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Background: The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels preCOVID-19 pandemic.
Methods: Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network (R) (NCCN (R)) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23.
Results: Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms.
Conclusions: This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created "COVID-19 pandemic questionnaire"could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support.
Background
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region.
Methods
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals.
Results
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period.
Conclusion
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers' burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients' CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients' functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers' burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers' burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients' functional status (r\(_p\) = −0.555, p < 0.001, n = 242). It was influenced by the CGs' own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients' wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs' depression (r\(_p\) = 0.627, p < 0.001, n = 234), anxiety (r\(_p\) = 0.550, p < 0.001, n = 234), and poorer physical condition (r\(_p\) = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients' impairment in daily routine (r\(_s\) = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs' lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs' work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required.
Ein Kennzeichen der spätmittelalterlichen Stadtchronistik ist das Auftreten von Autoren und Lesern aus neuen, bis dahin illiteraten sozialen Schichten. Zur Erforschung dieser Geschichtsschreibung liefert die Arbeit von Joachim Schneider am Beispiel Nürnberg mit seinen kodikologischen und rezeptionsgeschichtlichen, aber auch seinen modernen sozial- und mentalitätsgeschichtlichen Fragestellungen einen wichtigen Beitrag. Im Zentrum der Untersuchung steht die Chronik des Bierbrauers und Aufsehers über das Bettelwesen, Heinrich Deichsler. Nach eingehender Analyse von Materialgewinnung und Arbeitstechniken Deichslers ist das Bild, das die Nürnberger um 1500 von ihrer Vergangenheit hatten, ein weiterer Schwerpunkt dieses Werkes. Schneider vergleicht dazu die Deichslersche Chronik mit anderen Nürnberger historiographischen Texten. Insbesondere geht es dabei um die Gemeinsamkeiten und Unterschiede zwischen bürgerlicher und offiziöser Geschichtsbetrachtung. Zwei für die Stadt zentrale Geschichtsüberlieferungen stehen im Vordergrund: Die Erwerbung und Behauptung der Reichskleinodien sowie der Aufstand von 1348/49. Ein weiteres Kapitel der Arbeit liefert anhand der Zeitungen, Urkunden u.Ä., die Deichsler in seine Chronik als Inserte einfügte, einen Beitrag zu den noch wenig erforschten Anfängen des Zeitungswesens. Deichslers selbständige Chronistik führt schließlich mitten in das Nürnberger Alltagsleben um 1500. Auch hier zeigen sich bei Themen und Darstellungsweise bezeichnende Unterschiede zu anderen Nürnberger Chroniken, die aus sozial höherem Milieu stammen. Schneiders Untersuchung beschreibt nicht nur chronistische Techniken, Geschichtsbild und Mentalität eines bemerkenswert fleißigen Mittelschicht-Chronisten, es entsteht vielmehr ein Panorama der reichen spätmittelalterlichen Nürnberger Geschichtsschreibung und damit der Geschichte dieser Stadt selbst in ihren großen und kleinen Ereignissen - einer Stadt, die gerade damals ihre wohl größte Zeit erlebte.
The pathogenic yeast Candida albicans can develop resistance to the widely used antifungal agent fluconazole, which inhibits ergosterol biosynthesis, by the overexpression of genes encoding multidrug efflux pumps or ergosterol biosynthesis enzymes. Zinc cluster transcription factors play a central role in the transcriptional regulation of drug resistance. Mrr1 regulates the expression of the major facilitator MDR1, Tac1 controls the expression of the ABC transporters CDR1 and CDR2, and Upc2 regulates ergosterol biosynthesis (ERG) genes. Gain-of-function mutations in these transcription factors result in constitutive overexpression of their target genes and are responsible for fluconazole resistance in many clinical C. albicans isolates. The transcription factor Ndt80 contributes to the drug-induced upregulation of CDR1 and ERG genes and also binds to the MDR1 and CDR2 promoters, suggesting that it is an important component of all major transcriptional mechanisms of fluconazole resistance. However, we found that Ndt80 is not required for the induction of MDR1 and CDR2 expression by inducing chemicals. CDR2 was even partially derepressed in ndt80D mutants, indicating that Ndt80 is a repressor of CDR2 expression. Hyperactive forms of Mrr1, Tac1, and Upc2 promoted overexpression of MDR1, CDR1/CDR2, and ERG11, respectively, with the same efficiency in the presence and absence of Ndt80. Mrr1- and Tac1-mediated fluconazole resistance was even slightly enhanced in ndt80D mutants compared to wild-type cells. These results demonstrate that Ndt80 is dispensable for the constitutive overexpression of Mrr1, Tac1, and Upc2 target genes and the increased fluconazole resistance of strains that have acquired activating mutations in these transcription factors.
In der vorliegenden Studie wurde die Frage geprüft, inwieweit Schulanfänger im Vergleich zu fortgeschrittenen Grundschülern tatsächlich nur wenig darüber wissen, welche Strategien in freien Reproduktionsaufgaben (son-recall) voneilhaft sind. Zu diesem Zweck wurde das Metagedächtnis von Zweit- und Vienkläßlern, also ihr Wissen um die Vorteile unterschiedlicher Sortier- und Lernstrategien, mit ihrem Lernverhalten bzw. ihrem Leistungsvermögen in unterschiedlichen Varianten der sort-recall-Aufgabe verglichen. Diese Prozedur gestattete es, die Bewertung unterschiedlicher Strategien direkt mit ihrer jeweiligen Wirksamkeit zu vergleichen. Die an je 32 Zweit- und Viertkläßlern gewonnenen Befunde: lassen sich insgesamt so interpretieren, daß die jüngeren Kinder kaum etwas über angemessene Verhaltensweisen bei freien Reproduktionsaufgaben wissen; sie ziehen perzeptuelle Organisationsstrategien konzeptuellen (taxonomischen) Organisationsstrategien vor, profitieren tatsächlich jedoch signifikant mehr von konzeptuellen Strategien. Demgegenüber verfügten die: Vienkläßler in der Regel über angemessenes Metagedächtnis: sie schätzten taxonomische Strategien nicht nur höher ein, sondern profitierten auch de facto deutlich mehr von solchen Techniken. Die Befunde können insgesamt als Bestätigung der in der neueren Literatur verbreiteten Annahme gewertet werden, daß sich das Wissen um Gedächtnisanforderungen bei sort-recall-Aufgaben erst gegen Ende: der Grundschulzeit herausbildet.