Entwicklungsarbeit bei Frauengruppen in Indien : empirische Untersuchung am Beispiel eines Mikrokreditprogrammes und ihre Konsequenzen für den christlichen Sendungsbegriff

Die Promotionsarbeit stellt sich die Aufgabe, den christlichen Missions- oder Sendungsbegriff in seinem nachkonziliaren Verständnis durch eigene Feldforschung empirisch zu überprüfen. Am Beispiel von überwiegend von Christen durchgeführter Entwicklungsarbeit mit Frauengruppen in Indien kann der v.a. geschichtlich belastete Missionsbegriff revidiert werden. Im Schnittfeld von Soziologie/Ethnologie einerseits und Praktischer sowie Systematischer Theologie andererseits stehend gliedert sich die Arbeit in drei große Teile: Theorie-Teil A. Untersuchung des bisherigen Missionsbegriffs, Empirie-Teil B. Theoriegenerierung aus den erhobenen Daten des Entwicklungsprojektes und Synthese-Teil C. Rückfragen aus der Projektanalyse an den christlichen Sendungsbegriff. Teil A diskutiert die mit dem Zweiten Vatikanum eingeläutete Wende des Missionsverständnisses weg von einer geographischen Begrenzung hin zu einer Wesensaktivität der Kirche und die teilweise Rücknahme dieses Neuverständnisses in nachkonziliaren kirchenamtlichen Dokumenten. Sodann wird das Verständnis von Mission bzw. christlicher Sendung in der heutigen theologischen Forschung unter Einschluss der indischen Theologie dargestellt. Gerade in Indien wird die historische Belastung des Begriffs Mission und zugleich ein Bedarf an missionarischen Handeln in Form von Zeugnis geben deutlich. Vier entscheidende Leitfragen, welche durch die Feldforschung zu beantworten sind, resultieren daraus: Wer betreibt Mission? Bei welcher Zielgruppe spricht man von Mission? Wie ist Mission einzugrenzen? Was ist eine missionarische Tätigkeit? Teil 3 wertet die Daten der Feldforschung in einem südindischen Dorf aus. Dabei gewährleistet die Methode der Grounded Theorie als reflexiv-parallel verlaufender Prozess der Datengewinnung, Datenauswertung und Dateninterpretation, dass theoretische Missionsansätze nicht als Hypothesen herangezogen werden. Die Datenanalyse orientiert sich an der rekonstruktiven Sozialforschung. Der Teil C diskutiert anhand der vier Leitfragen den Überschuß des bisherigen, in Teil A diskutierten Sendungsbegriffs, der im Projekt noch nicht zum Tragen kommt, und zugleich seine Mängel, welche die Projektauswertung aufzeigt. Daraus resultiert: (1) Die Identifikation mit dem christlichen Glauben beinhaltet per se eine missionarische Dimension, jeder Christ handelt also unbewusst missionarisch. (2) Dieses missionarische Handeln geschieht sowohl gegenüber Christen wie gegenüber Nicht-Christen, jedoch ist die Kommunikationsweise verschieden. (3) Deswegen wird zwischen innerer und äußerer Mission unterschieden: Äußere Mission findet überall dort statt, wo Christen mit Nicht-Christen kommunizieren. Sie endet gegebenenfalls bei deren freier Entscheidung für das Christ-sein. Dort, wo die äußere Mission zu einer Identifizierung mit dem Inhalt der christlichen Botschaft führt, beginnt die innere Mission, welche nie endet. (4) Insofern ist jedwedes bewusste und unbewusste, verbale und non-verbale Kommunizieren eines überzeugten Christen als missionarische Tätigkeit zu bezeichnen. Entsprechend wird Entwicklungsarbeit, von Christen durchgeführt, auch zu einer missionarischen Tätigkeit, sofern Christen aus ihrem Christ-sein heraus leben und handeln

