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Kuut TA, Müller F, Csorba I, Braamse AMJ, Nieuwkerk P, Rovers CP, Knoop H. Positive Effects of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following COVID-19 Are Sustained Up to 1 Year After Treatment. Clin Infect Dis 2024; 78:1078-1079. [PMID: 37889495 DOI: 10.1093/cid/ciad661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
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Kuut TA, Buffart LM, Braamse AMJ, Csorba I, Bleijenberg G, Nieuwkerk P, Moss-Morris R, Müller F, Knoop H. Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis. Psychol Med 2024; 54:447-456. [PMID: 37927223 DOI: 10.1017/s0033291723003148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Debate is ongoing on the efficacy of cognitive behavior therapy (CBT) for myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). With an individual patient data (IPD) meta-analysis we investigated whether the effect of CBT varied by patient characteristics. These included post-exertional malaise (PEM), a central feature of ME/CFS according to many. We searched for randomized controlled trials similar with respect to comparison condition, outcomes and treatment-protocol. Moderation on fatigue severity (Checklist Individual Strength, subscale fatigue severity), functional impairment (Sickness Impact Profile-8) and physical functioning (Short Form-36, subscale physical functioning) was investigated using linear mixed model analyses and interaction tests. PROSPERO (CRD42022358245). Data from eight trials (n = 1298 patients) were pooled. CBT showed beneficial effects on fatigue severity (β = -11.46, 95% CI -15.13 to -7.79); p < 0.001, functional impairment (β = -448.40, 95% CI -625.58 to -271.23); p < 0.001; and physical functioning (β = 9.64, 95% CI 3.30 to 15.98); p < 0.001. The effect of CBT on fatigue severity varied by age (pinteraction = 0.003), functional impairment (pinteraction = 0.045) and physical activity pattern (pinteraction = 0.027). Patients who were younger, reported less functional impairments and had a fluctuating activity pattern benefitted more. The effect on physical functioning varied by self-efficacy (pinteraction = 0.025), with patients with higher self-efficacy benefitting most. No other moderators were found. It can be concluded from this study that CBT for ME/CFS can lead to significant reductions of fatigue, functional impairment, and physical limitations. There is no indication patients meeting different case definitions or reporting additional symptoms benefit less from CBT. Our findings do not support recent guidelines in which evidence from studies not mandating PEM was downgraded.
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Affiliation(s)
- T A Kuut
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - I Csorba
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - G Bleijenberg
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - R Moss-Morris
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - F Müller
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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King MT, Revicki DA, Norman R, Müller F, Viney RC, Pickard AS, Cella D, Shaw JW. United States Value Set for the Functional Assessment of Cancer Therapy-General Eight Dimensions (FACT-8D), a Cancer-Specific Preference-Based Quality of Life Instrument. Pharmacoecon Open 2024; 8:49-63. [PMID: 38060096 PMCID: PMC10781923 DOI: 10.1007/s41669-023-00448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To develop a value set reflecting the United States (US) general population's preferences for health states described by the Functional Assessment of Cancer Therapy (FACT) eight-dimensions preference-based multi-attribute utility instrument (FACT-8D), derived from the FACT-General cancer-specific health-related quality-of-life (HRQL) questionnaire. METHODS A US online panel was quota-sampled to achieve a general population sample representative by sex, age (≥ 18 years), race and ethnicity. A discrete choice experiment (DCE) was used to value health states. The valuation task involved choosing between pairs of health states (choice-sets) described by varying levels of the FACT-8D HRQL dimensions and survival (life-years). The DCE included 100 choice-sets; each respondent was randomly allocated 16 choice-sets. Data were analysed using conditional logit regression parameterized to fit the quality-adjusted life-year framework, weighted for sociodemographic variables that were non-representative of the US general population. Preference weights were calculated as the ratio of HRQL-level coefficients to the survival coefficient. RESULTS 2562 panel members opted in, 2462 (96%) completed at least one choice-set and 2357 (92%) completed 16 choice-sets. Pain and nausea were associated with the largest utility weights, work and sleep had more moderate utility weights, and sadness, worry and support had the smallest utility weights. Within dimensions, more severe HRQL levels were generally associated with larger weights. A preference-weighting algorithm to estimate US utilities from responses to the FACT-General questionnaire was generated. The worst health state's value was -0.33. CONCLUSIONS This value set provides US population utilities for health states defined by the FACT-8D for use in evaluating oncology treatments.
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Affiliation(s)
- Madeleine T King
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.
| | - D A Revicki
- Revicki Outcomes Research Consulting, Sarasota, FL, USA
| | - R Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - F Müller
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - R C Viney
- Centre for Health Economics Research & Evaluation, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - A S Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J W Shaw
- Patient-Reported Outcomes Assessment, Global Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, NJ, USA
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Müller F, van Dongen S, van Woezik R, Tibosch M, Tuinman MA, Schellekens MPJ, Laurenceau JP, van der Lee M, Hagedoorn M. A Web-Based Mindfulness-Based Cognitive Therapy for Couples Dealing With Chronic Cancer-Related Fatigue: Protocol for a Single-Arm Pilot Trial. JMIR Res Protoc 2023; 12:e48329. [PMID: 37930767 PMCID: PMC10660231 DOI: 10.2196/48329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Chronic fatigue is a common symptom among patients who have been treated for cancer. Current psychosocial interventions typically target the patient alone, despite growing evidence suggesting that a couples' approach can increase and broaden the efficacy of an intervention. Therefore, based on an existing web-based mindfulness-based cognitive therapy for patients, the couple intervention COMPANION was developed. OBJECTIVE The primary objectives of this study are to determine the acceptability of COMPANION and its potential efficacy in reducing fatigue in patients with cancer. Our secondary objectives are to examine the feasibility of the trial procedures and the potential working mechanisms of the couple intervention. METHODS We will conduct a single-arm pilot trial for couples (ie, patients with cancer with chronic fatigue and their partners). All couples are allocated to the web-based couple intervention that consists of psychoeducation, mindfulness, and cognitive-behavioral exercises. The 9 sessions of the intervention are supervised remotely by a trained therapist. Patients and partners will complete questionnaires before starting the intervention (T0), 2 weeks after completing the intervention (T1), and 1 month after T1 (T2). They will also fill out weekly diaries during the intervention period. A subsample of patients (n≈5) and partners (n≈5) as well as all the therapists providing COMPANION will participate in the final focus groups. Benchmark values have been defined to determine the acceptability (ie, ≥60% of couples complete the intervention and/or ≥70% of the participants are satisfied with the intervention) and potential efficacy (ie, a significant improvement in fatigue and/or a clinically relevant improvement in fatigue in 45% of the patients between T0 and T1) of the intervention. The trial procedures are deemed feasible if an average of at least three couples are included per recruiting month and/or adherence to the assessments is at least 65% for T1 and the diaries and 60% for T2. To establish potential working mechanisms, changes in affect, sleep, catastrophizing, partner communication and interactions, self-efficacy, mindfulness, and closeness will be examined. Quantitative outcomes will be interpreted along with the results from the focus groups. RESULTS Data collection is expected to be completed by March 2024. CONCLUSIONS This pilot trial will test the first web-based mindfulness-based cognitive therapy for couples targeting chronic cancer-related fatigue. Findings will indicate whether proceeding with a randomized controlled trial is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT05636696; https://clinicaltrials.gov/study/NCT05636696. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48329.
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Affiliation(s)
- Fabiola Müller
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sophie van Dongen
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
| | - Rosalie van Woezik
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
| | - Marijke Tibosch
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Melanie P J Schellekens
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Jean-Philippe Laurenceau
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Marije van der Lee
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Kuut TA, Müller F, Nieuwkerk P, Rovers CP, Knoop H. Reply to Crawford and Biere-Rafi et al. Clin Infect Dis 2023; 77:1075-1077. [PMID: 37387679 DOI: 10.1093/cid/ciad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
- Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
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Kuut TA, Müller F, Csorba I, Braamse A, Aldenkamp A, Appelman B, Assmann-Schuilwerve E, Geerlings SE, Gibney KB, Kanaan RAA, Mooij-Kalverda K, Hartman TCO, Pauëlsen D, Prins M, Slieker K, van Vugt M, Keijmel SP, Nieuwkerk P, Rovers CP, Knoop H. Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial. Clin Infect Dis 2023; 77:687-695. [PMID: 37155736 PMCID: PMC10495128 DOI: 10.1093/cid/ciad257] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Severe fatigue following coronavirus disease 2019 (COVID-19) is prevalent and debilitating. This study investigated the efficacy of cognitive-behavioral therapy (CBT) for severe fatigue following COVID-19. METHODS A multicenter, 2-arm randomized controlled trial was conducted in the Netherlands with patients being severely fatigued 3-12 months following COVID-19. Patients (N = 114) were randomly assigned (1:1) to CBT or care as usual (CAU). CBT, targeting perpetuating factors of fatigue, was provided for 17 weeks. The primary outcome was the overall mean difference between CBT and CAU on the fatigue severity subscale of the Checklist Individual Strength, directly post-CBT or CAU (T1), and after 6 months (T2). Secondary outcomes were differences in proportions of patients meeting criteria for severe and/or chronic fatigue, differences in physical and social functioning, somatic symptoms, and problems concentrating between CBT and CAU. RESULTS Patients were mainly nonhospitalized and self-referred. Patients who received CBT were significantly less severely fatigued across follow-up assessments than patients receiving CAU (-8.8 [95% confidence interval {CI}, -11.9 to -5.8]); P < .001), representing a medium Cohen's d effect size (0.69). The between-group difference in fatigue severity was present at T1 (-9.3 [95% CI, -13.3 to -5.3]) and T2 (-8.4 [95% CI, -13.1 to -3.7]). All secondary outcomes favored CBT. Eight adverse events were recorded during CBT, and 20 during CAU. No serious adverse events were recorded. CONCLUSIONS Among patients, who were mainly nonhospitalized and self-referred, CBT was effective in reducing fatigue. The positive effect was sustained at 6-month follow-up. CLINICAL TRIALS REGISTRATION Netherlands Trial Register NL8947.
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Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arnoud Aldenkamp
- Department of Lung Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | | | - Suzanne E Geerlings
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Katherine B Gibney
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, 3000 Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, 3084 Victoria, Australia
| | - Kirsten Mooij-Kalverda
- Department of Pulmonology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands
| | - Dominique Pauëlsen
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Maria Prins
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands
| | - Kitty Slieker
- Department of Internal Medicine, Bernhoven Hospital, 5406 PT Uden, The Netherlands
| | - Michele van Vugt
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Stephan P Keijmel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Müller F, Veen LM, Galenkamp H, Jim HSL, Lok A, Nieuwkerk PT, Suurmond J, van Laarhoven HWM, Knoop H. Emotional distress in cancer survivors from various ethnic backgrounds: Analysis of the multi-ethnic HELIUS study. Psychooncology 2023; 32:1412-1423. [PMID: 37482911 DOI: 10.1002/pon.6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/07/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Insight into emotional distress of cancer survivors from ethnic minority groups in Europe is scarce. We aimed to compare distress levels of survivors from ethnic minorities to that of the majority population, determine whether the association between having cancer (yes vs. no) and distress differs among ethnic groups and investigate sociocultural correlates of distress. METHODS Cross-sectional data were derived from HELIUS, a multi-ethnic cohort study conducted in the Netherlands. Of 19,147 participants, 351 were diagnosed with cancer (n = 130 Dutch, n = 75 African Surinamese, n = 53 South-Asian Surinamese, n = 43 Moroccan, n = 28 Turkish, n = 22 Ghanaian). Distress (PHQ-9, MCS-12) and correlates were assessed by self-report. Cancer-related variables were derived from the Netherlands Cancer Registry. RESULTS Survivors were on average 7 years post-diagnosis. Survivors from South-Asian Surinamese, Moroccan, Turkish and Ghanaian origin reported more distress than survivors from Dutch origin (effect sizerange : 0.44-1.17; adjusted models). The association between having cancer or not with distress differed in direction between Dutch and the non-Dutch ethnic groups: Non-Dutch cancer patients tended to have more distress than their cancer-free peers, whereas Dutch cancer patients tended to have less distress than their cancer-free peers. For Moroccan and Turkish patients, the acculturation style of separation/marginalization, compared to integration/assimilation, was associated with higher depressive symptoms. In analyses pooling data from all ethnic minorities, lower health literacy, lower emotional support satisfaction and younger age at the time of migration were associated with higher depressive symptoms. Lower health literacy, fewer emotional support transactions, and more frequent attendance at religious services were associated with worse mental health. CONCLUSION Cancer survivors from ethnic minorities experience more distress than those from the majority population. Culturally sensitive supportive care should be considered.
