Lohnt sich Arbeits- und Gesundheitsschutz? Bilanzierung von Kosten und Nutzen angesichts neuer Belastungsformen

"Zwei Argumente dominieren gegenwärtig die Diskussion um Zustand und Gestaltbarkeit des Arbeits- und Gesundheitsschutzes (AGS) in Deutschland: Das Kostenargument, meist vorgebracht von Unternehmensseite, versucht scheinbar zu aufwändige Maßnahmen abzuwenden, und die Beschreibung der Zunahme neuer Belastungen für Beschäftigte, wie es sich in steigenden psychisch bedingten Ausfalltagen und ansteigendem Präsentismus (also Anwesenheit trotz Krankheit) äußert. Tatsächlich können wir zeigen, dass die immensen volkswirtschaftlichen und betrieblichen Kosten durch mangelhaften AGS in Deutschland und durch Krankheit entstehen, und nicht durch ein zu hohes AGS-Niveau und einen hohen Gesundheitsstand. Es werden Beispiele für betriebliche Maßnahmen der Gesundheitsförderung vorgestellt, die u.a. auch unmittelbar kostenentlastende Effekte haben. Dabei lassen sich in der verschränkten Zielstellung einer Minimierung von klassischen Fehlbelastungen und der Reduzierung neuer Belastungsformen die besten Effekte erzielen, wenn ein beteiligungsorientierter Ansatz verfolgt wird." (Autorenreferat

Fetal Parvowirus B19 infection with hydrops fetalis, a case report

Parvovirus B 19 (B19V) infection during pregnancy is a cause of nonimmune hydrops. We report a case of hydrops fetalis with severe fetal anemia in the course of B19V infection in the third trimester of pregnancy. Maternal and fetal parvovirus B19 infection was confirmed using quantitative real time PCR detection of viral DNA. The affected fetus was treated with three intrauterine transfusions. The baby was delivered by caesarean section at 36 weeks. Up until 6 months of age no abnormalities in the development of the child were observed

Improvements to the APBS biomolecular solvation software suite

The Adaptive Poisson-Boltzmann Solver (APBS) software was developed to solve the equations of continuum electrostatics for large biomolecular assemblages that has provided impact in the study of a broad range of chemical, biological, and biomedical applications. APBS addresses three key technology challenges for understanding solvation and electrostatics in biomedical applications: accurate and efficient models for biomolecular solvation and electrostatics, robust and scalable software for applying those theories to biomolecular systems, and mechanisms for sharing and analyzing biomolecular electrostatics data in the scientific community. To address new research applications and advancing computational capabilities, we have continually updated APBS and its suite of accompanying software since its release in 2001. In this manuscript, we discuss the models and capabilities that have recently been implemented within the APBS software package including: a Poisson-Boltzmann analytical and a semi-analytical solver, an optimized boundary element solver, a geometry-based geometric flow solvation model, a graph theory based algorithm for determining p$K_a$ values, and an improved web-based visualization tool for viewing electrostatics

RHD variant in RhD/-/ mother with anti-D makes noninvasive fetal RHD genotyping impossible

