ABSTRACT
PURPOSE: Within families affected by parental cancer, open communication impacts the well-being of parents and their children; however, limited research exists on communication patterns in these families. This sub-study addresses this through the Family-SCOUT study, a multicenter, prospective, interventional, and non-randomized investigation with intervention (IG) and control group (CG). The purpose of this sub-study was to identify and compare the differences in communication patterns between the IG and CG as part of the process evaluation. The research question was addressed in both groups: What communication patterns do healthy parents perceive within their families? METHODS: Using a qualitative approach, the study involved interviewing healthy parents as surrogates for their families. The interviews were audio-recorded, transcribed, and coded using a template analysis. The resulting data were analyzed at the group level. RESULTS: Twenty-three interviews were conducted in the IG and 27 interviews in the CG. The analysis of themes centered on communication patterns as seen in the family structure. Both groups exhibited instances of open communication about fears and wishes as well as the use of child-friendly language when discussing cancer. Notable differences were observed: challenges in open communication with children were sorely reported in CG interviews, and "the illness is discussed when necessary" was sorely described in IG interviews. CONCLUSION: This study underscores the need to address and encourage open communication within families with parental cancer.
Subject(s)
Communication , Neoplasms , Parents , Humans , Neoplasms/psychology , Female , Male , Parents/psychology , Adult , Prospective Studies , Child , Middle Aged , Qualitative Research , Interviews as Topic , Child of Impaired Parents/psychologyABSTRACT
BACKGROUND: Cancer patients with minor children but also their families suffer from significant psychological distress and comorbidity. Protective factors predicting successful coping are well known. Corresponding systematic interventions are rare and limited by access barriers. We developed a comprehensive family-centered intervention for cancer patients with at least one dependent minor. PATIENTS AND METHODS: Family-SCOUT represents a multicentric, prospective, interventional, and controlled study for families with parental cancer and their minor children. In the intervention group (IG), all family members were addressed using a care and case management approach for nine months. Families in the control group (CG) received standard of care. Participating parents were asked to complete the Hospital-Anxiety-Depression-Scale (HADS) questionnaire at enrolment (T0) and after 9 months (T2). The primary outcome was a clinically relevant reduction of distress in at least one parent per family, measured as minimal important difference (MID) of ≥1.6 in the HADS total score. The percentage of families achieving MID is compared between the IG and CG by exact Fisher's test, followed by multivariate confounder analyses. RESULTS: T0-questionnaire of at least one parent was available for 424 of 472 participating families, T2-questionnaire after 9 months was available for 331 families (IG n = 175, CG n = 156). At baseline, both parents showed high levels of distress (HADS total: sick parents IG: 18.7 ± 8.1; CG: 16.0 ± 7.2; healthy partners: IG: 19.1 ± 7.9; CG: 15.2 ± 7.7). The intervention was associated with a significant reduction in parental distress in the IG (MID 70.4% in at least one parent) compared with the CG (MID 55.8%; P = 0.008). Adjustment for group differences from specific confounders retained significance (P = 0.047). Bias from other confounders cannot be excluded. CONCLUSIONS: Parental cancer leads to a high psychosocial burden in affected families. Significant distress reduction can be achieved through an optimized and structured care approach directed at the family level such as family-SCOUT.
Subject(s)
Neoplasms , Parents , Humans , Female , Male , Neoplasms/psychology , Neoplasms/therapy , Prospective Studies , Child , Adult , Parents/psychology , Adaptation, Psychological , Surveys and Questionnaires , Stress, Psychological/etiology , Adolescent , Child, Preschool , Middle AgedABSTRACT
BACKGROUND: Comorbid depression is frequent in internal medicine (e.g. in coronary heart disease, congestive heart failure or diabetes mellitus) and impairs quality of life as well as the prognosis of the somatic illness. AIM: To review evidence based recommendations for the treatment of depressive comorbidity in selected somatic disorders. MATERIALS AND METHODS: Selective literature search based on national and international guidelines. RESULTS: In clinical routine, depressive symptoms are often overseen or misinterpreted. Therefore, a specific diagnostic is recommended. Depressive symptoms should obligatory be screened during the clinical interview or by validated questionnaires. When screened positive, further diagnostic steps are mandatory. The treatment of depressive disorders has three main components: basic psychosomatic care, psychotherapy and antidepressant medication. These interventions are safe and effective for reducing depressive symptoms and enhancing quality of life. However, results regarding the effects on morbidity and mortality of the comorbid somatic disorder are still inconclusive. The greatest effects on depression are obtained by a preference-based, stepped-care approach and an optimal cooperation of all professionals ("collaborative care"). CONCLUSIONS: An effective treatment of depressive comorbidity is relevant for quality of life and possibly also for the prognosis of a somatic disease. Integrating a routine screening for depressive symptoms is the first step toward an effective, evidence-based therapy.
