Die psychosoziale/-sexuelle Entwicklung von Knaben mit einer Hypospadie

Zusammenfassung: Knaben mit einer Hypospadie sind spezifischen psychischen Belastungen im Zusammenhang mit dem chirurgischen Eingriff im Genitalbereich und einem kosmetisch und/oder funktionell beeinträchtigten Penis ausgesetzt. Während in den letzten Jahrzehnten intensive Anstrengungen zur Verbesserung der Operationstechniken unternommen worden sind, wurde die psychosoziale und psychosexuelle Entwicklung von Kindern und Jugendlichen nach Hypospadiekorrektur erst selten untersucht. Die Resultate der wenigen Studien sind insgesamt sehr widersprüchlich. Sie weisen aber auch deutlich daraufhin, dass die betroffenen Knaben unter spezifischen Problemen wie dem andersartigen Aussehen ihres Penis leiden. Das Angebot von medizinischen Verlaufskontrollen und psychosozialer Beratung muss ihnen deshalb bis ins junge Erwachsenenalter zur Verfügung gestellt werden. Für die zukünftige Forschung gilt es, in methodisch fundierten Studien Lebensqualität und Entwicklung der Knaben systematisch zu untersuchen. Dabei müssen insbesondere psychosoziale Risikofaktoren identifiziert werde

Tribocorrosion behavior of CoCrMo alloy for hip prosthesis as a function of loads: A comparison between two testing systems

Metal-on-metal (MOM) hip prosthesis bearings have enjoyed renewed popularity, but concerns remain with wear debris and metal ion release causing a negative response in the surrounding tissues. Further understanding into the wear and corrosion mechanisms occurring in MOM hips is therefore essential. The purpose of this study was to evaluate the tribocorrosion behavior, or interplay between corrosion and wear, of a low-carbon CoCrMo alloy as a function of loading. The tribocorrosion tests were performed using two tribometer configurations. In the first configuration, “System A”, a linearly reciprocating alumina ball slid against the flat metal immersed in a phosphate buffer solution (PBS). In the second configuration, “System B”, the flat end of a cylindrical metal pin was pressed against an alumina ball that oscillated rotationally, using bovine calf serum (BCS) as the lubricant and electrolyte. System B was custom-built to emulate in vivo conditions. The tribocorrosion tests were performed under potentiostatic conditions at −0.345 V, with a sliding duration of 1800 s and a frequency of 1 Hz. In System A the applied loads were 0.05, 0.5, and 1 N (138, 296 and 373 MPa, respectively) and in System B were 16, 32, and 64 N (474, 597, and 752 MPa, respectively). Electrochemical impedance spectroscopy (EIS) and polarization resistance were estimated. The total mass loss (Kwc) in the CoCrMo was determined. The mass loss due to wear (Kw) and that due to corrosion (Kc) were determined. The dominant wear regime for the CoCrMo alloy subjected to sliding changes from wear–corrosion to mechanical wear as the contact stress increases. An attempt was made to compare both system, in their tribochemical responses and formulate some insights in the total degradation processes. Our results also suggest that the proteins in the serum lubricant assist in the generation of a protective layer against corrosion during sliding. The study highlights the need of adequate methodology/guidelines to compare the results from different test systems and translating in solving the practical problems

Infectious, atopic and inflammatory diseases, childhood adversities and familial aggregation are independently associated with the risk for mental disorders: Results from a large Swiss epidemiological study.

To examine the associations between mental disorders and infectious, atopic, inflammatory diseases while adjusting for other risk factors. We used data from PsyCoLaus, a large Swiss Population Cohort Study (n = 3720; age range 35-66). Lifetime diagnoses of mental disorders were grouped into the following categories: Neurodevelopmental, anxiety (early and late onset), mood and substance disorders. They were regressed on infectious, atopic and other inflammatory diseases adjusting for sex, educational level, familial aggregation, childhood adversities and traumatic experiences in childhood. A multivariate logistic regression was applied to each group of disorders. In a complementary analysis interactions with sex were introduced via nested effects. Associations with infectious, atopic and other chronic inflammatory diseases were observable together with consistent effects of childhood adversities and familial aggregation, and less consistent effects of trauma in each group of mental disorders. Streptococcal infections were associated with neurodevelopmental disorders (men), and measles/mumps/rubella-infections with early and late anxiety disorders (women). Gastric inflammatory diseases took effect in mood disorders (both sexes) and in early disorders (men). Similarly, irritable bowel syndrome was prominent in a sex-specific way in mood disorders in women, and, moreover, was associated with early and late anxiety disorders. Atopic diseases were associated with late anxiety disorders. Acne (associations with mood disorders in men) and psoriasis (associations with early anxiety disorders in men and mood disorders in women) contributed sex-specific results. Urinary tract infections were associated with mood disorders and, in addition, in a sex-specific way with late anxiety disorders (men), and neurodevelopmental and early anxiety disorders (women). Infectious, atopic and inflammatory diseases are important risk factors for all groups of mental disorders. The sexual dimorphism of the associations is pronounced

Should health care professionals encourage living kidney donation?