Abstract Objectives: Noninvasive fetal RHD genotyping from maternal plasma of RhD(/-) pregnant women of Caucasian race may be used for predicting the risk of hemolytic disease because the RHD gene is usually absent in such populations. If detected in plasma of such women, the RHD gene originates from the RhD(+) fetus. The number of fetal copies of the gene in maternal plasma is extremely small. In the presented case of the RhD(/-) pregnant woman with anti-D it was impossible to give a fetal RHD result due to mother’s RHD(+) genotype. The fetal RHD was determined from amniocytes. Aim: to present the difficulties related to the interpretation of results of invasive and noninvasive procedures. Material and methods: whole blood, plasma and amniotic fluid of the RhD(-) woman with anti-D (14 week of pregnancy) as well as whole blood of the newborn. RHD and RHCE*c were genotyped by real-time PCR in DNA isolated from maternal plasma and amniocytes and the RHD and d-genotypes were tested by SSP methods in DNA isolated from whole blood and amniocytes . Results: RHD and RHCE*c were detected in DNA isolated from plasma. The high level of RHD suggested its origin from the mother’s DNA therefore it was impossible to determine the fetal RHD. The d-little test identified a RHD(IVS3+1G>A) variant in the mother’s genome. A weak signal of real-time PCR for the RHD was obtained in amniocytes but the RHD was not detected by SSP. The RHCE*c was detected by both methods. Results were inconclusive; the fetal RHD status remained unknown. The child was RhD(-) with RHD in its DNA undetected by either method. Conclusions: 1/ The RHD(IVS3+1G>A) variant in the RhD(-) mother precluded formal noninvasive fetal RHD genotyping. 2/Real-time PCR is too sensitive for amniocyte testing and may lead to false results as it detects trace maternal DNA in amniotic fluid 3/ The frequency of RHD(IVS3+1G>A) occurrence in Poland requires further studies

Estimation of diagnostic value of the middle cerebral artery peak systolic velocity in prediction of fetal anemia in pregnancies complicated by alloimmunisation

Abstract The use of the middle cerbral artery peak systolic velocity (PSV) for the noninvasive diagnosis of fetal anemia in pregnancies complicated by alloimmunisation has the potential to reduce the number of invesive procedures. Objectives: The study was undertaken to determine the detection of fetal anemia by fetal middle cerebral artery peak systolic velociy (MCA PSV). Material and methods: 31 fetuses with red cell alloimmunisation were evaluated with Doppler ultrasongraphy. On the basis of ROC (AUC) analysis the cutoff point of MoM=1.215 with the highest sensitivity and specivicity was established. We examined the relation between MoM=1.215 and neonatal hemoglobin level and the maternal antibody titre in the indirect antiglobulin test. Sensitivity, specificity, positive and negative value and statistical significance were calculated. Conclusions: Data reported to date suggest that a threshold of 1.215 multiples of the median can be used to better diagnostic of fetal anemia

Empatía en el proceso de cuidado en enfermería bajo la óptica de la teoría del reconocimiento: síntesis reflexiva

