Screening for Generalized Anxiety Disorder in inpatient psychosomatic rehabilitation: pathological worry and the impact of depressive symptoms

Objective: Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients

Potreba za psihosocijalnom rehabilitacijom oboljelih od raka

In addition to the healing and alleviation of primary somatic cancer symptoms, the comprehensive psycho oncological treatment of cancer patients is an important and fundamental component of oncological rehabilitation in Germany. Rehabilitation treatment encompasses medical, physiotherapeutic, psychological, and creative therapeutic methods, as well as psycho-educational interventions within the framework of an individualized therapy plan. Psycho-oncological interventions within rehabilitation are governed less by individual therapeutic schools of thought, and more by a supportive, patient-centered approach that integrates various psychotherapeutic methods. Adapted methods and techniques from various psychotherapeutic approaches (behavioral therapy, psychoanalytical psychotherapies, systemic family therapy, or hypnotherapy) are currently used in the treatment of cancer patients. A total of N=116 patients of the Paracelsus Clinic am See in Bad Gandersheim were able to be included in the study. In summary, this study shows that about two thirds of the patients admitted to the oncological rehabilitation clinic exhibit middle to high degrees of distress in the areas of anxiety and/or depression. Moreover, it appears to be particularly important to assess not only the mental distress of cancer patients but also their degree of information with regard to psycho-oncological treatment when performing screening for psycho-oncological treatment outside of the rehabilitation clinic setting. Here it is particularly important to accommodate for a differing need for differing forms of treatment (need for counseling, care, or treatment).Sveobuhvatno psiho-onkološko liječenje bolesnika s rakom važan je prilog u liječenju i ublažavanju primarnih somatskih simptoma te temeljna komponenta onkološke rehabilitacije u Saveznoj Republici Njemačkoj. Ova vrsta rehabilitacije obuhvaća medicinske, fizioterapijske, psihološke te kreativno terapijske pristupe, ali i psihoedukacijske intervencije u okviru individualiziranih terapijskih programa. Psiho-onkološki rehabilitacijski postupci manje su određeni kognitivnim psihoterapijskim metodma, a više potpornim, pacijentu usmjerenim pristupima koji obuhvaćaju različite psihoterapijske tehnike. Prilagođene metode i tehnike iz različitih psihoterapijskih pristupa (bihevioralna terapija, psihoanalitička psihoterapija, sistemska obiteljska terapija ili hipnoterapija) predstavljaju suvremeni koncept u liječenju onkoloških bolesnika. Ova studija provedena je na uzorku od 116 pacijenata Paracelsus Clinic am See u Bad Gandersheimu. Rezultati studije pokazali su da dvije trećine pacijenata uključenih u onkološku rehabilitaciju pokazuje srednji do visok stupanj poremećaja u području anksioznosti i/ili depresije. Osim toga, osobito je važno da se u uvjetima definiranja psiho-onkološkog liječenja u izvankliničkim uvjetima ne procjenjuje samo vrsta i stupanj psihičkog poremećaja, već također i razina informiranosti o psiho-onkološkom liječenju. U tom smislu posebno je važno različite oblike liječenja prilagoditi različitim osobnim potrebamabolesnika (npr. potreba za savjetovanjem, njegom, liječenjem)