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Affiliation(s)
- Fabiola Müller
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Linde M Veen
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anja Lok
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, the Netherlands
| | - Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Hans Knoop
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Expert Center for Chronic Fatigue, Amsterdam, the Netherlands
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Brendefur Corwin LM, Campbell P, Jakobsen K, Müller F, Lai X, Unemo M, Leegaard TM, Vildershøj Bjørnholt J, Olsen AO. Improvement in Neisseria gonorrhoeae culture rates by bedside inoculation and incubation at a clinic for sexually transmitted infections. Ann Clin Microbiol Antimicrob 2023; 22:27. [PMID: 37072830 PMCID: PMC10114361 DOI: 10.1186/s12941-023-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/28/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Culture of Neisseria gonorrhoeae is essential for surveillance of complete antimicrobial susceptibility profiles. In 2014, the culture success rate of N. gonorrhoeae from samples taken at the clinic for sexually transmitted infections (STI clinic), Oslo University Hospital, Norway, was only 20%. The present study aimed to improve gonococcal culture rates using bedside inoculation of patient samples on gonococcal agar plates and incubation at the STI clinic. METHODS This prospective quality improvement study was conducted by the STI clinic and the Department of Microbiology at Oslo University Hospital from May 2016 - October 2017. When culture of N. gonorrhoeae was clinically indicated, we introduced a parallel 'bedside culture' at the STI clinic and compared results with the standard culture at the microbiology department. Samples were taken from urethra, anorectum, pharynx and cervix. Culture rates were compared across symptomatic and asymptomatic anatomical sites. RESULTS From 596 gonococcal-positive PCR samples, bedside culture had a significantly higher success rate of 57% compared to 41% with standard culture (p < 0.05). Overall, culture rate from symptomatic sites was 91% v. 45% from asymptomatic sites. The culture rates from different anatomical sites were as follows: urethra 93%, anorectum 64%, pharynx 28% and cervix 70%. Bedside culture significantly (p < 0.05) improved the culture rates for symptomatic urethral and asymptomatic pharyngeal samples. CONCLUSIONS Where feasible, bedside inoculation on gonococcal agar plates and incubation of samples from patients with gonorrhoea is recommended. This will improve the culture diagnostics and provide additional gonococcal isolates for antimicrobial resistance surveillance.
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Affiliation(s)
- L M Brendefur Corwin
- Department of Microbiology, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - P Campbell
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
- National Advisory Unit for Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway
| | - K Jakobsen
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Müller
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - X Lai
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, UK
| | - T M Leegaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | - J Vildershøj Bjørnholt
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A O Olsen
- Section for Respiratory, Blood-borne and Sexually Transmitted Infections, Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Kretschmann S, Völkl S, Reimann H, Krönke G, Schett G, Achenbach S, Lutzny-Geier G, Müller F, Mougiakakos D, Dingfelder J, Flamann C, Hanssens L, Gary R, Mackensen A, Aigner M. Successful Generation of CD19 Chimeric Antigen Receptor T Cells from Patients with Advanced Systemic Lupus Erythematosus. Transplant Cell Ther 2023; 29:27-33. [PMID: 36241147 DOI: 10.1016/j.jtct.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
Although it has been shown that the production of functional chimeric antigen receptor T cells is feasible in patients with B-cell malignancies, it is currently unclear whether sufficient amounts of functional autologous CAR T cells can be generated from patients with autoimmune diseases. Intrinsic T-cell abnormalities and T-cell-targeted immune suppression in patients with autoimmunity may hamper the retrieval of sufficient T cells and their transduction and expansion into CAR T cells. Patients with active systemic lupus erythematosus (SLE) underwent leukapheresis after tapering glucocorticoids and stopping T-cell-suppressive drugs. This material was used as source for manufacturing anti-CD19 CAR T-cell products (CAR) in clinical scale. Cells were transduced with a lentiviral anti-CD19 CAR vector and expanded under good manufacturing practice (GMP) conditions using a closed, semi-automatic system. Functionality of these CAR T cells derived from autoimmune patient cells was tested in vitro. Six SLE patients were analyzed. Leukapheresis could be successfully performed in all patients yielding sufficient T-cell numbers for clinical scale CAR T-cell production. In addition, CAR T cells showed high expansion rates and viability, leading to CAR T cells in sufficient doses and quality for clinical use. CAR T cells from all patients showed specific cytotoxicity against CD19+ cell lines in vitro. GMP grade generation of CD19 CAR T-cell products suitable for clinical use is feasible in patients with autoimmune disease.
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Affiliation(s)
- S Kretschmann
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - S Völkl
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - H Reimann
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - G Krönke
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital of Erlangen, Erlangen, Germany
| | - G Schett
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital of Erlangen, Erlangen, Germany
| | - S Achenbach
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| | - G Lutzny-Geier
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - F Müller
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - D Mougiakakos
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | - J Dingfelder
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - C Flamann
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - L Hanssens
- Miltenyi Biomedicine GmbH, Bergisch Gladbach, Germany
| | - R Gary
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - A Mackensen
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - M Aigner
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Albrink K, Joos C, Schröder D, Müller F, Noack EM. Benutzerfreundlichkeit einer Anamnese-App für die
primärärztliche Versorgung aus Sicht der
Patient*innen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Degen C, Mikuteit M, Niewolik J, Joosten T, Schröder D, Vahldiek K, Mücke U, Heinemann S, Müller F, Behrens G, Klawonn F, Lenarz T, Dopfer-Jablonka A, Steffens S. Audiological profile of adult long COVID patients. Am J Otolaryngol 2022; 43:103579. [PMID: 35988361 PMCID: PMC9354445 DOI: 10.1016/j.amjoto.2022.103579] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022]
Abstract
Introduction Hearing loss is one of the self-reported symptoms of Long COVID patients, however data from objective and subjective audiological tests demonstrating diminished hearing in Long COVID patients has not been published. Materials and methods Respondents of a large Long COVID online survey were invited to the ENT-department for an otologic exam. The participants were split into three groups based on their history of SARS-CoV-2 infection and persistence of symptoms. Respondents with a history of a SARS-CoV-2 infection were allocated to the Long COVID group, if they reported persistent symptoms and to the Ex COVID group, if they had regained their previous level of health. Participants without a history of SARS-CoV-2 infection made up the No COVID control group. In total, 295 ears were examined with otoscopy, tympanograms, pure tone audiometry and otoacoustic emissions. Ears with known preexisting hearing loss or status post ear surgery, as well as those with abnormal otoscopic findings, non-type A tympanograms or negative Rinne test were excluded. Results Compared to the No COVID and Ex COVID groups, we did not find a clinically significant difference in either hearing thresholds or frequency specific TEOAEs. However, at 500 Hz the data from the left ear, but not the right ear showed a significantly better threshold in the Ex COVID group, compared to Long COVID and No COVID groups. Any of the other tested frequencies between 500 Hz and 8 kHz were not significantly different between the different groups. There was a significantly lower frequency-specific signal-to-noise-ratio of the TEOAEs in the Long COVID compared to the No COVID group at 2.8 kHz. At all other frequencies, there were no significant differences between the three groups in the TEOAE signal-to-noise-ratio. Conclusion This study detected no evidence of persistent cochlear damage months after SARS-CoV-2 infection in a large cohort of Long COVID patients, as well as those fully recovered.
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Joos C, Albrink K, Noack EM, Müller F, Schröder D. Liefert eine digitale Anamnese zuverlässige Angaben von
Patient*innen? Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zuidersma M, Müller F, Snippe E, Zuidema SU, Oude Voshaar RC. Feasibility, usability and clinical value of intensive longitudinal diary assessments in older persons with cognitive impairment and depressive symptoms. Aging Ment Health 2022:1-10. [PMID: 35876158 DOI: 10.1080/13607863.2022.2102143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To evaluate the feasibility, usability and clinical value of daily diary assessments combined with actigraphy in older persons with cognitive impairment. METHODS For 63 days, patients ≥60 years with cognitive impairments filled out a daily diary (including standardized questionnaires and cognitive test battery), and wore an actiwatch (sleep). After the study, participants and clinicians received personal feedback about patterns and daily triggers of depressive symptoms, sleep and cognitive performance. We assessed feasibility (participation rate, compliance and subjective burden), usability (variability and floor- or ceiling effects) and clinical value for patients and their clinicians (questionnaires). RESULTS Of 96 eligible patients, 13 agreed to participate (13.5%). One patient dropped out after 2 days, another after 37 days, and another did not complete the cognitive test battery. Compliance rate was high (6.7-10% missing values). Subjective burden was relatively low. Time-series data showed sufficient variability and no floor- or ceiling effects, except for one relevant ceiling effect on the One Back task. The personal feedback report was considered insightful by 4 out of 11 participants and 5 out of 7 clinicians. CONCLUSION Daily assessments are suitable for a minority of cognitively impaired older persons, but is helpful to increase insight into their symptoms.
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Affiliation(s)
- Marij Zuidersma
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fabiola Müller
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Müller F, Verdam MGE, Oort FJ, Riper H, van Straten A, Verdonck-de Leeuw IM, Sprangers MAG, Knoop H. Response Shift After Cognitive Behavioral Therapy Targeting Severe Fatigue: Explorative Analysis of Three Randomized Controlled Trials. Int J Behav Med 2022:10.1007/s12529-022-10111-8. [DOI: 10.1007/s12529-022-10111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Background
Cognitive behavioral therapy (CBT) is an evidence-based intervention for severe fatigue. Changes in patients’ fatigue scores following CBT might reflect not only the intended relief in fatigue but also response shift, a change in the meaning of patients’ self-evaluation. Objectives were to (1) identify the occurrence of response shift in patients undergoing CBT, (2) determine the impact of response shift on the intervention effect, and (3) investigate whether changes in fatigue-related cognitions and perceptions, targeted during CBT, are associated with response shift.
Methods
Data of three randomized controlled trials testing the efficacy of CBT in individuals with chronic fatigue syndrome (CFS, n = 222), cancer (n = 123), and diabetes (n = 107) were re-analyzed. Fatigue severity was measured with 8 items from the Checklist Individual Strength, a valid and widely used self-report questionnaire. Structural equation modelling was applied to assess lack of longitudinal measurement invariance, as indication of response shift.
Results
As expected, in all three trials, response shift was indicated in the CBT groups, not the control groups. Response shift through reprioritization was indicated for the items “Physically, I feel exhausted” (CFS) and “I tire easily” (cancer, diabetes), which became less vs. more important to the measurement of fatigue, respectively. However, this did not affect the intervention effects. Some changes in cognitions and perceptions were associated with the response shifts.
Conclusions
CBT seems to induce response shift through reprioritization across patient groups, but its occurrence does not affect the intervention effect. Future research should corroborate these findings and investigate whether patients indeed change their understanding of fatigue.