Introduction: The humanistic and scientific integration between scientific knowledge and healthcare practices is intended to promote care within the constructive perspective of the mutual-aid and trust process, focusing on the effectiveness of care. The essence of nursing care is based on trust relationships and the link between the nurse and the person in care; empathy emerges within this logic as the tie that binds the mutual relations of care. Materials and Methods: This is a reflective study intended to discuss the care provided by nursing professionals through empathy, in the light of the Recognition Theory. Results: Data crossing was performed by means of a philosophical central concept and two characterizing categories: Empathy in contemporaneity and nursing as a science of care. The aim was to capture the essence of the recognition in this dialogic and reciprocal process. Discussion: The literature shows empathy –within the nursing care process– as a procedural and relational construction between the professional and the person that seeks to establish interdependencies under mutual and reciprocal trust. Recognizing the other through empathy is a necessary step to build up a relation of affection and esteem, aiming at establishing relations of trust and reciprocity. Conclusions: Empathy is developed in nursing care through the intimate and individual recognition of those involved, by means of respect, dignity, civism, compassion, and overcoming differences. How to cite this article: Zuchetto M, Engel F, Medeiros L, Hammerschmidt K, Schoeller S. Empatia no processo de cuidado em enfermagem sob a ótica da teoria do reonhecimento: síntese reflexiva. Rev Cuid. 2019; 10(3): e624. http://dx.doi.org/10.15649/cuidarte.v10i3.624Introdução: A integração humanística-científica entre conhecimento cientifico e práticas em saúde visam a promoção do cuidado na ótica construtiva do processo de ajuda - mútua e de confiança focada na efetividade do cuidado. A essência do cuidado em Enfermagem é fundamentada nas relações de confiança e vínculo entre enfermeiro e pessoa cuidada, nesta lógica, a empatia surge como o entrelaçar das relações recíprocas de cuidado. Materiais e Métodos: Trata-se de um estudo reflexivo que objetivou discutir o cuidado realizado por profissionais de enfermagem através da empatia à luz da Teoria do Reconhecimento. Resultados: O cruzamento dos dados foi trabalhado em um eixo filosófico central e duas categorias caracterizadoras: empatia na contemporaneidade e a enfermagem como ciência do cuidado, buscando captar a essência do reconhecimento neste processo dialógico e recíproco. Discussão: A empatia, compreendida no processo de cuidado em enfermagem é vista na literatura como uma construção processual e relacional entre o profissional e a pessoa, buscando estabelecer interdependências com confiança mútua e recíproca. O reconhecimento do outro através da empatia é necessária para a construção de uma relação de afeto e estima, visando ter relações de confiança e reciprocidade. Conclusões: A empatia é construída no cuidado em enfermagem através da valorização íntima e individual dos envolvidos, por meio do respeito, dignidade, civilidade, compaixão e superação das diferenças. Como citar este artigo: Zuchetto M, Engel F, Medeiros L, Hammerschmidt K, Schoeller S. Empatia no processo de cuidado em enfermagem sob a ótica da teoria do reonhecimento: síntese reflexiva. Rev Cuid. 2019; 10(3): e624. http://dx.doi.org/10.15649/cuidarte.v10i3.624  Introducción: La integración humanística-científica entre conocimiento científico y prácticas en salud tienen por objeto promover el cuidado dentro de la perspectiva constructiva del proceso de ayuda mutua y de confianza enfocada en la efectividad del cuidado. La esencia del cuidado en Enfermería se fundamenta en las relaciones de confianza y el vínculo entre enfermero y persona cuidada, dentro de esta lógica surge la empatía como el lazo que une las relaciones recíprocas de cuidado. Materiales y Métodos: Se trata de un estudio reflexivo cuyo objetivo era discutir sobre el cuidado realizado por profesionales de enfermería a través de la empatía a la luz de la Teoría del Reconocimiento. Resultados: El cruce de los datos se hizo a través de un eje filosófico central y dos categorías caracterizadoras: empatía en la contemporaneidad y la enfermería como ciencia del cuidado, buscando captar la esencia del reconocimiento en este proceso dialógico y recíproco. Discusión: En la literatura, la empatía, comprendida en el proceso de cuidado en enfermería, aparece como una construcción procesal y relacional entre el profesional y la persona, buscando establecer interdependencias con confianza mutua y recíproca. El reconocimiento del otro a través de la empatía es necesario para construir una relación de afecto y estima, con miras a tener relaciones de confianza y reciprocidad. Conclusiones: La empatía se construye en el cuidado de enfermería a través de la valorización íntima e individual de los involucrados, por medio del respeto, dignidad, civismo, compasión y superación de las diferencias. Como citar este articulo: Zuchetto M, Engel F, Medeiros L, Hammerschmidt K, Schoeller S. Empatia no processo de cuidado em enfermagem sob a ótica da teoria do reonhecimento: síntese reflexiva. Rev Cuid. 2019; 10(3): e624. http://dx.doi.org/10.15649/cuidarte.v10i3.62

Whole blood co-expression modules associate with metabolic traits and type 2 diabetes : an IMI-DIRECT study

