Professional relationships during crisis interventions: A scoping review

INTRODUCTION

A crisis can be described as subjective experience that threatens and overwhelms a person's ability to handle a specific situation. In dealing with crises some people are looking for support from professionals. The "professional relationship" between people experiencing a crisis and professionals plays an important role in the successful management of a crisis which has been widely researched in many contexts. However, regarding outpatient services (e. g. crisis resolution home treatment teams), yet empirical evidence remains limited.

OBJECTIVE

We aim to explore descriptions of supportive professional relationships during outpatient crisis interventions in empirical literature. Accordingly, a scoping review was conducted to identify types of evidence, map the key concepts, and point out research gaps.

METHODS

MEDLINE, PsycINFO, CINAHL and Social Science Citation Index were searched for studies reporting empirical data on the professional relationship between people experiencing a crisis (18+) and professionals (e. g. social workers, psychiatrists) during a crisis intervention, defined as a short-term, face-to-face, low threshold, time-limited, outpatient, and voluntary intervention to cope with crises. Studies were excluded if they were published before 2007, in languages other than English and German, and if they couldn't be accessed. Included studies were summarized, compared, and synthesized using qualitative content analyses.

RESULTS

3.741 records were identified, of which 8 met the eligibility criteria. Only one study directly focused on the relationship; the others addressed varied aspects. Two studies explored the perspectives of service users, five focused on those of the professionals and one study examined both. The empirical literature was categorized into three main themes: strategies used to develop a supportive professional relationship, factors influencing the relationship and the nature of these relationships.

DISCUSSION

The results reveal a gap in understanding the nature of supportive professional relationships from the service users' perspective, as well as how professionals construct these relationships.

Local, collaborative, stepped, and personalized care management for older people with chronic diseases - results from the randomized controlled LoChro-trial

BACKGROUND

In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness.

METHODS

A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (n_IG = 261, n_CG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T₀: baseline, T₁: after 12 months, T₂: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants' evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling.

RESULTS

We analyzed N = 491 participants (n_IG = 244, n_CG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T₀ and T₂ (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity.

CONCLUSION

Supporting patients' self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904.

The CopA2-Type P1B-Type ATPase CcoI Serves as Central Hub for cbb 3-Type Cytochrome Oxidase Biogenesis

Copper (Cu)-transporting P_1B-type ATPases are ubiquitous metal transporters and crucial for maintaining Cu homeostasis in all domains of life. In bacteria, the P_1B-type ATPase CopA is required for Cu-detoxification and exports excess Cu(I) in an ATP-dependent reaction from the cytosol into the periplasm. CopA is a member of the CopA1-type ATPase family and has been biochemically and structurally characterized in detail. In contrast, less is known about members of the CopA2-type ATPase family, which are predicted to transport Cu(I) into the periplasm for cuproprotein maturation. One example is CcoI, which is required for the maturation of cbb ₃-type cytochrome oxidase (cbb ₃-Cox) in different species. Here, we reconstituted purified CcoI of Rhodobacter capsulatus into liposomes and determined Cu transport using solid-supported membrane electrophysiology. The data demonstrate ATP-dependent Cu(I) translocation by CcoI, while no transport is observed in the presence of a non-hydrolysable ATP analog. CcoI contains two cytosolically exposed N-terminal metal binding sites (N-MBSs), which are both important, but not essential for Cu delivery to cbb ₃-Cox. CcoI and cbb ₃-Cox activity assays in the presence of different Cu concentrations suggest that the glutaredoxin-like N-MBS1 is primarily involved in regulating the ATPase activity of CcoI, while the CopZ-like N-MBS2 is involved in Cu(I) acquisition. The interaction of CcoI with periplasmic Cu chaperones was analyzed by genetically fusing CcoI to the chaperone SenC. The CcoI-SenC fusion protein was fully functional in vivo and sufficient to provide Cu for cbb ₃-Cox maturation. In summary, our data demonstrate that CcoI provides the link between the cytosolic and periplasmic Cu chaperone networks during cbb ₃-Cox assembly.

Long-term application potential of urban air mobility complementing public transport: an upper Bavaria example

In this paper, the required models and methods to analyze and quantify the potential demand for urban air mobility (UAM) complementing public transport and possible impacts were defined and applied to the Munich Metropolitan region. An existing agent-based transport model of the study area were used and extended to cover socio-demographic changes up to the year 2030 and intermodal UAM services. An incremental logit model for UAM was derived to simulate demand for this new mode. An airport access model was developed as well. Three different UAM networks with different numbers of vertiports were defined. Sensitivity studies of ticket fare and structure, flying vehicle cruise speed, passenger process times at vertiports and different Urban Air Mobility networks sizes were performed. For the reference case, UAM accounts for a modal share of 0.5%. The absolute UAM demand is concentrated on very short routes; hence, UAM vehicle flight speed variation shows low UAM demand impacts. Kilometer-based fare, number of UAM vehicles per vertiport and passenger process times at vertiports show a significant impact on UAM demand.

