[Effects of Outpatient Compact Rehabilitation on Physical Performance and Quality of Life in Patients with Work-Related Lung Diseases]

In Germany, pulmonary rehabilitation (PR) traditionally takes place in rehabilitation clinics. According to the current German guideline "Diagnostics and assessment of asbestos-related occupational diseases", PR can also be offered as outpatient program with the essential elements of inpatient PR (compact rehabilitation [CR]). Our project investigated the effects of CR regarding acceptance, physical performance, and quality of life of patients with occupational lung diseases. CR included 24 units of 90 minutes each with physiotherapy and breathing therapy as well as device-supported strength and endurance training. The aim of our study was to investigate the effects of CR in subjects with occupational diseases of the respiratory system and a legally anchored right to PR. Randomization was therefore not planned. A total of 148 insured persons with a confirmed occupational disease of the respiratory system were invited to participate by the employers' liability insurance association; 126 patients (85 %) accepted the invitation, and 78 participants (mean age: 71 years) completed the entire program (53 %). Benign asbestos-related diseases (plaques, pleural thickening, asbestosis) dominated with around 80 %. Ailments, depression, and dementia were typical obstacles. No adverse events occurred with strict observance of the chosen inclusion and exclusion criteria and training conditions. The measurement results at enrolment were compared with those at completion of the CR. CR led to a significant (p < 0.01) improvement in all parameters of physical performance: 6-minute walking test: + 36 m, ergometer test: + 9 watts, hand dynamometry: + 29 N, quadriceps strength test: + 84 MKI. The inspiratory capacity of the respiratory muscles (Pi_max: + 1.1 kPa) also improved (p < 0.01). The SF-36 showed an improvement in quality of life (p < 0.05) in the subdomains "mental well-being" (+ 3.7) and "physical role function" (+ 4.2). Therefore, CR proves to be a safe therapy if the inclusion and exclusion criteria are adhered to. CR is widely accepted by patients without severe comorbidities and achieves positive effects comparable to those that have been demonstrated in rehabilitation clinics. Outpatient CR is therefore suitable for eliminating the lack of structured and certified rehabilitation and training offers in rehabilitation clinics and for preserving the effects achieved there for insured patients with work-related respiratory and lung diseases.

Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort

Background

In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance.

Methods

The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity.

Results

Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program.

Conclusions

The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a “high-risk” profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining.

Electronic supplementary material

The online version of this article (10.1186/s12895-018-0080-2) contains supplementary material, which is available to authorized users.

The arylhydrocarbon receptor is only marginally involved in the antileukemic effects of its ligand curcumin

BACKGROUND

Acute myeloid leukaemia (AML) continues to present demanding treatment challenges, as in general the prognosis for long-term survival remains dire for the patients. Natural plant-derived substances with antileukemic properties offer new treatment possibilities or may act as by-stander therapy. Their molecular mechanisms of action are often not entirely clear, limiting theory-directed screening and application strategies. The plant substance curcumin is a known activator of the transcription factor aryl hydrocarbon receptor (AhR), and has well-documented antileukemic effects. The AhR regulates cell processes, including cell cycle and apoptosis. We ask here whether direct AhR-activation by curcumin contributes to its antileukemic/apoptotic potential.

MATERIALS AND METHODS

The induction of caspases 3/7, 8, and 9, the breakdown of mitochondrial transmembrane potential, the BCL-2/BAX ratio, and the DNA content of cells were measured as indicators of apoptosis. In addition, the induction of cell cycle inhibitors p21 and p27 were assessed.

RESULTS

While triggering of AhR signalling by curcumin in HL-60 cells was confirmed, induction of the above apoptosis parameters was not blocked by two AhR antagonists, alpha-naphtoflavone (alphaNF) and 3'-methoxy-4'nitroflavone (MNF). Only a moderate (20%) AhR-dependent induction of caspases 3/7 was detectable. Interestingly, transcriptional changes induced by curcumin and by anticarcinogenic 1,25-dihydroxy vitamin D3 overlapped by one third.

CONCLUSION

We conclude that AhR is only marginally involved in the antileukemic effects of its ligand curcumin.