Patients' experiences in a guided Internet- and App-based stress intervention for college students: A qualitative study.

INTRODUCTION: Academic education is often associated with increased stress and adverse effects on mental health. Internet-based interventions have shown to be effective in reducing stress-related symptoms. However, college students as target group so far have not been reached appropriately with psychological interventions and little is known about college students' perception of Internet-based stress management interventions. The objective of this study was to explore the experiences of students participating in an Internet- and App-based stress management intervention originally developed for stressed employees and subsequently adapted and tailored to college students. METHOD: Semi-structured interviews were conducted with ten participants selected from a randomized controlled trial that evaluated the effectiveness of an Internet- and App-based stress training. The selection of participants aimed to include students with different levels of treatment success. In order to enable an in-depth examination of intervention elements causing dissatisfaction, the interviews were systematically adapted regarding participants' statements in a precedent questionnaire. The interview material was analyzed based on the grounded theory method and thematic analysis. RESULTS: Results suggest students perceive a necessity to adapt Internet-based interventions to their particular needs. Students' statements indicate that a scientific perspective on the intervention and instable life circumstances could be student-specific factors affecting treatment experience. General themes emerging from the data were attitudes towards individualization and authenticity as well as demands towards different functions of feedback. DISCUSSION: Participants' experiences hint at certain intellectual and lifestyle-related characteristics of this population. Future studies should explore whether adaptions to these characteristics lead to a higher acceptance, adherence and effectiveness in the target population.

The impact of intestinal resection on serum levels of anti-Saccharomyces cerevisiae antibodies (ASCA) in patients with Crohn's disease.

BACKGROUND: Antibodies to Saccharomyces cerevisiae (ASCA) are highly prevalent in sera of patients with Crohn's disease and have been proposed to identify subgroups of patients with a disabling disease course. AIM: To investigate the impact of intestinal resection on serum levels of ASCA in patients with Crohn's disease and the predictive value of ASCA levels on surgical recurrence. METHODS: Sera from 60 patients who underwent 'curative' intestinal resection due to stricturing and/or penetrating complications were collected preoperatively and during post-operative follow-up (week 2, months 4, 8 and 11 ± 1). Measurement of ASCA IgG and IgA isotypes were performed using ELISA. Re-operation rate was associated with ASCA status and serum levels. RESULTS: At baseline 44/60 (73%) of patients were rated as positive for ASCA IgG, 45/60 (75%) for ASCA IgA and 52/60 (87%) as positive for at least one of both. ASCA serum levels remained stable during first year from resection. After a median of 106 months 10 of 40 (25%) patients with long-term follow-up underwent one or more intestinal re-operations. Neither ASCA positivity nor absolute ASCA serum levels were predictive of surgical recurrence. CONCLUSIONS: Serum ASCA levels remain stable after curative intestinal resection in Crohn's disease. This indicates the persistence of both stimulus and immunological mechanism operative in the production of ASCA even after complete surgical resection of macroscopically inflamed intestinal tissue. After intestinal resection, neither ASCA positivity nor ASCA serum levels predict the risk of surgical recurrence during long-term follow-up.

Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease.

BACKGROUND: Antibiotics and thiopurines have been employed in the management of fistulizing Crohn's disease, although evidence of their efficacy is rare. AIM: To evaluate, in a prospective, open-label study, the influence of antibiotics and azathioprine on the clinical outcome of perianal fistulas in patients with Crohn's disease. METHODS: Fifty-two patients entered the study, starting with an 8-week regimen of ciprofloxacin (500-1000 mg/day) and/or metronidazole (1000-1500 mg/day). Seventeen patients had already received daily azathioprine (2-2.5 mg/kg) at enrollment, whereas in 14 patients azathioprine was initiated after 8 weeks of antibiotic treatment. Outcome was evaluated by Fistula Drainage Assessment and the Perianal Disease Activity Index at weeks 8 and 20. RESULTS: Overall, 26 patients (50%) responded to antibiotic treatment, with complete healing in 25% of patients at week 8. The Perianal Disease Activity Index decreased significantly from 8.4 +/- 2.9 to 6.0 +/- 4.0 (P < 0.0001). At week 20, the outcome was assessed in 49 patients (94%), 29 of whom (59%) had received azathioprine. Response was noted in 17 of the 49 patients (35%), with complete healing in nine patients (18%). Patients who received azathioprine were more likely to achieve a response (48%) than those without immunosuppression (15%) (P = 0.03). The Perianal Disease Activity Index was closely associated with treatment response and perianal disease activity. CONCLUSION: Antibiotics are useful to induce a short-term response in perianal Crohn's disease, and may provide a bridging strategy to azathioprine, which seems to be essential for the maintenance of fistula improvement.

