Subjective theories of illness affects clinical and psychological outcome in patients with Irritable Bowel Syndrome

Hintergrund: Ziel der Studien war es, den Einfluss subjektiver Krankheitstheorien von Patienten mit Reizdarmsyndrom (RDS) sowie Harn- und Analinkontinenz auf klinische Outcomevariablen wie Symptomschwere, Depression, Angst und Lebensqualität im Quer- und Längsschnitt nach einem Jahr zu untersuchen. Theoretischen Ausgangspunkt bildete das Common Sense Modell of Illness Representation von Leventhal et al., in dem ein Kausalzusammenhang zwischen subjektiven Krankheitstheorien, Bewältigungsverhalten und krankheits- und emotionsbezogenen Kriteriumsvariablen postuliert wird. Methoden: 88 Patienten mit RDS nach Rome-III-Kriterien wurde zu T1 ein Fragebogenset vorgelegt. Erfasst wurden soziodemographische Variablen, subjektive Krankheitstheorien (SKT, Ursachenfragebogen nach Fliege), Angst (HADS), Depression (BDI), Lebensqualität (SF-12) und reizdarmspezifische Symptome (GI- Symptomfragebogen). Bei 44 dieser Patienten wurden die Fragebögen zu zwei Messzeitpunkten (T1, T2) im Abstand eines Jahres subjektive Krankheitstheorien (SKT, URS), Angst (HADS), Depression (BDI), Lebensqualität (SF-12) und reizdarmspezifische Symptome (GI-Symptomfragebogen) erfasst. Im Vergleich zu RDS-Patienten wurden 115 Patienten mit Harn- und/ oder Analinkontinenz mittels des Fragebogens zum Krankheitskonzept (FzKK) untersucht. Ergebnisse: Sowohl RDS- als auch Inkontinenz-Patienten hatten subjektive Ursachenannahmen für ihre Erkrankung. Inkontinenzpatienten gaben überwiegend somatische Ursachenannahmen an, an zweiter Stelle dominierten intrapersonelle Ursachenannahmen. Die subjektiven Krankheitstheorien bei RDS-Patienten blieben in der Längsschnittuntersuchung über die Zeit stabil. Auch die Rangreihe der bevorzugten Kausalattributionen änderte sich über die zwei Messzeitpunkte nicht: Stress wurde am häufigsten genannt. Sowohl im Querschnitt als auch in der Longitudinaluntersuchung zeigten sich signifikante Zusammenhänge zwischen den Ursachenannahmen und klinischen und psychologischen Outcome-Kriterien. Insbesondere konnten wir erstmalig nachweisen, dass Ursachenannahmen eine prognostische Bedeutung für den klinischen Verlauf beim RDS haben. Die Attribution „soziale Ursachen“ zu T1 war ein signifikanter Prädiktor für RDS- Symptomschwere zu T2. Zusammenfassung: Subjektive Krankheitstheorien haben eine prognostische Bedeutung für klinisches und psychologisches Outcome bei Patienten mit Reizdarmsyndrom.Objectives: We sought to evaluate the influence of subjective theories of illness in patients with irritable bowel syndrome (IBS) based on the Common Sense Model of Illness Representation by Leventhal et al. which postulates a causal relationship between illness representations, coping strategies and illness outcome. Measurement parameters were clinical outcome such as severity of symptoms, depression, anxiety and quality of life after one year. Methods: Study participants were 88 patients recently diagnosed with IBS according to the Rome III criteria at the outpatient clinic at Charité Virchow-Klinikum. Assessed were subjective theories of illness (SKT, URS), anxiety (HADS), depression (BDI), quality of life (SF-12) and IBS specific symptoms (gastrointestinal symptoms questionnaire) at two time points (T1 = 0 and T2 = 12 months). Results: Subjective theories of illness did not change over the one year time period. “Stress” was the preferred causal attribution and the ranking of attributions did not vary over one year. Subjective illness attributions such as “dysfunctional stress regulation” and “interpersonal reasons” at T1 aim towards a higher anxiety in patients at T2. Naming „social reasons“ as attribution at T1 was a significant predictor for severity of symptoms at T2. Furthermore, the attributions „dysfunctional stress regulation“ and „fatalism“ at T1 affected physical quality of life at T2. These coherences were independent from variables such as age, sex and IBS subgroup and were still present after controlling for the respective starting level of outcome variables. Conclusions: Subjective theories of illness are of prognostic value for clinical and psychological outcome in IBS patients

Kirchenbild und Kircheneinheit : Der dominikanische „Tractatus contra Graecos“ (1252) in seinem theologischen und historischen Kontext

