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Auerswald T, Zwingmann K, Schlesinger T, Müller K. Development and Evaluation of a Community Health Program to Promote Physical Activity Among Vulnerable Community-Dwelling Older Adults: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2024; 13:e51462. [PMID: 38376903 PMCID: PMC10915733 DOI: 10.2196/51462] [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: 08/01/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Vulnerable older adults have a high risk of morbidity and mortality. Regular physical activity (PA) can have a positive effect on the health and health-related behavior of this specific target group. However, evidence of the impact and feasibility of community-based PA promotion interventions for vulnerable older adults is still limited. OBJECTIVE The BeTaSen (Bewegungs-Tandems in den Lebenswelten Chemnitzer Seniorinnen und Senioren: ein Beitrag zur kommunalen Gesundheitsförderung) study aims to evaluate the (1) impact as well as the (2) feasibility, acceptance, and usefulness of a 12-month low-threshold PA intervention program for community-dwelling vulnerable older adults. METHODS For our population-based prospective observational cohort study, a total of 120 vulnerable older adults (aged 75 years or older) in the area of Chemnitz (Germany) will be recruited to participate in (1) weekly neighborhood-based low-threshold PA meetings with trained mentors (activity tandems) and (2) monthly exercise meetings led by trained exercise instructors. Within the intervention, participants will be encouraged to perform the PA independently. Participants will complete assessments, which will include questionnaires as well as objective measurements of their physical, cognitive, and psychosocial health at 3 different time points (baseline, 6 months after the start, and 6 months after the end of the intervention). Additionally, a process evaluation will be performed, including questionnaires and qualitative interviews, involving the participants, mentors, and municipal project partner representatives. RESULTS The BeTaSen project process began in October 2021, with the start of data collection and intervention in August 2022 in the first neighborhoods of the city of Chemnitz. A total of 86 participants were recruited at the time of submission of the manuscript. Longitudinal results are expected by 2025. CONCLUSIONS This study's results will provide insights on (1) the PA behavior of vulnerable older adults as well as the impact of PA interventions on health-related outcomes such as cognitive, physical, and psychosocial health, and (2) the feasible and useful components of community-based PA interventions. Thus, this pilot study contributes to future recommendations and provides a basis for further research, such as the development of feasible and sustainable target group-specific interventions in community settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51462.
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Affiliation(s)
- Tina Auerswald
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Katharina Zwingmann
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Katrin Müller
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
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Ehnold P, Gohritz A, Lotzen L, Schlesinger T. Soccer above all? Analysis of academic and vocational education among female soccer players in the German women's Bundesliga and 2nd women's Bundesliga. Front Sports Act Living 2024; 6:1294803. [PMID: 38410355 PMCID: PMC10895006 DOI: 10.3389/fspor.2024.1294803] [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: 11/10/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Career-related (financial) reasons as well as advantages in terms of expanding social support systems, promoting a balanced lifestyle and personal development suggest that female soccer players should pursue academic or vocational education in parallel to elite sport. However, dual careers are fraught with challenges, mainly due to simultaneity in time and the associated conflicting goals. The aim of this article is to analyze the vocational or academic educational careers of professional female soccer players. Methods To generate the data, an online survey was conducted among soccer players in the German Women's Bundesliga and 2nd Women's Bundesliga. A total of n = 200 questionnaires (German: n = 191; English: n = 9) were included in the analysis, which corresponds to approx. 29.6% of the population addressed. Results 90.6% of the players are pursuing or have already completed academic or vocational education. The majority (71.2%) of female soccer players choose to study. 81.8% of players report no impact or even a positive impact of soccer on their performance in academic or vocational education. Willingness to pursue and complete academic or vocational education is influenced by membership of the A-National Team, time spent playing soccer, form of school-leaving qualification, nationality and age. Discussion This study increases the visibility of professional women's soccer as an object of analysis in sports science research, follows up on demands for a more athlete-centered approach and generates further insights for research and practice with regard to the success of dual careers in elite sport.
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Affiliation(s)
- Peter Ehnold
- Department of Sport & Management, IST-University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Andreas Gohritz
- Department of Sport & Management, IST-University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Lena Lotzen
- Department of Sport & Management, IST-University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
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Zwingmann K, Schlesinger T, Müller K. The Impact of an Outdoor Motor-Cognitive Exercise Programme on the Health Outcomes of Older Adults in Community Settings: A Pilot and Feasibility Study. Sports (Basel) 2024; 12:49. [PMID: 38393269 PMCID: PMC10892309 DOI: 10.3390/sports12020049] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Physical and cognitive exercises can prevent or at least mitigate the symptoms of certain diseases and help older adults perform a range of daily functions. Yet, most seniors do not meet the World Health Organisation's recommended guidelines for physical activity. The objective of this study is to promote and maintain the physical and cognitive capacity of older adults by implementing a feasible and effective low-threshold, age-appropriate, motor-cognitive training outdoors. In the German city of Chemnitz, citizens aged 60 years and older participated in a quasi-randomised intervention trial. Exercises to train coordination, strength, endurance, and cognition were integrated into a 12-week outdoor motor-cognitive exercise programme. Both the physical (e.g., 6MWT) and cognitive skills (e.g., TMT B) of the intervention group (n = 41) and control group (no intervention, n = 58) were measured before (T1) and after (T2) completion of the exercise programme. Some of the participants' physical and all their cognitive measures improved. Neurocognitive performance (DSST) showed a significant time × group interaction effect (F(1,95) = 6.943, p = 0.010, ηp2 = 0.068). Sex and age were found to be influencing factors. We consider our exercise programme to be successfully implemented, well received by the participants, and feasible and useful to promote the continued exercise of daily functions as part of healthy aging in community-dwelling older adults.
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Affiliation(s)
- Katharina Zwingmann
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany; (T.S.); (K.M.)