A randomised placebo controlled trial of pegylated interferon alpha in active ulcerative colitis.

BACKGROUND: Pilot studies of interferon alpha (IFN-alpha) suggest a high remission rate in the treatment of active ulcerative colitis. We evaluated the safety of pegylated interferon alpha (PegIFN) and its role in induction of remission in patients with active ulcerative colitis, in a multicentre placebo controlled trial. METHODS: Sixty patients with a clinical activity score (CAI) of >6 were randomised to receive placebo (n=20), PegIFN 0.5 microg/kg (n=19), or PegIFN 1.0 microg/kg body weight (n=21) once weekly (PegIntron; Schering-Plough, USA) over 12 weeks. Patients receiving 5-aminosalicylates, steroids, and/or azathioprine in stable dosages were included. RESULTS: Serious adverse events were seen in none of the placebo patients, in 3/19 patients in the PegIFN 0.5 microg/kg group (hospitalisation due to disease flare up n=3), and in 3/21 in the PegIFN 1.0 microg/kg group (hospitalisation due to disease flare up n=1; thrombosis n=1; grand mal seizure n=1). Otherwise, we observed only minor IFN-alpha side effects. Clinical remission rates at week 12 (CAI < or =4) were 7/20 (35%) in the placebo, 9/19 (47%) in the PegIFN 0.5 microg/kg group, and 7/21 (33%) in the PegIFN 1.0 microg/kg group (NS). Early withdrawal from the study was observed in 11/20 placebo patients, in 6/19 in the PegIFN 0.5 microg/kg group, and in 10/21 in the PegIFN 1.0 microg/kg group, mainly due to lack of efficacy. The higher PegIFN dose was associated with a significant decrease in levels of C reactive protein (p=0.003, day 0 v 85). CONCLUSIONS: PegIFN is safe but not effective, at the dosages used, in patients with ulcerative colitis.

An open-label trial of the selective cyclo-oxygenase-2 inhibitor, rofecoxib, in inflammatory bowel disease-associated peripheral arthritis and arthralgia.

BACKGROUND: Conventional non-steroidal anti-inflammatory drugs have been associated with an increased risk of exacerbation of inflammatory bowel disease. AIM: To evaluate, in a prospective, open-label study, the safety and efficacy of a 20-day regimen of the selective cyclo-oxygenase-2 inhibitor, rofecoxib, 12.5-25 mg/day, in inflammatory bowel disease patients with associated peripheral arthropathy and/or arthritis. METHODS: Patients with clinically inactive to mild inflammatory bowel disease and a joint pain score of at least two points on a scale ranging from zero (none) to four (very poor) were eligible. Response was defined by a decrease of at least two points in the arthralgia score. RESULTS: Of the 32 patients included, 26 (81%) were treated with rofecoxib, 25 mg/day, and six (19%) with rofecoxib, 12.5 mg/day. In three patients (9%), rofecoxib had to be withdrawn after a few days due to gastrointestinal complaints which ceased immediately after drug discontinuation. No flare of inflammatory bowel disease occurred. Thirteen of the 32 patients (41%) were responders and, overall, the arthralgia score decreased from two to one (P = 0.0001). CONCLUSIONS: This is the first prospective study on the use of a selective cyclo-oxygenase-2 inhibitor in inflammatory bowel disease patients with peripheral arthropathy and/or arthralgia. The promising safety and efficacy profile warrants further evaluation in controlled trials.

