610 Medizin und Gesundheit
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Hintergrund
Lungenkrebsbetroffene sind besonders stark durch psychischen Stress belastet. Gleichzeitig sind die Inanspruchnahmeraten von psychoonkologischer Unterstützung relativ gering. Es ist wenig über die Gründe der (Nicht‑)Inanspruchnahme bekannt.
Fragestellung
Welche emotionalen Herausforderungen erleben Menschen mit Lungenkrebs? Was sind ihre Gründe für die (Nicht‑)Inanspruchnahme psychoonkologischer Unterstützung?
Material und Methode
Es wurden qualitative Interviews mit 20 Lungenkrebsbetroffenen ausgewertet, die im Rahmen der CoreNAVI-Studie durchgeführt wurden.
Ergebnisse
Die Befragten erleben psychischen Stress in Form von Unsicherheiten und Zukunftsängsten. Auch den Druck, schnell von einer Behandlung in die nächste gehen zu müssen und keine Zeit für sich zu haben, nehmen die Betroffenen als belastend wahr. Das offene Sprechen, ohne das persönliche Umfeld belasten zu müssen, sowie konkrete Ratschläge erleben die Nutzer*innen der Psychoonkologie als große Hilfestellung. Die Nichtinanspruchnahme wird durch fehlenden Bedarf und mangelnde Kapazitäten begründet. Zudem werden Vorbehalte gegenüber psychologischer Unterstützung deutlich.
Schlussfolgerung
Betroffene mit Lungenkrebs erleben psychische und emotionale Belastungen auch durch die Vielzahl und Dichte an Therapien. Daraus resultierende fehlende Kapazitäten könnten eine Erklärung für die geringe Inanspruchnahme von psychoonkologischer Unterstützung sein. Eine stärkere Gewichtung der Psychoonkologie gegenüber aufwendigen medizinischen, oft nur geringfügig lebensverlängernden Therapien sowie der Abbau von Vorbehalten gegenüber psychologischer Hilfe sollten in der Versorgungspraxis verstärkt in den Fokus rücken.
In its “Windenergie”-decision, the BVerfG declared the legal obligation of wind turbine operators to involve citizens and communities in the vicinity of new wind farms in the projects essentially to be constitutional. The intention of the discussed provisions to promote acceptance for the expansion of wind energy serves the climate protection requirement under Article 20a Grundgesetz. The decision continues the line of the “Klimaschutz”-decision. The legal obligation of private persons is based on the factual necessity of the participation of all social actors to prevent climate change. The ecological long-term responsibility in Article 20a Grundgesetz is moved into the private sphere and thus, to a certain extent, subjectivized. These decisions pave the way for a constitutional change. They open up new perspectives for taking account of Article 20a Grundgesetz when weighing up the interests of freedom. Following the logic of the BVerfG, not only companies but also individuals would have to be obliged. In light of the decision, this article examines the possibilities of an emerging constitutional change toward a basic obligation (Grundpflicht) to use freedom in a sustainable manner. Thus, the discussed decision has a fundamental significance that has been too little appreciated and underestimated so far.
Zur Abschaffung des Gutachterverfahrens in der Vertragspsychotherapie – ein Qualitätsverlust?
(2021)
Zielsetzung: Der vorliegende Artikel befasst sich mit der Fragestellung, inwiefern das Gutachterverfahren in der Vertragspsychotherapie ein zuverlässiges Qualitätsinstrument darstellt und ob sich aus der geplanten Abschaffung des Gutachterverfahrens das Risiko einer Qualitätsminderung in der ambulanten Psychotherapie ergibt.
Methodik: Es wurde eine Literaturrecherche durchgeführt. Arbeiten von den Jahren 2000 bis 2020 wurden berücksichtigt, welche sich mit dem Gutachterverfahren als Qualitätsmerkmal der ambulanten Psychotherapie befassen. Um die unterschiedlichen Standpunkte der zitierten Autor_innen zu diskutieren, wurde auch Bezug auf weiterführende Literatur genommen.