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Pellacani G, Schlesinger T, Bhatia N, Berman B, Lebwohl M, Cohen JL, Patel GK, Kunstfeld R, Hadshiew I, Lear JT. Efficacy and safety of tirbanibulin 1% ointment in actinic keratoses: Data from two phase-III trials and the real-life clinical practice presented at the European Academy of Dermatology and Venereology Congress 2022. J Eur Acad Dermatol Venereol 2024; 38 Suppl 1:3-15. [PMID: 38116638 DOI: 10.1111/jdv.19636] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The 31st European Academy of Dermatology and Venereology (EADV) Congress took place between 7th and 10th of September 2022 in Milan, Italy. OBJECTIVES We report presented clinical data on the efficacy/effectiveness, safety and tolerability of tirbanibulin 1% ointment that has recently been licensed for actinic keratosis (AK) of the face or scalp in adults. METHODS Summary of presentations given at the EADV Congress. RESULTS Prof. Pellacani presented two post hoc analyses from two phase-III trials with AK patients (NCT03285477 [N = 351] and NCT03285490 [N = 351]): A descriptive analysis of medical history, concomitant medications, and safety results confirming a favourable profile for tirbanibulin showing that number of baseline AK lesions was not correlated to severity of local skin reactions. The latter analysis showed that cases of tirbanibulin application site pain or pruritus were few, and most were found to be mild. Prof. Kunstfeld reported six real-life clinical cases in Austria showing good tirbanibulin effectiveness, safety and tolerability for the treatment of new or recurring AK lesions. Results demonstrated that after 2- to 4-month follow-up, tirbanibulin was well tolerated and effective in AK patients. Presentations by Dr. Patel confirmed good outcomes and tolerability of tirbanibulin in Olsen grade 1-2 AK (N = 12) and porokeratosis patients (N = 4) treated once daily for 5 consecutive days in the United Kingdom. Furthermore, real-world experience in solid organ transplant recipients (N = 2) demonstrated effectiveness of tirbanibulin in skin field cancerization treatment. A symposium sponsored by Almirall was conducted during the congress in which Dr. Hadshiew and Dr. Lear brought together their clinical experience in Germany and the United Kingdom respectively. Interesting clinical cases of 5 consecutive days of tirbanibulin treatment compared to other treatments were discussed with attendees, as well as current treatment needs of AK patients. CONCLUSIONS This article provides an overview of presentations and symposium discussions, summarizing key phase-III results and real-life clinical experience with tirbanibulin shared by dermatologists across Europe.
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Affiliation(s)
- G Pellacani
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - T Schlesinger
- Clinical Research Center of the Carolinas, Charleston, South Carolina, USA
| | - N Bhatia
- Therapeutics Clinical Research, San Diego, California, USA
| | - B Berman
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - M Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J L Cohen
- Department of Dermatology, University of California, Irvine, California, USA
- AboutSkin Dermatology and DermSurgery, Greenwood Village, Colorado, USA
| | - G K Patel
- Welsh Institute of Dermatology, University Hospital Wales, Cardiff, UK
| | - R Kunstfeld
- Dermatology Department, Medical University Vienna, Vienna, Austria
| | | | - J T Lear
- Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
- MAHSC, Manchester University, Manchester, UK
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Schulz L, Parensen A, Schlesinger T. Expectation-based types of voluntary sports clubs in regional sports federations. Front Sports Act Living 2023; 5:1200246. [PMID: 37383065 PMCID: PMC10296196 DOI: 10.3389/fspor.2023.1200246] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Abstract
Sports federations as non-profit organizations play a crucial role for organized sports activities of the population. However, one key responsibility of sports federations is providing needs-based support services to affiliated member sports clubs. Due to limited resources and simultaneously increasing heterogeneous expectations from their member sports clubs, designing an appropriate service portfolio poses increasing difficulties for sports federations. This study addresses these challenges by analyzing member clubs' expectations and identifying distinct expectation types to enable more individually designed services. To analyze the expectations of member clubs (n = 354), the explorative case study was carried out in a regional sports federation in Germany. The findings reveal that member clubs' expectations can be represented using six reliable factors. The subsequent cluster analysis indicates four different expectation-based club types with heterogenous profiles. Based on the z-standardized factor values, the identified club types were labelled as follows: (1) "People Promoters" (32%), (2) "Undemanding" (22%), (3) "Competition-oriented Self-administrators" (23%) and (4) "Demanding Communicators" (23%). The extracted clusters were also reflected and validated by other structural and organizational characteristics of the sports clubs. The extracted types provide a first empirical step to identify different expectation schemes regarding services of sports federations. These schemes enable managers of sports federations to professionalize their service portfolios and, at the same time, to design services contributing to the development of sports clubs in a more targeted manner.
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Affiliation(s)
- Luc Schulz
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Andreas Parensen
- Department of Sport Management, Ruhr University Bochum, Bochum, Germany
| | - Torsten Schlesinger
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
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Müller K, Poppele I, Ottiger M, Zwingmann K, Berger I, Thomas A, Wastlhuber A, Ortwein F, Schultz AL, Weghofer A, Wilhelm E, Weber RC, Meder S, Stegbauer M, Schlesinger T. Impact of Rehabilitation on Physical and Neuropsychological Health of Patients Who Acquired COVID-19 in the Workplace. Int J Environ Res Public Health 2023; 20:1468. [PMID: 36674222 PMCID: PMC9864141 DOI: 10.3390/ijerph20021468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/17/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 05/27/2023]
Abstract
Workers, especially healthcare workers, are exposed to an increased risk for SARS-CoV-2 infection. However, less is known about the impact of rehabilitation on health outcomes associated with post-COVID. This longitudinal observational study examined the changes in physical and neuropsychological health and work ability after inpatient rehabilitation of 127 patients (97 females/30 males; age 21-69 years; Mean = 50.62) who acquired COVID-19 in the workplace. Post-COVID symptoms, functional status, physical performance, neuropsychological health, employment, and work ability were assessed before and after rehabilitation. Group differences relating to sex, professions, and acute COVID status were also analyzed. Except for fatigue, the prevalence of all post-COVID symptoms decreased after rehabilitation. Significant improvements in physical performance and neuropsychological health outcomes were determined. Moreover, healthcare workers showed a significantly greater reduction in depressive symptoms compared to non-healthcare workers. Nevertheless, participants reported poor work ability, and 72.5% of them were still unable to work after discharge from rehabilitation. As most participants were still suffering from the impact of COVID-19 at rehabilitation discharge, ongoing strategies in aftercare are necessary to improve their work ability. Further investigations of this study population at 6 and 12 months after rehabilitation should examine the further course of post-COVID regarding health and work ability status.
