Beurteilung der Lungengesundheit von Schweinen aus verschiedenen ökologischen Haltungssystemen mittels BAL und Lungenhistologie

Im vorliegenden Forschungsvorhaben wurde die Lungengesundheit von Schweinen in Abhängigkeit von verschiedenen Haltungs- und Managementbedingungen beschrieben. Die Untersuchung erfolgte an Mastschweinen verschiedener Herkünfte (konventionell – ökologischer Tiefstreustall – Stall nach EU-Öko-VO – Freilandhaltung) und an Tieren unterschiedlichen Alters. In der konventionellen Schweinemast handelte es sich hierbei um Ferkel, Läufer und Mastschweine derselben Herkunft, in der ökologischen Schweinemast um Läufer, Mastschweine und XXL-Schweine von jeweils zwei Beständen. Letztere Untersuchung diente vor allem der Abbildung möglicher Effekte von Unterschieden im betrieblichen und Hygienemanagement auf die Tiergesundheit in den beiden ökologischen Beständen. Der Gesundheitszustand der Tiere mit Betonung des Lungenbefundes wurde über Schlachtkörperuntersuchungen, bronchoalveoläre Lavage (BAL) und histologische Untersuchung makroskopisch auffälliger Lungenbefunde erfasst. Allgemein wurde festgestellt, dass die Tiere im Zeitverlauf und in Abhängigkeit von den Haltungsbedingungen Zeichen einer zunehmenden entzündlichen Veränderung im Bereich der Atemwege zeigten (BAL: prozentuale Reduktion der Makrophagen bei gleichzeitigem relativen Anstieg der Lymphozyten). Die histologische Untersuchung wies auf ein unterschiedlich ausgeprägtes v.a. viral bedingtes infektiöses Geschehen hin, das möglicherweise durch eine in unterschiedlichem Ausmaß bestehende irritative Schädigung der Atemwege gefördert wurde. Sowohl bei Untersuchung der Mastschweine als auch bei Probenahme bei unterschiedlich alten Tieren wurde deutlich, dass den Managementfaktoren (Entwurmung, Impfstatus, Hygiene) eine bedeutende Rolle im Hinblick auf den Gesundheitszustand zukommt. Im negativen Fall führte dieser Effekt dazu, dass die Anzahl auffälliger Befunde trotz vergleichsweiser guter Stallluftqualität (sehr) hoch war. Neben baulich-technischen Faktoren kommt folglich dem Management eine sehr große Bedeutung zu

General Practitioners' preferences and use of educational media: a German perspective

<p>Abstract</p> <p>Background</p> <p>Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs.</p> <p>Methods</p> <p>Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns.</p> <p>Results</p> <p>Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: <it>journals</it>, <it>colleagues</it>, and <it>quality circles</it>. New media like the <it>internet </it>was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its <it>relevancy for daily practice </it>and <it>dependability</it>.</p> <p>Conclusion</p> <p>Despite a growing use of the Internet it seems that German GPs favor "classical/traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN36550981.</p