Regionale Selbstversorgung mit erneuerbaren Energien

Die energetische Selbstversorgung von Kommunen und Regionen auf der Basis von erneuerbaren Energien kann einen entscheidenden Beitrag zum Klimaschutz leisten. Zu ihrer Verwirklichung müs- sen jedoch zahlreiche Faktoren berücksichtigt werden

Prognostic value of immune cell infiltration, tertiary lymphoid structures and PD-L1 expression in Merkel cell carcinomas

Merkel cell carcinoma (MCC) is an aggressive, virus-associated, neuroendocrine tumor of the skin mainly affecting immunocompromised patients. Higher intratumoral infiltration with CD3 and CD8 positive T-cells is associated with a better prognosis, highlighting the relevance of the immune system for MCC development and progression. In this study 21 primary MCCs were stained with immune cell markers including CD3, CD4, CD8, CD68, CD20, and S100. Furthermore, tumor-infiltrating neutrophils, tertiary lymphoid structures and PD-L1 expression were analyzed and correlated with overall and recurrence free survival. All MCCs were Merkel Cell Polyomavirus positive. Overall and recurrence-free survival did not correlate with intra-and peritumoral CD3 and CD8 T-cell infiltration. In addition, no significant association regarding prognosis was found for tumor-associated neutrophils, tumor-associated macrophages or PD-L1 positivity in MCCs. Interestingly, the presence of tertiary lymphoid structures (TLS) in the tumor microenvironment significantly correlated with recurrence-free survival (P=0.025). In addition, TLS were significantly associated with a higher CD8/CD4 ratio in the tumor periphery (P=0.032), but not in the center of the tumor (P > 0.999). These results demonstrate for the first time that TLS, easily assessed in paraffin-embedded tissue in the tumor periphery of MCCs, may be a valuable prognostic factor indicating prolonged recurrence free survival

Unique Cell Type-Specific Junctional Complexes in Vascular Endothelium of Human and Rat Liver Sinusoids

Liver sinusoidal endothelium is strategically positioned to control access of fluids, macromolecules and cells to the liver parenchyma and to serve clearance functions upstream of the hepatocytes. While clearance of macromolecular debris from the peripheral blood is performed by liver sinusoidal endothelial cells (LSECs) using a delicate endocytic receptor system featuring stabilin-1 and -2, the mannose receptor and CD32b, vascular permeability and cell trafficking are controlled by transcellular pores, i.e. the fenestrae, and by intercellular junctional complexes. In contrast to blood vascular and lymphatic endothelial cells in other organs, the junctional complexes of LSECs have not yet been consistently characterized in molecular terms. In a comprehensive analysis, we here show that LSECs express the typical proteins found in endothelial adherens junctions (AJ), i.e. VE-cadherin as well as α-, β-, p120-catenin and plakoglobin. Tight junction (TJ) transmembrane proteins typical of endothelial cells, i.e. claudin-5 and occludin, were not expressed by rat LSECs while heterogenous immunreactivity for claudin-5 was detected in human LSECs. In contrast, junctional molecules preferentially associating with TJ such as JAM-A, B and C and zonula occludens proteins ZO-1 and ZO-2 were readily detected in LSECs. Remarkably, among the JAMs JAM-C was considerably over-expressed in LSECs as compared to lung microvascular endothelial cells. In conclusion, we show here that LSECs form a special kind of mixed-type intercellular junctions characterized by co-occurrence of endothelial AJ proteins, and of ZO-1 and -2, and JAMs. The distinct molecular architecture of the intercellular junctional complexes of LSECs corroborates previous ultrastructural findings and provides the molecular basis for further analyses of the endothelial barrier function of liver sinusoids under pathologic conditions ranging from hepatic inflammation to formation of liver metastasis

The impact of COVID-19 pandemic on mental burden and quality of life in physicians: Results of an online survey