The book focuses on the “Tractatus contra Graecos” (1252) by an anonymous Dominican from the convent of Constantinople, a theological dossier outstanding with regard to its various interaction with contemporary Latin-Greek discourses. Polemical theology is, to a certain extent, always making of: Notions of the other church are conveyed, which - if they did not meet their own expectations of the question of church unity - turned from the partner to the enemy. The analysis of these notions shows that under an often polemical text surface there is sometimes a much more original theology than one would expect this genre of text to be, and this theology is the central leitmotif of this book, drawing out and working into the sketch of medieval ecclesiology.Mit dem Tractatus contra Graecos (1252) eines anonymen Dominikaners aus dem Konvent von Konstantinopel steht ein kontroverstheologisches Dossier im Fokus dieses Buches, dessen Besonderheit sich aus seiner vielfältigen Interaktion mit zeitgenössischen lateinisch-griechischen Diskursen ergibt. Kontroverstheologie ist zu einem gewissen Grad immer auch making of: Es werden Bilder der jeweils anderen Kirche transportiert, die – wenn sie den eigenen Erwartungen an die Lösung der Frage nach der Kircheneinheit nicht entsprach – von der Partnerin zum Feindbild wurde. Die Analyse dieser Bilder zeigt: Unter einer oft polemischen Textoberfläche verbirgt sich bisweilen eine weit originellere Theologie, als man diesem Textgenre zutrauen würde, und diese Theologie heraus- und in die Skizze mittelalterlicher Ekklesiologie einzuarbeiten ist das zentrale Leitmotiv dieses Buches

A comparison of perceptions of barriers to academic success among high-ability students from high- and low-income groups: Exposing poverty of a different kind

In 14 focus group interviews, sixth- to eighth-grade high-ability students from high- (n = 36) and low-income (n = 45) families were asked to describe the barriers they perceived to their academic success. Three themes were identified through the qualitative analysis: Constraining Environments, Integration versus Isolation, and Resource Plenty versus Resource Poor. Students in both groups experienced environments not conducive to learning, inhibiting peers, and teachers as a barrier. Students in the low-income group described mayhem in their schools, which interfered significantly with learning. These students were highly integrated in their school community, whereas the students in the high-income group were socially isolated from both peers and teachers. Both groups exhibited issues of poor fit within their schools: autonomy and competence for both, relatedness for students in the high-income group. Attention to these issues will help support these students in achieving their potential

Intelligent workpiece carrier for distributed data collection and control in manufacturing environments

Abstract The growing demand for customized products is challenging companies to change their organizational structure towards a flexible organizational model. However, small and medium sized enterprises (SME) do not have the necessary resources to integrate in their production processes new technologies which could help them facing such challenges. We propose a framework in which an intelligent workpiece carrier (IWC) is introduced in a traditional production line. We propose to integrate the knowledge of production steps in the IWC to make it able to take decisions about the process execution. A first prototype was developed and tested to verify the effectiveness of the proposed framework. Through the implementation, it has been shown that the IWC represents a promising component in the realization of flexible production systems

BendaEAM versus BEAM as conditioning regimen for ASCT in patients with relapsed lymphoma (BEB): a multicentre, randomised, phase 2 trial.

BACKGROUND Replacement of carmustine (BCNU) in the BEAM regimen (BCNU, etoposide, cytarabine, melphalan) with bendamustine (BendaEAM) before autologous stem cell transplantation (ASCT) is feasible in lymphoma. However, randomised trials are lacking. Here, we present the first trial addressing this topic. METHODS This multicentre, randomised, phase 2 study (BEB-trial) conducted at four haematological centres in Austria and Switzerland compares BEAM with BendaEAM in patients with relapsed lymphoma. Both regimens were administered intravenously before ASCT, in BEAM according to the standard protocol (300 mg/m2 BCNU on day -6), in BendaEAM, BCNU was replaced by 200 mg/m2 bendamustine given on days -7 and -6. Eligible patients were aged 18-75 years and had mantle cell lymphoma, diffuse large B-cell lymphoma, or follicular lymphoma in first or second remission or chemosensitive relapse. The primary endpoint of the study was to evaluate whether replacement of BCNU by bendamustine reduces lung toxicity, defined as a decrease of the diffusion capacity of the lung for carbon monoxide by at least 20% at three months after ASCT. Data analyses were performed on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT02278796, and is complete. FINDINGS Between April 20, 2015, and November 28, 2018, 108 patients were enrolled; of whom 53 were randomly assigned to receive BendaEAM (36 male, 17 female) and 55 to receive BEAM (39 male, 16 female). All patients engrafted rapidly. Lung toxicity did not differ between groups (BendaEAM: n = 8, 19.5%; BEAM: n = 11, 25.6%; risk difference = -6.1%: 95% confidence interval: -23.9% to 11.7%). Acute toxicities of at least grade 3 were comparable in both groups (BendaEAM: 35.8%, BEAM: 30.9%). Overall survival (BendaEAM: 92.5%, BEAM: 89.1%) and complete remission (BendaEAM: 76.7%, BEAM: 74.3%) after 1 year (median follow-up: 369 days) were similar. No difference in quality of life was observed. INTERPRETATION Results were similar for both regimens in terms of survival and response rates. A phase 3 non-inferiority study is required to investigate whether BendaEAM can be considered as an alternative to BEAM. FUNDING Mundipharma