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Affiliation(s)
- Katrin Müller
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Iris Poppele
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Marcel Ottiger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Katharina Zwingmann
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Ivo Berger
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Andreas Thomas
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Alois Wastlhuber
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Franziska Ortwein
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Anna-Lena Schultz
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Anna Weghofer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Eva Wilhelm
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | | | - Sylvia Meder
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435 Bad Reichenhall, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107 Chemnitz, Germany
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Hente L, Hodeck A, Schlesinger T. Establishment and management of a workplace health promotion network in rural areas: a case study. Health Promot Int 2022; 37:6730777. [PMID: 36173605 DOI: 10.1093/heapro/daac123] [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] [Indexed: 11/12/2022] Open
Abstract
Health is an increasingly important issue in the workplace, but the dissemination of health-promoting interventions in companies, especially in small and medium-sized enterprises (SMEs), remains limited. Inter-organizational networks seem to be a promising approach to promote and implement workplace health management (WHM) in SMEs. This study analyses the establishment and coordination of the network 'ERZgesund-Healthy Companies in the Ore Mountains' for WHM in SMEs in a rural area of Germany. The case study, which builds on a mixed method approach (expert interviews, participant observations and document analysis), finds that ERZgesund evolved from a top-down approach (politically initiated, regionally anchored and financed from promotional funds). The network's hierarchy is disproportionately vertical, and the project group has limited decision-taking power and limited opportunities to act, which has reduced their overall engagement in the network. We conclude that although long and stable relationships are important for successful networks, change-especially at the leadership level-can lead to increased engagement of network participants if the hierarchy within the network is horizontally aligned. The findings of this explorative case study contribute to the planning process, the development and implementation of network structures, and successful WHM interventions.
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Affiliation(s)
- Luisa Hente
- Department of Human Movement Science and Health, Chemnitz University of Technology, Thüringer Weg 11, 09126 Chemnitz, Germany
| | - Alexander Hodeck
- Department of Marketing, Tourism and Sports, International School of Management (ISM), Hauptstraße 27, 10827 Berlin, Germany
| | - Torsten Schlesinger
- Department of Human Movement Science and Health, Chemnitz University of Technology, Thüringer Weg 11, 09126 Chemnitz, Germany
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Schlesinger T. [Liberal transfusion strategy for prevention of mortality and anemia-associated ischemic events in older noncardiac surgery patients-LIBERAL study]. Anaesthesist 2021; 69:518-520. [PMID: 32291465 DOI: 10.1007/s00101-020-00752-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Abstract
PurposeWorkplace health promotion (WHP) is becoming increasingly important due to the ageing workforce and a shortage of skilled workers. Nevertheless, too few companies have reacted to the demographic change and introduced health-promoting measures. This paper aims to identify which factors influence the implementation of WHP, especially in small and medium-sized enterprises (SMEs) in rural areas.Design/methodology/approach253 companies in a rural area in the federal state of Saxony (Germany) were surveyed using a standardised questionnaire via a computer-assisted telephone interview. Bivariate analyses and logistic regression models were carried out. The focus was on the relationship between the status of WHP and the size of the company, pressure of demographic change, health-related attitude and organisational capacity factors.FindingsIt was shown that, in addition to the control variables company size and pressure of the shortage of skilled workers, a company's attitude regarding health promotion, financial capacity and planning and development capacity has a relevant influence on the status of WHP.Practical implicationsBased on the results, targeted measures can be developed and converted to implement WHP, particularly in SMEs in rural regions. The focus should be on sensitisation, knowledge transfer and capacity development.Originality/valueThe present paper reveals the relationship between company size, pressure of demographic change, health-related attitude and organisational capacities regarding the status of health-promoting measures in SMEs in a rural region.
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Barth M, Güllich A, Forstinger CA, Schlesinger T, Schröder F, Emrich E. Retirement of professional soccer players - A systematic review from social sciences perspectives. J Sports Sci 2020; 39:903-914. [PMID: 33295256 DOI: 10.1080/02640414.2020.1851449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
Retiring professional athletes face multifaceted changes and potential issues of adjustment, occupational development, and well-being, which raises concerns around the world. The study systematically reviewed the available research investigating professional soccer players' sport retirement from social sciences perspectives. The literature search in electronic databases and a "snowballing" procedure yielded 17 eligible studies investigating > 2,200 retired professional soccer players. The review followed the PRISMA statement. Nine studies focused on an early transition phase to retirement period; four studies investigated later periods of ten years or longer after retirement. Around half of the players reported involuntary retirement, often associated with declining performance and/or injury. Studies suggest issues of adjustment and mental health during early years after retirement, while psychological issues had apparently declined around 1-2 decades after retirement. However, available studies had notable limitations including lack of evidenced representative samples, report of measures' reliability, and control for confounders. Furthermore, while theoretical models emphasise a holistic perspective, quantitative research often took a narrow rather than holistic perspective. In summary, available knowledge is fraught with some uncertainty regarding reliability and representativeness of the population of retired professional soccer players. We offer future directions to advance the development of a theory of sport retirement.