Potreba za psihosocijalnom rehabilitacijom oboljelih od raka

In addition to the healing and alleviation of primary somatic cancer symptoms, the comprehensive psycho oncological treatment of cancer patients is an important and fundamental component of oncological rehabilitation in Germany. Rehabilitation treatment encompasses medical, physiotherapeutic, psychological, and creative therapeutic methods, as well as psycho-educational interventions within the framework of an individualized therapy plan. Psycho-oncological interventions within rehabilitation are governed less by individual therapeutic schools of thought, and more by a supportive, patient-centered approach that integrates various psychotherapeutic methods. Adapted methods and techniques from various psychotherapeutic approaches (behavioral therapy, psychoanalytical psychotherapies, systemic family therapy, or hypnotherapy) are currently used in the treatment of cancer patients. A total of N=116 patients of the Paracelsus Clinic am See in Bad Gandersheim were able to be included in the study. In summary, this study shows that about two thirds of the patients admitted to the oncological rehabilitation clinic exhibit middle to high degrees of distress in the areas of anxiety and/or depression. Moreover, it appears to be particularly important to assess not only the mental distress of cancer patients but also their degree of information with regard to psycho-oncological treatment when performing screening for psycho-oncological treatment outside of the rehabilitation clinic setting. Here it is particularly important to accommodate for a differing need for differing forms of treatment (need for counseling, care, or treatment).Sveobuhvatno psiho-onkološko liječenje bolesnika s rakom važan je prilog u liječenju i ublažavanju primarnih somatskih simptoma te temeljna komponenta onkološke rehabilitacije u Saveznoj Republici Njemačkoj. Ova vrsta rehabilitacije obuhvaća medicinske, fizioterapijske, psihološke te kreativno terapijske pristupe, ali i psihoedukacijske intervencije u okviru individualiziranih terapijskih programa. Psiho-onkološki rehabilitacijski postupci manje su određeni kognitivnim psihoterapijskim metodma, a više potpornim, pacijentu usmjerenim pristupima koji obuhvaćaju različite psihoterapijske tehnike. Prilagođene metode i tehnike iz različitih psihoterapijskih pristupa (bihevioralna terapija, psihoanalitička psihoterapija, sistemska obiteljska terapija ili hipnoterapija) predstavljaju suvremeni koncept u liječenju onkoloških bolesnika. Ova studija provedena je na uzorku od 116 pacijenata Paracelsus Clinic am See u Bad Gandersheimu. Rezultati studije pokazali su da dvije trećine pacijenata uključenih u onkološku rehabilitaciju pokazuje srednji do visok stupanj poremećaja u području anksioznosti i/ili depresije. Osim toga, osobito je važno da se u uvjetima definiranja psiho-onkološkog liječenja u izvankliničkim uvjetima ne procjenjuje samo vrsta i stupanj psihičkog poremećaja, već također i razina informiranosti o psiho-onkološkom liječenju. U tom smislu posebno je važno različite oblike liječenja prilagoditi različitim osobnim potrebamabolesnika (npr. potreba za savjetovanjem, njegom, liječenjem)

A family history of breast cancer will not predict female early onset breast cancer in a population-based setting

ABSTRACT: BACKGROUND: An increased risk of breast cancer for relatives of breast cancer patients has been demonstrated in many studies, and having a relative diagnosed with breast cancer at an early age is an indication for breast cancer screening. This indication has been derived from estimates based on data from cancer-prone families or from BRCA1/2 mutation families, and might be biased because BRCA1/2 mutations explain only a small proportion of the familial clustering of breast cancer. The aim of the current study was to determine the predictive value of a family history of cancer with regard to early onset of female breast cancer in a population based setting. METHODS: An unselected sample of 1,987 women with and without breast cancer was studied with regard to the age of diagnosis of breast cancer. RESULTS: The risk of early-onset breast cancer was increased when there were: (1) at least 2 cases of female breast cancer in first-degree relatives (yes/no; HR at age 30: 3.09; 95% CI: 128-7.44), (2) at least 2 cases of female breast cancer in first or second-degree relatives under the age of 50 (yes/no; HR at age 30: 3.36; 95% CI: 1.12-10.08), (3) at least 1 case of female breast cancer under the age of 40 in a first- or second-degree relative (yes/no; HR at age 30: 2.06; 95% CI: 0.83-5.12) and (4) any case of bilateral breast cancer (yes/no; HR at age 30: 3.47; 95%: 1.33-9.05). The positive predictive value of having 2 or more of these characteristics was 13% for breast cancer before the age of 70, 11% for breast cancer before the age of 50, and 1% for breast cancer before the age of 30. CONCLUSION: Applying family history related criteria in an unselected population could result in the screening of many women who will not develop breast cancer at an early age

Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience

BACKGROUND: Breast cancer (BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification. METHODS: We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio (SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided. RESULTS: After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased (SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk (SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P = .74). CONCLUSION: The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC

Reduced microvascular density in omental biopsies of children with chronic kidney disease

Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD.Omental tissue was collected from 32 healthy children (0-18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2.Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01).Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease