[Quality of life, stress management and health promotion in medical and dental students. A comparative study]

OBJECTIVE

Which are the differences in health-related quality of life and stress management in medical and dental students?

METHODS

101 dental and 237 medical students from different years of Justus-Liebig University Giessen were examined during winter term 2008/09 and summer term 2009 using the specific Questionnaire on Health Promotion, Life Satisfaction, and Stress Management in Dental or Medical Students (addressing work satisfaction and choice of subject, private life, relaxation behavior and stress management, and health behavior), Beck Depression Inventory (BDI) and SF-36 Health Survey. For statistical analysis, Mann-Whitney-U-Test, analysis of variance (ANOVA), Pearson correlation and Chi2-Tests were primarily used.

RESULTS

Dental and medical students showed considerable mental impairment in SF-36. Every fifth dental student suffered from slight to moderate depression. Though averaging more hours per week, medical students were more satisfied with their studies. More than half of the dental and medical students did not have appropriate strategies of coping with stress.

CONCLUSIONS

Concerning the mental impairment in both groups and regarding a higher health-related quality of life, specific prevention courses or mentoring programs should already be offered at the beginning of medical training in order to cope with strains of medical school and future job strains in the medical or dental profession.

Interaction-dependent temperature effects in Bose-Fermi mixtures in optical lattices

We present a quantitative finite temperature analysis of a recent experiment with Bose-Fermi mixtures in optical lattices, in which the dependence of the coherence of bosons on the interspecies interaction was analyzed. Our theory reproduces the characteristics of this dependence and suggests that intrinsic temperature effects play an important role in these systems. Namely, under the assumption that the ramping up of the optical lattice is an isentropic process, adiabatic temperature changes of the mixture occur that depend on the interaction between bosons and fermions. Matching the entropy of two regimes-no lattice on the one hand and deep lattices on the other-allows us to compute the temperature in the lattice and the visibility of the quasimomentum distribution of the bosonic atoms, which we compare to the experiment.

Measuring entanglement in condensed matter systems

We show how entanglement may be quantified in spin and cold atom many-body systems using standard experimental techniques only. The scheme requires no assumptions on the state in the laboratory, and a lower bound to the entanglement can be read off directly from the scattering cross section of neutrons deflected from solid state samples or the time-of-flight distribution of cold atoms in optical lattices, respectively. This removes a major obstacle which so far has prevented the direct and quantitative experimental study of genuine quantum correlations in many-body systems: The need for a full characterization of the state to quantify the entanglement contained in it. Instead, the scheme presented here relies solely on global measurements that are routinely performed and is versatile enough to accommodate systems and measurements different from the ones we exemplify in this work.

Stability over 36 months of a new liquid 10% polyclonal immunoglobulin product (IgPro10, Privigen) stabilized with L-proline

BACKGROUND AND OBJECTIVES

IgPro10 (Privigen) is a new liquid intravenous immunoglobulin (IVIG) product that is formulated with 250 mM L-proline at pH 4.8. A 3-year study was performed to assess its stability.

MATERIALS AND METHODS

Physicochemical, biological and immunological parameters of Privigen were assessed during storage under controlled conditions over up to 36 months at 25 degrees C.

RESULTS

Privigen was shown to be stable after storage for 3 years at room temperature (25 degrees C). Of all parameters tested, only a few showed changes during storage. The appearance of the solution complied with the specifications given by the European Pharmacopeia over the full study period, with a single exception. The IgG fraction in Privigen displayed high purity (> or = 98%), which did not change during storage over 36 months. No relevant amounts of aggregated IgG molecules were formed in Privigen samples and the ratio between monomers and dimers shifted slightly towards the equilibrium over time. Testing of reference antibody contents and the Fc function demonstrated that the biological activity and effector functions of Privigen were preserved over the full study period of 36 months.

CONCLUSION

Thirty-six months room temperature stability of Privigen was achieved at pH 4.8 with an innovative formulation containing the physiological stabilizer L-proline.

Pharmaceutical Care for Migraine and Headache Patients: A Community-Based, Randomized Intervention

Background:

Despite the high prevalence of headache and migraine in the general population, many people do not receive adequate medical attention and treatment.

Objective:

To evaluate the effects of pharmaceutical care (defined as intensified structured counseling between patient and pharmacist, including the use of drug databases), for patients with headache or migraine, on both clinical and psychological endpoints.

Methods:

A prospective, randomized, controlled intervention study was conducted using pharmacies in Northern Germany. A total of 112 pharmacies (26% of all pharmacies in the study region) recruited 410 patients with headaches. Pharmacies were randomly assigned to an intervention or control group. Patients were interviewed by telephone prior to the intervention and again after 4 months. Primary endpoints were number of days with headache, number and severity of headaches, self-efficacy, and the patients' perceptions of their health-related quality of life.

Results:

Each pharmacy treated an average of 4.6 patients (total time effort 9 h). The intervention group consisted of 201 patients who received pharmaceutical care, whereas the control group comprised 209 patients who received standard counseling. In both groups, the number of headache attacks and intensity of pain in treated headache attacks did not change significantly between the first and second interviews. However, a statistically significant improvement in mental health and self-efficacy was shown in the intervention group. Intensity of pain in untreated headache attacks and the number of days with headache decreased in both groups. Most participants described this intervention as helpful and effective and 90% reported that they would recommend pharmaceutical care to other patients with headache.

Conclusions:

A short-term pharmaceutical care intervention improved patients' mental health and self-efficacy, although it did not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving long-term pharmacotherapy of patients with migraine and headache. To fully assess the effects of pharmaceutical care, a longer study may be required.

Exploring local quantum many-body relaxation by atoms in optical superlattices

We establish a setting-atoms in optical superlattices with period 2-in which one can experimentally probe signatures of the process of local relaxation and apparent thermalization in nonequilibrium dynamics without the need of addressing single sites. This opens up a way to explore the convergence of subsystems to maximum entropy states in quenched quantum many-body systems with present technology. Remarkably, the emergence of thermal states does not follow from a coupling to an environment but is a result of the complex nonequilibrium dynamics in closed systems. We explore ways of measuring the relevant signatures of thermalization in this analogue quantum simulation of a relaxation process, exploiting the possibilities offered by optical superlattices.

Do mixtures of bosonic and fermionic atoms adiabatically heat up in optical lattices?

Mixtures of bosonic and fermionic atoms in optical lattices provide a promising arena to study strongly correlated systems. In experiments realizing such mixtures in the quantum-degenerate regime the temperature is a key parameter. We investigate the intrinsic heating and cooling effects due to an entropy-preserving raising of the optical lattice, identify the generic behavior valid for a wide range of parameters, and discuss it quantitatively for the recent experiments with 87Rb and 40K atoms. In the absence of a lattice, we treat the bosons in the Hartree-Fock-Bogoliubov-Popov approximation, including the fermions in a self-consistent mean-field interaction. In the presence of the full three-dimensional lattice, we use a strong coupling expansion. We find the temperature of the mixture in the lattice to be always higher than for the pure bosonic case, shedding light onto a key point in the analysis of recent experiments.

Exact relaxation in a class of nonequilibrium quantum lattice systems

A reasonable physical intuition in the study of interacting quantum systems says that, independent of the initial state, the system will tend to equilibrate. In this work we introduce an experimentally accessible setting where relaxation to a steady state is exact, namely, for the Bose-Hubbard model quenched from a Mott quantum phase to the free strong superfluid regime. We rigorously prove that the evolving state locally relaxes to a steady state with maximum entropy constrained by second moments--thus maximizing the entanglement. Remarkably, for this to be true, no time average is necessary. Our argument includes a central limit theorem and exploits the finite speed of information transfer. We also show that for all periodic initial configurations (charge density waves) the system relaxes locally, and identify experimentally accessible signatures in optical lattices as well as implications for the foundations of statistical mechanics.

Statistics dependence of the entanglement entropy

The entanglement entropy of a distinguished region of a quantum many-body system reflects the entanglement in its pure ground state. Here we establish scaling laws for this entanglement in critical quasifree fermionic and bosonic lattice systems, without resorting to numerical means. We consider the setting of D-dimensional half-spaces which allows us to exploit a connection to the one-dimensional case. Intriguingly, we find a difference in the scaling properties depending on whether the system is bosonic-where an area law is proven to hold-or fermionic where we determine a logarithmic correction to the area law, which depends on the topology of the Fermi surface. We find Lifshitz quantum phase transitions accompanied with a nonanalyticity in the prefactor of the leading order term.

[Health-related quality of life in dermatologists compared to other physicians]

BACKGROUND

According to recent studies, there may be differences in quality of life for physicians depending on gender and field of medicine. Presently, there are hardly any data with respect to health-related quality of life in dermatologists.

METHODS

Using the SF-36 Health Survey, 112 dermatologists and 113 physicians in other fields of medicine were studied in a cross-sectional study.

RESULTS

Dermatologists' mental health level averaged lower than their physical health level (chi2=28.49; p<.001). The mental and physical health level were higher in female dermatologists than in their male colleagues (e.g., GH: chi2=6.15; p<.05 and MH: chi2=6.83; p<.05). These findings are the opposite of results in other medical specialists. The differences between mental and physical health dimensions on the one hand, and between women and men on the other hand, were found in all age groups.

CONCLUSIONS

In comparison to other medical specialists, dermatologists differ only slightly in their health-related quality of life. Therefore, it may be advisable to implement preventive measures concerning their comparatively low mental health status.

Entropy, entanglement, and area: analytical results for harmonic lattice systems

We revisit the question of the relation between entanglement, entropy, and area for harmonic lattice Hamiltonians corresponding to discrete versions of real free Klein-Gordon fields. For the ground state of the d-dimensional cubic harmonic lattice we establish a strict relationship between the surface area of a distinguished hypercube and the degree of entanglement between the hypercube and the rest of the lattice analytically, without resorting to numerical means. We outline extensions of these results to longer ranged interactions, finite temperatures, and for classical correlations in classical harmonic lattice systems. These findings further suggest that the tools of quantum information science may help in establishing results in quantum field theory that were previously less accessible.

Inhomogeneous atomic Bose-Fermi mixtures in cubic lattices

We determine the ground state properties of inhomogeneous mixtures of bosons and fermions in cubic lattices and parabolic confining potentials. For finite hopping we determine the domain boundaries between Mott-insulator plateaux and hopping-dominated regions for lattices of arbitrary dimension within mean-field and perturbation theory. The results are compared with a new numerical method that is based on a Gutzwiller variational approach for the bosons and an exact treatment for the fermions. The findings can be applied as a guideline for future experiments with trapped atomic Bose-Fermi mixtures in optical lattices.

[Multislice CT of the pelvis: dose reduction with regard to image quality]

PURPOSE

To optimize the examination protocols of multislice CT (MSCT) of the pelvis for dose reduction with regard to image quality.

MATERIALS AND METHODS

MSCT of the pelvis was performed on 5 cadaver specimens with stepwise reduction of the tube current at 140 kV (250, 200, 150, 100, 75, 50, 35, 25 mAs) and 120 kV (50, 27 mAs). The remaining scan parameters like collimation (4 x 1 mm) and table speed of 4 mm per rotation remained unchanged. Axial sections and coronal reconstructions were used to evaluate cortex, trabecular structures, subjective image quality, image noise and detail detectability (pelvis and SI joint), with evaluation performed independently by four blinded experienced radiologists on a 5-point scale. Kappa coefficient, accuracy of the observers to sort the films with regard to dose reduction and mean scores of image evaluation were determined for statistical analysis.

RESULTS

The deterioration of the image quality was most pronounced for all criteria between 75 mAs and 50 mAs at 140 kV. Good results with adequate image quality were obtained for detail detectability at 50 mAs and 140 kV (effective dose [E]: 3.3 mSv) and for the remaining four criteria at 75 mAs (E: 4.9 mSv). There was a moderate agreement between the four observers (kappa coefficient: 0.27). All observers were excellent in arranging the images according to the increasing dose reduction.

CONCLUSIONS

Image quality of MSCT of the pelvis appears to be acceptable at 75 mAs and 140 kV with the dose reduced to 46% of the average value of the nation-wide survey of the German Roentgen Society in 1999 for this type of examination.

Prospective assessment of falls in Parkinson's disease

We studied prospectively the epidemiology, clinical impact and prediction of falls in 59 moderately affected patients with Parkinson's disease (PD) (mean UPDRS motor score 31.5; mean age 61 years) and 55 controls (mean age 60 years). At baseline, balance and gait were evaluated extensively. The retropulsion test (response to sudden shoulder pull) was executed first unexpectedly and five more times following prior warning. All persons used standardised scoring forms to document their falls during six months. Thirty patients (50.8 %) and eight controls (14.5%) fell at least once (relative risk [RR] 6.1; 95% confidence interval [CI] 2.5-15.1, p < 0.001). Recurrent (> or = 2) falls occurred in 15 patients (25.4%), but in only two controls (RR 9.0; 95 % CI 2.0-41.7; p=0.001). Recurrent falls were more common among persons taking benzodiazepines (RR 5.0; 95% CI 1.6-15.5; p < 0.01). Sixty-two percent of the falls in patients caused soft tissue injuries, but no fractures occurred. A fear of future falls was common (45.8 % of patients) and was accompanied by restriction of daily activities (44.1 % of patients). Seventy percent of falls reported by patients were'intrinsic' (due to patient-related factors), but falls in controls were mainly (50%) 'extrinsic' (due to environmental factors). None of the baseline posture and gait variables predicted falls adequately. The first 'unexpected' retropulsion test was more often abnormal than all subsequent (predictable) tests. Irrespective of its method of execution, the retropulsion test did not predict falls. A combination of asking for prior falls, disease severity and the Romberg test yielded the best overall diagnostic utility (sensitivity 65 % and specificity 98 %). Recurrent fallers were best predicted by disease severity (RR for Hoehn and Yahr stage 3 was > 100; 95% CI 3.1-585) and asking for prior falls (RR 5.0; 95% CI 1.2-20.9). We conclude that falls are common and disabling, even in relatively early stage PD. Recurrent fallers were best predicted by disease severity and presence of prior falls. Strategies to prevent falls in PD should particularly focus at intrinsic (patient-related) factors, such as minimising the use of benzodiazepines.

Perceived health needs of urban African American church congregants

Theory-based assessment of congregant expectations and needs should be conducted prior to beginning a parish nurse program. However, no such assessments are found in the literature. Using Andersen's Health Access Model as a framework, investigators conducted interviews with 117 randomly selected congregants in five urban African American churches to describe their perceived needs and expectations. Causing most concern were the following: (a) symptoms of illness--high blood pressure (50.4%), dental problems (43.6%), and back pain (41%); and (b) health habits/risks--weight (75%), exercise (63%), and diet (63%). Younger adults were significantly more concerned about all aspects of their health than their older counterparts. Women were significantly more likely to express concern about health habits and health risks than males. No significant relationship was found between perceived need and access to care. Although terming health care services "adequate", congregants expressed many unmet health needs. This seemingly contradictory finding may illuminate a concrete role for the parish nurse, i.e., addressing personal health care concerns not alleviated by the current "adequate" health care delivery system. This study's significance lies not only in providing programming guidance, but also in theoretical insights into the role of the parish nurse.

Falls in the elderly. I. Identification of risk factors

Falls severely threaten the health of elderly persons and pose high costs to the public health service. Unfortunately, falls are often regarded as unavoidable and untreatable features of aging. Therefore, many clinicians merely treat the physical injuries of a fall. However, falls and gait limitations are markers of underlying (sometimes otherwise subclinical) diseases that can be amenable to treatment. Moreover, falls and gait limitations herald the onset of repeated falls, physical decline, serious psychosocial consequences and a reduced survival. We review how clinically relevant risk factors can be traced by reviewing the medical notes, by careful history taking and by physical examination. The identified risk factors can serve as a template for the design of prevention strategies, which are discussed in the companion article.

The human transcriptional repressor protein NAB1: expression and biological activity

The zinc finger protein early growth response 1 (Egr-1) is a transcriptional activator involved in the regulation of growth and differentiation. Egr-1 has a large activating domain and three zinc finger motifs that function as a DNA binding region. We show here that a third functional domain of the Egr-1 protein, localized between the extended activation domain and the zinc finger DNA binding region, acts as a transcriptional repressor domain when fused to a heterologous DNA binding domain (DBD). Through protein-protein interaction this inhibitory domain of Egr-1 brings the transcriptional corepressor NAB1 in close proximity to the transcription unit. NAB1 is expressed ubiquitously in human cell lines as shown by RNase protection mapping. Overexpression studies revealed that NAB1 is able to completely block transcription mediated by Egr-1. In addition, the transcriptional repression activity of a fusion protein containing the inhibitory domain of Egr-1 and the DBD of the yeast transcription factor GAL4 was increased by overexpression of NAB1. A fusion protein consisting of the DBD of GAL4 and the coding region of human NAB1 repressed transcription from model promoters with engineered upstream GAL4 binding sites. The GAL4-NAB1 fusion protein functioned from proximal and distal positions indicating that NAB1 displays transcriptional repressor activity at any position within the transcription unit. Thus, the biological function of the inhibitory domain of Egr-1 is solely to provide a docking site for NAB1 via protein-protein interaction.

Biological activity and modular structure of RE-1-silencing transcription factor (REST), a repressor of neuronal genes

The zinc finger protein RE-1-silencing transcription factor (REST)1 is a transcriptional repressor that represses neuronal genes in nonneuronal tissues. Transfection experiments of neuroblastoma cells using a REST expression vector revealed that synapsin I promoter activity is controlled by REST. The biological activity of REST was further investigated using a battery of model promoters containing strong promoters/enhancers and REST binding sites. REST functioned as a transcriptional repressor when REST binding motifs derived from the genes encoding synapsin I, SCG10, alpha1-glycine receptor, the beta2-subunit of the neuronal nicotinic acetylcholine receptor, and the m4-subunit of the muscarinic acetylcholine receptor were present in the promoter region. No differences in the biological activity of these REST binding motifs tested were detected. Moreover, we found that REST functioned very effectively as a transcriptional repressor at a distance. Thus, REST represents a general transcriptional repressor that blocks transcription regardless of the location or orientation of its binding site relative to the enhancer and promoter. This biological activity could also be attributed to isolated domains of REST. Both repressor domains identified at the N and C termini of REST were transferable to a heterologous DNA binding domain and functioned from proximal and distal positions, similar to the REST protein.