Prevalence, symptomatology, risk factors and healthcare services utilization regarding paternal depression in Germany: study protocol of a controlled cross-sectional epidemiological study

BACKGROUND

While postpartum depression is a well-researched disorder in mothers, there is growing evidence indicating that some fathers also develop depressive symptoms (paternal postpartum depression, PPD). A recent meta-analysis revealed a total prevalence of paternal depression during pregnancy and up to one year postpartum of 8.4%, with significant heterogeneity observed among prevalence rates. International studies suggest that PPD is characterized by additional symptoms compared to maternal postpartum depression. Furthermore, various risk factors of PPD have been identified. However, the prevalence, symptomatology, risk factors and healthcare situation of fathers affected by PPD in Germany are unknown.

METHODS/DESIGN

This study comprises a controlled, cross-sectional epidemiological survey administered via postal questionnaires. The primary objective is to compare the prevalence of depressive symptoms in fathers with a 0-12-month-old infant to the prevalence of depressive symptoms in men without recent paternity. Two structurally differing regions (concerning birthrate, employment status, socioeconomic structure, and nationality of inhabitants) will be included. A random sample of 4600 fathers (2300 in each region) in the postpartum period and 4600 men without recent paternity matched by age, nationality and marital status will be assessed regarding depressive symptoms using the PHQ-9. Contact data will be extracted from residents' registration offices. As secondary objectives, the study aims to provide insights into symptoms and risk factors of PPD in fathers and to assess the current healthcare situation of fathers with PPD in Germany. In an add-on study, genetic and epigenetic mechanisms of PPD will be explored.

DISCUSSION

This study will conduct the first direct comparison between fathers in the postpartum period of one year after childbirth and a matched sample of men without a newborn child. Besides closing this research gap, the findings will provide prevalence estimates as well as insights into specific symptomatology, risk factors, and the current healthcare situation regarding fathers with PPD in Germany. The results will identify low-threshold approaches as a relevant issue for healthcare. Moreover, the findings should inform the development of PPD-specific screening instruments and healthcare offers addressing fathers with PPD.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00013339 ; Trial registration date: August 20, 2018; Universal Trial Number (UTN): U1111-1218-8185.

Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial

Background

Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved.

Methods

The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios.

Discussion

The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people.

Trial registration

German Clinical Trials Register (DRKS): DRKS00013904; Trial registration date: 02. February 2018.

[Implementation of the GermanIMPACT collaborative care program: A qualitative study on the perspective of care managers and supervisors]

BACKGROUND

Collaborative Care programs like the Improving Mood Promoting Access to Collaborative Care Program (IMPACT) present an opportunity to support primary care for elderly depressed patients. The GermanIMPACT study evaluates whether this low-threshold model using short behavioral interventions that are conducted by care managers and supervised by a psychotherapist/psychiatrist, is as effective as in other countries. Besides effectiveness, the feasibility of the intervention is also essential for the implementation of the program.

METHOD

Care managers and supervisors were interviewed using a qualitative interview guide with questions concerning feasibility and effectiveness of the GermanIMPACT intervention, and the interviews were then evaluated using qualitative content analysis.

RESULTS

The interviewees provided important information on how to optimize the realization of the intervention by selecting patients more carefully and by providing case managers with more training. Moreover, the intervention was described as being supportive of patients and as providing relief for general practitioners. Whereas interviewees wanted the intervention to be expanded to other disorders, they simultaneously highlighted the limits of the intervention.

CONCLUSIONS

The present study provides practical information for implementing the GermanIMPACT model. Thus, specific recommendations for implementation into standard care can be derived.

Signaling ammonium across membranes through an ammonium sensor histidine kinase

Sensing and uptake of external ammonium is essential for anaerobic ammonium-oxidizing (anammox) bacteria, and is typically the domain of the ubiquitous Amt/Rh ammonium transporters. Here, we report on the structure and function of an ammonium sensor/transducer from the anammox bacterium "Candidatus Kuenenia stuttgartiensis" that combines a membrane-integral ammonium transporter domain with a fused histidine kinase. It contains a high-affinity ammonium binding site not present in assimilatory Amt proteins. The levels of phosphorylated histidine in the kinase are coupled to the presence of ammonium, as conformational changes during signal recognition by the Amt module are transduced internally to modulate the kinase activity. The structural analysis of this ammonium sensor by X-ray crystallography and small-angle X-ray-scattering reveals a flexible, bipartite system that recruits a large uptake transporter as a sensory module and modulates its functionality to achieve a mechanistic coupling to a kinase domain in order to trigger downstream signaling events.

[Attendance for Using Internet-Based Support After Inpatient Treatment - A Cross-Sectional Survey]

OBJECTIVE

Examination of the attendance for using internet-based measures after inpatient treatment.

METHODS

Cross-sectional-survey in former inpatients (N = 247).