Living kidney donation provides a promising opportunity in situations where the scarcity of cadaveric kidneys is widely acknowledged. While many patients and their relatives are willing to accept its benefits, others are concerned about living kidney programs; they appear to feel pressured into accepting living kidney transplantations as the only proper option for them. As we studied the attitudes and views of patients and their relatives, we considered just how actively health care professionals should encourage living donation. We argue that active interference in peoples’ personal lives is justified - if not obligatory. First, we address the ambiguous ideals of non-directivity and value neutrality in counselling. We describe the main pitfalls implied in these concepts, and conclude that these concepts cannot account for the complex reality of living donation and transplantation. We depict what is required instead as truthful information and context-relative counselling. We then consider professional interference into personal belief systems. We argue that individual convictions are not necessarily strong, stable, or deep. They may be flawed in many ways. In order to justify interference in peoples’ personal lives, it is crucial to understand the structure of these convictions. Evidence suggests that both patients and their relatives have attitudes towards living kidney donation that are often open to change and, accordingly, can be influenced. We show how ethical theories can account for this reality and can help us to discern between justified and unjustified interference. We refer to Stephen Toulmin’s model of the structure of logical argument, the Rawlsian model of reflective equilibrium, and Thomas Nagel’s representation of the particularistic position

Fitting the integrated Spectral Energy Distributions of Galaxies

Fitting the spectral energy distributions (SEDs) of galaxies is an almost universally used technique that has matured significantly in the last decade. Model predictions and fitting procedures have improved significantly over this time, attempting to keep up with the vastly increased volume and quality of available data. We review here the field of SED fitting, describing the modelling of ultraviolet to infrared galaxy SEDs, the creation of multiwavelength data sets, and the methods used to fit model SEDs to observed galaxy data sets. We touch upon the achievements and challenges in the major ingredients of SED fitting, with a special emphasis on describing the interplay between the quality of the available data, the quality of the available models, and the best fitting technique to use in order to obtain a realistic measurement as well as realistic uncertainties. We conclude that SED fitting can be used effectively to derive a range of physical properties of galaxies, such as redshift, stellar masses, star formation rates, dust masses, and metallicities, with care taken not to over-interpret the available data. Yet there still exist many issues such as estimating the age of the oldest stars in a galaxy, finer details ofdust properties and dust-star geometry, and the influences of poorly understood, luminous stellar types and phases. The challenge for the coming years will be to improve both the models and the observational data sets to resolve these uncertainties. The present review will be made available on an interactive, moderated web page (sedfitting.org), where the community can access and change the text. The intention is to expand the text and keep it up to date over the coming years.Comment: 54 pages, 26 figures, Accepted for publication in Astrophysics & Space Scienc

A step beyond the hygiene hypothesis-immune-mediated classes determined in a population-based study.

Comorbidity patterns of childhood infections, atopic diseases, and adverse childhood experiences (ACE) are related to immune system programming conditions. The aim of this study was to make a step beyond the hygiene hypothesis and to comprehensively classify these patterns with latent class analysis (LCA). A second aim was to characterize the classes by associations with immunological, clinical, and sociodemographic variables. LCA was applied to data from the CoLaus|PsyCoLaus study (N = 4874, age range 35-82 years) separately for men and women. It was based on survey information on chickenpox, measles, mumps, rubella, herpes simplex, pertussis, scarlet fever, hay fever, asthma, eczema, urticaria, drug allergy, interparental violence, parental maltreatment, and trauma in early childhood. Subsequently, we examined how immune-mediated classes were reflected in leukocyte counts, inflammatory markers (IL-1β, IL-6, TNF-α, hsCRP), chronic inflammatory diseases, and mental disorders, and how they differed across social classes and birth cohorts. LCA results with five classes were selected for further analysis. Latent classes were similar in both sexes and were labeled according to their associations as neutral, resilient, atopic, mixed (comprising infectious and atopic diseases), and ACE class. They came across with specific differences in biomarker levels. Mental disorders typically displayed increased lifetime prevalence rates in the atopic, the mixed, and the ACE classes, and decreased rates in the resilient class. The same patterns were apparent in chronic inflammatory diseases, except that the ACE class was relevant specifically in women but not in men. This is the first study to systematically determine immune-mediated classes that evolve early in life. They display characteristic associations with biomarker levels and somatic and psychiatric diseases occurring later in life. Moreover, they show different distributions across social classes and allow to better understand the mechanisms beyond the changes in the prevalence of chronic somatic and psychiatric diseases

Quality of life and psychologic adjustment in children and adolescents with early treated phenylketonuria can be normal.

OBJECTIVES: To assess quality of life and psychologic adjustment in children and adolescents with early treated phenylketonuria (PKU). STUDY DESIGN: Cross-sectional study. METHODS: Assessment of 37 patients with PKU between 3 and 18 years of age (mean, 10.9 years), with parents used as informants. The TNO-AZL Questionnaire for Children's Health-Related Quality of Life and Child Behavior Checklist scores were compared with healthy reference groups. Predictive values of sociodemographic and clinical variables for quality of life and psychologic adjustment were assessed. RESULTS: Most dimensions of quality of life in children with PKU were not different from reference values. The only deviation in the PKU group was a reduction of positive emotions. Psychologic adjustment in patients with PKU was better than in a healthy reference group. Whereas sociodemographic variables and phenylalanine levels in the 12 months preceding the study were not associated to quality of life and psychologic adjustment, a long-term negative effect of higher phenylalanine levels during the first year of life on some dimensions of quality of life and psychologic adjustment could be identified. CONCLUSIONS: Although the results may not necessarily apply to patients with PKU in other geographic or socioeconomic contexts, they demonstrate that normal health-related quality of life and good psychologic adjustment is an achievable goal in children with PKU