Ergebnisse: Das Gutachterverfahren scheint empirisch nicht sicher als zuverlässiges Qualitätsmerkmal der ambulanten Psychotherapie herangezogen werden zu können. Die Annahme, dass sich durch eine gutachterbefreite Vertragspsychotherapie eine Qualitätsminderung der Psychotherapie ergibt, wird durch die hier zusammengefassten Arbeiten insgesamt nicht gestützt.
Background
Coronavirus disease (COVID-19) has a severe impact on all aspects of patient care. Among the numerous biomarkers of potential validity for diagnostic and clinical management of COVID-19 are biomarkers at the interface of iron metabolism and inflammation.
Methods
The follow-up study included 54 hospitalized patients with laboratory-confirmed COVID-19 with a moderate and severe/critical form of the disease. Iron deficiency specific biomarkers such as iron, ferritin, transferrin receptor, hepcidin, and zinc protoporphyrin (ZnPP) as well as relevant markers of inflammation were evaluated twice: in the first five days when the patient was admitted to the hospital and during five to 15 days; and their validity to diagnose iron deficiency was further assessed. The regression and Receiver Operating Characteristics (ROC) analyses were performed to evaluate the prognosis and determine the probability for predicting the severity of the disease in the first five days of COVID-19.
Results
Based on hemoglobin values, anemia was observed in 21 of 54 patients. Of all iron deficiency anemia-related markers, only ZnPP was significantly elevated (P<0.001) in the anemic group. When patients were grouped according to the severity of disease, slight differences in hemoglobin or other anemia-related parameters could be observed. However, the levels of ZnPP were significantly increased in the severely ill group of patients. The ratio of ZnPP to lymphocyte count (ZnPP/L) had a discrimination power stronger than the neutrophil to lymphocyte count ratio (N/L) to determine disease severity. Additionally, only two markers were independently associated with the severity of COVID-19 in logistic regression analysis; D-dimer (OR (5.606)(95% CI 1.019–30.867)) and ZnPP/L ratio (OR (74.313) (95% CI 1.081–5108.103)).
Conclusions
For the first time ZnPP in COVID-19 patients were reported in this study. Among all iron-related markers tested, ZnPP was the only one that was associated with anemia as based on hemoglobin. The increase in ZnPP might indicate that the underlying cause of anemia in COVID-19 patients is not only due to the inflammation but also of nutritional origin. Additionally, the ZnPP/L ratio might be a valid prognostic marker for the severity of COVID-19.
Background
Coronavirus disease (COVID-19) has a severe impact on all aspects of patient care. Among the numerous biomarkers of potential validity for diagnostic and clinical management of COVID-19 are biomarkers at the interface of iron metabolism and inflammation.
Methods
The follow-up study included 54 hospitalized patients with laboratory-confirmed COVID-19 with a moderate and severe/critical form of the disease. Iron deficiency specific biomarkers such as iron, ferritin, transferrin receptor, hepcidin, and zinc protoporphyrin (ZnPP) as well as relevant markers of inflammation were evaluated twice: in the first five days when the patient was admitted to the hospital and during five to 15 days; and their validity to diagnose iron deficiency was further assessed. The regression and Receiver Operating Characteristics (ROC) analyses were performed to evaluate the prognosis and determine the probability for predicting the severity of the disease in the first five days of COVID-19.
Results
Based on hemoglobin values, anemia was observed in 21 of 54 patients. Of all iron deficiency anemia-related markers, only ZnPP was significantly elevated (P<0.001) in the anemic group. When patients were grouped according to the severity of disease, slight differences in hemoglobin or other anemia-related parameters could be observed. However, the levels of ZnPP were significantly increased in the severely ill group of patients. The ratio of ZnPP to lymphocyte count (ZnPP/L) had a discrimination power stronger than the neutrophil to lymphocyte count ratio (N/L) to determine disease severity. Additionally, only two markers were independently associated with the severity of COVID-19 in logistic regression analysis; D-dimer (OR (5.606)(95% CI 1.019–30.867)) and ZnPP/L ratio (OR (74.313) (95% CI 1.081–5108.103)).