RESULTS

44.9 % are willing to use measures via videoconference, 34.7 % via Chat, 50.0 % via E-Mail and 38.0 % as onlinetherapy. Attendance is lower in older age groups. Benefits regarding the introduced measures are seen mainly in the flexibility and disadvantages in the impersonal character.

CONCLUSIONS

A relevant share of especially younger patients is willing to use internet-based measures.

Myelodysplastic syndromes without peripheral monocytosis but with evidence of marrow monocytosis share clinical and molecular characteristics with CMML

MDS patients may present with monocytic marrow proliferation not fulfilling criteria for CMML. We analyzed MDS patients with or without a marrow monocytic proliferation by following up the amount of monocytic proliferation and characterizing their molecular profile. 315 MDS patients of Duesseldorf MDS registry were divided into two groups: A) 183 patients with monocytic esterase positive cells in marrow and monocytes between 101 and 900/μl in blood and B) 132 patients without monocytic esterase positive cells in marrow and monocytes in blood ≤100/μl. Twenty patients of each group were screened with regard to ASXL1, TET2, RUNX1, SETBP1, NRAS, and SRSF2 using Illumina myeloid panel. Group A patients were older, had significantly higher WBC, hemoglobin levels, neutrophils and platelets. CMML evolution rates were 4.9% and 1.5%, respectively (p=n.s.). TET2, NRAS and SRFS2 mutation frequencies were higher in group A and four patients had coexisting TET2 and SRFS2 mutation, which was shown to be characteristic but not specific for CMML. MDS patients with marrow monocytic proliferation have a more CMML-like pheno- and genotype and develop CMML more often. Those patients could potentially be very early stages of CMML or represent a CMML-like myeloid neoplasma with marrow adherence of the monocytic cell population.

[On the Way to Culture-Sensitive Patient Information Materials: Results of a Focus Group Study]

AIM

This study was part of a double-blind randomised controlled trial aimed to evaluate the effects of culture-sensitive patient information materials (PIM) compared with standard translated material. The study aimed to obtain the data for the development of culture sensitive PIM about unipolar depression for the 4 largest migrant groups in Germany (Turkish, Polish, Russian and Italian migration background).

METHOD

A qualitative study using 4 manual-based focus groups (FG), one for each migrant group, with 29 participants (9 with a Turkish (TüG), 8 with a Polish (PoG), 5 with a Russian (RuG) and 7 with an Italian (ItG) migration background) was conducted. The discussions were recorded, transcribed and analyzed using qualitative content analysis.

RESULTS

7 categories were identified. For the (1.) development of a good culture-sensitive PIM an easy language, a clear structure, an assessable extent of information and the avoidance of stereotypes were highlighted cross-culturally in all four FG. RuG and PoG had the largest (2.) lack of information about the German health care system. Concerning the (3.) illness perception RuG named problems with recognizing and understanding depression. PoG, RuG and TüG thematized (4.) feared consequences of the illness and of professional helpseeking. ItG, PoG, RuG had fears concerning (5.) psychotropic drugs as a result from insufficient knowledge about medication. For (6.) doctor-patient relationship cultural specifics were identified in RuG and TüG and for (7.) migration or culture specific reasons for depression in RuG, ItG and TüG.

CONCLUSION

Although the identified categories were relevant for all or for the majority of migrant groups, for most categories specific cultural aspects were discovered. These findings show the importance of a culture sensitive adaptation of PIM.

[Dying at Life's Beginning]

AIM

When parents-to-be are faced with a terminal prenatal diagnosis, they are confronted with the decision either to continue the pregnancy or to terminate it at an advanced stage. This difficult decision is intimately affected by the experience of the inevitability of loss, and ethical dilemmas posed in this usually completely unexpected situation. Studies indicate that perinatal child loss due to lethal foetal anomalies is a major life event and a source of serious psychological issues, which can last for many years after the experience. Moreover, it has been shown that care for bereaved parents, if guided by their needs, can ease their burden, regardless of whether they choose to end or continue the pregnancy. The aim of this study is to inspect current practices of counselling and support of affected families and develop practical guidelines for health and social professionals involved.

METHODS

A sample of 32 parents in the German-speaking part of Switzerland was investigated between December 2012 and March 2014. Semi-structured problem-centred interviews were conducted, transcribed verbatim and thematically analysed.

RESULTS

4 main time periods and 6 themes were identified by participants ranging from diagnosis until birth: "shock", "choices and dilemmas", "taking responsibility", "still being pregnant", "saying goodbye/letting go" and "planning the future". However, findings reflect critical points of care and showed gaps not only between emphasising time periods but also between affected parents' and involved professionals' views. This article reports the findings from the parents.

CONCLUSION

This study provided new insights into parental responses when they are confronted with a fatal prenatal diagnosis. The results contribute towards rethinking current practices in midwifery and other healthcare during pregnancy, birth and puerperium as well as the palliative care of the child.