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Schett G, Boeltz S, Müller F, Kleyer A, Völkl S, Aigner M, Gary R, Kretschmann S, Simon D, Kharboutli S, Mougiakakos D, Krönke G, Andreas M. OP0279 CAR-T CELL TREATMENT OF REFRACTORY SYSTEMIC LUPUS ERYTHEMATOSUS- SAFETY AND PRELIMINARY EFFICACY DATA FROM THE FIRST FOUR PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundWhile treatment of Systemic lupus erythematosus (SLE) has substantially improved, a subset of patients experiences severe progressive disease despite T- and B cell targeted therapy. Furthermore, drug-free remission and seroconversion is difficult to achieve in SLE to dateObjectivesTo study the safety, tolerability, and preliminary efficacy of deep B cell depletion using autologous CD19 chimeric antigen receptor (CAR) T cells in patients with severe and treatment-refractory SLEMethodsThe CAR product was manufactured by CliniMACS Prodigy system (Miltenyi Biotec, Bergisch Gladbach, Germany). T-cells were enriched from the patients’ peripheral blood apheresis product and 1x108 cells were used as starting cell population. The cells were transfected with a lentiviral vector encoding an anti-CD19 CAR is composed of the FMC63 scFv, a CD8- derived hinge region, TNFRSF19-derived transmembrane domain, CD3ζ intracellular domain, and 4-1BB co-stimulatory domain (Miltenyi Biotec) and expanded for 12 days. After conditioning with cyclophosphamide/ fludarabine patients received 1x106 CD19-CAR-T cells/kg body weight as a single infusion. All SLE treatments with the exception of low dose prednisolone were stopped before CAR-T cell administration. After CAR-T cell treatment, also prednisolone was stopped. Tolerability was assessed by monitoring for Cytokine-release syndrome (CRS), immune-related effector cell neurotoxicity syndrome (ICANS) and infections. Preliminary efficacy was assessed by reaching a Lupus Low Disease Activity State (LLDAS), seroconversion in dsDNA antibodies and ANA and cessation of all SLE-specific treatmentsResultsAs of January 22, 2022, our 4 SLE patients had been treated with CD19 CAR-T cells with a follow up of 10 months (patient 1, female aged 20, SLEDAI-2K: 16), 7 months (patient 2, male aged 22; SLEDAI-2K:8), 2 months (patient 3, female aged 22; SLEDAI 2K: 6), and 1 month (patient 4; female aged 24; SLEDAI-2K: 6), respectively. All patients had active severe SLE with failure of standard treatment including pulsed steroids, hydroxychloroquine, mycophenolate, cyclophosphamide, intravenous immunoglobulins, rituximab and belimumab before CD19 CAR-T cell administration. All patients had active kidney disease. No infections occurred. All four patients experienced fever without proof of infectious disease (CRS °I); only one patient was treated with a single dose of tocilizumab. No ICANS and no CRS of other organs occurred. In vivo, CAR-T cells rapidly expanded to a maximum of 27,6% (day 9, patient 1), 41,2% (day 9, patient 2), 11,5% (day 9, patient 3) and 59,1% (day 9, patient 4) of total circulating T cells followed by a typical decline, with circulating CAR-T cells being continuously detectable during the next months. Expansion of CAR T cells preceded the complete and sustained depletion of circulating B cells. Patient 1 experienced sustained drug-free remission (SLEDAI-2K=0) with complete loss of ANA and dsDNA antibodies despite reappearance of B cells at 6 months. Patient 2 also experienced complete loss of ANA and dsDNA antibodies with B cells not yet returned. Low-level proteinuria remained most likely due to previously accrued damage in glomerular filter function (SLEDAI-2K: 2). Patient 3 and patient 4 had a shorter observation period to date but also achieved clinical remission (both SLEDAI-2K 0). All patients met LLDAS and could successfully stop all SLE-specific medication, including glucocorticoids. No SLE flare occurred so far.ConclusionTaken together, these data show that CD19 CAR T-cell therapy is well tolerated and may induce rapid remission of severe refractory SLE.References[1]Mougiakakos D et al., CD19-Targeted CAR T Cells in Refractory Systemic Lupus Erythematosus. N Engl J Med 2021;385:567-569.Disclosure of InterestsNone declared
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Verveen A, Müller F, Lloyd A, Moss-Morris R, Omland T, Penninx B, Raijmakers RPH, van der Schaaf M, Sandler CX, Stavem K, Wessely S, Wyller VBB, Nieuwkerk P, Knoop H. A research agenda for post-COVID-19 fatigue. J Psychosom Res 2022; 154:110726. [PMID: 35086054 PMCID: PMC8786369 DOI: 10.1016/j.jpsychores.2022.110726] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Anouk Verveen
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Andrew Lloyd
- The Kirby Institute, UNSW Sydney, NSW, Australia
| | - Rona Moss-Morris
- Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brenda Penninx
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Ruud P H Raijmakers
- Department of Primary Care, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Carolina X Sandler
- The Kirby Institute, UNSW Sydney, NSW, Australia; School of Health Sciences, Western Sydney University, NSW, Australia
| | - Knut Stavem
- Department of Pulmonary Medicine, Akershus University Hospital, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Simon Wessely
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Vegard B B Wyller
- Department of Pediatrics and Adolescent Medicine, Akershus University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
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Kuut TA, Müller F, Aldenkamp A, Assmann-Schuilwerve E, Braamse A, Geerlings SE, Gibney KB, Kanaan RAA, Nieuwkerk P, Olde Hartman TC, Pauëlsen D, Prins M, Slieker K, Van Vugt M, Bleeker-Rovers CP, Keijmel SP, Knoop H. A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol. Trials 2021; 22:867. [PMID: 34857010 PMCID: PMC8637041 DOI: 10.1186/s13063-021-05569-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) results in debilitating long-term symptoms, often referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), in a substantial subgroup of patients. One of the most prevalent symptoms following COVID-19 is severe fatigue. Prompt delivery of cognitive behavioural therapy (CBT), an evidence-based treatment that has shown benefit in reducing severe fatigue in other conditions, may reduce post-COVID-19 fatigue. Based on an existing CBT protocol, a blended intervention of 17 weeks, Fit after COVID, was developed to treat severe fatigue after the acute phase of infection with SARS-CoV-2. METHOD The ReCOVer study is a multicentre 2-arm randomised controlled trial (RCT) to test the efficacy of Fit after COVID on severe post-infectious fatigue. Participants are eligible if they report severe fatigue 3 up to and including 12 months following COVID-19. One hundred and fourteen participants will be randomised to either Fit after COVID or care as usual (ratio 1:1). The primary outcome, the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue), is assessed in both groups before randomisation (T0), directly post CBT or following care as usual (T1), and at follow-up 6 months after the second assessment (T2). In addition, a long-term follow-up (T3), 12 months after the second assessment, is performed in the CBT group only. The primary objective is to investigate whether CBT will lead to a significantly lower mean fatigue severity score measured with the CIS-fatigue across the first two follow-up assessments (T1 and T2) as compared to care as usual. Secondary objectives are to determine the proportion of participants no longer being severely fatigued (operationalised in different ways) at T1 and T2 and to investigate changes in physical and social functioning, in the number and severity of somatic symptoms and in problems concentrating across T1 and T2. DISCUSSION This is the first trial testing a cognitive behavioural intervention targeting severe fatigue after COVID-19. If Fit after COVID is effective in reducing fatigue severity following COVID-19, this intervention could contribute to alleviating the long-term health consequences of COVID-19 by relieving one of its most prevalent and distressing long-term symptoms. TRIAL REGISTRATION Netherlands Trial Register NL8947 . Registered on 14 October 2020.
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Affiliation(s)
- T A Kuut
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Amsterdam University Medical Centers, Expert Center for Chronic Fatigue, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - F Müller
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Aldenkamp
- Department of Lung Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | | | - A Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S E Geerlings
- Department of Internal Medicine, Division Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - K B Gibney
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - R A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - P Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - T C Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Pauëlsen
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M Prins
- Department of Internal Medicine, Division Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - K Slieker
- Department of Internal Medicine, Bernhoven, Uden, The Netherlands
| | - M Van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - C P Bleeker-Rovers
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - S P Keijmel
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, Expert Center for Chronic Fatigue, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Poort H, Müller F, Bleijenberg G, Verhagen SAHHVM, Verdam MGE, Nieuwkerk PT, Knoop H. Condition or cognition? Mechanism of change in fatigue in a randomized controlled trial of graded exercise therapy or cognitive behavior therapy for severe fatigue in patients with advanced cancer. J Consult Clin Psychol 2021; 89:731-741. [PMID: 34435804 DOI: 10.1037/ccp0000670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Fatigue remains one of the most common and distressing symptoms during treatment for advanced cancer. The TIRED trial demonstrated cognitive behavior therapy's (CBT) significant and clinically relevant effects to reduce fatigue among patients with advanced cancer, while graded exercise therapy (GET) did not prove beneficial. The present study aims to determine the mechanisms by which CBT and GET affect fatigue. METHOD The TIRED trial randomized 134 patients with advanced cancer to CBT (n = 46), GET (n = 42), or usual care (n = 46). At 14 weeks, 126 evaluable patients provided fatigue data and of those 117 received ≥1 CBT or GET session or usual care. We tested a prespecified multiple mediation model with four potential mediators (physical activity, exercise capacity, self-efficacy, and fatigue catastrophizing) assessed at baseline and at 14 weeks. Post-hoc analyses also included perceived physical activity and emotional functioning as potential mediators. RESULTS A total of 82 of 117 patients completed all required measures. CBT reduced fatigue indirectly through its effect on self-efficacy, ab = -3.292; 97.5% bootstrap CI [-6.518 to -0.598]. CBT participants experienced an increase in fatigue self-efficacy, with greater self-efficacy associated with decreased fatigue severity. There was no evidence that changes in physical activity, exercise capacity, perceived physical activity, fatigue catastrophizing, or emotional functioning mediated CBT's or GET's effects on fatigue. CONCLUSIONS The effect of CBT was attributable to changes in cognition, that is, increased self-efficacy led to reduced fatigue severity. No significant mediators for GET were found. The findings inform further refinement of interventions for fatigue in this seriously ill population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Hanneke Poort
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam
| | - Gijs Bleijenberg
- Department of Medical Psychology, Radboud University Medical Center
| | | | - Mathilde G E Verdam
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam
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Butow P, Müller F, Napier CE, Bartley N, Ballinger ML, Biesecker B, Juraskova I, Meiser B, Schlub TE, Thomas DM, Goldstein D, Best MC. Longitudinal patterns in fear of cancer progression in patients with rare, advanced cancers undergoing comprehensive tumour genomic profiling. Psychooncology 2021; 30:1920-1929. [PMID: 34240516 DOI: 10.1002/pon.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/13/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Fear of cancer progression (FCP) impacts quality of life and is a prevalent unmet need in patients diagnosed with advanced cancer, particularly as treatment options are reduced. We aimed to identify longitudinal patterns in FCP over 6 months in patients with advanced cancer receiving comprehensive tumour genomic profiling (CTGP) results, and their correlates. METHODS Patients with pathologically confirmed metastatic disease (∼70% rare cancers) receiving or post their last line of standard therapy completed questionnaires at T0 (prior to CTGP), T1 (immediately post CTGP results) and T2 (2 months later). RESULTS High stable (N = 52; 7.3%) and low/moderate stable (N = 56; 7.8%) FCP patterns over time typified the largest participant groups (N = 721). Those with an immediately actionable variant versus a non-actionable variant (p = 0.045), with higher FCP (p < 0.001), and lower Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) scores (p = 0.006) at T0, had higher FCP at T1. Those with higher FCP at T0 (p < 0.001) and at T1 (p < 0.001), lower FACIT-Sp scores at T1 (p = 0.001), lower education (p = 0.031) and female gender (p = 0.027) had higher FCP at T2. DISCUSSION Routine screening for psychological/spiritual characteristics in those about to undergo CTGP may help to identify patients who may benefit from closer monitoring and provision of psychosocial support. Future studies should explore interventions to best address FCP in this vulnerable group, as interventions assessed to date have almost all addressed patients with curative cancers or newly diagnosed advanced disease.