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Affiliation(s)
- Michael Barth
- Department of Sports Science, Saarland University, Saarbrücken, Germany.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Arne Güllich
- Department of Sports Science, University of Kaiserslautern, Kaiserslautern, Germany
| | | | | | - Frank Schröder
- Department of Sport Management, Ruhr University Bochum, Bochum, Germany
| | - Eike Emrich
- Department of Sports Science, Saarland University, Saarbrücken, Germany
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Weibel S, Schaefer MS, Raj D, Rücker G, Pace NL, Schlesinger T, Meybohm P, Kienbaum P, Eberhart LHJ, Kranke P. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: an abridged Cochrane network meta-analysis. Anaesthesia 2020; 76:962-973. [PMID: 33170514 DOI: 10.1111/anae.15295] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
Postoperative nausea and vomiting is a common adverse effect of anaesthesia. Although dozens of different anti-emetics are available for clinical practice, there is currently no comparative ranking of efficacy and safety of these drugs to inform clinical practice. We performed a systematic review with network meta-analyses to compare, and rank in terms of efficacy and safety, single anti-emetic drugs and their combinations, including 5-hydroxytryptamine3 , dopamine-2 and neurokinin-1 receptor antagonists; corticosteroids; antihistamines; and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anaesthesia. We systematically searched for placebo-controlled and head-to-head randomised controlled trials up to November 2017 (updated in April 2020). We assessed how trustworthy the evidence was using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence In Network Meta-Analysis (CINeMA) approaches for vomiting within 24 h postoperatively, serious adverse events, any adverse event and drug class-specific side-effects. We included 585 trials (97,516 participants, 83% women) testing 44 single drugs and 51 drug combinations. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 trials, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared with placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single neurokinin-1 receptor antagonists were as effective as other drug combinations. Out of the 10 effective single drugs, certainty of evidence was high for aprepitant, with risk ratio (95%CI) 0.26 (0.18-0.38); ramosetron, 0.44 (0.32-0.59); granisetron, 0.45 (0.38-0.54); dexamethasone, 0.51 (0.44-0.57); and ondansetron, 0.55 (0.51-0.60). It was moderate for fosaprepitant, 0.06 (0.02-0.21) and droperidol, 0.61 (0.54-0.69). Granisetron and amisulpride are likely to have little or no increase in any adverse event compared with placebo, while dimenhydrinate and scopolamine may increase the number of patients with any adverse event compared with placebo. So far, there is no convincing evidence that other single drugs effect the incidence of serious, or any, adverse events when compared with placebo. Among drug class specific side-effects, evidence for single drugs is mostly not convincing. There is convincing evidence regarding the prophylactic effect of at least seven single drugs for postoperative vomiting such that future studies investigating these drugs will probably not change the estimated beneficial effect. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation.
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Affiliation(s)
- S Weibel
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
| | - M S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - D Raj
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - G Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - N L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - T Schlesinger
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
| | - P Meybohm
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
| | - P Kienbaum
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - L H J Eberhart
- Department of Anaesthesiology and Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany
| | - P Kranke
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Wuerzburg, Germany
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Schlesinger T, Doherty A. The utility of certification for managing the state-voluntary sport club relationship: an agency theory perspective. Managing Sport and Leisure 2020. [DOI: 10.1080/23750472.2020.1804438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Faß E, Pyun H, Schlesinger T. Perception of aging in the relation between sport activity and self-rated health in middle and older age - A longitudinal analysis. SSM Popul Health 2020; 11:100610. [PMID: 32743040 PMCID: PMC7388187 DOI: 10.1016/j.ssmph.2020.100610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 01/15/2023] Open
Abstract
Background This study aims to generate more comprehensive knowledge regarding underlying mechanisms of health production in middle and older age by focusing on perception of aging in the relation between sport activity and self-rated health. More differentiated information can be generated by using more age-specific data and applying advanced empirical methods. Methods Panel data from the German Ageing Survey (DEAS) (n = 1027) is used, whereby individuals are included, that participated at least in two waves. First, a blockwise fixed effects logistic regression model is carried out, which allows to investigate mediation as well as moderation effects and controls for time invariant unobserved heterogeneity. Additionally, two recursive bivariate probit models are conducted to identify further indirect pathways. Findings A mediating and moderating effect of perception of aging regarding self-rated health is found in the fixed effects model. Indirect pathways of perception of aging and retirement over sport activity (mediator) are confirmed in the recursive bivariate probit models. Conclusion The results highlight the complexity of the underlying mechanisms as well as the importance of individual and needs-based designed health promotion. Here, public health policy should not solely focus on sport activity, rather it should include target group specific strategies to shape individual perceptions of aging towards a more positive view on aging, while considering the heterogeneity of middle and older age groups. Sport activity and health-specific perception of aging are positively associated with self-rated health. A mediating and moderating effect of perception of aging on sport activity regarding self-rated health is found. Indirect pathways of perception of aging and retirement over sport activity are confirmed.
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Affiliation(s)
- Eric Faß
- Ruhr University Bochum, Faculty of Sport Science, Department of Sport Management & Economics, Germany
- Corresponding author. Faculty of Sport Science, Ruhr University Bochum, Germany.
| | - Hyunwoong Pyun
- Sungkyunkwan University, College of Sport Science, South Korea
| | - Torsten Schlesinger
- Ruhr University Bochum, Faculty of Sport Science, Department of Sport Management & Economics, Germany
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Nardi-Hiebl S, Eberhart LHJ, Gehling M, Koch T, Schlesinger T, Kranke P. Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia. Anesthesiol Res Pract 2020; 2020:9201967. [PMID: 32099543 PMCID: PMC7040376 DOI: 10.1155/2020/9201967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023] Open
Abstract
This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.
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Affiliation(s)
- S. Nardi-Hiebl
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - L. H. J. Eberhart
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - M. Gehling
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - T. Koch
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - T. Schlesinger
- Department of Anaesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg, Germany
| | - P. Kranke
- Department of Anaesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg, Germany
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Helf A, Schlesinger T, Roewer N, Kranke P. [Identification of the epidural space using pressure waveform analysis (CompuFlo® technology): a case series]. Anaesthesist 2019; 68:689-694. [PMID: 31541259 DOI: 10.1007/s00101-019-00671-y] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Abstract
Anesthesiologists commonly perform the loss of resistance technique in order to identify the epidural space during neuraxial procedures; however, this technique is subjective and lacks reliability in certain cases. The so-called CompuFlo® technology provides objective information about the position of the epidural needle by means of a pressure curve and acoustic signals. The technology was introduced several years ago and was evaluated in several trials, which showed promising results. The purpose of the present publication is to report on the first experiences with the CompuFlo® technology in German-speaking countries. A series of 24 epidural procedures using the CompuFlo® device was carried out in routine daily practice. The epidural space was successfully identified in 23 cases. Conversion to the conventional loss of resistance technique was performed during the initial cases in a prolonged procedure. The CompuFlo® technique is considered to be a promising technology, which might help to reduce complications after epidural anesthesia, e.g. postdural puncture headache.
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Affiliation(s)
- A Helf
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - T Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - N Roewer
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - P Kranke
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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16
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Schlesinger T, Löbig A, Ehnold P, Nagel S. What is influencing the dropout behaviour of youth players from organised football? Ger J Exerc Sport Res 2018. [DOI: 10.1007/s12662-018-0513-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Klenk C, Egli B, Schlesinger T. Exploring how voluntary sports clubs implement external advisory inputs. Managing Sport and Leisure 2017. [DOI: 10.1080/23750472.2017.1386587] [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: 10/18/2022]
Affiliation(s)
- C. Klenk
- Institute of Sports Science, University of Bern, Bern, Switzerland
| | - B. Egli
- Swiss Football Association, Bern, Switzerland
| | - T. Schlesinger
- Institute of Human Movement Science, Chemnitz University of Technology, Chemnitz, Germany
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18
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Schlesinger T, Studer F, Nagel S. The relationship between competencies acquired through Swiss academic sports science courses and the job requirements. Eur J Sport Sci 2015; 16:115-27. [PMID: 25599128 DOI: 10.1080/17461391.2014.995234] [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] [Indexed: 10/24/2022]
Abstract
In view of the changes in and growing variety of sports-related occupations, it is highly relevant for educational institutions to know how well the educational contents of their sport science courses meet the professional requirements. This study analyses the relationship between the competencies acquired through academic sports science courses and the requirements of the relevant jobs in Switzerland. The data for this empirical analysis were drawn from a sample of n = 1054 graduates of different academic sport science programmes at all eight Swiss universities. The results show that academic sport science courses primarily communicate sports-specific expertise and practical sports skills. On the other hand, most graduates consider that the acquisition of interdisciplinary competencies plays a comparatively minor role in sport science education, even though these competencies are felt to be an important requirement in a variety of work-related environments and challenges.
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Affiliation(s)
- T Schlesinger
- a Institut für Sportwissenschaft , Universität Bern , Bern , Switzerland
| | - F Studer
- a Institut für Sportwissenschaft , Universität Bern , Bern , Switzerland
| | - S Nagel
- a Institut für Sportwissenschaft , Universität Bern , Bern , Switzerland
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19
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Schlesinger T, Nagel S. Who will volunteer? Analysing individual and structural factors of volunteering in Swiss sports clubs. Eur J Sport Sci 2013; 13:707-15. [DOI: 10.1080/17461391.2013.773089] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Broisman A, Schlesinger T, Alfassi ZB. Measurement of the radiation dose and assessment of the risk in mammography screening for early detection of cancer of the breast, in Israel. Radiat Prot Dosimetry 2011; 143:113-116. [PMID: 21068021 DOI: 10.1093/rpd/ncq354] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The mean glandular doses to samples of women attending for mammographic screening are measured routinely at screening centres in Israel. As at present, no detailed and systematic data have been collected regarding the average glandular dose in mammography screening procedures carried out in Israel for the last 20 y. Especially data are lacking related to the glandular dose (GD) involved in mammography with the new digital mammography systems. In this work, partial results of the measurements are presented to asses the radiation dose to the breast and to the glandular tissue within the Israeli national mammography programme updated to year 2009.
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Affiliation(s)
- A Broisman
- Ariel University Center of Samaria, Ariel, Israel.
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21
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Abstract
Cutaneous mastocytosis appears to occur sporadically; however, familial inheritance has been reported in 50 families since the mid-1880s. We report four cases of telangiectasia macularis eruptiva perstans (TMEP) occurring in three generations of a family. Whereas most patients with TMEP manifest in adulthood, all of the members of this family developed initial lesions during childhood. This is the third documented instance of familial mastocytosis affecting members of three generations, and the first report of familial TMEP. Although the inheritance pattern is unknown, the presentation of disease in this family further supports the hypothesis of an autosomal dominant mode of transmission with incomplete penetrance.
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Affiliation(s)
- A Chang
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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22
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Ginsberg GM, Schlesinger T, Ben-Shlomo A, Kushilevsky A, Margaliot M, Oren M, Finkleman M, Friedman A, Handlesman M, Lev B. An economic evaluation of the use of rare earth screens to reduce the radiation dose from diagnostic X-ray procedures in Israel. Br J Radiol 1998; 71:406-12. [PMID: 9659134 DOI: 10.1259/bjr.71.844.9659134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/05/2022] Open
Abstract
In Israel the diffusion of rare earth screen technology has been limited. These screens could halve the radiation dose to the patient from diagnostic X-ray radiography, with little managerial effort and without being detrimental to the quality of the diagnostic image. We estimated the total effective dose from diagnostic film radiography capable of reduction by the use of rare earth screens, based on the number of hospital and ambulatory diagnostic X-ray procedures. This number was multiplied by the computed radiation dose per body site for a series of diagnostic procedures. The annual dose was approximately 0.53 mSv per head, approximately half of which could be averted by the introduction of rare earth screen technology. Based on a fatality risk of 3% Sv-1, it is estimated that the adoption of rare earth screen technology might reduce the annual incidence of cancer by some 93 cases, half of which would be fatal after an average latency period of 18.4 years. The cost of purchasing rare earth screens on a nationwide basis is approximately $3.0 million. This cost is outweighed by a saving of $9.6 million in X-ray tube replacement costs over the period 1997-2006. Government legislation enforcing the use of rare earth screens is essential, because of the lack of prestige associated with acquiring rare earth technology, as well as institutional reluctance to accept the external benefits of reduced morbidity and mortality and/or to extend budgetary time horizons.