Subject(s)
Antidepressive Agents/therapeutic use , Depression/therapy , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Psychotherapy/methods , Quality of Life , Comorbidity , Depression/epidemiology , Depression/psychology , Evidence-Based Medicine , Humans , Psychophysiologic Disorders/epidemiology , Psychophysiologic Disorders/therapyABSTRACT
Increasing isolation rates of resistant bacteria in the last years require identification of potential infection reservoirs in healthcare facilities. Especially the clinical wastewater network represents a potential source of antibiotic resistant bacteria. In this work, the siphons of the sanitary installations from 18 hospital rooms of two German hospitals were examined for antibiotic resistant bacteria and antibiotic residues including siphons of showers and washbasins and toilets in sanitary units of psychosomatic, haemato-oncological, and rehabilitation wards. In addition, in seven rooms of the haemato-oncological ward, the effect of 24â¯h of stagnation on the antibiotic concentrations and MDR (multi-drug-resistant) bacteria in biofilms was evaluated. Whereas no antibiotic residues were found in the psychosomatic ward, potential selective concentrations of piperacillin, meropenem and ciprofloxacin were detected at a rehabilitation ward and ciprofloxacin and trimethoprim were present at a haemato-oncology ward. Antibiotic resistant bacteria were isolated from the siphons of all wards, however in the psychosomatic ward, only one MDR strain with resistance to piperacillin, third generation cephalosporins and quinolones (3MRGN) was detected. In contrast, the other two wards yielded 11 carbapenemase producing MDR isolates and 15 3MRGN strains. The isolates from the haemato-oncological ward belonged mostly to two specific rare sequence types (ST) (P. aeruginosa ST823 and Enterobacter cloacae complex ST167). In conclusion, clinical wastewater systems represent a reservoir for multi-drug-resistant bacteria. Consequently, preventive and intervention measures should not start at the wastewater treatment in the treatment plant, but already in the immediate surroundings of the patient, in order to minimize the infection potential.
Subject(s)
Bacteria/isolation & purification , Bathroom Equipment/microbiology , Drug Resistance, Multiple, Bacterial , Hospitals , Wastewater/microbiology , Anti-Bacterial Agents/analysis , Anti-Bacterial Agents/pharmacology , Bacteria/drug effects , Bacteria/genetics , Drug Resistance, Multiple, Bacterial/genetics , Environmental Monitoring , Genes, BacterialABSTRACT
Endothermic mammals and birds require intensive energy turnover to sustain high body temperatures and metabolic rates. To cope with the energetic bottlenecks associated with the change of seasons, and to minimise energy expenditure, complex mechanisms and strategies are used, such as daily torpor and hibernation. During torpor, metabolic depression and low body temperatures save energy. However, these bouts of torpor, lasting for hours to weeks, are interrupted by active 'euthermic' phases with high body temperatures. These dynamic transitions require precise communication between the brain and peripheral tissues to defend rheostasis in energetics, body mass and body temperature. The hypothalamus appears to be the major control centre in the brain, coordinating energy metabolism and body temperature. The sympathetic nervous system controls body temperature by adjustments of shivering and nonshivering thermogenesis, with the latter being primarily executed by brown adipose tissue. Over the last decade, comparative physiologists have put forward integrative studies on the ecophysiology, biochemistry and molecular regulation of energy balance in response to seasonal challenges, food availability and ambient temperature. Mammals coping with such environments comprise excellent model organisms for studying the dynamic regulation of energy metabolism. Beyond the understanding of how animals survive in nature, these studies also uncover general mechanisms of mammalian energy homeostasis. This research will benefit efforts of translational medicine aiming to combat emerging human metabolic disorders. The present review focuses on recent advances in the understanding of energy balance and its neuronal and endocrine control during the most extreme metabolic fluctuations in nature: daily torpor and hibernation.
Subject(s)
Energy Metabolism , Hibernation , Homeostasis , Mammals/physiology , Torpor , Animals , Brain/physiology , Circadian Rhythm , Endocrine System/physiology , Humans , SeasonsABSTRACT
With a lifetime prevalence of approximately 17% anxiety disorders are among the most common mental disorders worldwide. The disease progression can take a chronic course leading to a considerable impairment of the affected person. The current medical classification list (ICD-10) by the World Health Organization differentiates between agoraphobia, social phobia, specific phobia, panic disorder and generalized anxiety disorder. The etiology is multicausal comprising an interaction of genetic and psychosocial factors. For treatment, psychotherapy, psychopharmacological treatment and a combination of both methods are eligible. Anxiety disorders are often associated with physical illness either as the causative factor or the consequence. In particular, anxiety has been identified as an independent risk factor for cardiovascular disease. Anxiety disorders associated with somatic diseases are often unrecognized, therefore an optimization of diagnostic and treatment strategies is necessary.
Subject(s)
Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Internal Medicine/trends , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Cardiovascular Diseases/psychology , Cardiovascular Diseases/therapy , Causality , Comorbidity , HumansABSTRACT
Seasonal cycles of reproduction are common in many mammals and these are combined with the necessary energy budgeting for thermoregulatory challenges. Many mammals meet the challenge of changing environmental temperatures in winter by using torpor, a controlled reduction in body temperature and metabolic rate. We aimed to determine the effects of photoperiod and reproductive hormones on the seasonal cycles of reproduction and torpor use in a marsupial that commences reproduction in winter, the stripe-faced dunnart, Sminthopsis macroura. Males and females were placed under LD 14:10 and natural reproductive hormones blocked by either flutamide (males) or mifepristone (females) or tamoxifen (females). Reproductive parameters, metabolic rate and torpor variables were determined. The same animals were then placed under LD 10:14 and given testosterone (males) or progesterone (females) or oestrogen (females). Reproductive parameters, metabolic rate and torpor variables were measured. Body mass and tail widths (fattening indicator) in males were significantly affected by testosterone, and the effects were reversed by hormone blockers. Reproductive parameters were unaffected. Resting metabolic rate and ability to use torpor were not affected by treatment in males, however torpor characteristics, especially torpor bout duration, were affected by presence of testosterone in males. In females, body mass was unaffected by hormone presence, although tail widths were affected. Disruption of reproductive cycles occurred with hormone blockers in females, however, resting metabolic rate was not affected, and only presence of progesterone affected torpor characteristics in females. Our results differ from those found for rodents, where presence of testosterone abolishes the use of torpor in males, and oestrogen inhibits torpor use in females. Our study suggests that, in this mammal, metabolic responses to the presence or absence of reproductive hormones differs between males and females, and there is no absolute endocrinologically-driven reproductive season demarcated from the torpor season.
Subject(s)
Adaptation, Physiological , Basal Metabolism/drug effects , Body Temperature Regulation/physiology , Estrogens/physiology , Hormone Antagonists/pharmacology , Marsupialia/physiology , Progesterone/physiology , Reproduction/drug effects , Testosterone/physiology , Animals , Body Temperature , Body Weight , Circadian Rhythm , Female , Flutamide/pharmacology , Male , Mifepristone/pharmacology , Photoperiod , Tamoxifen/pharmacologyABSTRACT
Giles' planigale (Planigale gilesi) is among the smallest extant marsupials and inhabits deep soil cracks in arid floodplains. We examined whether its physiology shows specific adaptations to its extreme habitat. Metabolic rate, body temperature, evaporative water loss and thermal conductance were measured for eight planigales (average mass 9 g) exposed to four different ambient temperatures ranging from 10 degrees C to 32 degrees C. Water economy and respiratory variables were measured for the first time in this species. All of these standard physiological variables conformed to allometrically-predicted values for a marsupial. All variables were significantly affected by ambient temperature, except tidal volume and dry thermal conductance. Metabolic rate increased substantially at low ambient temperatures, as required to maintain a relatively constant body temperature of about 32-34 degrees C. This increased oxygen demand was accommodated by increased ventilation rather than increased oxygen extraction. Planigales had a comparatively high point of relative water economy of 19.1 degrees C, consistent with their small body size and arid habitat. Torpor reduced energy expenditure by 79% and evaporative water loss by 62%. Our study suggests that torpor use, along with behavioural adaptations, suffice for P. gilesi to live underground in arid habitats without further physiological adaptations.
Subject(s)
Adaptation, Physiological/physiology , Desert Climate , Ecosystem , Floods , Marsupialia/physiology , Animals , Body Size , Body Temperature , Energy Metabolism , Female , Male , Marsupialia/anatomy & histology , Temperature , Water Loss, Insensible/physiologyABSTRACT
Seasonal changes in weather and food availability differ vastly between temperate and subtropical climates, yet knowledge on how free-ranging subtropical insectivorous bats cope with such changes is limited. We quantified ambient temperatures, torpor patterns and thermal physiology of subtropical insectivorous northern long-eared bats, Nyctophilus bifax, during summer (n=13) and winter (n=8) by temperature telemetry. As predicted, ambient conditions varied significantly between seasons, with warmer weather during summer. All bats used torpor on 85% of observation days during summer in comparison to 100% during winter. During summer, patterns of torpor varied and the duration of torpor bouts was not significantly affected by ambient temperature, whereas during winter torpor bout duration was negatively correlated with mean ambient temperature. Mean torpor bout duration in summer was 3.2+/-1.3 h and in winter was 26.8+/-11.3 h. Mean arousal time during summer was in the early afternoon and during winter in the late afternoon, and throughout both seasons arousals for possible foraging periods occurred near sunset. Skin temperature was positively correlated with ambient temperatures in both seasons, but the relationship differed between seasons. We show that torpor is used regularly throughout the year in a free-ranging subtropical bat and provide the first evidence demonstrating that torpor patterns and thermal physiology change with season.
Subject(s)
Behavior, Animal/physiology , Chiroptera/physiology , Hibernation/physiology , Seasons , Tropical Climate , Animals , Skin Temperature/physiology , Time FactorsABSTRACT
BACKGROUND: There is evidence that chronic idiopathic urticaria (CIU) and psoriasis are associated with personality based difficulties in emotional regulation particularly with regard to the feeling of anger. This deficit in emotional awareness could lead to the phenomenon that emotions are rather experienced in bodily symptoms such as pruritus. AIM: We investigated whether there is a relationship between pruritus as major symptoms in CIU and psoriasis and the experience of negative emotions. SETTING: Forty-one CIU patients and 44 psoriasis patients treated at Bonn University Hospital and 49 healthy controls were included. METHOD: Patients and controls were compared on questionnaires measuring alexithymia (TAS-20), emotional distress (SCL-90-R) and anger (STAXI). In skin-disordered patients, separate stepwise regressions with pruritus severity as dependent variable and questionnaires, skin status, duration, sex and age as independent variables were calculated. RESULTS: CIU and psoriasis patients showed higher alexithymia, emotional distress, depression, anxiety and state anger compared with controls. State anger was the only significant predictor of pruritus severity in CIU explaining 19% of variance. Depression was the only significant predictor of pruritus severity in psoriasis explaining 12% of variance. CONCLUSIONS: Our findings suggest a relationship between pruritus severity and anger in CIU. Furthermore, our results indicate a relationship between pruritus severity and depression in psoriasis.