The gender issue: epidemiology of ankle injuries in athletes who participate in basketball.

The increased participation of women in organized athletics has resulted in an interest in gender-related injury patterns. Previous reports have indicated an increased incidence in anterior cruciate knee injuries among female intercollegiate basketball players compared with their male counterparts. The current epidemiologic study prospectively evaluated the relative risk of ankle injuries in scholastic and collegiate basketball players during a 2-year period. Eleven thousand seven hundred eighty athletes participated in this study, 4940 females and 6840 males. There were 1052 ankle injuries. Overall, females had a 25% greater risk of sustaining a Grade I ankle sprain compared with their male counterparts. This increased risk was present in the interscholastic and intercollegiate players. There was no significant difference in the risk for Grades II and III ankle sprains, ankle fractures, or syndesmotic sprains. Male and female athletes doubled their risk for sustaining an ankle injury at the intercollegiate level compared with the interscholastic level.

Experimental correction of irregular corneal astigmatism using topography-based flying-spot-mode excimer laser photoablation.

PURPOSE: To present a novel experimental approach for treating irregular corneal astigmatism. METHODS: After decomposition of topographic analysis data into orthogonal Zernike polynomials, a regular target surface was defined, and the ablation profile was calculated. In a polymethylmethacrylate with an irregular surface, computer-controlled ablation was performed using a 193-nm excimer laser in "flying-spot mode." RESULTS: The difference between flattest and steepest hemimeridians in the 3-mm zone, surface regularity index, and surface asymmetry index were reduced from 8.7 to 1.1 diopters, 1.19 to 0.39, and 1.84 to 0.14, respectively. CONCLUSION: Tying corneal topography into laser software offers a straightforward concept for correction of irregular corneal astigmatism in an experimental model.

Topographic organization of Fos-like immunoreactivity in the rostral nucleus of the solitary tract evoked by gustatory stimulation with sucrose and quinine.

Fos immunohistochemistry was used to elucidate the pattern of activation elicited by two qualitatively and hedonically distinct taste stimuli, sucrose and quinine, within the first-order gustatory relay, the rostral division of the nucleus of the solitary tract. Compared to unstimulated controls, both sucrose and quinine elicited significant increases in Fos-like immunoreactivity in the rostral central subnucleus, the region of the rostral solitary nucleus that receives the densest primary afferent input. Within the rostral central subnucleus, neurons that exhibited Fos-like immunoreactivity following quinine stimulation were concentrated medially, but neurons that exhibited Fos-like immunoreactivity following sucrose stimulation were distributed more evenly along the mediolateral axis. Despite their differential distribution, sucrose- and quinine-activated neurons also demonstrated notable intermingling. Further, the chemotopic arrangement was only partially consistent with what would be predicted if chemotopy was merely an outcome of orotopy. Our results suggest that a rough chemotopy characterizes the organization of taste responses in the nucleus of the solitary tract, and that the topographic pattern of taste afferent terminations in this nucleus is related to their chemosensitivity as well as to their peripheral spatial distribution.

[Purulent meningoencephalitis--studies of disease progression and prognosis]. / Die eitrige Meningoenzephalitis--Untersuchungen zum Verlauf und zur Prognose.

The course of acute purulent meningitis and meningocephalitis was investigated in 101 patients using records and a questionnaire directed to all patients. Patients who survived meningoencephalitis were asked to come to a neurological examination. Neuropsychological status, EEG and Tc-HMPAO-Spect were also performed in these patients. The patients were treated with a combination of three antimicrobial agents which was commonly used at our hospital during the investigation time consisting of penicillin, a cephalosporine of the third generation and an aminoglycoside. 40% of the patients suffered from more or less severe neurologic sequelae; remaining cognitive deficits were also frequent. On the whole there was a tendency towards improvement in patients who suffered from less severe deficits at the time of discharge from hospital, patients with more severe deficits also showed slight improvement but generally did not reach a restitutio ad integrum. Regarding this, in our opinion a broad initial antimicrobial therapy should be used, although a statistically significant improvement of the patient's outcome by this could not be shown. Lethality as well as the frequency of complications do not seem to differ over many years although antimicrobial and intensive care treatment were improved. Thus, the outcome seems to depend largely on the occurrence of secondary focal complications or brain oedema.

