Disruption of the stress response in wastewater treatment works effluent-exposed three-spined sticklebacks persists after translocation to an unpolluted environment

The hypothalamic-pituitary-adrenal/interrenal (HPA/I) axis plays a key role in responding to biotic and abiotic challenges in all vertebrates. Recent studies have shown that the apical response of the HPI axis to stressors in three-spined sticklebacks varies in proportion to the concentration of wastewater treatment works (WWTW) effluent to which the fish are exposed. This study was conducted to determine whether between-site variation in stress responsiveness among WWTW effluent-exposed sticklebacks is persistent or reversible. Sticklebacks from eight sites in north-west England affected by WWTW effluent and exhibiting between-population variation in HPI axis reactivity, were moved to a clean-water aquarium environment. After five months in the contaminant-free environment the responsiveness of these fish to a standardised stressor was determined, by measuring the rate of stress-induced cortisol release across the gills, and compared with the responses of fish newly sampled from the eight original capture sites. Inter-site differences in the reactivity of the HPI axis, proportional to the effluent concentration at each site, persisted among the translocated female sticklebacks for at least 5 months. In male fish however, the direct relationship between stress responsiveness and site-specific effluent was not evident 5 months post-translocation. These results support previous observations that the HPA/I axis, a non-reproductive endocrine system, is vulnerable to modulation by anthropogenic factors in fish and show for the first time that, in female fish at least, this modulation is not transient. The mechanisms underlying these observations, and the implications for the fitness and resilience of affected populations, requires investigation

Long-term water quality data explain interpopulation variation in responsiveness to stress in sticklebacks at both wastewater effluent-contaminated and uncontaminated sites

The magnitude of the corticosteroid response to a standardised stressor varied in proportion to the concentration of effluent in three-spined sticklebacks (Gasterosteus aculeatus L.) captured downstream of 10 wastewater treatment works (WWTW). However, at 9 sites with no upstream WWTW input inter-population variation in the reactivity of the stress axis occurred across a similar range to that seen for fish at impacted sites, suggesting that the factor(s) responsible for modulating stress responsiveness in sticklebacks are not unique to sites receiving WWTW effluent. Physicochemical data from a long-term monitoring programme were employed to investigate whether variation in water quality contributed to between-site variation in stress axis reactivity. Between-site variation in fourteen water quality determinands explained between 30% and 60% of the variation in stress reactivity, and fish size, for sticklebacks at both WWTW-contaminated and uncontaminated sites. At uncontaminated sites the mean mass and length of sticklebacks increased with total oxidised N concentration (as an indicator of anthropogenic input) whereas at WWTW-contaminated sites fish size decreased with increasing effluent concentration, suggesting that factors adversely affecting growth were present predominantly at WWTW-contaminated sites. In contrast, at contaminated and uncontaminated sites the magnitude of the corticosteroid response to a standardised stressor increased with anthropogenic input (effluent concentration or total oxidised N respectively), indicating that factor(s) modulating the reactivity of the stress axis may be present at both WWTW-contaminated and uncontaminated sites

Role of religion and spirituality in medical patients: Confirmatory results with the SpREUK questionnaire

BACKGROUND: Spirituality has become a subject of interest in health care as it is was recognized to have the potential to prevent, heal or cope with illness. There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives. However, there is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that their illness may have "meaning" to them. To raise these questions and to more precisely survey the basic attitudes of patients with severe diseases towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire. METHODS: In order to re-validate our previously described SpREUK instrument, reliability and factor analysis of the new inventory (Version 1.1) were performed according to the standard procedures. The test sample contained 257 German subjects (53.3 ± 13.4 years) with cancer (51%), multiple sclerosis (24%), other chronic diseases (16%) and patients with acute diseases (7%). RESULTS: As some items of the SpREUK construct require a positive attitude towards SpR, these items (item pool 2) were separated from the others (item pool 1). The reliability of the 15-item the construct derived from the item pool 1 respectively the 14-item construct which refers to the item pool 2 both had a good quality (Cronbach's alpha = 0.9065 resp. 0.9525). Factor analysis of item pool 1 resulted in a 3-factor solution (i.e. the 6-item sub-scale 1: "Search for meaningful support"; the 6-item sub-scale 2: "Positive interpretation of disease"; and the 3-item sub-scale 3: "Trust in external guidance") which explains 53.8% of variance. Factor analysis of item pool 2 pointed to a 2-factor solution (i.e. the 10-item sub-scale 4: "Support in relations with the External life through SpR" and the 4-item sub-scale 5: "Support of the Internality through SpR") which explains 58.8% of variance. Generally, women had significantly higher SpREUK scores than male patients. Univariate variance analyses revealed significant associations between the sub-scales and SpR attitude and the educational level. CONCLUSIONS: The current re-evaluation of the SpREUK 1.1 questionnaire indicates that it is a reliable, valid measure of distinct topics of SpR that may be especially useful of assessing the role of SpR in health related research. The instrument appears to be a good choice for assessing a patients interest in spiritual concerns which is not biased for or against a particular religious commitment. Moreover it addresses the topic of "positive reinterpretation of disease" which seems to be of outstanding importance for patients with life-changing diseases