Subject(s)
Anger , Perception , Pruritus/physiopathology , Psoriasis/physiopathology , Urticaria/physiopathology , Adult , Aged , Case-Control Studies , Chronic Disease , Female , Humans , Male , Middle Aged , Pruritus/psychology , Psoriasis/psychology , Urticaria/psychologyABSTRACT
Metabolic rate and evaporative water loss (EWL) were measured for a small, arid-zone marsupial, the stripe-faced dunnart (Sminthopsis macroura), when normothermic and torpid. Metabolic rate increased linearly with decreasing ambient temperature (T(a)) for normothermic dunnarts, and calculated metabolic water production (MWP) ranged from 0.85+/-0.05 (T(a)=30 degrees C) to 3.13+/-0.22 mg H2O g(-1) h(-1) (T(a)=11 degrees C). Torpor at T(a)=11 and 16 degrees C reduced MWP to 24-36% of normothermic values. EWL increased with decreasing T(a), and ranged from 1.81+/-0.37 (T(a)=30 degrees C) to 5.26+/-0.86 mg H2O g(-1) h(-1) (T(a)=11 degrees C). Torpor significantly reduced absolute EWL to 23.5-42.3% of normothermic values, resulting in absolute water savings of 50-55 mg H2O h(-1). The relative water economy (EWL/MWP) of the dunnarts was unfavourable, remaining >1 at all T(a) investigated, and did not improve with torpor. Thus torpor in stripe-faced dunnarts results in absolute, but not relative, water savings.
Subject(s)
Adaptation, Physiological/physiology , Energy Metabolism/physiology , Marsupialia/physiology , Water Loss, Insensible/physiology , Animals , Australia , Body Water/metabolism , Carbon Dioxide/metabolism , Desert Climate , Female , Male , Oxygen Consumption/physiology , TemperatureABSTRACT
The physiological signal for torpor initiation appears to be related to fuel availability. Studies on metabolic fuel inhibition in placental heterotherms show that glucose deprivation via the inhibitor 2-deoxy-D-glucose (2DG) initiates a torpor-like state, whereas fatty acid deprivation via mercaptoacetate (MA) does not. As previous studies using inhibitors were limited to quantifying body temperature in placentals, we investigated whether inhibition of glucose or fatty acids for cellular oxidation induces torpor in the marsupial hibernator Cercartetus nanus, and how the response of metabolic rate is related to body temperature. Glucoprivation initiated a torpor-like state in C. nanus, but animals had much higher minimum body temperatures and metabolic rates than those of torpid food-deprived animals and arousal rates were slower. Moreover, 2DG-treated animals were thermoregulating at ambient temperatures of 20 and 12 degrees C, whereas food-deprived torpid animals were thermo-conforming. We suggest that glucoprivation reduces the hypothalamic body temperature set point, but only by about 8 degrees C rather than the approximately 28 degrees C during natural torpor. Reduced fatty acid availability via MA also induced a torpor-like state in some C. nanus, with physiological variables that did not differ from those of torpid food-deprived animals. We conclude that reduced glucose availability forms only part of the physiological trigger for torpor initiation in C. nanus. Reduced fatty acid availability, unlike for placental heterotherms, may be an important cue for torpor initiation in C. nanus, perhaps because marsupials lack functional brown adipose tissue.
Subject(s)
Adaptation, Physiological/physiology , Body Temperature Regulation/physiology , Energy Metabolism , Hibernation/physiology , Marsupialia/physiology , Adaptation, Physiological/drug effects , Adipose Tissue, Brown/metabolism , Animals , Body Temperature/drug effects , Body Temperature Regulation/drug effects , Deoxyglucose/pharmacology , Dose-Response Relationship, Drug , Fatty Acids/antagonists & inhibitors , Fatty Acids/metabolism , Glucose/antagonists & inhibitors , Glucose/metabolism , Hibernation/drug effects , Time FactorsABSTRACT
Marsupials, unlike placental mammals, are believed to be unable to increase heat production and thermal performance after cold-acclimation. It has been suggested that this may be because marsupials lack functional brown fat, a thermogenic tissue, which proliferates during cold-acclimation in many placentals. However, arid zone marsupials have to cope with unpredictable, short-term and occasionally extreme changes in environmental conditions, and thus they would benefit from an appropriate physiological response. We therefore investigated whether a sequential two to four week acclimation in Sminthopsis macroura (body mass approx. 25 g) to both cold (16 degrees C) and warm (26 degrees C) ambient temperatures affects the thermal physiology of the species. Cold-acclimated S. macroura were able to significantly increase maximum heat production (by 27%) and could maintain a constant body temperature at significantly lower effective ambient temperatures (about 9 degrees C lower) than when warm-acclimated. Moreover, metabolic rates during torpor were increased following cold-acclimation in comparison to warm-acclimation. Our study shows that, despite the lack of functional brown fat, short-term acclimation can have significant effects on thermoenergetics of marsupials. It is likely that the rapid response in S. macroura reflects an adaptation to the unpredictability of the climate in their habitat.