Effectiveness of a brief psychoeducational group intervention for relatives on the course of disease in patients after inpatient depression treatment compared with treatment as usual--study protocol of a multisite randomised controlled trial

BACKGROUND

Relapses and rehospitalisations are common after acute inpatient treatment in depressive disorders. Interventions for stabilising treatment outcomes are urgently needed. Psychoeducational group interventions for relatives were shown to be suitable for improving the course of disease in schizophrenia and bipolar disorders. A small Japanese monocentre randomised controlled trial also showed promising results for depressive disorders. However, the evidence regarding psychoeducation for relatives of patients with depressive disorders is unclear.

METHODS/DESIGN

The study is conducted as a two-arm multisite randomised controlled trial to evaluate the incremental effect of a brief psychoeducational group intervention for relatives as a maintenance treatment on the course of disease compared to treatment as usual. Primary outcome is the estimated number of depression-free-days in patients within one year after discharge from inpatient treatment. 180 patients diagnosed with unipolar depressive disorders as well as one key relative per patient will be included during inpatient treatment and randomly allocated to the conditions at discharge. In the intervention group, relatives will participate in a brief psychoeducational group intervention following the patient's discharge. The intervention consists of four group sessions lasting 90 to 120 min each. Every group session contains informational parts as well as structured training in problem-solving. In both study conditions, patients will receive treatment as usual. Patients as well as relatives will be surveyed by means of questionnaires at discharge and three, six, nine and twelve months after discharge. In addition to the primary outcome, several patient-related and relative-related secondary outcomes will be considered and health economics will be investigated.

DISCUSSION

Our study will provide evidence on the incremental effect of a brief psychoeducational intervention for relatives as a maintenance treatment after inpatient depression treatment. Positive results may have a major impact on health care for depression.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00006819; Trial registration date: 2014 Oktober 31; Universal Trial Number (UTN): U1111-1163-5391.

[Psychoeducation for Relatives of Persons with Depressive Disorders: A Focus Group Study on Information Demands]

BACKGROUND

Depressive disorders place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives' burden and improve the course of disease in patients. To foster the development of psychoeducational interventions which meet relatives' needs, information demands in relatives of patients with depressive disorders were examined.

METHODS

A qualitative study using 3 focus groups was conducted among adult relatives of patients with depressive disorders (N=17). Discussions were audio-taped, transcribed and analyzed using qualitative content analysis.

RESULTS

Information demands are based on information gaps, emotional burden as well as strains in everyday living and were identified with regard to illness-specific (symptoms, course and etiology), treatment-specific (treatment options and health care system) and - as central aspects - interaction-specific issues (dealing with the patient, difficulties in everyday living and relationship problems) as well as support options for relatives themselves and self-care.

CONCLUSIONS

Information brokerage within psychoeducational groups for relatives should consider the burden of relatives as well as strains in everyday living on which information demands are based. To consider interaction-specific issues, specific skills - e. g. in problemsolving - should be trained.

[Transcultural prevention of alcohol-related disorders : effects of a culture- and migration-sensitive approach in elderly migrants with respect to attitudes and behavior: a cluster randomized controlled trial]

BACKGROUND

For migrants who are older than 50, alcohol frequently becomes a problem. Simultaneously alcohol-related prevention measures only reach this group insufficiently. Therefore, a transcultural concept for preventing alcohol-related disorders in elderly (≥ 45 years) migrants has been developed.

METHOD

The transcultural concept, which consisted of a prevention event as well as a cultural and language-sensitive information booklet, was evaluated in a cluster-randomized controlled trial (n = 310 immigrants). As a control condition there was a prevention event with materials from Deutsche Hauptstelle für Suchtfragen (German Centre for Addiction Issues). Data were obtained before and after the event, as well as after 6 months. All materials were available both in German and in Russian, Italian, Spanish and Turkish.

RESULTS

Directly after the event, as well as 6 months thereafter, the transcultural approach was rated significantly better than the general prevention event. 73.4 % of the participants read the cultural and migration-sensitive booklet, whereas only 21.2 % in the control condition (p = 0.0001). Furthermore, significantly more participants of the transcultural approach reported a reduced alcohol consumption (49.4 vs. 16.7 %; p = 0.004) after 6 months.

CONCLUSION

The consideration of diversity with respect to cultural, migration-related, socio demographic und linguistic aspects improves the effectiveness of prevention measures.

In silico study of structural and geometrical requirements of natural sesquiterpene lactones with trypanocidal activity

Chagas' disease, caused by the intracellular protozoan Trypanosoma cruzi, is one of the most serious health problems throughout South America. Despite the progress that has been made in the study of its biochemistry and physiology, more efficient chemotherapies to control this parasitic infection are still lacking. In this paper we report the trypanocidal and cytotoxic activities of a series of sesquiterpene lactones, isolated from Asteraceae medicinal plants. The significant trypanocidal activity and high selectivity indexes found for many of the compounds evaluated, prompted us to undertake a quantitative structure-activity relationship study. A model using 3D molecular descriptors allowed us to set up a high correlation of the observed activity and the atomic spatial arrangement of these sesquiterpene lactones closely related to steric parameters.

