Datenerhebung und -auswertung an der Opferschutzambulanz des Instituts für Rechtsmedizin der Universität München in den Jahren 2010 bis 2013

Ziel dieser Arbeit ist es, anhand eigenständig entwickelter Referenzkriterien darzustellen, inwieweit das niederschwellige Angebot der Ambulanz seit 2010 durch erwachsene Gewaltopfer genutzt wird sowie die Analyse mit der aktuellen Studien- und Literaturlage zu vergleichen und Rückschlüsse daraus zu ziehen. Zudem werden eine selbstständige Neugestaltung der Dokumentationsbögen und eines Informationsschreibens sowie die Ausarbeitung eines elektronischen Protokollformats präsentiert

The Cortisol Awakening Response and Depressive Symptomatology: The Moderating Role of Sleep and Gender

The association between depression and the cortisol awakening response (CAR) has been widely examined, yet the results are mixed and factors responsible for such inconsistencies are poorly understood. The current study investigated whether the link between depressive symptomatology and CAR varied as a function of two such factors: sleep and gender. The sample included 58 young adults (30 females; Mageâ =â 18.7; SDageâ =â 0.91). Participants completed the Beck Depression Inventory as well as the Consensus Sleep Diary to assess depressive symptomatology and daily sleep patterns, respectively. Participants also provided four salivary cortisol samples (0, 30, 45 and 60â min after awakening) during two consecutive weekdays. Results demonstrated that greater depressive symptoms were associated with a greater CAR but only when depressive symptoms were linked to a shorter sleep time. In addition, gender significantly moderated the association between depressive symptoms and CAR. While greater depressive symptoms were associated with an elevated CAR among females, they were associated with a blunted CAR among males. These findings provide some insight into potential mechanisms linking depressive symptomatology and CAR, and suggest that future studies examining CAR as a biomarker of depression should account for differences in sleep and gender. Copyright © 2016 John Wiley & Sons, Ltd.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138213/1/smi2691_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138213/2/smi2691.pd

Examining the Relationships Between Chronic Stress, HPA Axis Activity, and Depression in a Prospective and Longitudinal Study of Medical Internship

OBJECTIVE: Depression is common, and stress plays a causal role in depression onset, perhaps via Hypothalamic-Pituitary-Adrenal (HPA) axis activation. Decades of work documented HPA hyperactivity in depression. Yet, the nature of this relationship is unclear, partly because the HPA axis is a complex system and cortisol measurement over time has been challenging. A recent development of cortisol assessment in hair has now made it possible to quantify cortisol secretions over prolonged periods of time. In this study, we incorporated hair cortisol measurement into an existing prospective and longitudinal study of medical internship, stress, and depression. This gave us a rare opportunity to investigate links between chronic stress, hair cortisol, and depressive symptoms and allowed us to test the impact of psychological factors. Specifically, we examined 1) hair cortisol changes in response to medical internship, 2) associations between hair cortisol levels and depressive symptoms, 3) psychological factors that impact respective associations, and 4) prospective indicators of depression vulnerability. METHODS: Seventy-four medical residents (age 25-33) were recruited. We assessed hair cortisol, depressive symptoms, and psychological variables (perceived stress, mastery/control, social support, loneliness, resilience, compassion, childhood trauma) prior to internship start as well as repeatedly throughout medical internship. RESULTS: Hair cortisol levels changed over time: they increased sharply with the onset of internship stress, decreased as internship continued, and rose again towards the end of internship, prior the start of the second residency year. The initial increase in hair cortisol responses to internship stress was not directly related to depressive symptoms in response to or in the midst of internship. Preliminary findings showed that elevated hair cortisol levels were related to increased depressive symptoms during periods of anticipation, and that both were related to less adaptive psychosocial correlates prior to internship stress. CONCLUSION: The prospective and longitudinal study examined links between chronic stress, HPA axis activity, depressive symptoms, and psychological factors. Our finding supports the validity of hair cortisol as a field-friendly biomarker for chronic stress exposure. Hair cortisol responses to chronic stress may perhaps reflect context-specific psychological processes related to anticipation, novelty/familiarity, and social evaluative threat. Hair cortisol and depressive symptom responses to stress were not directly related, but links between hair cortisol, depressive symptoms, and psychological factors were present prior to stress exposure, perhaps reflecting shared underlying vulnerabilities that were most apparent in the context of stressor anticipation, when stress was moderate and uniquely characterized by high levels of uncertainty. During internship stress, hair cortisol may reflect the impact of stress exposure, perhaps related to contextual features, which may not be mechanistically linked to depression risk; however, in the absence of ongoing stress, it may indicate the impact of underlying vulnerabilities, which may be more directly linked to depressive symptoms. In sum, our results are consistent with a paradigm shift in the literature towards more complex models of how stress context, stress systems, and disorders are linked, suggesting interwoven interactions between neuroendocrine, genetic, environmental, and psychological factors that constitute vulnerability for the development of depression in the context of stress.PHDPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/137074/1/stemayer_1.pd

More than a feeling: A unified view of stress measurement for population science.

Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes alone have been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic - and more precise language for dimensions of stress measurement

Systematic review of the clinical effectiveness of biomarkers as cancer screening test offered as self-pay service in Austria and Germany [Abstract]

Background: Individual health services (IGeL) are medical self-pay services that are not under the liability of the German statutory health insurance. Up to 14% of IGeL are blood or laboratory and cancer screening tests, which are offered to asymptomatic individuals [1]. The aim was to investigate the clinical effectiveness of eleven biomarkers that are the most often offered biomarkers for cancer screening by physicians and laboratories on the internet in Germany (i.e., AFP, CA125, CA15-3, CA19-9, CEA, Cyfra21-1, β-HCG, NMP22, M2-PK, NSE and PCA3). Research Question: What is the benefit-harm-balance regarding patient relevant outcomes (mortality, morbidity, quality of life) for using these biomarkers as cancer screening test in comparison to usual care? Methods: Firstly, searches for Health Technology Assessment (HTA) reports and systematic reviews (SR) were performed in three different databases in spring 2012. Secondly, randomized controlled trials (RCT) that were published after the end of the research period of the most recent included secondary study were searched. We included publications in English or German which compared cancer screening with one of these biomarkers in asymptomatic persons to unscreened controls. References were independently screened by two reviewers. One reviewer extracted relevant characteristics from full text and evaluated the quality of included studies. Results: Five HTA or SR dealing with CA125 (4) or NMP22 (1) and 2 RCTs (CA125) were included. For ten biomarkers, incl. NMP22, no direct evidence on patient relevant outcomes was available. One RCT combining CA125 and vaginal ultrasound for ovarian cancer screening provided results of interest [2]. Screening compared with usual care did not reduce ovarian cancer mortality (RR, 1.18; 95% CI, 0.82-1.71) [2]. Harms occurred through overdiagnosis and false-positive results, e.g., 20.6 complications occurred per 100 surgical procedures in women who underwent surgery after a false-positive result [2]. About 4.5 surgeries were performed per one case of invasive cancer identified through CA125 screening [3]. Conclusion: While ovarian cancer screening with CA125 showed no survival benefit, false-positive tests, overdiagnosis and -treatment resulted in harm. For ten biomarkers no sufficient evidence was available. When IGeL are offered, patients should get comprehensive information about the lack of evidence on patient-relevant outcomes and potential harm caused by biomarker screening

Using the R Package Spatstat to Assess Inhibitory Effects of Microregional Hypoxia on the Infiltration of Cancers of the Head and Neck Region by Cytotoxic T Lymphocytes

(1) Background: The immune system has physiological antitumor activity, which is partially mediated by cytotoxic T lymphocytes (CTL). Tumor hypoxia, which is highly prevalent in cancers of the head and neck region, has been hypothesized to inhibit the infiltration of tumors by CTL. In situ data validating this concept have so far been based solely upon the visual assessment of the distribution of CTL. Here, we have established a set of spatial statistical tools to address this problem mathematically and tested their performance. (2) Patients and Methods: We have analyzed regions of interest (ROI) of 22 specimens of cancers of the head and neck region after 4-plex immunofluorescence staining and whole-slide scanning. Single cell-based segmentation was carried out in QuPath. Specimens were analyzed with the endpoints clustering and interactions between CTL, normoxic, and hypoxic tumor areas, both visually and using spatial statistical tools implemented in the R package Spatstat. (3) Results: Visual assessment suggested clustering of CTL in all instances. The visual analysis also suggested an inhibitory effect between hypoxic tumor areas and CTL in a minority of the whole-slide scans (9 of 22, 41%). Conversely, the objective mathematical analysis in Spatstat demonstrated statistically significant inhibitory interactions between hypoxia and CTL accumulation in a substantially higher number of specimens (16 of 22, 73%). It showed a similar trend in all but one of the remaining samples. (4) Conclusion: Our findings provide non-obvious but statistically rigorous evidence of inhibition of CTL infiltration into hypoxic tumor subregions of cancers of the head and neck. Importantly, these shielded sites may be the origin of tumor recurrences. We provide the methodology for the transfer of our statistical approach to similar questions. We discuss why versions of the Kcross and pcf.cross functions may be the methods of choice among the repertoire of statistical tests in Spatstat for this type of analysis