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Affiliation(s)
- Phyllis Butow
- School of Psychology, Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Fabiola Müller
- Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Christine E Napier
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Nicci Bartley
- School of Psychology, Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Mandy L Ballinger
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
| | | | - Ilona Juraskova
- School of Psychology, Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Kensington, New South Wales, Australia
| | - Timothy E Schlub
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David M Thomas
- Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Megan C Best
- School of Psychology, Psycho-Oncology Co-operative Research Group, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Ethics and Society, University of Notre Dame, Broadway, New South Wales, Australia
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20
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Gazsi G, Ivánovics B, Izabella RB, Szabó T, Daniel Z, Kucska B, Urbányi B, Horváth L, Müller F, Müller T. Artificial sperm insemination in externally fertilised fish as a novel tool for ex situ and in situ conservation of valuable populations. ENDANGER SPECIES RES 2021. [DOI: 10.3354/esr01124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Loss of genetic diversity and accumulation of deleterious mutations may lead to inbreeding depression in captive breeding. To address the problem of maintaining genetic diversity, we developed a new fish spawning method which offers flexibility in crossing diverse species when in vitro fertilisation (IVF) is not available. This method involves the collection of sperm from several males of ovuliparous fish; the sperm mix is then injected by catheter into the ovarian cavity of a female through the oviduct. We demonstrate, using zebrafish as a model for externally fertilised fish, that the sperm survives the ovarian conditions and can fertilise ovulated eggs, which are released from the body cavity during natural spawning. Wild type females were injected with reporter transgenic sperm from homozygous transgenic males before intended spawning with wild type males. The sperm injection method did not have an impact on reproductive parameters such as egg production or fertilisation rate compared to controls. In 25 successful spawning experiments, 20 females produced mixed genotype offspring comprising both transgenic and wild type larvae in varying ratios, indicating that the injected transgenic sperm efficiently competed with sperm released by non-transgenic wild type mating males, and both sperm types contributed to the fertilisation of the released eggs. This experiment provides proof of principle for increasing the genetic base of offspring of fish species, including that of many endangered fish species for which IVF is not available due to lack of timed induction of ovulation or when gametic release cannot be synchronised.
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Affiliation(s)
- G Gazsi
- Department of Environmental Toxicology, Institute of Aquaculture and Environmental Safety, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
| | - B Ivánovics
- Department of Environmental Toxicology, Institute of Aquaculture and Environmental Safety, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
| | - RB Izabella
- Department of Environmental Toxicology, Institute of Aquaculture and Environmental Safety, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
| | - T Szabó
- Department of Aquaculture, Institute of Aquaculture and Environmental Safety, Department of Aquaculture, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
| | - Z Daniel
- Institute of Animal Reproduction and Food Research of Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland
| | - B Kucska
- Department of Applied Fish Biology, Institute of Aquaculture and Environmental Safety, Kaposvár Campus, Hungarian University of Agriculture and Life Sciences 7400 Kaposvár, Guba S. u. 40, Hungary
| | - B Urbányi
- Department of Aquaculture, Institute of Aquaculture and Environmental Safety, Department of Aquaculture, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
| | - L Horváth
- Department of Aquaculture, Institute of Aquaculture and Environmental Safety, Department of Aquaculture, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
| | - F Müller
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT Birmingham, UK
| | - T Müller
- Department of Freshwater Fish Ecology, Institute of Aquaculture and Environmental Safety, Szent István Campus, Hungarian University of Agriculture and Life Sciences, 2100 Gödöllő, Páter K. u. 1, Hungary
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21
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King MT, Norman R, Mercieca-Bebber R, Costa DSJ, McTaggart-Cowan H, Peacock S, Janda M, Müller F, Viney R, Pickard AS, Cella D. The Functional Assessment of Cancer Therapy Eight Dimension (FACT-8D), a Multi-Attribute Utility Instrument Derived From the Cancer-Specific FACT-General (FACT-G) Quality of Life Questionnaire: Development and Australian Value Set. Value Health 2021; 24:862-873. [PMID: 34119085 DOI: 10.1016/j.jval.2021.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To develop a cancer-specific multi-attribute utility instrument derived from the Functional Assessment of Cancer Therapy - General (FACT-G) health-related quality of life (HRQL) questionnaire. METHODS We derived a descriptive system based on a subset of the 27-item FACT-G. Item selection was informed by psychometric analyses of existing FACT-G data (n = 6912) and by patient input (n = 82). We then conducted an online valuation survey, with participants recruited via an Australian general population online panel. A discrete choice experiment (DCE) was used, with attributes being the HRQL dimensions of the descriptive system and survival duration, and 16 choice-pairs per participant. Utility decrements were estimated with conditional logit and mixed logit modeling. RESULTS Eight HRQL dimensions were included in the descriptive system: pain, fatigue, nausea, sleep, work, social support, sadness, and future health worry; each with 5 levels. Of 1737 panel members who accessed the valuation survey, 1644 (95%) completed 1 or more DCE choice-pairs and were included in analyses. Utility decrements were generally monotonic; within each dimension, poorer HRQL levels generally had larger utility decrements. The largest utility decrements were for the highest levels of pain (-0.40) and nausea (-0.28). The worst health state had a utility of -0.54, considerably worse than dead. CONCLUSIONS A descriptive system and preference-based scoring approach were developed for the FACT-8D, a new cancer-specific multi-attribute utility instrument derived from the FACT-G. The Australian value set is the first of a series of country-specific value sets planned that can facilitate cost-utility analyses based on items from the FACT-G and related FACIT questionnaires containing FACT-G items.
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Affiliation(s)
- Madeleine T King
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia.
| | - Richard Norman
- Curtin University - Perth City Campus, and Department of Health Policy and Management, Bentley Campus, Perth, ACT, Australia
| | - Rebecca Mercieca-Bebber
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; The University of Sydney, Faculty of Medicine and Health, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Daniel S J Costa
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; Pain Management Research Institute, Saint Leonards, NSW, Australia and The University of Sydney, Sydney Medical School, Sydney, NSW, Australia
| | - Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada and British Columbia Cancer Agency, Vancouver, BC, Canada; Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada and British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Monika Janda
- Queensland University of Technology, School of Public Health, Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
| | - Fabiola Müller
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia; Amsterdam University Medical Centres, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, NL
| | - Rosalie Viney
- University of Technology Sydney, Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia
| | - Alan Simon Pickard
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | - David Cella
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, IL, USA
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22
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Müller F, Wijayanto F, Abrahams H, Gielissen M, Prinsen H, Braamse A, van Laarhoven HWM, Groot P, Heskes T, Knoop H. Potential mechanisms of the fatigue-reducing effect of cognitive-behavioral therapy in cancer survivors: Three randomized controlled trials. Psychooncology 2021; 30:1476-1484. [PMID: 33899978 PMCID: PMC8518952 DOI: 10.1002/pon.5710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive-behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive-behavioral variables and reduced depressive symptoms mediate the fatigue-reducing effect of CBT. METHODS We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre-treatment and 6 months later. Classical mediation analysis testing a pre-specified model was conducted and its results compared to those of causal discovery, an explorative data-driven approach testing all possible causal associations and retaining the most likely model. RESULTS Data from 250 cancer survivors (n = 129 CBT, n = 121 waitlist) were analyzed. Classical mediation analysis suggests that increased self-efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post-hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms. CONCLUSIONS Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre- and post-treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one-way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT.
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Affiliation(s)
- Fabiola Müller
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
| | - Feri Wijayanto
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.,Department of Informatics, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Harriët Abrahams
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marieke Gielissen
- Academy Het Dorp, Arnhem, The Netherlands.,Siza (disability service) Arnhem, Arnhem, The Netherlands
| | - Hetty Prinsen
- Department of Medical Oncology, Radboud University, Nijmegen, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Perry Groot
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam University Medical Centers, Expert Center for Chronic Fatigue, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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23
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Revicki DA, King MT, Viney R, Pickard AS, Mercieca-Bebber R, Shaw JW, Müller F, Norman R. United States Utility Algorithm for the EORTC QLU-C10D, a Multiattribute Utility Instrument Based on a Cancer-Specific Quality-of-Life Instrument. Med Decis Making 2021; 41:485-501. [PMID: 33813946 DOI: 10.1177/0272989x211003569] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The EORTC QLU-C10D is a multiattribute utility measure derived from the cancer-specific quality-of-life questionnaire, the EORTC QLQ-C30. The QLU-C10D contains 10 dimensions (physical, role, social and emotional functioning, pain, fatigue, sleep, appetite, nausea, bowel problems). The objective of this study was to develop a United States value set for the QLU-C10D. METHODS A US online panel was quota recruited to achieve a representative sample for sex, age (≥18 y), race, and ethnicity. Respondents undertook a discrete choice experiment, each completing 16 choice-pairs, randomly assigned from a total of 960 choice-pairs. Each pair included 2 QLU-C10D health states and duration. Data were analyzed using conditional logistic regression, parameterized to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each dimension-level coefficient to the coefficient for life expectancy. RESULTS A total of 2480 panel members opted in, 2333 (94%) completed at least 1 choice-pair, and 2273 (92%) completed all choice-pairs. Within dimensions, weights were generally monotonic. Physical functioning, role functioning, and pain were associated with the largest utility weights. Cancer-specific dimensions, such as nausea and bowel problems, were associated with moderate utility decrements, as were general issues such as problems with emotional functioning and social functioning. Sleep problems and fatigue were associated with smaller utility decrements. The value of the worst health state was 0.032, which was slightly greater than 0 (equivalent to being dead). CONCLUSIONS This study provides the US-specific value set for the QLU-C10D. These estimated health state scores, based on responses to the EORTC QLQ-C30 questionnaire, can be used to evaluate the cost-utility of oncology treatments.
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Affiliation(s)
| | - Madeleine T King
- School of Psychology, Sydney, University of Sydney, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research & Evaluation, UTS Business School, University of Technology Sydney, Sydney, New South Wales, Australia
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca Mercieca-Bebber
- School of Psychology, Sydney, University of Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - James W Shaw
- Patient-Reported Outcomes Assessment, Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - Fabiola Müller
- School of Psychology, Sydney, University of Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
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Rincón Montes V, Gehlen J, Ingebrandt S, Mokwa W, Walter P, Müller F, Offenhäusser A. Development and in vitro validation of flexible intraretinal probes. Sci Rep 2020; 10:19836. [PMID: 33199768 PMCID: PMC7669900 DOI: 10.1038/s41598-020-76582-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/28/2020] [Indexed: 12/01/2022] Open
Abstract
The efforts to improve the treatment efficacy in blind patients with retinal degenerative diseases would greatly benefit from retinal activity feedback, which is lacking in current retinal implants. While the door for a bidirectional communication device that stimulates and records intraretinally has been opened by the recent use of silicon-based penetrating probes, the biological impact induced by the insertion of such rigid devices is still unknown. Here, we developed for the first time, flexible intraretinal probes and validated in vitro the acute biological insertion impact in mouse retinae compared to standard silicon-based probes. Our results show that probes based on flexible materials, such as polyimide and parylene-C, in combination with a narrow shank design 50 µm wide and 7 µm thick, and the use of insertion speeds as high as 187.5 µm/s will successfully penetrate the retina, reduce the footprint of the insertion to roughly 2 times the cross-section of the probe, and induce low dead cell counts, while keeping the vitality of the tissue and recording the neural activity at different depths.