Provision of group psychoeducation for relatives of persons in inpatient depression treatment--a cross-sectional survey of acute care hospitals in Germany

BACKGROUND

Depressive disorders are often recurrent and place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives' burden, help prevent relapses in patients, and are recommended by the German "National Disease Management Guideline Unipolar Depression". Since there is limited knowledge on the provision of psychoeducational groups for relatives of persons in inpatient depression treatment, we conducted a survey among acute care hospitals in Germany.

METHODS

We conducted a two-step cross-sectional survey. Step I consisted of a questionnaire asking the heads of all psychiatric/psychosomatic acute care hospitals in Germany (N = 512) whether psychoeducational groups for relatives were provided within depression treatment, and if not, the reasons for not implementing them. In group offering hospitals the person responsible for conducting psychoeducational groups received a detailed questionnaire on intervention characteristics (step II). We performed descriptive data analysis.

RESULTS

The response rate was 50.2% (N = 257) in step I and 58.4% in step II (N = 45). 35.4% of the responding hospitals offered psychoeducational groups for relatives of patients with depressive disorders. According to the estimates of the respondents, relatives of about one in five patients took part in psychoeducational groups in 2011. Groups were mostly provided by two moderators (62.2%) as continuous groups (77.8%), without patients' participation (77.8%), with up to ten participants (65.9%), consisting of four or fewer sessions (51.5%) which lasted between one and one and a half hours each (77.8%). The moderators in charge were mostly psychologists (43.9%) or physicians (26.8%). Approximately one third used published manuals. Reasons for not conducting such psychoeducational groups were lack of manpower (60.1%), time (44.9%) and financial constraints (24.1%). 25.3% mentioned adequate concepts of intervention as a required condition for initiating such groups.

CONCLUSIONS

Only a small proportion of relatives of patients with depressive disorders participated in psychoeducational groups in 2011 in Germany. Mostly short interventions were favoured and main implementation barriers were scarce resources. Brief interventions that fit with healthcare routine should be developed and tested within randomised controlled trials. This could promote the provision of psychoeducational groups for relatives as evidence-based practice in inpatient depression treatment in Germany.

Invited review article: technology for attosecond science

We describe a complete technological system at Imperial College London for Attosecond Science studies. The system comprises a few-cycle, carrier envelope phase stabilized laser source which delivers sub 4 fs pulses to a vibration-isolated attosecond vacuum beamline. The beamline is used for the generation of isolated attosecond pulses in the extreme ultraviolet (XUV) at kilohertz repetition rates through laser-driven high harmonic generation in gas targets. The beamline incorporates: interferometers for producing pulse sequences for pump-probe studies; the facility to spectrally and spatially filter the harmonic radiation; an in-line spatially resolving XUV spectrometer; and a photoelectron spectroscopy chamber in which attosecond streaking is used to characterize the attosecond pulses. We discuss the technology and techniques behind the development of our complete system and summarize its performance. This versatile apparatus has enabled a number of new experimental investigations which we briefly describe.

[Health care utilisation of migrants with mental disorders compared with Germans]

OBJECTIVE

Analysis of the health care utilisation of migrants with mental disorders compared to Germans with mental disorders under consideration of migration-related and socio-economic factors.

METHODS

Reanalysis of the supplement survey "Mental Disorders" of the "German Health Survey" 1998 with a matched sample of migrants (n = 151) and Germans (n = 151) with a positive 12-month prevalence of mental disorders.

RESULTS

Regarding the prevalence rates for mental disorders and health care utilisation no differences in the sample between Germans and migrants could be found.

CONCLUSIONS

The migration background alone does not explain the differences in health care utilisation which are found in many studies. It is assumed, that differences arise multifactorial, and can be explained through migration-related factors but especially through socio-economic factors. To provide a better understanding of health care utilisation of migrants it might be necessary to set the focus on socio-economic factors. In addition a differentiated measurement of cultural and migration-related factors is needed in future studies.

Enhancement of high harmonics from plasmas using two-color pump and chirp variation of 1 kHz Ti:sapphire laser pulses

We have investigated resonance effects in high-order harmonic generation (HHG) within laser-produced plasmas. We demonstrate a significantly improved harmonic yield by using two-color pump-induced enhancement and a 1 kHz pulse repetition rate. Together with an increased HHG output, the even harmonics in the cutoff region were enhanced with respect to odd harmonics. We report the observation of a resonance-induced growth in intensity of 20th harmonic in silver plasma (2×), 26th harmonic in vanadium plasma (4×), and 28th harmonic in chromium plasma (5×).

