Results of a poll of cancer patients with respect to pain and quality of life

AIM: Bernatzky et al. recently published a study on the prescribing practices of general practitioners in Austria with respect to the prescribing of opioids in cancer patients.The aim of the study was to assess the adequately of pain therapy and the resulting quality of life in chronic cancer patients. METHODS: A representative sample of patients was taken from the Carinthian tumor register.These patient were sent a questionnaire alone with an explanatory letter and at a later date a reminder letter by mail. RESULTS: Of the 1.895 returned questionnaires 665 (35%) were completed. In this study only the data of the 429 patients who indicated that they experienced pain were processed.More than one fifth of the patients complained of a poor or a very poor quality of life and 80% of the patients were limited in their activities of daily living by pain.There are still many prejudices and informational gaps with respect to the effects of morphine.The main focus of treatment was medication therapy and was generally carried out by the family physician.The satisfaction with pain therapy was at best moderate.This is insofar of importance, as the satisfaction with pain therapy has a massive impact on the quality of life. CONCLUSIONS: More extensive information and education are required with respect to the various options and possibilities of pain control.Explanations of the mode of action and side-effects of pain medication in order to deal with the prejudices.Earlier and more focused use of pain therapy (long duration of pain), and use of coping aids for activities of daily living (limited through pain) and a broadening of the spectrum of treatment are all necessary.Patient satisfaction with pain therapy should be the main focus, as this is the deciding factor in terms of the quality of life.     

Schmerzerleben und Schmerzbehandlung von Tumorpatienten aus der Sicht von Allgemeinmedizinern

AIM: The aim of the study presented in this paper is to find out how general practitioners evaluate their cancer patients' health, quality of life and type and extent of pain. In addition the study aims to get information about the training in pain therapy and palliative medicine. METHODS: A representative sample of 440 of all Austrian general practitioners was interviewed via a standardized questionnaire. The consent for the questioning had been obtained by telephone. RESULTS: The state of health and quality of life of the treated cancer patients are described as little satisfying and most unfavourably affected by the disease. The physicians suppose that the patients experience pain more intense than could be expected of them as endurable. Nevertheless the cancer patients appreciate pain therapy. CONCLUSION: As a result the medical training in pain therapy and palliative medicine should be improved. At the same time the future general practitioners should gain psychological competences, which would consequently provide them with a broad spectrum of treatment needed when dealing with pain patients (suffering from cancer).     

Aktivierungsangebote in Pflegeheimen

The following survey aims to ascertain the range of activities offered by different nursing homes, the extent to which residents use these activities as well as the satisfaction of residents and nursing staff concerning these activities. Focus is put on activating activities and activities of residents' own initiative.The analysis, which is based on 255 residents and 171 nursing staff from 11 nursing homes, shows a clear distinction between the various homes as to their ranges of activities. Activation in the home's everyday life is mainly done following the "watering-can principle", which means that it does not take into consideration the residents' individualities. The study provides clear evidence that the possibility to actively participate in the home's everyday life or to follow one's own interests makes residents feel highly satisfied. The fact that some residents as well as those nursing them place more importance on activities than others shows that the attitude towards aging is still characterized by the deficit model.     

Clusterin associates with altered elastic fibers in human photoaged skin and prevents elastin from ultraviolet-induced aggregation in vitro

Clusterin is a secreted glycoprotein with stress-induced expression in various diseased and aged tissues. It shares basic features with small heat shock proteins because it may stabilize proteins in a folding-competent state. Besides its presence in all human body fluids, clusterin associates with altered extracellular matrix proteins, such as beta-amyloid in Alzheimer senile plaques in the brain. Because dermal connective tissue alterations occur because of aging and UV radiation, we explored the occurrence of clusterin in young, aged, and sun-exposed human skin. Immunohistochemical analysis showed that clusterin is constantly associated with altered elastic fibers in aged human skin. Elastotic material of sun-damaged skin (solar elastosis), in particular, revealed a strong staining for clusterin. Because of the striking co-localization of clusterin with abnormal elastic material, we investigated the interaction of clusterin with elastin in vitro. A chaperone assay was established in which elastin was denatured by UV irradiation in the absence or presence of clusterin. This assay demonstrated that clusterin exerted a chaperone-like activity and effectively inhibited UV-induced aggregation of elastin. The interaction of both proteins was further analyzed by electron microscopy, size exclusion chromatography, and mass spectrometry, in which clusterin was found in a stable complex with elastin after UV exposure.     

How a cell deals with abnormal proteins. Pathogenetic mechanisms in protein aggregation diseases.

Defective protein folding is responsible for many diseases. Although these diseases seem to be quite diverse at the first glance, there is evidence for common pathogenetic principles. The basis of the pathological changes is the cell's inability to prevent protein misfolding, to revert misfolded proteins to normal or to eliminate misfolded proteins by degradation. This could result in deposition of potentially cytotoxic protein aggregates (protein aggregation diseases). Chronic degenerative diseases of the central nervous system (e.g. Alzheimer's and Parkinson's disease), the amyloidoses, but also chronic liver diseases, for example alcoholic and nonalcoholic steatohepatitis, belong to this category of disorders. This review highlights general pathogenic principles of protein aggregation diseases based on immunohistochemical and biochemical studies as well as observations in a mouse model for protein aggregation in the context of alcoholic and nonalcoholic steatohepatitis. The cellular defense mechanisms involved in protein quality control as well as the pathogenesis of protein aggregation diseases will be discussed.