BackgroundIn previous pan-/epidemics such as the SARS epidemic of 2002/2003, negative effects on the wellbeing and an increase in symptoms of depression and anxiety were observed in doctors due to social isolation and the threat they experienced. Therefore, it is feared that the COVID-19 pandemic will also have a negative impact on the mental health and quality of life of doctors.ObjectiveThe impact of the COVID-19 pandemic on the mental health of physicians. In particular, on the subjective anxiety and burden, depression and quality of life for the total sample and subsamples (work in COVID-19 units vs. no work in COVID-19 units).Materials and methodsIn an online survey, 107 physicians (23–42 years) were asked about their mental health during the COVID-19 pandemic. In addition to socio-demographic data, pandemic- and work-related data were also included. For example, infection control measures, deployment on COVID-19 wards and the subjective perceived threat posed by the pandemic. The physicians were asked to rate their perceived anxiety and stress, retrospectively, at 7 different points in time during the pandemic. The Hospital Anxiety and Depression Scale (HADS) was used to retrospectively assess symptoms of anxiety and depression before and after the onset of the pandemic. The quality of life of the participants after 2 years of the pandemic was assessed using the WHO Quality of Life (WHOQOL-BREF).ResultsBoth subjective anxiety and burden showed wave-like patterns with higher scores in autumn, winter and spring. We observed significant differences between the seven measurement time points for anxiety [Chi2(6) = 197.05, p < 0.001] as well as for burden [Chi2(6) = 106.33, p < 0.001]. Symptoms of depression and anxiety increased significantly during the COVID-19 pandemic (M = 14.16, SD = 7.83) compared to the pre-pandemic time [M = 7.31, SD = 5.14, t(106) = −10.67, p < 0.001]. Physicians who worked at COVID-19 units showed higher scores in quality of life related to social relationships (M = 70.39, SD = 17.69) than physicians not working at COVID-19 units [M = 61.44, SD = 24.55, t(90.14) = −2.145, p = 0.035]. The multi-factorial ANOVA showed that previous psychiatric illness (p < 0.001), greater difference in depression scores (p = 0.014), higher anxiety scores (p = 0.048) and less work experience (p = 0.032) led to lower quality of life.ConclusionHospitals should offer specific support, such as supervision, to prevent the development of longer-term psychiatric sequelae likely to lead to sick leave and high costs for the healthcare system.Trial registrationThe study has been registered at the German Clinical Trials Registry (DRKS-ID: DRKS00028984)

Outcomes associated with matching patients' treatment preferences to physicians' recommendations: study methodology

<p>Abstract</p> <p>Background</p> <p>Patients often express strong preferences for the forms of treatment available for their disease. Incorporating these preferences into the process of treatment decision-making might improve patients' adherence to treatment, contributing to better outcomes. We describe the methodology used in a study aiming to assess treatment outcomes when patients' preferences for treatment are closely matched to recommended treatments.</p> <p>Method</p> <p>Participants included patients with moderate and severe psoriasis attending outpatient dermatology clinics at the University Medical Centre Mannheim, University of Heidelberg, Germany. A self-administered online survey used conjoint analysis to measure participants' preferences for psoriasis treatment options at the initial study visit. Physicians' treatment recommendations were abstracted from each participant's medical records. The Preference Matching Index (PMI), a measure of concordance between the participant's preferences for treatment and the physician's recommended treatment, was determined for each participant at t₁(initial study visit). A clinical outcome measure, the Psoriasis Area and Severity Index, and two participant-derived outcomes assessing treatment satisfaction and health related quality of life were employed at t₁, t₂(twelve weeks post-t₁) and t₃(twelve weeks post-t₂). Change in outcomes was assessed using repeated measures analysis of variance. The association between participants' PMI scores at t₁and outcomes at t₂and t₃was evaluated using multivariate regressions analysis.</p> <p>Discussion</p> <p>We describe methods for capturing concordance between patients' treatment preferences and recommended treatment and for assessing its association with specific treatment outcomes. The methods are intended to promote the incorporation of patients' preferences in treatment decision-making, enhance treatment satisfaction, and improve treatment effectiveness through greater adherence.</p

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life