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Affiliation(s)
- V Rincón Montes
- Bioelectronics, Institute of Biological Information Processing-3, Forschungszentrum Jülich, Jülich, Germany
- RWTH Aachen University, Aachen, Germany
| | - J Gehlen
- Molecular and Cellular Physiology, Institute of Biological Information Processing-1, Forschungszentrum Jülich, Jülich, Germany
| | - S Ingebrandt
- Institute of Materials in Electrical Engineering 1, RWTH Aachen University, Aachen, Germany
| | - W Mokwa
- Institute of Materials in Electrical Engineering 1, RWTH Aachen University, Aachen, Germany
| | - P Walter
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - F Müller
- Molecular and Cellular Physiology, Institute of Biological Information Processing-1, Forschungszentrum Jülich, Jülich, Germany
| | - A Offenhäusser
- Bioelectronics, Institute of Biological Information Processing-3, Forschungszentrum Jülich, Jülich, Germany.
- RWTH Aachen University, Aachen, Germany.
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25
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Mason NL, Kuypers KPC, Müller F, Reckweg J, Tse DHY, Toennes SW, Hutten NRPW, Jansen JFA, Stiers P, Feilding A, Ramaekers JG. Me, myself, bye: regional alterations in glutamate and the experience of ego dissolution with psilocybin. Neuropsychopharmacology 2020; 45:2003-2011. [PMID: 32446245 PMCID: PMC7547711 DOI: 10.1038/s41386-020-0718-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/14/2020] [Indexed: 01/21/2023]
Abstract
There is growing interest in the therapeutic utility of psychedelic substances, like psilocybin, for disorders characterized by distortions of the self-experience, like depression. Accumulating preclinical evidence emphasizes the role of the glutamate system in the acute action of the drug on brain and behavior; however this has never been tested in humans. Following a double-blind, placebo-controlled, parallel group design, we utilized an ultra-high field multimodal brain imaging approach and demonstrated that psilocybin (0.17 mg/kg) induced region-dependent alterations in glutamate, which predicted distortions in the subjective experience of one's self (ego dissolution). Whereas higher levels of medial prefrontal cortical glutamate were associated with negatively experienced ego dissolution, lower levels in hippocampal glutamate were associated with positively experienced ego dissolution. Such findings provide further insights into the underlying neurobiological mechanisms of the psychedelic, as well as the baseline, state. Importantly, they may also provide a neurochemical basis for therapeutic effects as witnessed in ongoing clinical trials.
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Affiliation(s)
- N L Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - K P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - F Müller
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - J Reckweg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - D H Y Tse
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - S W Toennes
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt/Main, Germany
| | - N R P W Hutten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - J F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, the Netherlands
| | - P Stiers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - A Feilding
- The Beckley Foundation, Beckley Park, Oxford, OX3 9SY, UK
| | - J G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
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26
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Rutherford C, Müller F, Faiz N, King MT, White K. Patient-reported outcomes and experiences from the perspective of colorectal cancer survivors: meta-synthesis of qualitative studies. J Patient Rep Outcomes 2020; 4:27. [PMID: 32335745 PMCID: PMC7183519 DOI: 10.1186/s41687-020-00195-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is prevalent in the developed world. Favourable survival rates highlight the need to better understand CRC survivors' experiences of long-term impacts of treatment, which can in turn inform decision making. This systematic review aimed to identify and synthesise CRC survivors' experiences of long-term impacts on health-related quality of life. METHODS We searched Medline, Embase and PsychINFO from inception to January 2019. Qualitative studies describing CRC survivors' experiences at least 1-year post-treatment were included. Study eligibility, quality assessment (COREQ guidelines), and data synthesis was performed independently by two reviewers and discussed with the study team. RESULTS Of 1363 papers retrieved, 20 reporting 15 studies met eligibility. Thematic synthesis produced 12 themes: symptoms, physical, social, psychological and sexual functioning, impact on relationships, informal care needs provided by family/friend, supportive care needs provided by healthcare professional, health care experiences, health behaviour, financial toxicity and occupational experiences. Stoma problems (e.g. leakage, skin irritation) were common in ostomates. Survivors with no/reversed stoma experienced unexpected, long-term altered and unpredictable bowel functioning. Survivors often regulated timing, amount and foods consumed to manage bowel functioning. Less common symptoms included fatigue, impaired sleep and anal pain. Stoma problems and altered bowel functioning impaired survivors' physical, social, sexual and psychological functioning. Cognitive functioning and heredity issues were not reported in any paper. CONCLUSION CRC survivors experience ongoing symptoms and functioning impairments more than 1-year post-treatment completion. Many survivors find their own ways to manage symptoms rather than seek professional help. Follow-up care for CRC survivors should integrate screening for long-term effects and provide targeted supportive care.
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Affiliation(s)
- Claudia Rutherford
- The University of Sydney, School of Psychology, Quality of Life Office, Faculty of Science, Sydney, Australia.
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia.
| | - Fabiola Müller
- The University of Sydney, School of Psychology, Quality of Life Office, Faculty of Science, Sydney, Australia
| | - Nasiba Faiz
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia
| | - Madeleine T King
- The University of Sydney, School of Psychology, Quality of Life Office, Faculty of Science, Sydney, Australia
| | - Kate White
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia
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Kremer J, Müller F, Heininger A, Soethoff J, Farag M, Karck M, Ruhparwar A, Schmack B. Wound Management of Driveline Infections with Cold Atmospheric Argon Plasma - Proof of Concept. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Müller F, Hagedoorn M, Soriano EC, Stephenson E, Smink A, Hoff C, DeLongis A, Laurenceau JP, Tuinman MA. Couples' catastrophizing and co-rumination: Dyadic diary study of patient fatigue after cancer. Health Psychol 2019; 38:1096-1106. [PMID: 31580128 DOI: 10.1037/hea0000803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Fatigue is a prevalent and long-lasting symptom among patients with cancer that is known to be worsened by patients' catastrophizing thoughts about their fatigue. Spouses are also burdened by patient fatigue, which may lead them to catastrophize as well. Based on the dyadic coping literature, this study hypothesized that patient and spouse catastrophizing translate into worse fatigue through co-rumination-couples' communications dwelling on the negative aspects of fatigue (H1). While maladaptive for fatigue, co-rumination also was expected to foster couple relationship satisfaction (H2). METHOD Posttreatment patients with cancer and their spouses (n = 101 dyads) completed daily diaries for 14 days. Patients reported on their momentary fatigue severity. Both couple members reported on their catastrophizing about the patients' fatigue, co-rumination, and their momentary relationship satisfaction. Multilevel structural equation modeling was applied to test within-person actor- and partner-effects between catastrophizing, co-rumination, and changes in fatigue (H1) and between co-rumination and changes in relationship satisfaction (H2). RESULTS Whereas patient catastrophizing was directly related to their fatigue (b = 0.52, 95% credibility interval [CI] [0.09, 0.95]), as hypothesized, the effect of spouse catastrophizing on patient fatigue was mediated through co-rumination (indirect effect = 0.32, 95% CI [0.07, 0.60]). Unexpectedly, patient- and spouse-reported co-rumination were unrelated to both couple members' relationship satisfaction. CONCLUSIONS Spouse catastrophizing contributes to patient fatigue severity through couples' ruminative communications. Co-rumination was not related to relationship satisfaction. Reducing patient and spouse catastrophizing and fostering adaptive dyadic communication in daily life could be targets for future interventions aiming to relieve fatigue in patients after completion of cancer treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Fassunke J, Heydt C, Michels S, Van Veggel B, Müller F, Keul M, Dammert M, Schmitt A, Smit E, Kast S, Wolf J, Buettner R, Sos M, Rauh D, Merkelbach-Bruse S. New insights into acquired resistance mechanisms to third-generation EGFR tyrosine kinase inhibitor therapy in lung cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Müller F, Tuinman MA, Stephenson E, Smink A, DeLongis A, Hagedoorn M. Associations of daily partner responses with fatigue interference and relationship satisfaction in colorectal cancer patients. Health Psychol 2018; 37:1015-1024. [PMID: 30247065 DOI: 10.1037/hea0000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study investigates the associations of daily partner responses toward patient's fatigue and well behavior with patient's fatigue interference and relationship satisfaction. The moderating effect of fatigue severity was also examined. METHOD In an intensive longitudinal design, patients treated for colorectal cancer and their partners (n = 101 dyads) completed diaries for 14 days. Patients and partners reported on partner responses toward patient's fatigue behavior (e.g., resting), partner responses toward patient's well behavior (e.g., being active), and fatigue severity. Patients also indicated their fatigue interference and relationship satisfaction. Multilevel modeling was applied to assess within-person main and interaction effects. RESULTS Patient-reported solicitous responses toward fatigue behavior and negative responses toward well behavior were associated with increases in fatigue interference, while facilitative responses toward well behavior were associated with a decrease in fatigue interference. The latter two associations were intensified on days patients reported relatively high fatigue. Solicitous responses toward fatigue behavior and facilitative responses toward well behavior were also associated with increases in relationship satisfaction. Punishing responses toward fatigue behavior were associated with a decrease in relationship satisfaction, especially on days patients reported higher fatigue. Models using partner reports largely confirmed the main effects of partner responses on fatigue interference and relationship satisfaction but failed to reproduce the moderating effect of fatigue. CONCLUSIONS Daily partner responses appear to impact patients' fatigue adjustment, especially on days patients experience high fatigue levels. Only facilitative responses toward well behavior seem to benefit both patients' fatigue interference and relationship satisfaction. Couple interventions should guide partners to encourage patients' well behavior and aid them to correctly estimate patients' current fatigue severity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Fabiola Müller
- Department of Health Psychology, University of Groningen, University Medical Center Groningen
| | - Marrit A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen
| | | | - Ans Smink
- Department of Health Psychology, University of Groningen, University Medical Center Groningen
| | - Anita DeLongis
- Department of Psychology, University of British Columbia
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen
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Kadish N, Brunke M, Spychalski P, Müller F, Berghaeuser J, Pedersen A, Siniatchkin M, Moliadze V. PB19. tDCS in the left DLPFC: When to stimulate and which cognitive domains it affects. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Recent evidence shows that the serotonin 2A receptor (5-hydroxytryptamine2A receptor, 5-HT2AR) is critically involved in the formation of visual hallucinations and cognitive impairments in lysergic acid diethylamide (LSD)-induced states and neuropsychiatric diseases. However, the interaction between 5-HT2AR activation, cognitive impairments and visual hallucinations is still poorly understood. This study explored the effect of 5-HT2AR activation on response inhibition neural networks in healthy subjects by using LSD and further tested whether brain activation during response inhibition under LSD exposure was related to LSD-induced visual hallucinations. METHODS In a double-blind, randomized, placebo-controlled, cross-over study, LSD (100 µg) and placebo were administered to 18 healthy subjects. Response inhibition was assessed using a functional magnetic resonance imaging Go/No-Go task. LSD-induced visual hallucinations were measured using the 5 Dimensions of Altered States of Consciousness (5D-ASC) questionnaire. RESULTS Relative to placebo, LSD administration impaired inhibitory performance and reduced brain activation in the right middle temporal gyrus, superior/middle/inferior frontal gyrus and anterior cingulate cortex and in the left superior frontal and postcentral gyrus and cerebellum. Parahippocampal activation during response inhibition was differently related to inhibitory performance after placebo and LSD administration. Finally, activation in the left superior frontal gyrus under LSD exposure was negatively related to LSD-induced cognitive impairments and visual imagery. CONCLUSION Our findings show that 5-HT2AR activation by LSD leads to a hippocampal-prefrontal cortex-mediated breakdown of inhibitory processing, which might subsequently promote the formation of LSD-induced visual imageries. These findings help to better understand the neuropsychopharmacological mechanisms of visual hallucinations in LSD-induced states and neuropsychiatric disorders.