Inanspruchnahme von Angebotsuntersuchungen in der arbeitsmedizinischen Vorsorge

In den vergangenen zehn Jahren wurde die arbeitsmedizinische Vorsorge zu einem individuellen Arbeitsschutzinstrument weiterentwickelt, das der Aufklärung und Beratung der Beschäftigten über die Wechselwirkungen zwischen Arbeit und Gesundheit dient und bei dem die Selbstbestimmungs- und Datenschutzrechte zu achten sind. In dem vorliegenden Forschungsprojekt hat das Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung der Universitätsklinik Tübingen exemplarisch untersucht, welche Faktoren für die erfolgreiche Durchführung von Angebotsuntersuchungen bedeutsam sind. Die Studie bedient sich hierfür eines multimodularen Ansatzes mit qualitativen und quantitativen Anteilen. Im Ergebnis wird sichtbar, dass die Verordnung zur arbeitsmedizinischen Vorsorge (ArbMedVV) in der Praxis angekommen ist. Zum Teil werden arbeitsmedizinische Vorsorge und Eignungsuntersuchungen jedoch nicht adäquat unterschieden. Mit der Änderung der ArbMedVV Ende Oktober 2013 konnten bereits wichtige Klarstellungen erreicht werden. Unsicherheiten bestehen auch im Zusammenhang mit den so genannten Berufsgenossenschaftlichen Grundsätzen, die teilweise irrtümlich als verbindlich verstanden werden. Hier besteht noch Änderungs- und Klarstellungsbedarf. Übergreifend zeigt die Studie, dass die Inanspruchnahme der arbeitsmedizinischen Vorsorge maßgeblich vom Kenntnisstand aller Beteiligten zur Rechtslage abhängt und das Vertrauensverhältnis zum Betriebsarzt für die Beschäftigten von besonderer Bedeutung ist. Aufklärungsarbeit spielt deshalb auch weiterhin eine wichtige Rolle

An alternative CYB5A transcript is expressed in aneuploid ALL and enriched in relapse

Background: B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is a genetically heterogenous malignancy with poor prognosis in relapsed adult patients. The genetic basis for relapse in aneuploid subtypes such as near haploid (NH) and high hyperdiploid (HeH) BCP-ALL is only poorly understood. Pathogenic genetic alterations remain to be identified. To this end, we investigated the dynamics of genetic alterations in a matched initial diagnosis-relapse (ID-REL) BCP-ALL cohort. Here, we firstly report the identification of the novel genetic alteration CYB5Aalt, an alternative transcript of CYB5A, in two independent cohorts. Methods: We identified CYB5alt in the RNAseq-analysis of a matched ID-REL BCP-ALL cohort with 50 patients and quantified its expression in various molecular BCP-ALL subtypes. Findings were validated in an independent cohort of 140 first diagnosis samples from adult BCP-ALL patients. Derived from patient material, the alternative open reading frame of CYB5Aalt was cloned (pCYB5Aalt) and pCYB5Aalt or the empty vector were stably overexpressed in NALM-6 cells. RNA sequencing was performed of pCYB5Aalt clones and empty vector controls followed by differential expression analysis, gene set enrichment analysis and complementing cell death and viability assays to determine functional implications of CYB5Aalt. Results: RNAseq data analysis revealed non-canonical exon usage of CYB5Aalt starting from a previously undescribed transcription start site. CYB5Aalt expression was increased in relapsed BCP-ALL and its occurrence was specific towards the shared gene expression cluster of NH and HeH BCP-ALL in independent cohorts. Overexpression of pCYB5Aalt in NALM-6 cells induced a distinct transcriptional program compared to empty vector controls with downregulation of pathways related to reported functions of CYB5A wildtype. Interestingly, CYB5A wildtype expression was decreased in CYB5Aalt samples in silico and in vitro. Additionally, pCYB5Aalt NALM-6 elicited a more resistant drug response. Conclusions: Across all age groups, CYB5Aalt was the most frequent secondary genetic event in relapsed NH and HeH BCP-ALL. In addition to its high subgroup specificity, CYB5Aalt is a novel candidate to be potentially implicated in therapy resistance in NH and HeH BCP-ALL. This is underlined by overexpressing CYB5Aalt providing first evidence for a functional role in BCL2-mediated apoptosis

Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital:The results of a mixed-method phase-II study

OBJECTIVES: Hospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership. DESIGN: This is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants’ change in everyday work. SETTING: A tertiary hospital in Germany. PARTICIPANTS: N=93 leaders of different professions. INTERVENTION: An interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource ‘team’, (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention. OUTCOME MEASURES: Feasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership. RESULTS: After the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants’ self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work. CONCLUSIONS: This intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre—randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus)

German ambulatory care physicians' perspectives on clinical guidelines – a national survey

BACKGROUND: There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM) The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. METHODS: Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi(2 )test was used to investigate distribution of two or more categorical variables. RESULTS: Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. CONCLUSION: Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs

A systematic review on the impact of leg ulceration on patients' quality of life

<p>Abstract</p> <p>Background</p> <p>A systematic review was conducted to analyse journal articles that describe or measure the impact of leg ulceration on patients' quality of life (QoL) in order to improve the content of an educational programme that aims to enhance self-care agency in leg ulcer patients.</p> <p>Method</p> <p>Original articles published in English and German between 1990 and 2006 were included if the findings were analysed at the level of patients. Articles were excluded if (1) they investigated the impact of specific treatments or settings on QoL or (2) focused mainly on arterial ulcers or diabetic foot ulcers.</p> <p>Results</p> <p>Twenty-four original research articles met the inclusion criteria; 11 studies used a quantitative, 11 studies a qualitative, and 2 used a mixed method approach. The findings were collapsed into 5 core domains. Quantitative studies commonly investigated the parameters of pain, sleep, social isolation, and physical mobility. Patients had significantly more pain, more restrictions regarding social functioning, less vitality, and limitations with respect to emotional roles compared to the respective controls. Other problem areas identified were restrictions in work capacity, recreation, social interaction, psychological well-being, as well as problems caused by treatment regimes. Inconclusive results were obtained regarding pain intensity, physical restrictions, and gender effects.</p> <p>Limitations</p> <p>Numerous original studies neither undertook a differentiation of participants by ulcer aetiology nor did they analyse the results according to gender differences.</p> <p>Conclusion</p> <p>As leg ulceration has an impact on QoL, national guidelines on the treatment of leg ulceration need to more specifically address these far-ranging effects identified in this review.</p

Specific Gene Expression Responses to Parasite Genotypes Reveal Redundancy of Innate Immunity in Vertebrates

Vertebrate innate immunity is the first line of defense against an invading pathogen and has long been assumed to be largely unspecific with respect to parasite/pathogen species. However, recent phenotypic evidence suggests that immunogenetic variation, i.e. allelic variability in genes associated with the immune system, results in host-parasite genotype-by-genotype interactions and thus specific innate immune responses. Immunogenetic variation is common in all vertebrate taxa and this reflects an effective immunological function in complex environments. However, the underlying variability in host gene expression patterns as response of innate immunity to within-species genetic diversity of macroparasites in vertebrates is unknown. We hypothesized that intra-specific variation among parasite genotypes must be reflected in host gene expression patterns. Here we used high-throughput RNA-sequencing to examine the effect of parasite genotypes on gene expression patterns of a vertebrate host, the three-spined stickleback (Gasterosteus aculeatus). By infecting naïve fish with distinct trematode genotypes of the species Diplostomum pseudospathaceum we show that gene activity of innate immunity in three-spined sticklebacks depended on the identity of an infecting macroparasite genotype. In addition to a suite of genes indicative for a general response against the trematode we also find parasite-strain specific gene expression, in particular in the complement system genes, despite similar infection rates of single clone treatments. The observed discrepancy between infection rates and gene expression indicates the presence of alternative pathways which execute similar functions. This suggests that the innate immune system can induce redundant responses specific to parasite genotypes

Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to determine the prevalence and the predictors of musculoskeletal symptoms in the upper extremities and neck at visual display terminal (VDT) workstations.</p> <p>Methods</p> <p>In a cross-sectional study 1,065 employees working at VDT > 1 h/d completed a standardised questionnaire. Workstation conditions were documented in a standardised checklist, and a subgroup of 82 employees underwent a physical examination.</p> <p>Results</p> <p>Using the Nordic Questionnaire, the 12-month prevalence of symptoms of the neck, shoulder region, hand/wrist, or elbow/lower arm was 55%, 38%, 21%, and 15% respectively. The duration of VDT work had a significant impact on the frequency of neck symptoms in employees performing such work > 6 h/d.</p> <p>Conclusion</p> <p>With regard to musculoskeletal symptoms of the upper extremities, preventive measures at VDT workstations should be focused on neck and shoulder symptoms (e.g. ergonomic measures, breaks to avoid sitting over long periods).</p