A rapid method for assessing the environmental performance of commercial farms in the Pampas of Argentina

The generation of reliable updated information is critical to support the harmonization of socio-economic and environmental issues in a context of sustainable development. The agro-environmental assessment and management of agricultural systems often relies on indicators that are necessary to make sound decisions. This work aims to provide an approach to (a) assess the environmental performance of commercial farms in the Pampas of Argentina, and (b) propose a methodological framework to calculate environmental indicators that can rapidly be applied to practical farming. 120 commercial farms scattered across the Pampas were analyzed in this study during 2002 and 2003. Eleven basic indicators were identified and calculation methods described. Such indicators were fossil energy (FE) use, FE use efficiency, nitrogen (N) balance, phosphorus (P) balance, N contamination risk, P contamination risk, pesticide contamination risk, soil erosion risk, habitat intervention, changes in soil carbon stock, and balance of greenhouse gases. A model named Agro-Eco-Index was developed on a Microsoft-Excel support to incorporate on-farm collected data and facilitate the calculation of indicators by users. Different procedures were applied to validate the model and present the results to the users. Regression models (based on linear and non-linear models) were used to validate the comparative performance of the study farms across the Pampas. An environmental dashboard was provided to represent in a graphical way the behavior of farms. The method provides a tool to discriminate environmentally friendly farms from those that do not pay enough attention to environmental issues. Our procedure might be useful for implementing an ecological certification system to reward a good environmental behavior in society (e.g., through tax benefits) and generate a commercial advantage (e.g., through the allocation of green labels) for committed farmers.

Calpha methylation in molecular recognition. Application to substance P and the two neurokinin-1 receptor binding sites

Two binding sites NK-1M (major, more abundant) and NK-1m (minor) are associated with the neurokinin-1 receptor. For the first time with a bioactive peptide, the Calpha methylation constraint, shown to be a helix stabiliser in model peptides, was systematically used to probe the molecular requirements of NK-1M and NK-1m binding sites and the previously postulated bioactive helical conformation of substance P (SP). Seven Calpha methylated analogues of the undecapeptide SP (from position 5-11) have been assayed for their affinities and their potencies to stimulate second messenger production. The consequences of Calpha methylation on the structure of SP have been analysed by circular dichroism and nuclear magnetic resonance combined with restrained molecular dynamics. The decreased potencies of six out of these seven Calpha methylated SP analogues do not allow the identification of any clear-cut differences in the structural requirements between the two binding sites. Strikingly, the most active analogue, [alphaMeMet5]SP, leads to variable subnanomolar affinity and potency when interacting with the NK-1m binding site. The conformational analyses show that the structural consequences associated with Calpha methylation of SP are sequence dependent. Moreover, a single Calpha methylation is not sufficient by itself to drastically stabilize a helical structure even pre-existing in solution, except when Gly9 is substituted by an alpha-aminoisobutyric acid. Furthermore, Calpha methylation of residues 5 and 6 of SP in the middle of the postulated helix does not stabilize, but decreases (to different extents) the stability of the helical structure previously observed in the 4-8 domain of other potent SP analogues.

Helicobacter pylori infection in recurrent abdominal pain

BACKGROUND

Helicobacter pylori is associated with chronic gastritis and peptic ulcer in adults and in children. The purpose of the present study was to analyze the association of recurrent abdominal pain and H. pylori infection in children and to evaluate the efficacy of antimicrobial treatment in patients with evidence of infection.

METHODS

The clinical and histopathologic findings in children who underwent diagnostic upper endoscopy for recurrent abdominal pain were analyzed retrospectively. Patients with evidence of infection with H. pylori were treated with a combination of omeprazole, amoxicillin, and clarithromycin. Efficacy of treatment was assessed using the 13C-urea-breath test.

RESULTS

H. pylori was found in histopathologic sections of 29 (40%) of 73 patients undergoing diagnostic endoscopy for recurrent abdominal pain. Five children (17%) were of Swiss ethnic origin, and 24 (83%) were non-Swiss. All the infected patients had chronic gastritis and 4 (14%) had ulcerations in the duodenum. Treatment with omeprazole, amoxicillin, and clarithromycin resulted in eradication of the infection in all and in resolution of the clinical symptoms in 15 (80%) of 19 patients who had a follow-up examination.

CONCLUSIONS

The presented data suggest that gastritis induced by H. pylori may be associated with recurrent abdominal pain and that in Switzerland infections with H. pylori primarily involve persons who are non-Swiss. A combined therapy results in eradication of the bacterium and in improvement of the clinical symptoms in a significant majority of the patients.