[Coping and life satisfaction in patients with Hodgkin's disease in remission. A contribution to the question of adaptive aspects of coping processes]. / Coping und Lebenszufriedenheit bei Patienten mit M. Hodgkin in Remission. Ein Beitrag zur Frage der Adaptivität von Coping-Prozessen.

Widening the focus from survival time to the "quality of survival" this cross-sectional study was designed to find correlations between coping strategies, quality of life, sociodemographic and medical data. 61 patients (31 women, 30 men; mean age 41 [22-74] with Hodgkin's disease receiving no treatment since 1 month to 16 years (mean 5 years) were assessed for coping and quality of life. Two standardized questionnaires were used: "Freiburg Questionnaire of Coping with Chronic Illness" (FKV 102) and "Questions for Life Satisfaction" (FLZ). Coping strategies were evaluated. The most used strategies were compliance strategies and trust in doctors. Some coping strategies correlated significantly with age, sex, marital status, education, and medical data as B symptoms and occurrence of recidivs. The scores for life satisfaction were absolutely high in comparison with postoesophagectomy patients and healthy controls from other studies. Life satisfaction was correlated with age, B symptoms and type of therapy. These correlations and correlations between FKV and FLZ were discussed and basic problems were reflected.

Oculographic diagnosis of hemineglect in patients with homonymous hemianopia.

Two patients with complete dense left homonymous hemianopia of acute onset are presented. There was a striking difference in visuospatial orientation between them in the early stages of their disease, due to additional left hemineglect in the second patient. While eye movement patterns known to be typical for homonymous hemianopia were found in the first patient by means of infrared reflection oculography, the second showed several findings which could be attributed to hemineglect. Based on these observations and those described in earlier literature, oculographic criteria are listed that enable hemineglect to be detected in the presence of homonymous hemianopia. The practical importance of diagnosing hemineglect with objective and quantitative methods is stressed.

Interaction of the alkylating antitumor agent 2,3,5-tris(ethyleneimino)benzoquinone with the plasma membrane of Ehrlich ascites tumor cells.

The effect of the alkylating agent 2,3,5-tris(ethyleneimino)benzoquinone (Trenimon) on the uptake of 2-aminoisobutyric acid, 1-aminocyclopentane-1-carboxylic acid (cycloleucine), 3-O-methyl-D-glucose, and 86Rb was studied. All transport studies were performed at nonsaturating conditions where the specific transport system was rate limiting for the uptake. The activities of all systems are reduced after treatment with the alkylating agent. The impairment of the plasma membrane is expressed 30 sec after exposure to the drug, as measured by the 86Rb uptake, and lasts for at least 12 hr according to the reduced 3-O-methyl-D-glucose uptake. Inhibition of protein synthesis by cycloheximide for 2 hr does not affect the uptake of 86Rb. The short interval which is necessary before an inhibition of 86Rb uptake can be registered and the resistance of the 86Rb transport system to an inhibition of protein synthesis are considered as indicative for a direct alkylation of a membrane constituent. Treatment with the alkylating agent increases the cyclic adenosine 3':5'-monophosphate of the cells. This effect is not due to an effect on adenylate cyclase or the membrane-bound cyclic adenosine 3':5'-monophosphate phosphodiesterase. In view of the known correlations between plasma membrane functions and the regulation of cell division, it is proposed that the growth inhibition by Trenimon of Ehrlich ascites tumor cells may be caused by its interaction with the plasma membrane.