Einstellungen zum krankheitsmodell und zu Selbsthilfegruppen als prädiktoren der teilnahme an nachsorgeangeboten und des therapieergebnisses bei alkoholikern

Summary The study was conducted to determine the predictive value of attitudes towards the goals derived from the disease model of alcoholism (life-long acceptance of alcoholic status and endorsement of abstinence) as well as towards selfhelp groups. The criteria to be predicted were the intention to participate and actual participation in self-help groups as well as four indicators of therapeutic success. Only in cross-sectional analysis were significant correlations found. Longitudinally, there were no relevant relationships between the attitudes expressed by the patients at the end of inpatient treatment (t1) and subsequent participation in self-help groups or indicators of therapeutic success (t2: follow-up, 9 month after discharge). The discrepancy between cross-sectional and longitudinal analysis can be attributed to the fact that attitudes become increasingly less stable with time. This indicates that it is only possible to a limited extent to predict from the attitudes expressed during inpatient treatment how patients will actually behave in daily life outside the clinic. The consequences of these findings for therapy are discussed.     

Arbeitsbedingungen und gesundheitliches Befinden aus der Sicht der Erwerbst?tigen

Zusammenfassung Mittels einer anonymen postalischen Befragung von einer nahezu repräsentativen Stichprobe von rund 2000 Erwerbstätigen in der Schweiz wurden detaillierte Angaben über störende Faktoren der Arbeitsbedingungen, Störungen der Gesundheit und des Wohlbefindens, persönliche Einstellung zur Arbeit, Lebensgewohnheiten etc. erhoben. Von den potientiellen Störfaktoren der Arbeitsbedingungen werden am häufigsten (>30%) Lärm und zu wenig Zeit für Familie oder Freunde angegeben. Relativ viele Erwerbstätige (20–25%) beklagen sich über unbefriedigende Belüftung, Luftverunreinigung mit Staub, Rauch etc., Zugluft, unbehagliche Temperatur, zu trockene Luft, Heben und Tragen schwerer Lasten, dauerndes Stehen sowie andere Zwangshaltungen des Körpers, zuviel Überzeitarbeit, unpassende Arbeitszeiten, ferner auch Zeitdruck, Verantwortungsdruck, Erfolgszwang, mangelnde Anerkennung und mangelnde Information über die Planung und Ergebnisse der Arbeit. Von den angegebenen gesundheitlichen Beschwerden stehen Rükkenschmerzen und Nervosität an der Spitze (39%), gefolgt von Müdigkeit, Schlafstörungen, Nackenschmerzen, Beinbeschwerden, Augenbrennen und Magen-Darmbeschwerden (15–34%). Aus der Analyse der Ergebnisse lässt sich entnehmen, dass zwischen Beanstandungen von Störfaktoren der Arbeitsbedingungen, Berufszugehörigkeit, gesundheitlichen Beschwerden, Einstellung zur Berufsarbeit und zum Leben überhaupt gewisse Wechselbeziehungen — z. T. im Sinne eines Teufelskreises—bestehen, die offensichtlich auch von Persönlichkeitsmerkmalen und allgemeiner Lebenssituation abhängen. Die Ergebnisse ermöglichen eine umfassende Orientierung über die aktuellen Problemfelder des Arbeitnehmerschutzes.

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Summary In the present study details about disruptive factors in working conditions, elements injurious to health or general well-being, personal attitudes to work etc. have been obtained by means of a representative survey of about 2000 employed persons in Switzerland. The most frequent disruptive factors in working conditions (>30%) are noise and too little time for family and friends. A relatively large number of employed persons (20–25%) complain about unsatisfactory ventilation, air pollution due to dust, smoke etc., draughts, uncomfortable temperature, dry air, lifting and carrying heavy weights, uncomfortable body positions at work, unsuitable working hours, as well as pressure on time, too much concentration required, pressure of responsibility, insufficient recognition and lack of information about the planning and results of work being done. In the field of health complaints, back problems and nervous tension are at the top of the list (39%), followed by fatigue, sleeping problems, neck or leg problems, burning eyes, and stomach and intestinal problems (25–34%). The analysis shows that interrelationships exist — sometimes in the sense of a vicious circle—between complaints about disruptive factors in work conditions, professional groups, health problems and attitudes to professional live. The results provide a comprehensive survey of the incidence of problems in the fields of worker protection.