Emotional and rational disease acceptance in patients with depression and alcohol addiction

<p>Abstract</p> <p>Background</p> <p>The concept of a rational respectively emotional acceptance of disease is highly valued in the treatment of patients with depression or addiction. Due to the importance of this concept for the long-term course of disease, there is a strong interest to develop a tool to identify the levels and factors of acceptance. We thus intended to test an instrument designed to assess the level of positive psychological wellbeing and coping, particularly emotional disease acceptance and life satisfaction</p> <p>Methods</p> <p>In an anonymous cross-sectional survey enrolling 115 patients (51% female, 49% male; mean age 47.6 ± 10.0 years) with depression and/or alcohol addiction, the ERDA questionnaire was tested.</p> <p>Results</p> <p>Factor analysis of the 29-item construct (Cronbach's alpha = 0.933) revealed a 4-factor solution, which explained 59.4% of variance: (1) Positive Life Construction, Contentedness and Well-Being; (2) Conscious Dealing with Illness; (3) Rejection of an Irrational Dealing with Disease; (4) Disease Acceptance. Two factors could be ascribed to a rational, and two to an emotional acceptance. All factors correlated negatively with Depression and Escape, while several aspects of Life Satisfaction" (i.e. myself, overall life, where I live, and future prospects) correlated positively. The highest factor scores were found for the rational acceptance styles (i.e. Conscious Dealing with Illness; Disease Acceptance). Emotional acceptance styles were not valued in a state of depression. Escape from illness was the strongest predictor for several acceptance aspects, while life satisfaction was the most relevant predictor for "Positive Life Construction, Contentedness and Well-Being".</p> <p>Conclusion</p> <p>The ERDA questionnaire was found to be a reliable and valid assessment of disease acceptance strategies in patients with depressive disorders and drug abuses. The results indicate the preferential use of rational acceptance styles even in depression. Disease acceptance should not be regarded as a coping style with an attitude of fatalistic resignation, but as a complex and active process of dealing with a chronic disease. One may assume that an emotional acceptance of disease will result in a therapeutic coping process associated with higher level of life satisfaction and overall quality of life.</p

Engagement of patients in religious and spiritual practices: Confirmatory results with the SpREUK-P 1.1 questionnaire as a tool of quality of life research

BACKGROUND: Quality of life is a multidimensional construct composed of functional, physical, emotional, social and spiritual well-being. In order to examine how patients with severe diseases view the impact of spirituality and religiosity on their health and how they cope with illness, we have developed the SpREUK questionnaire. We deliberately avoided the intermingling of attitudes, convictions and practices, and thus addressed the distinct forms and frequencies of spiritual/religious practices in an additional manual, the SpREUK-P questionnaire. METHODS: The SpREUK-P was designed to differentiate spiritual, religious, existentialistic and philosophical practices. It was tested in a sample of 354 German subjects (71% women; 49.0 ± 12.5 years). Half of them were healthy controls, while among the patients cancer was diagnosed in 54%, multiple sclerosis in 22%, and other chronic diseases in 23%. Reliability and factor analysis of the inventory were performed according to the standard procedures. RESULTS: We confirmed the structure and consistency of the previously described 18-item SpREUK-P manual and improved the quality of the current construct by adding several new items. The new 25-item SpREUK-P 1.1 (Cronbach's alpha = 0.8517) has the following scales: (1) conventional religious practice (CRP), (2) existentialistic practice (ExP), (3) unconventional spiritual practice (USP), (4) nature/environment-oriented practice (NoP), and (5) humanistic practice (HuP). Among the tested individuals, the highest engagement scores were found for HuP and NoP, while the lowest were found for the USP. Women had significantly higher scores for ExP than male patients. With respect to age, the engagement in CRP increases with increasing age, while the engagement in a HuP decreased. Individuals with a Christian orientation and with a religious and spiritual attitude had the highest engagement scores for CRP, while the engagement in an USP was high with respect to a spiritual attitude. Variance analyses confirmed that the SpR attitude and religious affiliation are the main relevant covariates for CRP and ExP, while for the USP the SpR attitude and the educational level are of significance, but not religious affiliation. Patients with multiple sclerosis overall had the lowest engagement scores for all five forms of SpR practice, while it is remarkable that cancer patients had lower scores for HuP and USP than healthy subjects. CONCLUSION: The current re-evaluation of the SpREUK-P questionnaire (Version 1.1) indicates that it is a reliable, valid measure of five distinct forms of spiritual, religious and philosophical practice that may be especially useful for assessing the role of spirituality and religiosity in health related research. An advantage of our instruments is the clear-cut differentiation between convictions and attitudes on the one hand, and the expression of these attitudes in a concrete engagement on the other hand