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Affiliation(s)
- A Schmidt
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - F Müller
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - C Lenz
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - P C Dolder
- Division of Clinical Pharmacology and Toxicology,Department of Biomedicine and Department of Clinical Research,University of Basel, University Hospital Basel,Basel,Switzerland
| | - Y Schmid
- Division of Clinical Pharmacology and Toxicology,Department of Biomedicine and Department of Clinical Research,University of Basel, University Hospital Basel,Basel,Switzerland
| | - D Zanchi
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - U E Lang
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - M E Liechti
- Division of Clinical Pharmacology and Toxicology,Department of Biomedicine and Department of Clinical Research,University of Basel, University Hospital Basel,Basel,Switzerland
| | - S Borgwardt
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
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Galler M, Zellner M, Roll C, Bäuml C, Füchtmeier B, Müller F. A prospective study with ten years follow-up of two-hundred patients with proximal femoral fracture. Injury 2018; 49:841-845. [PMID: 29510856 DOI: 10.1016/j.injury.2018.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The proximal femoral fracture is one of the most common injuries in the elderly. Nevertheless, no results beyond the second year post surgery have been reported in the literature. Therefore, the purpose of this study was to evaluate any revision and mortality within 10 years follow-up as well as the walking ability of still alive patients. METHODS A total of 200 consecutive patients were included. A prospective database was first used to collect the demographic data. Exactly ten years after the surgery, a final evaluation was conducted by telephone for every patient. Any revision, any contralateral as well as other fractures and the date of death were recorded. For all patients who were still alive, the mobility score according to Parker was also surveyed. RESULTS The average age was 79.0 years (SD: 12.5); women were affected at higher numbers (73.5%). The total surgical revision rate was 17.5% (35/200), due in particular to hematoma (9×) or infection (7×). A surgical revision later than two years was only needed in three patients (1.5%). The risk of another fracture caused by a fall was 19% (38/200), most often a contralateral femoral fracture (22/200; 11%) that happened on average 51.9 months (1-97) after the initial surgery. The risk of a contralateral femoral fracture was 15.4% (22/143) in patients who survived the first year post surgery. The postoperative mortality was 1, 2, 5 and 10 years or 23.5%, 32.5%, 55% as well as 81.5%, respectively. An average Parker's mobility score of 6.3 points (0-9) was determined for the 37 patients (18.5%) who were still alive at the time of the follow-up. CONCLUSION The long-term study showed that revision surgery was only required in 3/200 patients (1.5%) beyond the second year of that surgery. On the other hand, more than half of all patients had already passed away five years after the initial surgery. The exact incidence of a contralateral femoral fracture was 11.9%, climbing to 15.4% if the patient survived at least one year. Nearly every fifth patient experienced another fall resulting in a severe fracture requiring treatment during the long-term course.
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Affiliation(s)
- M Galler
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | - M Zellner
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | - C Roll
- University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93055, Regensburg, Germany
| | - C Bäuml
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | - B Füchtmeier
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | - F Müller
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Germany.
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Weger M, Diotel N, Weger BD, Beil T, Zaucker A, Eachus HL, Oakes JA, do Rego JL, Storbeck KH, Gut P, Strähle U, Rastegar S, Müller F, Krone N. Expression and activity profiling of the steroidogenic enzymes of glucocorticoid biosynthesis and the fdx1 co-factors in zebrafish. J Neuroendocrinol 2018; 30:e12586. [PMID: 29486070 DOI: 10.1111/jne.12586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/06/2018] [Accepted: 02/22/2018] [Indexed: 01/23/2023]
Abstract
The spatial and temporal expression of steroidogenic genes in zebrafish has not been fully characterised. Because zebrafish are increasingly employed in endocrine and stress research, a better characterisation of steroidogenic pathways is required to target specific steps in the biosynthetic pathways. In the present study, we have systematically defined the temporal and spatial expression of steroidogenic enzymes involved in glucocorticoid biosynthesis (cyp21a2, cyp11c1, cyp11a1, cyp11a2, cyp17a1, cyp17a2, hsd3b1, hsd3b2), as well as the mitochondrial electron-providing ferredoxin co-factors (fdx1, fdx1b), during zebrafish development. Our studies showed an early expression of all these genes during embryogenesis. In larvae, expression of cyp11a2, cyp11c1, cyp17a2, cyp21a2, hsd3b1 and fdx1b can be detected in the interrenal gland, which is the zebrafish counterpart of the mammalian adrenal gland, whereas the fdx1 transcript is mainly found in the digestive system. Gene expression studies using quantitative reverse transcriptase-PCR and whole-mount in situ hybridisation in the adult zebrafish brain revealed a wide expression of these genes throughout the encephalon, including neurogenic regions. Using ultra-high-performance liquid chromatography tandem mass spectrometry, we were able to demonstrate the presence of the glucocorticoid cortisol in the adult zebrafish brain. Moreover, we demonstrate de novo biosynthesis of cortisol and the neurosteroid tetrahydrodeoxycorticosterone in the adult zebrafish brain from radiolabelled pregnenolone. Taken together, the present study comprises a comprehensive characterisation of the steroidogenic genes and the fdx co-factors facilitating glucocorticoid biosynthesis in zebrafish. Furthermore, we provide additional evidence of de novo neurosteroid biosynthesising in the brain of adult zebrafish facilitated by enzymes involved in glucocorticoid biosynthesis. Our study provides a valuable source for establishing the zebrafish as a translational model with respect to understanding the roles of the genes for glucocorticoid biosynthesis and fdx co-factors during embryonic development and stress, as well as in brain homeostasis and function.
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Affiliation(s)
- M Weger
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N Diotel
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - B D Weger
- Nestlé Institute of Health Sciences SA, Lausanne, Switzerland
| | - T Beil
- Institute of Toxicology and Genetics, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
| | - A Zaucker
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - H L Eachus
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Biomedical Science, The Bateson Centre, Sheffield, UK
| | - J A Oakes
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Biomedical Science, The Bateson Centre, Sheffield, UK
| | - J L do Rego
- Plateforme d'Analyse Comportementale (SCAC), Institut de Recherche et d'Innovation Biomédicale, Inserm U1234, Université de Rouen, Rouen Cedex, France
| | - K-H Storbeck
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - P Gut
- Nestlé Institute of Health Sciences SA, Lausanne, Switzerland
| | - U Strähle
- Institute of Toxicology and Genetics, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
| | - S Rastegar
- Institute of Toxicology and Genetics, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany
| | - F Müller
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N Krone
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Biomedical Science, The Bateson Centre, Sheffield, UK
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Kossioni AE, Maggi S, Müller F, Petrovic M. Oral health in older people: time for action. Eur Geriatr Med 2018; 9:3-4. [DOI: 10.1007/s41999-017-0004-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/23/2017] [Indexed: 11/29/2022]
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Bjørnsen S, Lunden B, Otterdal K, Ng EC, Ameln W, Ueland T, Müller F, Solum NO, Brosstad F, Frøland SS, Aukrust P. Persistently Elevated Levels of von Willebrand Factor Antigen in HIV Infection. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryLevels of circulating von Willebrand factor (vWf) antigen are thought to reflect endothelial involvement in various disorders. In the present study we found markedly elevated plasma levels of vWf in HIV-infected patients demonstrated on both cross-sectional and longitudinal testing. Notably, we found that a persistent rise in vWf antigen was associated with progression of HIV-related disease. This elevation of vWf antigen represented functionally normal vWf as evaluated by plasma FVIII, ristocetin cofactor assay and vWf multimer analyses. While HIV-infected patients showed enhanced platelet activation, platelets did not contribute substantially to the increased vWf levels. The high vWf levels were significantly correlated with high viral load, and during HAART, the pronounced decline in HIV RNA levels was accompanied by a corresponding decrease in vWf. The persistent elevation of functionally normal vWf during HIV infection, most probably reflecting a persistent endothelial cell activation, may have an important role in the pathogenesis of HIV infection.
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Müller F, Lenz C, Dolder P, Lang U, Schmidt A, Liechti M, Borgwardt S. Increased thalamic resting-state connectivity as a core driver of LSD-induced hallucinations. Acta Psychiatr Scand 2017; 136:648-657. [PMID: 28940312 PMCID: PMC5698745 DOI: 10.1111/acps.12818] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE It has been proposed that the thalamocortical system is an important site of action of hallucinogenic drugs and an essential component of the neural correlates of consciousness. Hallucinogenic drugs such as LSD can be used to induce profoundly altered states of consciousness, and it is thus of interest to test the effects of these drugs on this system. METHOD 100 μg LSD was administrated orally to 20 healthy participants prior to fMRI assessment. Whole brain thalamic functional connectivity was measured using ROI-to-ROI and ROI-to-voxel approaches. Correlation analyses were used to explore relationships between thalamic connectivity to regions involved in auditory and visual hallucinations and subjective ratings on auditory and visual drug effects. RESULTS LSD caused significant alterations in all dimensions of the 5D-ASC scale and significantly increased thalamic functional connectivity to various cortical regions. Furthermore, LSD-induced functional connectivity measures between the thalamus and the right fusiform gyrus and insula correlated significantly with subjective auditory and visual drug effects. CONCLUSION Hallucinogenic drug effects might be provoked by facilitations of cortical excitability via thalamocortical interactions. Our findings have implications for the understanding of the mechanism of action of hallucinogenic drugs and provide further insight into the role of the 5-HT2A -receptor in altered states of consciousness.
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Affiliation(s)
- F. Müller
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - C. Lenz
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - P. Dolder
- Division of Clinical Pharmacology and ToxicologyDepartment of Biomedicine and Department of Clinical ResearchUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - U. Lang
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - A. Schmidt
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - M. Liechti
- Division of Clinical Pharmacology and ToxicologyDepartment of Biomedicine and Department of Clinical ResearchUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - S. Borgwardt
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
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Müller F, Stephenson E, DeLongis A, Smink A, Van Ginkel RJ, Tuinman MA, Hagedoorn M. The reciprocal relationship between daily fatigue and catastrophizing following cancer treatment: Affect and physical activity as potential mediators. Psychooncology 2017; 27:831-837. [PMID: 29076568 DOI: 10.1002/pon.4574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Fatigue is a distressing symptom many cancer patients experience even after completion of treatment. Although theory and empirical evidence indicate that negative cognitions perpetuate fatigue after completion of treatment, insight into how this process unfolds in daily life is limited. This study used an intensive longitudinal design to investigate the reciprocal relationship between catastrophizing and fatigue in daily life and whether affective and behavioral processes mediate these relationships. METHODS Post-treatment colorectal cancer patients (n = 101) completed daily diaries (14 days, 3 times daily) regarding their fatigue, catastrophizing, positive and negative affect, and physical activity. Multilevel modeling was applied to investigate within-person associations within days. RESULTS Analyses revealed a positive reciprocal relationship between fatigue and catastrophizing throughout the day. That is, high levels of catastrophizing were associated with increases in fatigue within patients. In turn, but to a lesser extent, high levels of fatigue predicted increases in catastrophizing at the next assessment. Low positive affect and high negative affect mediated the effect of catastrophizing on increases in fatigue. Only negative affect mediated the reverse relationship. Physical activity did not mediate either relationship. CONCLUSIONS This study provides evidence for a mutually reinforcing relationship between catastrophizing and fatigue in daily life, which might explain the perpetuation of fatigue after completion of cancer treatment. Fatigue-specific cognitive behavior therapy could be improved by educating patients about this daily reciprocal relationship, train them to quickly replace catastrophizing thoughts in daily life, and help them to cope with affective changes induced by fatigue.