Conclusions
For the first time ZnPP in COVID-19 patients were reported in this study. Among all iron-related markers tested, ZnPP was the only one that was associated with anemia as based on hemoglobin. The increase in ZnPP might indicate that the underlying cause of anemia in COVID-19 patients is not only due to the inflammation but also of nutritional origin. Additionally, the ZnPP/L ratio might be a valid prognostic marker for the severity of COVID-19.
WRKY23 is a component of the transcriptional network mediating auxin feedback on PIN polarity
(2018)
Auxin is unique among plant hormones due to its directional transport that is mediated by the polarly distributed PIN auxin transporters at the plasma membrane. The canalization hypothesis proposes that the auxin feedback on its polar flow is a crucial, plant-specific mechanism mediating multiple self-organizing developmental processes. Here, we used the auxin effect on the PIN polar localization in Arabidopsis thaliana roots as a proxy for the auxin feedback on the PIN polarity during canalization. We performed microarray experiments to find regulators of this process that act downstream of auxin. We identified genes that were transcriptionally regulated by auxin in an AXR3/IAA17-and ARF7/ARF19-dependent manner. Besides the known components of the PIN polarity, such as PID and PIP5K kinases, a number of potential new regulators were detected, among which the WRKY23 transcription factor, which was characterized in more detail. Gain-and loss-of-function mutants confirmed a role for WRKY23 in mediating the auxin effect on the PIN polarity. Accordingly, processes requiring auxin-mediated PIN polarity rearrangements, such as vascular tissue development during leaf venation, showed a higher WRKY23 expression and required the WRKY23 activity. Our results provide initial insights into the auxin transcriptional network acting upstream of PIN polarization and, potentially, canalization-mediated plant development.
WRKY23 is a component of the transcriptional network mediating auxin feedback on PIN polarity
(2018)
Auxin is unique among plant hormones due to its directional transport that is mediated by the polarly distributed PIN auxin transporters at the plasma membrane. The canalization hypothesis proposes that the auxin feedback on its polar flow is a crucial, plant-specific mechanism mediating multiple self-organizing developmental processes. Here, we used the auxin effect on the PIN polar localization in Arabidopsis thaliana roots as a proxy for the auxin feedback on the PIN polarity during canalization. We performed microarray experiments to find regulators of this process that act downstream of auxin. We identified genes that were transcriptionally regulated by auxin in an AXR3/IAA17-and ARF7/ARF19-dependent manner. Besides the known components of the PIN polarity, such as PID and PIP5K kinases, a number of potential new regulators were detected, among which the WRKY23 transcription factor, which was characterized in more detail. Gain-and loss-of-function mutants confirmed a role for WRKY23 in mediating the auxin effect on the PIN polarity. Accordingly, processes requiring auxin-mediated PIN polarity rearrangements, such as vascular tissue development during leaf venation, showed a higher WRKY23 expression and required the WRKY23 activity. Our results provide initial insights into the auxin transcriptional network acting upstream of PIN polarization and, potentially, canalization-mediated plant development.
Working memory (WM), which underlies the temporary storage and manipulation of information, is critical for multiple aspects of cognition and everyday life. Nevertheless, research examining WM specifically in older adults remains limited, despite the global rapid increase in human life expectancy. We examined WM in a large sample (N=754) of healthy older adults (aged 58-89) in a non-Western population (Chinese speakers) in Taiwan, on a digit n-back task. We tested not only the influence of age itself and of load (1-back vs. 2-back) but also the effects of both sex and education, which have been shown to modulate WM abilities. Mixed-effects regression revealed that, within older adulthood, age negatively impacted WM abilities (with linear, not nonlinear, effects), as did load (worse performance at 2-back). In contrast, education level was positively associated with WM. Moreover, both age and education interacted with sex. With increasing age, males showed a steeper WM decline than females; with increasing education, females showed greater WM gains than males. Together with other findings, the evidence suggests that age, sex, and education all impact WM in older adults, but interact in particular ways. The results have both basic research and translational implications and are consistent with particular benefits from increased education for women.