Background The rising prevalence of type 2 diabetes (T2D) poses a major global challenge. It remains unresolved to what extent transcriptomic signatures of metabolic dysregulation and T2D can be observed in easily accessible tissues such as blood. Additionally, large-scale human studies are required to further our understanding of the putative inflammatory component of insulin resistance and T2D. Here we used transcriptomics data from individuals with (n = 789) and without (n = 2127) T2D from the IMI-DIRECT cohorts to describe the co-expression structure of whole blood that mainly reflects processes and cell types of the immune system, and how it relates to metabolically relevant clinical traits and T2D. Methods Clusters of co-expressed genes were identified in the non-diabetic IMI-DIRECT cohort and evaluated with regard to stability, as well as preservation and rewiring in the cohort of individuals with T2D. We performed functional and immune cell signature enrichment analyses, and a genome-wide association study to describe the genetic regulation of the modules. Phenotypic and trans-omics associations of the transcriptomic modules were investigated across both IMI-DIRECT cohorts. Results We identified 55 whole blood co-expression modules, some of which clustered in larger super-modules. We identified a large number of associations between these transcriptomic modules and measures of insulin action and glucose tolerance. Some of the metabolically linked modules reflect neutrophil-lymphocyte ratio in blood while others are independent of white blood cell estimates, including a module of genes encoding neutrophil granule proteins with antibacterial properties for which the strongest associations with clinical traits and T2D status were observed. Through the integration of genetic and multi-omics data, we provide a holistic view of the regulation and molecular context of whole blood transcriptomic modules. We furthermore identified an overlap between genetic signals for T2D and co-expression modules involved in type II interferon signaling. Conclusions Our results offer a large-scale map of whole blood transcriptomic modules in the context of metabolic disease and point to novel biological candidates for future studies related to T2D.Peer reviewe

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Unidad de excelencia María de Maeztu CEX2019-000940-MAim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Estimating the global conservation status of more than 15,000 Amazonian tree species

Estimates of extinction risk for Amazonian plant and animal species are rare and not often incorporated into land-use policy and conservation planning. We overlay spatial distribution models with historical and projected deforestation to show that at least 36% and up to 57% of all Amazonian tree species are likely to qualify as globally threatened under International Union for Conservation of Nature (IUCN) Red List criteria. If confirmed, these results would increase the number of threatened plant species on Earth by 22%. We show that the trends observed in Amazonia apply to trees throughout the tropics, and we predict thatmost of the world’s >40,000 tropical tree species now qualify as globally threatened. A gap analysis suggests that existing Amazonian protected areas and indigenous territories will protect viable populations of most threatened species if these areas suffer no further degradation, highlighting the key roles that protected areas, indigenous peoples, and improved governance can play in preventing large-scale extinctions in the tropics in this century

Copy number variants as modifiers of breast cancer risk for BRCA1/BRCA2 pathogenic variant carriers

The risk of germline copy number variants (CNVs) in BRCA1 and BRCA2 pathogenic variant carriers in breast cancer is assessed, with CNVs overlapping SULT1A1 decreasing breast cancer risk in BRCA1 carriers.The contribution of germline copy number variants (CNVs) to risk of developing cancer in individuals with pathogenic BRCA1 or BRCA2 variants remains relatively unknown. We conducted the largest genome-wide analysis of CNVs in 15,342 BRCA1 and 10,740 BRCA2 pathogenic variant carriers. We used these results to prioritise a candidate breast cancer risk-modifier gene for laboratory analysis and biological validation. Notably, the HR for deletions in BRCA1 suggested an elevated breast cancer risk estimate (hazard ratio (HR) = 1.21), 95% confidence interval (95% CI = 1.09-1.35) compared with non-CNV pathogenic variants. In contrast, deletions overlapping SULT1A1 suggested a decreased breast cancer risk (HR = 0.73, 95% CI 0.59-0.91) in BRCA1 pathogenic variant carriers. Functional analyses of SULT1A1 showed that reduced mRNA expression in pathogenic BRCA1 variant cells was associated with reduced cellular proliferation and reduced DNA damage after treatment with DNA damaging agents. These data provide evidence that deleterious variants in BRCA1 plus SULT1A1 deletions contribute to variable breast cancer risk in BRCA1 carriers.Peer reviewe