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Résumé Dans le cadre de la présente étude, nous avons effectué une enquête anonyme par correspondance auprés d'un échantillon représentatif comprenant quelque 2000 personnes actives en Suisse. Cette enquête a fourni des données détaillées sur les nuisances liées aux conditions de travail, sur les troubles de la santé et du bien-être ainsi que sur l'attitude personnelle à l'égard du travail et de la vie. Sur les nuisances liées aux conditions de travail les plus fréquemment mentionnées (>30%) sont le bruit et le manque de temps pour la famille ou les amis. Un assez grand nombre de personnes actives (20–25%) se plaignent que les locaux sont mal aérés, que l'air est pollué par des poussières, de la fumée etc., qu'il y a des courants d'air, que la température est désagréable, que l'air est sec, qu'elles ont à fournir de trop grands efforts physiques, particulièrement en soulevant et en portant des charges, qu'elles doivent rester longtemps debout ou dans des positions fatigantes, que leur horaire de travail ne leur convient pas, qu'elles sont stressées par le temps ou par leurs responsabilités, que leur travail n'est pas reconnu à sa juste valeur et qu'elles manquent d'informations quant à la planification et au résultat de leur travail. Des troubles de la santé mentionnés, les douleurs dorsales et la nervosité viennent en tête (39%), suivies de la fatigue, des troubles du sommeil, des douleurs à la nuque et aux jambes, des irritations des yeux et des troubles gastriques et intestinaux. L'analyse des résultats laisse paraître qu'entre les nuisances liées aux conditions de travail, la profession exercée, les problèmes de santé et l'attitude à l'égard du travail et de la vie en général, il y a des corrélations — en partie dans le sens d'un cercle vicieux — qui dépendent manifestement des traits de caractère et de la situation générale de l'individu. Les résultats permettent d'être informé sur l'ensemble des problèmes actuels de la protection des travailleurs.

     

Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention

Context  A higher mortality risk for women with acute myocardial infarction (AMI) is a common finding in studies that compare the postinfarction outcome of women vs men. It is not clear, however, whether sex is an independent predictor of death among patients systematically treated with aggressive reperfusion and medical strategies. Objective  To assess the impact of patient's sex on outcome in a consecutive series of patients with AMI treated with a reperfusion strategy largely based on percutaneous coronary interventions. Design, Setting, and Patients  Inception cohort of 1937 patients (502 women and 1435 men) who were admitted with a diagnosis of AMI to a tertiary referral institution between January 1995 and December 2000. Main Outcome Measures  Mortality at 1 year after AMI. Results  Compared with men, women were older (70 vs 61 years; P<.001) and had known diabetes or hypertension more often. Both men and women received essentially identical therapy with the majority of patients (86%) receiving reperfusion therapy via percutaneous coronary interventions. There were no significant differences in 1-year Kaplan-Meier death rates with 13.8% (68 cases) among women and 12.9% (184 cases) among men (unadjusted hazard ratio, 1.06; 95% confidence interval, 0.80-1.39; P = .70). After age adjustment, women had a lower risk of death (hazard ratio, 0.65; 95% confidence interval, 0.49-0.87; P = .004). Conclusion  Despite their more advanced age and greater prevalence of diabetes or hypertension, women with AMI who were treated with a reperfusion strategy largely based on percutaneous coronary interventions show a similar outcome as men.      

Mitogen stimulated rise of intracellular calcium concentration in single t lymphocytes from patients with major depression is reduced

1. 1. The authors investigated the signal transduction in T-lymphocytes as a peripheral model for central neurons.

2. 2. Intracellular free calcium concentration [Ca²⁺]_i was measured using fura 2 in T-lymphocytes from 6 patients with major depression during and after depression and from 6 healthy controls Patients were treated with interpersonal therapy (IPT) but not with psychotropic medication.

3. 3 Phytohemagglutinin (PHA) triggers an oscillatory [Ca²⁺]_i signal in human T-lymphocytes. This implies two mechanisms for [Ca²⁺]_i regulation: inositol phophate (IP) mediated release from intracellular stores and [Ca²⁺]_i influx from the extracellular medium.