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Affiliation(s)
- G M Ginsberg
- Department of Technology Assessment, Ministry of Health, Jerusalem, Israel
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23
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Schlesinger T, McCarron K, Camisa C, Anhalt G. Paraneoplastic pemphigus occurring in a patient with B-cell non-Hodgkin's lymphoma. Cutis 1998; 61:94-6. [PMID: 9515216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present the case of a 71-year-old white male with paraneoplastic pemphigus associated with a B-cell non-Hodgkin's lymphoma. Diagnosis of paraneoplastic pemphigus was made by the characteristic findings on immunoprecipitation performed on a serum specimen. Paraneoplastic pemphigus is a severe autoimmune disease comprised of polymorphous mucocutaneous lesions, characteristic laboratory findings, association with one of several types of neoplasms, and a very poor prognosis.
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Affiliation(s)
- T Schlesinger
- Department of Dermatology, Cleveland Clinic, Ohio, USA
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24
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Abstract
Following ingestion of a meal, unabsorbed nutrients may reach the distal intestine partly after the termination of the prandial period, i.e., in the presence of interdigestive motor and secretory patterns. To determine if interdigestive motility and pancreatic enzyme secretion are modulated by the delivery of nutrient into the ileal lumen, six fasting volunteers were intubated with an oroileal multilumen tube system that permitted multiple small intestinal manometry, gastric and duodenal aspiration, and perfusions of marker and test solutions. Ileal perfusions of nutrient or saline solutions were started during phase I of the interdigestive motility cycle. Ileal perfusion with carbohydrate or lipids increased the duration of motor quiescence and decreased the length of the interdigestive cycle, mainly by decreasing the proportion of phase II activity compared with ileal saline (p < 0.01). Pancreatic outputs of amylase, trypsin, and chymotrypsin prior to ileal perfusions were low because, due to the protocol, perfusions were started during phase I. With ileal saline, enzyme outputs increased (p < 0.05) in association with the occurrence of phase II motility, as expected. By contrast, ileal carbohydrate and triglyceride perfusion prevented the phase II-associated increase in enzyme outputs (p < 0.05). The data suggest that the presence of nutrients within the ileal lumen may modulate interdigestive motor and pancreatic functions.
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Affiliation(s)
- P Layer
- Department of Medicine, University of Essen, Germany
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25
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Biberman R, Lusky A, Schlesinger T, Margaloit M, Neeman E, Modan B. Increased risk for small cell lung cancer following residential exposure to low-dose radon: a pilot study. Arch Environ Health 1993; 48:209-12. [PMID: 8395166 DOI: 10.1080/00039896.1993.9940361] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Alpha track radon detectors were placed in the homes of 35 lung cancer patients and 35 matched controls for a period of 8 to 10 mo. Twenty lung cancer patients had small cell lung carcinoma; 11 had adenocarcinoma, 2 had squamous cell carcinoma, and 2 had unclassified carcinoma among 15 nonsmokers. Mean overall living on ground level was significantly higher in the group with small cell lung carcinoma (50 y +/- 15) than among controls (33 y +/- 19); the adjusted odds ratio for lung cancer was 5.2 (90% confidence interval [90% CI] = 1.1-24.9) per decade of living on the ground floor for the group with small cell lung carcinoma. Radon exposure of more than 1.0 pci/l in the group with small cell lung carcinoma was associated with increased risk of lung cancer, although it did not reach statistical significance [odds ratio = 1.5 (90% CI = 0.4-5.4)], adjusting for differences in smoking habits. Our study supports the presence of a differentially increased risk for small cell lung carcinoma following long-term radon exposure.
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Affiliation(s)
- R Biberman
- Department of Clinical Epidemiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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26
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Tatcher M, Faerman S, Schlesinger T. [Mammography screening for early detection of breast cancer: benefits vs risks]. Harefuah 1993; 124:26-8. [PMID: 8436308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Layer P, Peschel S, Schlesinger T, Goebell H. Human pancreatic secretion and intestinal motility: effects of ileal nutrient perfusion. Am J Physiol 1990; 258:G196-201. [PMID: 1689548 DOI: 10.1152/ajpgi.1990.258.2.g196] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To study the effects of intraileal nutrients on human pancreatic secretion and gastrointestinal motility, nine healthy subjects were intubated with an oroileal multilumen tube for ileal perfusion, duodenal juice aspiration, and intestinal motility recording. The duodenum was perfused continuously with essential amino acids to induce submaximal stimulation of pancreatic enzyme secretion and fed motility pattern. Additional ileal perfusion with carbohydrate at quantities similar to those observed under physiological late postprandial conditions or fat at isocaloric loads significantly decreased pancreatic enzyme outputs by greater than 80% (P less than 0.001) compared with saline. Ileal carbohydrate or fat induced a duodenal motor activity front that migrated distally and was followed by reduced motility. In summary, ileal delivery of small quantities of nutrient markedly decreased endogenously stimulated pancreatic enzyme secretion in humans. This was associated with specific changes in fed intestinal motility that converted to patterns characteristic of the interdigestive state. Our findings suggest that the distal small intestine may participate in the late postprandial regulation of gastrointestinal function in humans.