Subject(s)
Acclimatization/physiology , Body Temperature Regulation/physiology , Marsupialia/physiology , Temperature , Thermogenesis/physiology , Analysis of Variance , Animals , Body Constitution , MaleABSTRACT
The high expenditure of energy required for endogenous rewarming is one of the widely perceived disadvantages of torpor. However, recent evidence demonstrates that passive rewarming either by the increase of ambient temperature or by basking in the sun appears to be common in heterothermic birds and mammals. As it is presently unknown how radiant heat affects energy expenditure during rewarming from torpor and little is known about how it affects normothermic thermoregulation, we quantified the effects of radiant heat on body temperature and metabolic rate of the small (body mass 25 g) marsupial Sminthopsis macroura in the laboratory. Normothermic resting individuals exposed to radiant heat were able to maintain metabolic rates near basal levels (at 0.91 ml O(2) g(-1) h(-1)) and a constant body temperature down to an ambient temperature of 12 degrees C. In contrast, metabolic rates of individuals without access to radiant heat were 4.5-times higher at an ambient temperature of 12 degrees C and body temperature fell with ambient temperature. During radiant heat-assisted passive rewarming from torpor, animals did not employ shivering but appeared to maximise uptake of radiant heat. Their metabolic rate increased only 3.2-times with a 15- degrees C rise of body temperature (Q(10)=2.2), as predicted by Q(10) effects. In contrast, during active rewarming shivering was intensive and metabolic rates showed an 11.6-times increase. Although body temperature showed a similar absolute change between the beginning and the end of the rewarming process, the overall energetic cost during active rewarming was 6.3-times greater than that during passive, radiant heat-assisted rewarming. Our study demonstrates that energetic models assuming active rewarming from torpor at low ambient temperatures can substantially over-estimate energetic costs. The low energy expenditure during passive arousal provides an alternative explanation as to why daily torpor is common in sunny regions and suggests that the prevalence of torpor in low latitudes may have been under-estimated in the past.
Subject(s)
Arousal/physiology , Body Temperature Regulation/physiology , Energy Metabolism/physiology , Marsupialia/physiology , Acclimatization/physiology , Animals , Behavior, Animal/physiology , Hot Temperature , Seasons , SunlightABSTRACT
The authors examined the relation between specific defense mechanisms and treatment process and outcome in psychodynamic psychotherapy. Three measures, Questionnaire for Conflict Coping Strategies, Questionnaire on the Experience of the Inpatient Therapeutic Process, and Symptom Checklist-90-R, were given to 65 inpatients of a psychosomatic clinic, predominantly with depressive or eating disorders. Turning against self was the most frequently used defense mechanism in the patient group. A high level of turning against self that could be reduced significantly during treatment was associated with good adaptation to treatment setting and positive treatment outcome defined by symptom distress reduction. Assessment of defense mechanisms and their interaction with therapeutic factors in the therapy setting can be useful to better understand the treatment process and the subsequent development of specific interventions to enhance treatment outcome.