4. 4. PHA stimulates 49% of T cells from controls but only 17% of T cells from depressed patients. This finding explains previous results from cells in suspension indicating that [Ca²⁺]_i signals after PHA-stimulation are reduced in cells from depressed patients.

5. 5 Cells from depressed patients show less [Ca²⁺]_i oscillations. Normal oscillation pattems are restored after clinical recovery from depression.

6. 6. Thus altered [Ca²⁺]_i oscillations in T-lymphocytes are a state phenomenon and may give us clues where to search for altered cellular mechanisms during depression.

     

Cytoskeleton and motility: an immunohistological and computer simulation analysis of melanocytic skin tumors

Tumor cell motility and tumor cell proliferation are supposed to be essential for tumor invasion. The cytoskeleton, which consists of different components, is considered to be important for maintaining cell shape and facilitating cell movement. Numerous data are available about tumor cell motility in vitro , but the behavior of tumor cells in vivo is as yet poorly understood. In the present study, estimates of tumor cell motility and proliferation were statistically derived from morphological tumor patterns in human melanocytic skin tumors, and their relationship to expression of certain cytoskeletal components was evaluated. Over-expression of vimentin within tumor cells correlated with low actual tumor cell motility and proliferation, indicating a structurally stabilizing function of these filaments. An overexpression of actin was found within tumor cells of high motility and proliferation, suggesting the contribution of cytocontractile elements to active tumor cell locomotion in situ. Concerning the cytoskeleton of the stromal cells, expression of actin, myosin and tubulin correlated with a high number of motile tumor cells and high mitotic counts. Thus increased tumor cell motility seems to be associated with cytoskeletal changes not only of the tumor cells themselves but also of the surrounding stromal cells.
Fink-Puches R, Smolle J. Cytoskeleton and motility: an immunohistological and computer simulation analysis of melanocytic skin tumors.     

The relationship between congenital cardiovascular malformations and spontaneous abortion in preceding pregnancy

Previous studies have shown an increased frequency of spontaneous abortions in the pregnancy preceding a fetus or a newborn with neural tube defect (NTD) compared with a normal newborn. One explanation of this observation is the trophoblastic cell rest hypothesis put forward by Knox and Clarke, suggesting a teratogenic interaction between the developing embryo and pathological remnants of a previous pregnancy. The other explanation is that the previously lost fetus was also affected with neural tube defect. The aim of this study was to verify whether this observation is also valid for congenital cardiovascular malformations (CCVM). Demographic and obstetric data of 99 mothers (58 Jewish and 41 Bedouin) of newborns who died in the neonatal period from isolated CCVM were compared with those of 103 mothers (48 Jewish and 55 Bedouin) of newborns who died of congenital defects other than NTD and CCVM. Spontaneous abortions in the preceding pregnancy were found in 32% of the cases with CCVM compared with 14% of cases with other defects (ODs) ( P  = 0.0012; odds ratio = 3.1, 95% confidence interval 1.5–6.4). This significant difference was independent of maternal age and number of pregnancies or deliveries. No difference was found between Jews and Bedouins. As there is no indication in the literature that fetuses with isolated CCVM tend to be spontaneously aborted, our findings are more supportive of the trophoblastic cell rest theory.     

Inhibition of melanoma cell directional migration in vitro via different cellular targets

Abstract In malignant melanoma active movement of cancer cells is considered to be essential for tissue invasion. Various mechanisms, such as the Ca²⁺-calmodulin-proteinkinase C cascade or G-protein-dependent processes are considered to play a role in tumor cell functions. The assay of directional migration, combined with computer-assisted image analysis, was used to evaluate the antimigratory efficacy of drugs interfering with different steps of signal (ransduction pathways. Treatment with different compounds showed a more or less concentration-dependent reduction of migration rates: The Ca²⁺-channel blockers verapamil and devapamil showed a slight reduction of molility. The effect was more pronounced when the calmodulin antagonist flunarizine was used or the proteinkinase C inhibitors dequalinium, tamoxifen and H-7 were applied. A marked inhibition of molility was found with the G-protein antagonist L 651582. Thus, our results indicate that different signal transduclion pathways are involved in the regulation of directional migration of K1735-M2 melanoma cells.