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Affiliation(s)
- P Layer
- Department of Medicine, University of Essen, Federal Republic of Germany
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29
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Flower MA, Schlesinger T, Hinton PJ, Adam I, Masoomi AM, Elbelli MA, Ott RJ, McCready VR, Harmer CL. Radiation dose assessment in radioiodine therapy. 2. Practical implementation using quantitative scanning and PET, with initial results on thyroid carcinoma. Radiother Oncol 1989; 15:345-57. [PMID: 2508192 DOI: 10.1016/0167-8140(89)90081-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [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: 01/01/2023]
Abstract
We have designed special high-resolution, low-sensitivity collimators for a dual-headed whole-body scanner for imaging and quantifying therapy levels of iodine-131. In addition, we have used positron emission tomography (PET) with a low-cost large-area PET camera to achieve improved accuracy in the estimate to tumor mass. The physical performance of these two imaging systems is described. In order to illustrate the practical implementation of these systems for the assessment of radiation dose to normal and tumour tissue during radioiodine therapy, three clinical examples are reported, and a summary of the initial clinical results obtained from 16 patients with carcinoma of the thyroid is presented. The dose to normal thyroid remnants for patients undergoing ablation ranged from 16 to 400 Gy, while the dose to involved neck nodes ranged from 2.5 to 33 Gy for patients undergoing post-ablation radioiodine therapy. In one patient with distant metastasis in the spine, a dose of 100 Gy was achieved. The techniques described in this paper can be used to determine if sufficient activity can be accumulated in tumours to provide a therapeutic effect while minimising irradiation of normal tissues by avoiding administrations which do not provide tumouricidal radiation doses.
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Affiliation(s)
- M A Flower
- Physics Department, Royal Marsden Hospital, Sutton, Surrey, U.K
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Schlesinger T, Flower MA, McCready VR. Radiation dose assessments in radioiodine (131I) therapy. 1. The necessity for in vivo quantitation and dosimetry in the treatment of carcinoma of the thyroid. Radiother Oncol 1989; 14:35-41. [PMID: 2928556 DOI: 10.1016/0167-8140(89)90006-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [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: 01/03/2023]
Abstract
In order to destroy thyroid cancer metastases by radioiodine an average tissue dose of 80-300 Gy is needed. Such high doses can be expected, following the administration of the conventional 5.5 GBq of 131I, only if both the percentage uptake per gram in the target tissue and the effective half life of the radioiodine in it are higher than well-defined threshold values, and if every dimension of the tissue exceeds several millimeters. The fulfillment of such favourable conditions in actual clinical cases can only be confirmed by in vivo quantitation of the absorbed dose achieved as a result of the administration of radioiodine.
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Affiliation(s)
- T Schlesinger
- Physics Department, Royal Marsden Hospital Sutton, U.K
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31
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Hetey L, Berg R, Schlesinger T. Characterization of synaptosomal dopamine uptake in post-mortem brain regions of schizophrenics. Neurochem Pathol 1987; 7:221-32. [PMID: 3453902 DOI: 10.1007/bf03160182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The drug sensitivity of synaptosomal high-affinity dopamine (DA) uptake was investigated in post-mortem brain regions of schizophrenics, in comparison to controls matched for age, sex, and post-mortem delay, and in model experiments in rats. DA uptake was inhibited by nomifensine in the investigated regions of rat brain in a concentration-dependent manner; the regional rank order of inhibitory potency was: nucleus (n) caudatus greater than n. accumbens greater than frontal cortex. Furthermore, it was shown that the inhibitory potency of nomifensine is unchanged after in situ storage of rat brain tissue for 48 h and after the cryopreservation method used. In post-mortem brain of human controls, nomifensine inhibited DA uptake with the same regional differences as in rats; however, the inhibitory potencies were three-fourfold weaker. In schizophrenia, on the other hand, synaptosomal DA uptake inhibition by nomifensine was significantly weaker than in the corresponding control brains for all regions studied. This suggests a decreased affinity of the DA uptake carrier to nomifensine, similar to DA shown in recent studies with schizophrenic patients. The possible relevance of investigating functional parameters for understanding patho-biochemical mechanisms in schizophrenia is discussed.
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Affiliation(s)
- L Hetey
- Institute of Pharmacology and Toxicology of Charité, Humboldt University Berlin, GDR
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Ognibene FP, Martin SE, Parker MM, Schlesinger T, Roach P, Burch C, Shelhamer JH, Parrillo JE. Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 1986; 315:547-51. [PMID: 3736638 DOI: 10.1056/nejm198608283150904] [Citation(s) in RCA: 302] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Most investigators believe that the pulmonary endothelial damage that is characteristic of the adult respiratory distress syndrome (ARDS) requires the action of neutrophils. In a retrospective review of patients with ARDS, we looked for cases that had developed in patients who already had neutropenia. Four clinical criteria were required for the diagnosis of ARDS: the occurrence of a precipitating event, diffuse bilateral pulmonary infiltrates on a chest x-ray film, a normal intravascular volume (as reflected by a wedge pressure of less than 18 mm Hg), and arterial hypoxemia. During 2 1/2 years, 11 patients fulfilled these clinical criteria, had severe neutropenia that antedated the onset of ARDS, and had pulmonary histologic specimens obtained during the early stages (less than seven days) of clinical respiratory distress. Five of these specimens showed diffuse alveolar damage without evidence of infectious pneumonitis (the histopathological finding characteristic of ARDS), and none had a neutrophil infiltrate. We conclude that ARDS can occur in the setting of severe neutropenia, without pulmonary neutrophil infiltration.
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Shani J, Barak S, Levi D, Ram M, Schachner ER, Schlesinger T, Robberecht H, Van Grieken R, Avrach WW. Skin penetration of minerals in psoriatics and guinea-pigs bathing in hypertonic salt solutions. Pharmacol Res Commun 1985; 17:501-12. [PMID: 4023031 DOI: 10.1016/0031-6989(85)90123-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Penetration of electrolytes through the human skin was measured in healthy volunteers and in psoriatic patients after bathing in the Dead-Sea or in simulated bath-salt solutions. Significant increases in the levels of serum Br, Rb, Ca and Zn were noticed only in the psoriatic patients after daily bathing in the Dead-Sea for a 4-week regimen. Guinea-pigs "bathed" in simulated Dead-Sea bath-salt solutions containing radionuclides of Ca, Mg, K and Br. Traces of each radionuclide were detected in the blood and in some internal organs after 60 minutes of bathing. The radionuclides showed a physiological pattern in their organ distribution. Even though the whole investigation was carried out in hypertonic solutions, there is a definite penetration of salts through healthy (human and guinea-pigs) and damaged (psoriatic) epidermis. This finding suggests that improvement of the psoriatic condition after bathing in the Dead-Sea, may be partly attributed (in addition to ultraviolet irradiation) to the minerals' effect on the psoriatic skin.