The effect of placental subfractions on Trypanosoma cruzi

Five subfractions were collected from six term placentas by mincing and differential centrifugation: homogenate, nuclear, mitochondrial, lysosomal, and supernatant. The effect of each subfraction on Trypanosoma cruzi was assessed by trypan blue exclusion, relative infectivity of mice, and penetration of susceptible cultured VERO cells. Ultrastructural changes in trypomastigotes were identified after high cell mortality was shown by dye exclusion following treatment with lysosomal and supernatant fractions. Trypomastigotes treated with other subfractions or preheated subfractions, those recovered from infected VERO cells, and controls remained unaffected. This was confirmed by the ability of treated trypomastigotes to infect mice or to penetrate susceptible cultured VERO cells. There were a 48% decrease in parasitemia and fewer myocardial lesions in Balb/c mice following treatment with the lysosomal subfraction compared to homogenate and controls. VERO cells were invaded about half as often after lysosomal treatment compared to controls (P < 0. 05); an 11% decrease in cell invasion following homogenate treatment was not significant. Placental lysosomal enzyme activity was unaffected by trypomastigotes. Human placentas contain one or more heat-labile substances in lysosomal and supernatant subfractions which inhibit or injure trypomastigotes of T. cruzi in cell-free systems.

Primary non-Hodgkin's lymphoma of the sciatic nerve followed by localization in the central nervous system: case report and review of the literature

OBJECTIVE AND IMPORTANCE

A unique case of primary non-Hodgkin's lymphoma of the sciatic nerve followed by multiple loci in the central nervous system is described.

CLINICAL PRESENTATION

The lesion occurred in a 44-year-old immunocompetent man with a palpable mass in the left popliteal fossa and a 10-month history of progressive weakness and numbness of the left foot. The tumor was a diffuse large lymphoma of B-cell origin of an intermediate grade of malignancy according to the criteria of the International Working Formulation.

INTERVENTION

Because diagnosis of the malignant lymphoma was performed on frozen section, resection of the nerve trunk was avoided. The patient was treated with radiotherapy and chemotherapy. At 6 months after the discovery, biopsy, and treatment of the sciatic nerve lymphoma, other lesions demonstrating the same histological features were observed in the central nervous system. The patient died 4 years and 2 months after presentation as a result of the central nervous system lesions and without clinical evidence of systemic extraneural localization.

CONCLUSION

A review of the literature indicates that primary peripheral nerve lymphomas occur in the sciatic nerve. These cases, and the case described in our study, share common clinicopathological findings that justify discussing them separately as distinct entities.

Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward

Genotyping and antibiotic susceptibility testing were used to analyze Pseudomonas aeruginosa and Burkholderia cepacia strains from sink drain from 14 pediatric patients with cystic fibrosis (CF) and from hospital personnel as part of a 4 week prospective study of strain transmission in a pediatric ward. A total of 87.5% of all washbasin drains were contaminated with P. aeruginosa [10(2) to 10(5) colony forming units (CFU)/ml sink fluid], whereas B. cepacia was found only once in a sink drain. From the eight CF patients already infected with P. aeruginosa upon entering the ward, we isolated six genotypes that were identical with strains found in sink drains of the ward. Four of the 16 members of the personnel had one positive P. aeruginosa hand culture. B. cepacia was never found in patients or on personnel hands. Hand washing in contaminated sinks (> or = 10(3) CFU/ml) led to positive P. aeruginosa or B. cepacia hand cultures. P. aeruginosa or B. cepacia embedded in sputum were transmissable by hand shaking for up to 180 min, whereas both pathogens suspended in physiological saline were transmissable to other hands only up to 30 min. Genotyping of P. aeruginosa revealed strain transmission from CF patients or the environment to other patients or the personnel, as well as one transmission from the environment to a CF patient. The ability of CF sputum to prolong survival of P. aeruginosa and B. cepacia may be important for strain transmission. The results suggest that improved hygienic measures are required to prevent routes of bacterial transmission via the hands and sink drains.

Internal exposure of waste incineration workers to organic and inorganic substances

One hundred and twenty-two persons employed in an industrial waste incineration plant were examined with respect to organic and inorganic substances which may be produced during the combustion of different waste. The employees were divided into three groups: persons with contact with the incinerator (WI workers, n = 45), periphery workers (n = 54) and management (n = 23). For the evaluation of internal exposure, the levels of lead, cadmium, mercury, benzene, toluene, ethylbenzene and m-xylene in blood, chromium in the erythrocytes, polychlorinated biphenyls, hexachlorobenzene and pentachlorophenol in plasma, and arsenic, chromium, nickel, vanadium, chlorophenols and hydroxypyrene in urine were determined. The internal exposures of the three groups were tested against each other and were compared with the reference values of the general population. Differences between the groups investigated were tested using the U test according to Wilcoxon, Mann and Whitney (P < 0.05). The biological exposure limits valid in Germany (BAT values) were not exceeded in any cases. Compared with the background levels of the German population, certain parameters were exceeded in several employees. Significantly higher levels of the WI workers in comparison to both periphery workers and management were found for toluene in blood (median: 1.1 vs 0.9 vs 0.6 microgram/l). For the lead and cadmium levels in blood and for the urinary excretion of arsenic, 2,4-dichlorophenol and tetrachlorophenols, statistical differences were found only between WI workers and one of the other groups. However, in all cases the elevations were very small and of interest more from the environmental than from the occupational point of view. It must be stressed that this waste incineration plant is very modern in terms of worker health and safety. At older plants without corresponding health and safety measures, higher internal exposure of the employees to hazardous substances may exist.

Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward

Genotyping and antibiotic susceptibility testing were used to analyze Pseudomonas aeruginosa and Burkholderia cepacia strains from sink drain from 14 pediatric patients with cystic fibrosis (CF) and from hospital personnel as part of a 4 week prospective study of strain transmission in a pediatric ward. A total of 87.5% of all washbasin drains were contaminated with P. aeruginosa [10(2) to 10(5) colony forming units (CFU)/ml sink fluid], whereas B. cepacia was found only once in a sink drain. From the eight CF patients already infected with P. aeruginosa upon entering the ward, we isolated six genotypes that were identical with strains found in sink drains of the ward. Four of the 16 members of the personnel had one positive P. aeruginosa hand culture. B. cepacia was never found in patients or on personnel hands. Hand washing in contaminated sinks (> or = 10(3) CFU/ml) led to positive P. aeruginosa or B. cepacia hand cultures. P. aeruginosa or B. cepacia embedded in sputum were transmissable by hand shaking for up to 180 min, whereas both pathogens suspended in physiological saline were transmissable to other hands only up to 30 min. Genotyping of P. aeruginosa revealed strain transmission from CF patients or the environment to other patients or the personnel, as well as one transmission from the environment to a CF patient. The ability of CF sputum to prolong survival of P. aeruginosa and B. cepacia may be important for strain transmission. The results suggest that improved hygienic measures are required to prevent routes of bacterial transmission via the hands and sink drains.

Cleavage of lymphocyte surface antigens CD2, CD4, and CD8 by polymorphonuclear leukocyte elastase and cathepsin G in patients with cystic fibrosis

Polymorphonuclear leukocytes (PMN) accumulating in airways of patients with cystic fibrosis (CF) as a response to chronic endobronchial bacterial lung infection, release lysosomal serine proteinases such as PMN-elastase at concentrations of approximately 0.5 microM to 5 microM into the airway lumen. Immunohistology of CF lung material and fluorescence activated cell sorter analysis of sequential CF bronchoalveolar lavages demonstrated loss of the CD4 and CD8 Ag on CD3+ T lymphocytes in sputum-filled airways. In 10 CF sputum samples 1.0%, 19.1%, and 15.7% of all CD3+ T lymphocytes expressed CD4, CD8, and CD2, respectively. Incubation of CF sputum supernatant fluids with peripheral blood T lymphocytes resulted in total reduction of CD4 and CD8 but not CD2. Addition of alpha 1-proteinase inhibitor abolished surface Ag cleavage completely. Purified PMN-elastase and cathepsin G cleaved CD2, CD4, and CD8 on peripheral blood T lymphocytes at proteinase concentrations of 0.83 to 8.3 microM in a dose-dependent manner. Cleaved CD4 and CD8 were reexpressed on the surface of T lymphocytes after 24 h in the absence of PMN-elastase. Incubation of a CD4+ T cell clone with PMN-elastase lead to a significant reduction of cytotoxicity toward target cells and significantly reduced IL-2 and IL-4 production. The results suggest a temporary functional impairment of T lymphocytes in foci of high inflammation characterized by stimulated PMN, which may lower tissue destruction.

Cleavage of lymphocyte surface antigens CD2, CD4, and CD8 by polymorphonuclear leukocyte elastase and cathepsin G in patients with cystic fibrosis

Polymorphonuclear leukocytes (PMN) accumulating in airways of patients with cystic fibrosis (CF) as a response to chronic endobronchial bacterial lung infection, release lysosomal serine proteinases such as PMN-elastase at concentrations of approximately 0.5 microM to 5 microM into the airway lumen. Immunohistology of CF lung material and fluorescence activated cell sorter analysis of sequential CF bronchoalveolar lavages demonstrated loss of the CD4 and CD8 Ag on CD3+ T lymphocytes in sputum-filled airways. In 10 CF sputum samples 1.0%, 19.1%, and 15.7% of all CD3+ T lymphocytes expressed CD4, CD8, and CD2, respectively. Incubation of CF sputum supernatant fluids with peripheral blood T lymphocytes resulted in total reduction of CD4 and CD8 but not CD2. Addition of alpha 1-proteinase inhibitor abolished surface Ag cleavage completely. Purified PMN-elastase and cathepsin G cleaved CD2, CD4, and CD8 on peripheral blood T lymphocytes at proteinase concentrations of 0.83 to 8.3 microM in a dose-dependent manner. Cleaved CD4 and CD8 were reexpressed on the surface of T lymphocytes after 24 h in the absence of PMN-elastase. Incubation of a CD4+ T cell clone with PMN-elastase lead to a significant reduction of cytotoxicity toward target cells and significantly reduced IL-2 and IL-4 production. The results suggest a temporary functional impairment of T lymphocytes in foci of high inflammation characterized by stimulated PMN, which may lower tissue destruction.