The Herdecke questionnaire on quality of life (HLQ): Validation of factorial structure and development of a short form within a naturopathy treated in-patient collective

BACKGROUND: Quality of life (QoL) of patients has become a central evaluation parameter that also acts as an aid for decisions related to treatment strategies particularly for patients with chronic illnesses. In Germany, one of the newer instruments attempting to measure distinct QoL aspects is the "Herdecke Questionnaire for Quality of Life" (HLQ). In this study, we aimed to validate the HLQ with respect to its factorial structure, and to develop a short form. The validation has been carried out in relation to other questionnaires including the SF-36 Health Survey, the Mood-Scale Bf-S, the Giessen Physical Complaints Questionnaire GBB-24 and McGill's Pain Perception Scale SES. METHODS: Data for this study derived from a model project on the treatment of patients using naturopathy methods in Blankenstein Hospital, Hattingen. In total, 2,461 patients between the ages of 16 and 92 years (mean age: 58.0 ± 13.4 years) were included in this study. Most of the patients (62%) suffered from rheumatic diseases. Factorial validation of the HLQ, it's reliability and external consistency analysis and the development of a short form were carried out using the SPSS software. RESULTS: Structural analysis of the HLQ-items pointed to a 6-factor model. The internal consistency of both the long and the short version is excellent (Cronbach's α is 0.935 for the HLQ-L and 0.862 for the HLQ-S). The highest reliability in the HLQ-L was obtained for the "Initiative Power and Interest" scale, the lowest for the 2-item scales "Digestive Well-Being" and the "Physical Complaints". However, the scales found by factor analysis herein were only in part congruent with the original 5-scale model which was approved a multitrait analysis approach. The new instrument shows good correlations with several scales of other relevant QoL instruments. The scales "Initiative Power and Interest", "Social Interaction", "Mental Balance", "Motility", "Physical Complaints", "Digestive Well-Being" sufficiently differentiate the diagnostic groups, particularly between the patients suffering on connective tissue and soft tissue disorders from those with metabolic and nutritional disorders or hypersensitivity reactions. CONCLUSION: Both the factorial validation and the development of a consistent short-form of the HLQ are important steps forward for researchers in the field of QoL who wish to use the HLQ as a reliable and valid instrument. The results indicate that the HLQ is a unique QoL-instrument that can be used for both in-patient and out-patient-treatment. However, to improve to profile of the HLQ, there is still the need for strengthening the Questionnaire in the dimensions of physical well-being. This is the subject of a separate ongoing study

Linguistic Processing and Classification of Semi Structured Bibliographic Data on Complementary Medicine

Complementary and alternative therapies and medicines (CAM) such as acupuncture or mistletoe treatment are much asked for by cancer patients. With a growing interest in such therapies, physicians need a simple tool with which to get an overview of the scientific publications on CAM, particularly those that are not listed in common bibliographic databases like MEDLINE. CAMbase is an XML-based bibliographical database on CAM which serves to address this need. A custom front end search engine performs semantic analysis of textual input enabling users to quickly find information relevant to the search queries. This article describes the technical background and the architecture behind CAMbase, a free online database on CAM (www.cambase.de). We give examples on its use, describe the underlying algorithms and present recent statistics for search terms related to complementary therapies in oncology

Preoperative biomarkers related to inflammation may identify high-risk anastomoses in colorectal cancer surgery : explorative study