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Shani J, Barak S, Ram M, Levi D, Pfeifer Y, Schlesinger T, Avrach WW, Robberecht H, Van Grieken R. Serum bromine levels in psoriasis. Pharmacology 1982; 25:297-307. [PMID: 7156179 DOI: 10.1159/000137756] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Serum bromine levels in psoriatic Danes increased 2- to 3-fold during a 4-week bathing course in the Dead Sea. This increase correlated well with the improvement in their clinical and psychic condition. Serum bromine levels in psoriatic Danes were somewhat lower than those in healthy subjects residing in Denmark, but the difference was not significant. Israelis working in the open air in the Dead Sea area (air bromine 20-fold higher than in Jerusalem) had higher bromine levels than psoriatic or healthy Israelis residing in Jerusalem or healthy Israelis working in air-conditioned rooms in the Dead Sea area (p less than 0.05), but those levels were still within the normal range. As our animal experimentation indicates that the skin is a major target organ for 82Br, applied either by bathing or as an aerosol, we conclude that the higher bromine levels noticed in the psoriatic Danes after their 4-week stay at the Dead Sea may be equally due to their contact with the bromine-containing aerosol and the high bromine level of the Dead Sea waters.
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Shani J, Lieberman LM, Samuni A, Schlesinger T, Cais M. Tissue distribution of 2- and 4-[203Hg]-estradiol in mammary-tumor-bearing rats. Int J Nucl Med Biol 1982; 9:251-8. [PMID: 7186497 DOI: 10.1016/0047-0740(82)90085-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The newly synthesized 2-[203Hg]-estradiol-17 beta and 4-[203Hg]-estradiol-17 beta were injected into Fischer female rats bearing transplanted mammary adenocarcinomas and into Sprague-Dawley female rats bearing spontaneous mammary tumors. Four days after injection, tumor to blood ratios (and uterine to blood ratios) in the various groups were between 5 and 14, compared to a ratio of unity observed in normal mammary glands. When injected into male rats, the accumulation of 4-[203Hg]-estradiol in the prostate and in the epididimis was very low. With minute doses of 4-[203Hg]-estradiol injected into healthy male rats, the whole-body retention of the drug was found to decrease exponentially with time, and biphasic first order kinetics were observed. With pharmacological doses of the same drug, the clearance exhibited a biphasic pattern.
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Shani J, Young D, Schlesinger T, Siemsen JK, Chlebowski RT, Bateman JR, Wolf W. Dosimetry and preliminary human studies of 18F-5-fluorouracil. Int J Nucl Med Biol 1982; 9:25-35. [PMID: 7085187 DOI: 10.1016/0047-0740(82)90071-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The relative distribution, metabolism and kinetics of 18F containing compounds, following administration of 18F-5-fluorouracil, has been proposed as a prognostic aid in predicting response to 5-fluorouracil chemotherapy. Because 18F has a relatively short physical half-life (t1/2 = 110 min), and the distribution and kinetics of the radiolabeled 5-fluorouracil need to be studied over periods of time that range over several half-lives of the radionuclide, significant quantities of the labeled drug must be administered in order to obtain good counting statistics. The distribution of 18F, following injection of 18F-5-fluorouracil to rats and mice, has been well documented in our previous work. It appears that the distribution of 18F in humans, following administration of 18F-5-fluorouracil is similar to that in rats. We calculated the radiation dose according to the MIRD technique for the eleven main target organs for a reference man. The critical organs, according to these calculations, are the bladder wall, the kidney and the liver, receiving a radiation dose of 729, 184 and 114 mrad per mCi injected, respectively.
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Eisen Y, Shamai Y, Ovadia E, Karpinovitch Z, Faermann S, Schlesinger T. A Rem equivalent personnel neutron dosimeter for neutron energies of 1 eV--14 MeV. Health Phys 1981; 41:349-362. [PMID: 7275618 DOI: 10.1097/00004032-198108000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Eisen Y, Karpinowitz Z, Gavron A, Tal A, Itzkin Y, Schlesinger T. Development of a polycarbonate fast neutron dosimeter and comparison with the conventional emulsion dosimeter. Health Phys 1980; 38:497-505. [PMID: 7410075 DOI: 10.1097/00004032-198004000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Shani J, Wolf W, Schlesinger T, Atkins HL, Bradley-Moore PR, Casella V, Fowler JS, Greenberg D, Ido T, Lambrecht RM, MacGregor R, Mantescu C, Neirinckx R, Som P, Wolf AP, Wodinsky I, Meaney K. Distribution of 18F-5-fluorouracil in tumor-bearing mice and rats. Int J Nucl Med Biol 1978; 5:19-28. [PMID: 207653 DOI: 10.1016/0047-0740(78)90086-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
MESH Headings
- 9,10-Dimethyl-1,2-benzanthracene
- Animals
- Carcinoma, Ehrlich Tumor/metabolism
- Carcinoma, Hepatocellular/metabolism
- Fluorine
- Fluorouracil/metabolism
- Leukemia, Experimental/metabolism
- Liver Neoplasms
- Mammary Neoplasms, Experimental/metabolism
- Mice
- Mice, Inbred AKR
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Neoplasm Transplantation
- Neoplasms, Experimental/chemically induced
- Neoplasms, Experimental/metabolism
- Radioisotopes
- Rats
- Rats, Inbred BUF
- Rats, Inbred F344
- Sarcoma, Experimental/metabolism
- Tissue Distribution
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