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Affiliation(s)
- Fabiola Müller
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen Stephenson
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Anita DeLongis
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Ans Smink
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J Van Ginkel
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bove J, Chateau G, Holland P, Kluge A, Roelcke D, Menke H, van Eijk R, Müller F, Leikola J, Schmidt P, Wagstaff W. Does it Make Sense for Blood Transfusion Services to
Continue the Time-Honored Syphilis Screening with
Cardiolipin Antigen? Vox Sang 2017. [DOI: 10.1159/000460641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hempelmann N, Hejny V, Pretz J, Stephenson E, Augustyniak W, Bagdasarian Z, Bai M, Barion L, Berz M, Chekmenev S, Ciullo G, Dymov S, Etzkorn FJ, Eversmann D, Gaisser M, Gebel R, Grigoryev K, Grzonka D, Guidoboni G, Hanraths T, Heberling D, Hetzel J, Hinder F, Kacharava A, Kamerdzhiev V, Keshelashvili I, Koop I, Kulikov A, Lehrach A, Lenisa P, Lomidze N, Lorentz B, Maanen P, Macharashvili G, Magiera A, Mchedlishvili D, Mey S, Müller F, Nass A, Nikolaev NN, Pesce A, Prasuhn D, Rathmann F, Rosenthal M, Saleev A, Schmidt V, Semertzidis Y, Shmakova V, Silenko A, Slim J, Soltner H, Stahl A, Stassen R, Stockhorst H, Ströher H, Tabidze M, Tagliente G, Talman R, Thörngren Engblom P, Trinkel F, Uzikov Y, Valdau Y, Valetov E, Vassiliev A, Weidemann C, Wrońska A, Wüstner P, Zuprański P, Żurek M. Phase Locking the Spin Precession in a Storage Ring. Phys Rev Lett 2017; 119:014801. [PMID: 28731757 DOI: 10.1103/physrevlett.119.014801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Indexed: 06/07/2023]
Abstract
This Letter reports the successful use of feedback from a spin polarization measurement to the revolution frequency of a 0.97 GeV/c bunched and polarized deuteron beam in the Cooler Synchrotron (COSY) storage ring in order to control both the precession rate (≈121 kHz) and the phase of the horizontal polarization component. Real time synchronization with a radio frequency (rf) solenoid made possible the rotation of the polarization out of the horizontal plane, yielding a demonstration of the feedback method to manipulate the polarization. In particular, the rotation rate shows a sinusoidal function of the horizontal polarization phase (relative to the rf solenoid), which was controlled to within a 1 standard deviation range of σ=0.21 rad. The minimum possible adjustment was 3.7 mHz out of a revolution frequency of 753 kHz, which changes the precession rate by 26 mrad/s. Such a capability meets a requirement for the use of storage rings to look for an intrinsic electric dipole moment of charged particles.
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Affiliation(s)
- N Hempelmann
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - V Hejny
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - J Pretz
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- JARA-FAME (Forces and Matter Experiments), Forschungszentrum Jülich and RWTH Aachen University, 52056 Aachen, Germany
| | - E Stephenson
- Indiana University Center for Spacetime Symmetries, Bloomington, Indiana 47405, USA
| | - W Augustyniak
- Department of Nuclear Physics, National Centre for Nuclear Research, 00681 Warsaw, Poland
| | - Z Bagdasarian
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- High Energy Physics Institute, Tbilisi State University, 0186 Tbilisi, Georgia
| | - M Bai
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- JARA-FAME (Forces and Matter Experiments), Forschungszentrum Jülich and RWTH Aachen University, 52056 Aachen, Germany
| | - L Barion
- University of Ferrara and INFN, 44100 Ferrara, Italy
| | - M Berz
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - S Chekmenev
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
| | - G Ciullo
- University of Ferrara and INFN, 44100 Ferrara, Italy
| | - S Dymov
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 141980 Dubna, Russia
| | - F-J Etzkorn
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - D Eversmann
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
| | - M Gaisser
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Center for Axion and Precision Physics Research, Institute for Basic Science (IBS), Daejeon 34141, Republic of Korea
| | - R Gebel
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - K Grigoryev
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
| | - D Grzonka
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - G Guidoboni
- University of Ferrara and INFN, 44100 Ferrara, Italy
| | - T Hanraths
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - D Heberling
- JARA-FAME (Forces and Matter Experiments), Forschungszentrum Jülich and RWTH Aachen University, 52056 Aachen, Germany
- Institut für Hochfrequenztechnik, RWTH Aachen University, 52056 Aachen, Germany
| | - J Hetzel
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - F Hinder
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - A Kacharava
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - V Kamerdzhiev
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - I Keshelashvili
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - I Koop
- Budker Institute of Nuclear Physics, 630090 Novosibirsk, Russia
| | - A Kulikov
- Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 141980 Dubna, Russia
| | - A Lehrach
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- JARA-FAME (Forces and Matter Experiments), Forschungszentrum Jülich and RWTH Aachen University, 52056 Aachen, Germany
| | - P Lenisa
- University of Ferrara and INFN, 44100 Ferrara, Italy
| | - N Lomidze
- High Energy Physics Institute, Tbilisi State University, 0186 Tbilisi, Georgia
| | - B Lorentz
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - P Maanen
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
| | - G Macharashvili
- High Energy Physics Institute, Tbilisi State University, 0186 Tbilisi, Georgia
- Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 141980 Dubna, Russia
| | - A Magiera
- Institute of Physics, Jagiellonian University, 30348 Cracow, Poland
| | - D Mchedlishvili
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- High Energy Physics Institute, Tbilisi State University, 0186 Tbilisi, Georgia
| | - S Mey
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - F Müller
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - A Nass
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - N N Nikolaev
- L.D. Landau Institute for Theoretical Physics, 142432 Chernogolovka, Russia
- Moscow Institute for Physics and Technology, 141700 Dolgoprudny, Russia
| | - A Pesce
- University of Ferrara and INFN, 44100 Ferrara, Italy
| | - D Prasuhn
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - F Rathmann
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - M Rosenthal
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - A Saleev
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- Samara National Research University, 443086 Samara, Russia
| | - V Schmidt
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Y Semertzidis
- Center for Axion and Precision Physics Research, Institute for Basic Science (IBS), Daejeon 34141, Republic of Korea
- Research Institute for Nuclear Problems, Belarusian State University, 220030 Minsk, Belarus
| | - V Shmakova
- Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 141980 Dubna, Russia
| | - A Silenko
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
- Bogoliubov Laboratory of Theoretical Physics, Joint Institute for Nuclear Research, 141980 Dubna, Russia
| | - J Slim
- Institut für Hochfrequenztechnik, RWTH Aachen University, 52056 Aachen, Germany
| | - H Soltner
- Zentralinstitut für Engineering, Elektronik und Analytik (ZEA-1), Forschungszentrum Jülich, 52425 Jülich, Germany
| | - A Stahl
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- JARA-FAME (Forces and Matter Experiments), Forschungszentrum Jülich and RWTH Aachen University, 52056 Aachen, Germany
| | - R Stassen
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - H Stockhorst
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - H Ströher
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
- JARA-FAME (Forces and Matter Experiments), Forschungszentrum Jülich and RWTH Aachen University, 52056 Aachen, Germany
| | - M Tabidze
- High Energy Physics Institute, Tbilisi State University, 0186 Tbilisi, Georgia
| | | | - R Talman
- Cornell University, Ithaca, New York 14850, USA
| | - P Thörngren Engblom
- Department of Physics, KTH Royal Institute of Technology, SE-10691 Stockholm, Sweden
| | - F Trinkel
- III. Physikalisches Institut B, RWTH Aachen University, 52056 Aachen, Germany
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Yu Uzikov
- Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, 141980 Dubna, Russia
| | - Yu Valdau
- Helmholtz-Institut für Strahlen- und Kernphysik, Universität Bonn, 53115 Bonn, Germany
- Petersburg Nuclear Physics Institute, 188300 Gatchina, Russia
| | - E Valetov
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Vassiliev
- Petersburg Nuclear Physics Institute, 188300 Gatchina, Russia
| | - C Weidemann
- University of Ferrara and INFN, 44100 Ferrara, Italy
| | - A Wrońska
- Institute of Physics, Jagiellonian University, 30348 Cracow, Poland
| | - P Wüstner
- Zentralinstitut für Engineering, Elektronik und Analytik (ZEA-2), Forschungszentrum Jülich, 52425 Jülich, Germany
| | - P Zuprański
- Department of Nuclear Physics, National Centre for Nuclear Research, 00681 Warsaw, Poland
| | - M Żurek
- Institut für Kernphysik, Forschungszentrum Jülich, 52425 Jülich, Germany
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Müller F, Tuinman MA, Janse M, Almansa J, Sprangers MAG, Smink A, Ranchor AV, Fleer J, Hagedoorn M. Clinically distinct trajectories of fatigue and their longitudinal relationship with the disturbance of personal goals following a cancer diagnosis. Br J Health Psychol 2017. [DOI: 10.1111/bjhp.12253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fabiola Müller
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Marrit A. Tuinman
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Moniek Janse
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Josué Almansa
- Division of Community and Occupational Medicine; Department of Health Sciences; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Mirjam A. G. Sprangers
- Department of Medical Psychology; Academic Medical Center; University of Amsterdam; The Netherlands
| | - Ans Smink
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Joke Fleer
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology; University Medical Center Groningen; University of Groningen; The Netherlands
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Müller F, Proquitté H, Renz D, Mentzel H. Objektive Bildqualität der kranialen MRT bei Früh- und Neugeborenen mit und ohne Anwendung des MR-kompatiblen Inkubators. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F Müller
- Universitätsklinikum Jena, Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena
| | - H Proquitté
- Universitätsklinikum Jena, Sektion Neonatologie und Pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Jena
| | - D Renz
- Universitätsklinikum Jena, Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena
| | - H Mentzel
- Universitätsklinikum Jena, Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena
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Müller F. Neue Aspekte der Diagnostik und Therapie der Adnexitis. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0036-1597734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- F Müller
- Krankenhaus Waldfriede, Klinik für Gynäkologie und Geburtshilfe, Berlin
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Abstract
Stroke is considered one of the leading causes of death and acquired disability with a peak prevalence over the age of 80 years. Stroke may cause debilitating neurological deficiencies that frequently result in sensory deficits, motor impairment, muscular atrophy, cognitive deficits and psychosocial impairment. Oro-facial impairment may occur due to the frequent involvement of the cranial nerves' cortical representation areas, central nervous system pathways or motoneuron pools. The aim of this narrative, non-systematic review was to discuss the implications of stroke on oro-facial functions and oral health-related quality of life (OHRQoL). Stroke patients demonstrate an impaired masticatory performance, possibly due to reduced tongue forces and disturbed oral sensitivity. Furthermore, facial asymmetry is common, but mostly discrete and lip restraining forces are reduced. Bite force is not different between the ipsi- and contra-lesional side. In contrast, the contra-lesional handgrip strength and tongue-palate contact during swallowing are significantly impaired. OHRQoL is significantly reduced mainly because of the functional impairment. It can be concluded that impaired chewing efficiency, dysphagia, facial asymmetry, reduced lip force and OHRQoL are quantifiable symptoms of oro-facial impairment following a stroke. In the absence of functional rehabilitation, these symptoms seem not to improve. Furthermore, stroke affects the upper limb and the masseter muscle differently, both, at a functional and a morphological level. The rehabilitation of stroke survivors should, therefore, also seek to improve the strength and co-ordination of the oro-facial musculature. This would in turn help improve OHRQoL and the masticatory function, subsequently preventing weight loss and malnutrition.
