-infinity; one-sided p = 0.049) and a trend in the population-based controls (OR = 1.124, one-sided 95% CI 0.932-infinity; one-sided p = 0.056). Interestingly, compared to both control groups, we further detected a nominal association of the rs9939609 A-allele to AN (OR = 1.181, 95% CI 1.027-1.359, two-sided p = 0.020 or OR = 1.673, 95% CI 1.101-2.541, two-sided p = 0.015,). Conclusion: Our data suggest that the obesity-predisposing FTO allele might be relevant in both AN and BN. Copyright (C) 2012 S. Karger GmbH, Freibur

Forebrain Deletion of αGDI in Adult Mice Worsens the Pre-Synaptic Deficit at Cortico-Lateral Amygdala Synaptic Connections

The GDI1 gene encodes αGDI, which retrieves inactive GDP-bound RAB from membranes to form a cytosolic pool awaiting vesicular release. Mutations in GDI1 are responsible for X-linked Intellectual Disability. Characterization of the Gdi1-null mice has revealed alterations in the total number and distribution of hippocampal and cortical synaptic vesicles, hippocampal short-term synaptic plasticity and specific short-term memory deficits in adult mice, which are possibly caused by alterations of different synaptic vesicle recycling pathways controlled by several RAB GTPases. However, interpretation of these studies is complicated by the complete ablation of Gdi1 in all cells in the brain throughout development. In this study, we generated conditionally gene-targeted mice in which the knockout of Gdi1 is restricted to the forebrain, hippocampus, cortex and amygdala and occurs only during postnatal development. Adult mutant mice reproduce the short-term memory deficit previously reported in Gdi1-null mice. Surprisingly, the delayed ablation of Gdi1 worsens the pre-synaptic phenotype at cortico-amygdala synaptic connections compared to Gdi1-null mice. These results suggest a pivotal role of αGDI via specific RAB GTPases acting specifically in forebrain regions at the pre-synaptic sites involved in memory formation

Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder.

OBJECTIVE For adolescents, DSM-5 differentiates anorexia nervosa (AN) and atypical AN with the 5th BMI-centile-for-age. We hypothesized that the diagnostic weight cut-off yields (i) lower weight loss in atypical AN and (ii) discrepant premorbid BMI distributions between the two disorders. Prior studies demonstrate that premorbid BMI predicts admission BMI and weight loss in patients with AN. We explore these relationships in atypical AN. METHOD Based on admission BMI-centile < or ≥5th, participants included 411 female adolescent inpatients with AN and 49 with atypical AN from our registry study. Regression analysis and t-tests statistically addressed our hypotheses and exploratory correlation analyses compared interrelationships between weight loss, admission BMI, and premorbid BMI in both disorders. RESULTS Weight loss in atypical AN was 5.6 kg lower than in AN upon adjustment for admission age, admission height, premorbid weight and duration of illness. Premorbid BMI-standard deviation scores differed by almost one between both disorders. Premorbid BMI and weight loss were strongly correlated in both AN and atypical AN. DISCUSSION Whereas the weight cut-off induces discrepancies in premorbid weight and adjusted weight loss, AN and atypical AN overall share strong weight-specific interrelationships that merit etiological consideration. Epidemiological and genetic associations between AN and low body weight may reflect a skewed premorbid BMI distribution. In combination with prior findings for similar psychological and medical characteristics in AN and atypical AN, our findings support a homogenous illness conceptualization. We propose that diagnostic subcategorization based on premorbid BMI, rather than admission BMI, may improve clinical validity. PUBLIC SIGNIFICANCE Because body weights of patients with AN must drop below the 5th BMI-centile per DSM-5, they will inherently require greater weight loss than their counterparts with atypical AN of the same sex, age, height and premorbid weight. Indeed, patients with atypical AN had a 5.6 kg lower weight loss after controlling for these variables. In comparison to the reference population, we found a lower and higher mean premorbid weight in patients with AN and atypical AN, respectively. Considering previous psychological and medical comparisons showing little differences between AN and atypical AN, we view a single disorder as the most parsimonious explanation. Etiological models need to particularly account for the strong relationship between weight loss and premorbid body weight

In Vivo Control of CpG and Non-CpG DNA Methylation by DNA Methyltransferases

The enzymatic control of the setting and maintenance of symmetric and non-symmetric DNA methylation patterns in a particular genome context is not well understood. Here, we describe a comprehensive analysis of DNA methylation patterns generated by high resolution sequencing of hairpin-bisulfite amplicons of selected single copy genes and repetitive elements (LINE1, B1, IAP-LTR-retrotransposons, and major satellites). The analysis unambiguously identifies a substantial amount of regional incomplete methylation maintenance, i.e. hemimethylated CpG positions, with variant degrees among cell types. Moreover, non-CpG cytosine methylation is confined to ESCs and exclusively catalysed by Dnmt3a and Dnmt3b. This sequence position–, cell type–, and region-dependent non-CpG methylation is strongly linked to neighboring CpG methylation and requires the presence of Dnmt3L. The generation of a comprehensive data set of 146,000 CpG dyads was used to apply and develop parameter estimated hidden Markov models (HMM) to calculate the relative contribution of DNA methyltransferases (Dnmts) for de novo and maintenance DNA methylation. The comparative modelling included wild-type ESCs and mutant ESCs deficient for Dnmt1, Dnmt3a, Dnmt3b, or Dnmt3a/3b, respectively. The HMM analysis identifies a considerable de novo methylation activity for Dnmt1 at certain repetitive elements and single copy sequences. Dnmt3a and Dnmt3b contribute de novo function. However, both enzymes are also essential to maintain symmetrical CpG methylation at distinct repetitive and single copy sequences in ESCs

Brain ageing in schizophrenia: evidence from 26 international cohorts via the ENIGMA Schizophrenia consortium

Schizophrenia (SZ) is associated with an increased risk of life-long cognitive impairments, age-related chronic disease, and premature mortality. We investigated evidence for advanced brain ageing in adult SZ patients, and whether this was associated with clinical characteristics in a prospective meta-analytic study conducted by the ENIGMA Schizophrenia Working Group. The study included data from 26 cohorts worldwide, with a total of 2803 SZ patients (mean age 34.2 years; range 18-72 years; 67% male) and 2598 healthy controls (mean age 33.8 years, range 18-73 years, 55% male). Brain-predicted age was individually estimated using a model trained on independent data based on 68 measures of cortical thickness and surface area, 7 subcortical volumes, lateral ventricular volumes and total intracranial volume, all derived from T1-weighted brain magnetic resonance imaging (MRI) scans. Deviations from a healthy brain ageing trajectory were assessed by the difference between brain-predicted age and chronological age (brain-predicted age difference [brain-PAD]). On average, SZ patients showed a higher brain-PAD of +3.55 years (95% CI: 2.91, 4.19; I2 = 57.53%) compared to controls, after adjusting for age, sex and site (Cohen's d = 0.48). Among SZ patients, brain-PAD was not associated with specific clinical characteristics (age of onset, duration of illness, symptom severity, or antipsychotic use and dose). This large-scale collaborative study suggests advanced structural brain ageing in SZ. Longitudinal studies of SZ and a range of mental and somatic health outcomes will help to further evaluate the clinical implications of increased brain-PAD and its ability to be influenced by interventions