Anastomotic leakage is a major complication after colorectal surgery, presumed to correspond with a process of failed wound healing, involving inflammation. Circulating levels of inflammation-related biomarkers were investigated in preoperative samples from 41 patients with leakage, who had elective treatment with a primary anastomosis for non-disseminated colorectal cancer, matched to 41 complication-free controls. A total of 15 inflammation-related proteins were elevated before surgery in patients with rectal cancer with leakage, of which C-X-C motif chemokine 6 and C-C motif chemokine 11 remained significantly increased after controlling for multiplicity. As a corresponding expression pattern difference did not emerge when tissue adjacent to the anastomosis was evaluated with immunohistochemistry, findings may reflect a systemic rather than a local host response. While these findings require validation before implementation into surgical practice, they highlight the need for further translational investigations as a promising research area to help decrease leakage rates. Background Colorectal anastomotic leakage can be considered a process of failed wound healing, for which related biomarkers might be a promising research area to decrease leak rates. Methods Patients who had elective surgery with a primary anastomosis for non-metastatic colorectal cancer, at two university hospitals between 1 January 2010 and 31 December 2015 were included. Patients with an anastomotic leak were identified and matched (1:1) to complication-free controls on the basis of sex, age, tumour stage, tumour location, and operating hospital. Preoperative blood samples were analysed by use of protein panels associated with systemic or enteric inflammation by proteomics, and enzyme-linked immunosorbent assays. Multivariable projection methods were used in the statistical analyses and adjusted for multiple comparisons to reduce false positivity. Rectal cancer tissue samples were evaluated with immunohistochemistry to determine local expression of biomarkers that differed significantly between cases and controls. Results Out of 726 patients undergoing resection, 41 patients with anastomotic leakage were matched to 41 controls. Patients with rectal cancer with leakage displayed significantly elevated serum levels of 15 proteins related to inflammation. After controlling for a false discovery rate, levels of C-X-C motif chemokine 6 (CXCL6) and C-C motif chemokine 11 (CCL11) remained significant. In patients with colonic cancer with leakage, levels of high-sensitivity C-reactive protein (hs-CRP) were increased before surgery. Local expression of CXCL6 and CCL11, and their receptors, were similar in rectal tissues between cases and controls. Conclusion Patients with anastomotic leakage could have an upregulated inflammatory response before surgery, as expressed by elevated serological levels of CXCL6 and CCL11 for rectal cancer and hs-CRP levels in patients with colonic cancer respectively. Preoperative inflammation-related serum proteins were evaluated in a case-control study of 41 patients with anastomotic leakage matched 1:1 with 41 complication-free controls. The chemokines C-X-C motif chemokine 6 and C-C motif chemokine 11 were significantly increased before surgery in patients with rectal cancer and leakage, a finding requiring further validation.Peer reviewe

Narrative Medizin – was ist es, was bringt es, wie setzt man es um?

Erzählungen spielten schon immer eine wichtige Rolle in der Medizin. Mit Beginn der "modernen" Medizin wurden diese Erzählungen mehr und mehr vernachlässigt, der Fokus lag auf "Fakten", die als objektiv und wissenschaftlich galten. In den letzten Jahren jedoch erleben Erzählungen eine Renaissance – insbesondere Patientenerzählungen und Geschichten über das, was zwischen Ärzten und Patienten geschieht. Dies resultierte in der Formulierung von Narrativer Medizin oder Narrative based Medicine (NbM). Der Begriff wurde insbesondere in Abgrenzung zur evidenzbasierten Medizin (EbM) entwickelt. Man wollte damit auch auf die Grenzen der EbM hinweisen. Was aber wird unter Narrativer Medizin verstanden? Die Spannbreite geht von einer besonderen therapeutischen Methode, einer spezifischen Art der Arzt-Patienten- Kommunikation bis hin zu einer qualitativen Forschungsmethode. Was sind die Potentiale von NbM und was bedeuten sie für Theorie, Forschung und Anwendung in der hausärztlichen Medizin? Wo liegen ihre Begrenzungen für die hausärztliche Medizin?Narratives have always been a vital part of medicine. With the rise of "modern" medicine narratives have been more and more neglected in favour of "facts and findings" regarded as more objective and scientific. Yet, in the recent years there is a renaissance of narratives – especially patient narratives and the unfolding story between doctors and patients. Eventually this led to the formation of so called Narrative based Medicine (NbM). The term was coined specifically in distinction to Evidence based Medicine (EbM), with NbM being propagated to counteract the shortcomings of EbM. But what does narrative medicine actually contain? Its’ meaning spans from a specific therapeutic tool, a special form of doctor-patient-communication to a qualitative research tool. What are the potentials of NbM and its implications for theory, research, as well as for general practice? Where are the limitations of a narrative approach in general practice