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Affiliation(s)
- M Schimmel
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - T Ono
- Division of Comprehensive Prosthodontics, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - O L T Lam
- Department of Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - F Müller
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
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Müller F, Hagedoorn M, Tuinman MA. Chronic multimorbidity impairs role functioning in middle-aged and older individuals mostly when non-partnered or living alone. PLoS One 2017; 12:e0170525. [PMID: 28151967 PMCID: PMC5289430 DOI: 10.1371/journal.pone.0170525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background Due to the aging of the population, society includes a growing proportion of older individuals prone to chronic morbidity. This study aimed to investigate the adverse effects of single and multiple chronic morbidity on psychosocial health and whether these effects are more pronounced in individuals who are non-partnered or living alone. Materials and methods Baseline data from the ‘Lifelines Cohort Study’ collected between 2006 and 2013 in the Netherlands were used. Individuals aged 50+ (n = 25,214) were categorized according to their health status (healthy, single chronic morbidity, multiple chronic morbidity), relationship status (partnered, non-partnered), and living arrangement (living with someone, living alone). Analyses of covariance (ANCOVA) were performed to study the main- and the interaction-effects on mental health and role functioning as assessed with the RAND-36. Results Irrespective of having chronic morbidity, having a partner was associated with better mental health when partners shared a home. Individuals with single and especially multiple chronic morbidity had impaired role functioning. Having a partner mitigated the adverse effects of multimorbidity on role functioning, but only in individuals who shared a home with their partner. Non-partnered individuals with multimorbidity and those not sharing a home with their partner demonstrated impaired role functioning. Conclusions The results demonstrate that multimorbidity negatively affects role functioning, but not the mental health, of middle-aged and older individuals. Sharing a home with a partner can mitigate these adverse effects, while other combinations of relationship status and living arrangement do not. Offering intervention to those individuals most vulnerable to impaired functioning may relieve some of the increasing pressure on the health care system. An individual’s relationship status along with one’s living arrangement could foster the identification of a target group for such interventions attempting to sustain physical functioning or to adapt daily goals.
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Affiliation(s)
- Fabiola Müller
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, The Netherlands
- * E-mail:
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, The Netherlands
| | - Marrit A. Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, The Netherlands
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Schimmel M, Voegeli G, Duvernay E, Leemann B, Müller F. Oral tactile sensitivity and masticatory performance are impaired in stroke patients. J Oral Rehabil 2017; 44:163-171. [PMID: 28075495 DOI: 10.1111/joor.12482] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2017] [Indexed: 11/29/2022]
Abstract
Oro-facial impairment following stroke frequently involves reduced chewing performance, that is oral phase dysphagia. The aim was to investigate the sensitivity of oral tissues following stroke and its potential impact on masticatory function. Therefore, hospitalised post-stroke patients were recruited and compared to healthy controls. Outcome measures comprised masticatory performance employing a colour-mixing ability, that is a bolus-kneading test, maximum lip- and bite force and the one-point and two-point tactile thresholds. Food hoarding and prevalence of dry mouth were evaluated with ordinal scales. Twenty-seven stroke patients (age 64·3 ± 14·1 years) and 27 healthy controls (age 60·8 ± 14·3 years, P = 0·254) participated in this study. The groups had similar numbers of occluding units. Stroke patients reported more frequently dry mouth sensations and food hoarding. The intra-oral tactile sensitivity on the contra-lesional side was significantly lower in stroke patients compared to controls (0·0001 < P < 0·0002), and significant intra-group side differences were found only in the stroke group (0·0001 < P < 0·0010). For the lip, both sides were less sensitive in the stroke group compared with controls. The experiments confirmed lower masticatory performance and lip force in the stroke group, but the bite force was similar compared to healthy controls. Oral sensitivity was correlated with masticatory performance when a global correlation model was applied. A stroke may affect the sensitivity of the intra-oral tissues contra-lesionally, thus potentially affecting chewing function. Rehabilitation should therefore not only focus on motor impairment, but equally stimulate the sensitivity of the oral tissues, employing dry ice application or similar specific treatments.
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Affiliation(s)
- M Schimmel
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - G Voegeli
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - E Duvernay
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - B Leemann
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Geneva, Switzerland
| | - F Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
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Huanca Ghislanzoni L, Leemann B, Christou P, Müller F, Schimmel M, Kiliaridis S. Palatal morphology changes in post-stroke patients measured by geometric morphometrics. J Oral Rehabil 2017; 44:172-177. [PMID: 28094863 DOI: 10.1111/joor.12484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 12/01/2022]
Abstract
This study aimed to describe longitudinal palatal shape changes in post-stroke patients when compared to a sample of healthy subjects through linear measurements and geometric morphometrics. The 3D palatal scanned models of seven stroke patients having a 1-year post-stroke follow-up were matched with seven control subjects of the same age group (range 50-87 years). Intercanine, intermolar distances and palatal height were measured. 3D images were also analysed through geometric morphometrics to assess changes in the shape of the palate from T0 to T1 (1 year after the stroke). Principal component analysis was used to describe shape morphology changes, and visual colour maps were used to qualitatively assess differences between T0 and T1. No changes were detected nor in linear measures neither in palatal shape in healthy subjects from T0 to T1. The palates of stroke patients showed no linear differences either. However, when visualising shape changes through colour maps, the lateral aspects of the palatal vault were slightly narrower in T1, with respect to T0 in stroke patients. This may be attributed to altered tongue function following the stroke.
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Affiliation(s)
| | - B Leemann
- Department for Clinical Neurosciences, University of Geneva, Geneva, Switzerland
| | - P Christou
- Department of Orthodontics, University of Geneva, Geneva, Switzerland
| | - F Müller
- Department of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - M Schimmel
- Division of Gerodontology, University of Bern, Bern, Switzerland
| | - S Kiliaridis
- Department of Orthodontics, University of Geneva, Geneva, Switzerland
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Löhler J, Akcicek B, Müller F, Dreier G, Meerpohl JJ, Vach W, Werner JA. Evidence gaps in ENT surgery - a qualitative survey. GMS Curr Top Otorhinolaryngol Head Neck Surg 2016; 15:Doc10. [PMID: 28025610 PMCID: PMC5169083 DOI: 10.3205/cto000137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: As in other disciplines, the burgeoning knowledge in ENT medicine long ago surpassed our ability to adequately absorb it and maintain a proper overview. This can give rise to actual or assumed evidence gaps that can impede the progress of the discipline and evidence-based treatment of patients. Clinics and medical practices also hold to traditional doctrines that shape day-to-day medicine, without these schools being challenged based on evidence. Methods: Between February and June 2015, 160 ENT clinics, including 34 university hospitals, and 2,670 ENT practices took part in a two-arm online survey on existing or perceived evidentiary gaps in ENT medicine using a previously developed questionnaire. The survey used for half of the participants was open in form; the other half were given a closed survey with systematics of the field for orientation. The survey was augmented with additional data such as the number of publications and focus areas in the clinics and the age and type of practice of the established physicians. Results: The return rate from the clinics was 39.7%; the return rate of the closed surveys was 29.3%. Of the physicians in medical practice, 14.6% responded to the closed and 18.6% to the open survey. There were no major differences between the two forms of survey. Otological and oncological issues comprised approximately 30% of the list of answers from clinics. Corresponding questions were formulated regarding the current diagnostic and therapeutic problems, such as with stage-related tumor treatment or implantable hearing aids. Diagnostic procedures, e.g., special new procedures in audiology and vestibulogy, dominated the surveys from the practices. However clinics and practices alike cited marginal areas of the discipline that are of daily relevance. Discussion: The cited evidence gaps then needed to be verified or refuted and clarified based on research of the literature as to whether the existing evidence actually reached healthcare providers in the form of guidelines, publications, conferences, or continuing training for application in daily practice. Other steps would include prioritizing future research, evidence mapping, deciding on further systematic reviews, and targeted studies in conjunction with procuring third-party funding and in cooperation with patient associations. The knowledge thus gained should ultimately be transferred in improved form for application in daily clinical practice. Ten questions of key importance each needed to be formulated for the hospitals and practices.
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Affiliation(s)
- Jan Löhler
- German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; Scientific Institute for Applied Otolaryngology, Bad Bramstedt, Germany
| | - B Akcicek
- Scientific Institute for Applied Otolaryngology, Bad Bramstedt, Germany
| | - F Müller
- University Department of Otolaryngology, Philipps University of Marburg, Germany
| | - G Dreier
- German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; Study Center of the University Hospital of Freiburg, Germany
| | - J J Meerpohl
- Cochrane Germany, University Hospital of Freiburg, Germany
| | - W Vach
- Department of Medical Biometry and Medical Informatics, University Hospital of Freiburg, Germany
| | - J A Werner
- German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; University Department of Otolaryngology, Philipps University of Marburg, Germany
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Pfistermeister B, Dormann H, Patapovas A, Müller F, Sonst A, Glaeser H, Plank-Kiegele B, Bürkle T, Maas R. Adverse drug events related to COX inhibitors in patients presenting at an emergency department. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kuon RJ, Vomstein K, Weber M, Müller F, Seitz C, Wallwiener S, Strowitzki T, Schleussner E, Markert UR, Daniel V, Toth B. The "killer cell story" in recurrent miscarriage: Association between activated peripheral lymphocytes and uterine natural killer cells. J Reprod Immunol 2016; 119:9-14. [PMID: 27865124 DOI: 10.1016/j.jri.2016.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 01/02/2023]
Abstract
Peripheral and uterine NK cells (pNK, uNK) can be distinguished according to their receptor expression. Recent studies indicate an association of elevated pNK and uNK with recurrent miscarriage (RM). This study aimed to analyze pNK and uNK in patients with RM and healthy controls. Out of n=590 RM patients screened according to a standard diagnostic protocol, n=268 couples with ≥3 consecutive RM were identified. Subgroups consisted of n=151 primary RM (pRM), n=85 secondary RM (sRM), n=32 tertiary RM (tRM) and n=42 healthy controls. Finally, n=147 idiopathic RM (iRM) and n=121 non-iRM patients were identified. Peripheral blood levels of CD45+CD3-CD56+CD16+ NK cells were determined in non-pregnant patients and controls in the mid-luteal phase by FACS. In n=129 RM patients a uterine biopsy was taken to evaluate CD56+ NK cells by immunohistochemistry. PRM showed higher absolute pNK than sRM (median/μl (Q1;Q3): 234 (147;306) vs 176 (128;245), p=0.02). Further a trend towards higher pNK percentages in pRM was detected. UNK numbers did not differ between RM subgroups and did not correlate with pNK. However, the rate of highly elevated uNK was increased in iRM compared to non-iRM patients (p=0.04). Further, higher numbers of CD45+CD3-DR+ (p<0.01) and CD45+CD3+CD8+DR+ (p=0.04) peripheral lymphocytes were associated with higher uNK numbers. In conclusion, elevated pNK were present in pRM patients. Although pNK and uNK numbers did not correlate, the association between high CD45+CD3-DR+ and CD45+CD3+CD8+DR+ peripheral lymphocytes and uNK might indicate that activated NK, B and T cells provide cytokines for the differentiation of uNK.
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Affiliation(s)
- R J Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - K Vomstein
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - M Weber
- Placenta-Lab, Department of Obstetrics, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
| | - F Müller
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - C Seitz
- Department of Neonatology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - S Wallwiener
- Department of Obstetrics and Gynecology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - T Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - E Schleussner
- Department of Obstetrics and Gynecology, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
| | - U R Markert
- Placenta-Lab, Department of Obstetrics, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
| | - V Daniel
- Transplantation-Immunology, Institute of Immunology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - B Toth
- Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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