ABSTRACT
In this study we investigated the relationship between personality attitudes, psychopathological symptoms and biological parameters in male infertility. Eighty-four infertile men underwent a psychological and medical examination at our clinic. The psychological tests comprised the Symptom Checklist 90-R, the Toronto Alexithymia Scale and the NEO-Five Factor Inventory. Seminal parameters, gonadotrophins, sex steroids, cortisol and prolactin were analyzed to obtain biological data. Compared with questionnaires completed by normal populations those in the study group scored higher on the scales for 'conscientiousness', 'agreeableness', 'alexithymia' and 'somatization' and lower on the scale for 'neuroticism'. Regarding psychobiological correlations we found a negative correlation between seminal parameters and 'extraversion', 'anxiety' and 'psychoticism'. 'Alexithymia' was negatively correlated with stress hormones and 'conscientiousness' was correlated with sex steroids. The findings suggest above average social competence in the study group. The psychobiological correlations indicate a link between social-competence-related personality traits such as 'extraversion' and 'conscientiousness' and biological fertility characteristics. Implications of a higher alexithymia in infertile men, which is negatively correlated with stress hormones, are discussed.
Subject(s)
Infertility, Male/psychology , Personality , Stress, Psychological/psychology , Adult , Affective Symptoms/blood , Affective Symptoms/complications , Extraversion, Psychological , Gonadal Steroid Hormones/blood , Humans , Hydrocortisone/blood , Infertility, Male/blood , Male , Middle Aged , Social Adjustment , Sperm Motility , Stress, Psychological/blood , Stress, Psychological/complicationsABSTRACT
OBJECTIVE: To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders. METHODS: A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed. RESULTS: Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance"). CONCLUSIONS: Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.
Subject(s)
Anxiety Disorders/therapy , Patient Admission , Patient Satisfaction , Psychotherapy , Adolescent , Adult , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Behavior Therapy , Combined Modality Therapy , Desensitization, Psychologic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Personality Inventory , Psychoanalytic TherapyABSTRACT
There are several other diseases besides BSE which belong to the group of transmissible spongiform encephalopathies (TSE). Although most mammals can be experimentally infected with the agent of these diseases, generally only single representatives of the orders Artiodactyla (cloven-hoofed animals), Carnivora (carnivores) and Primates (humans and monkeys) are naturally infected in the field. An overview of the current state of knowledge on TSE in several species like exotic ruminants, deer, mink and cats is presented. Etiological, clinical, anatomic-pathological and epidemiological aspects are described.
Subject(s)
Artiodactyla , Carnivora , Primates , Prion Diseases/veterinary , Animals , Cats , Humans , Prion Diseases/epidemiology , Prion Diseases/transmission , Species SpecificityABSTRACT
Several small caprimulgiform birds (<80 g) are known to enter torpor, apparently to cope with a fluctuating supply of insect prey. Since the large Australian tawny frogmouth (Podargus strigoides; 381-556 g) is also insectivorous, we investigated its thermoregulatory behaviour and thermal biology to determine whether this species is also heterothermic. In an open woodland at approximately 1,000 m altitude, we equipped eight free-ranging birds with external temperature-sensitive radio transmitters attached to an elastic harness to measure skin temperature (T(skin)). Core body temperature (T(b)) was measured in three of these birds fitted with an additional intraperitoneal transmitter. T(skin) was closely correlated with T(b), although T(skin) was usually several degrees below T(b). During the three coldest months of the year (June-August), shallow torpor with T(b) as low as 29.1 degrees C occurred frequently, whereas during spring and summer, torpor was not recorded. Torpor occurred either during the night and/or during the first half of the day. Night torpor bouts were initiated after a short activity period around dusk and lasted on average for about 7 h. Torpid birds always aroused before sunrise to either commence a second short foraging period or to fly directly to a day roost tree. After birds roosted, T(b) fell again around sunrise, and birds occasionally entered a second dawn torpor bout; however, in most cases, T(b) increased rapidly not long after entry, most likely due to passive heating by the sun. We conclude that despite their large body size and energetically conservative hunting strategy, tawny frogmouths, like several related caprimulgiform species, frequently enter shallow torpor when low T(a) demands high energetic costs for normothermic thermoregulation and likely reduces insect availability.
Subject(s)
Adaptation, Physiological , Birds/physiology , Body Temperature Regulation , Energy Metabolism , Movement , Animals , Diet , Female , Flight, Animal , Insecta , Male , Population Dynamics , TemperatureABSTRACT
Studies on the physiology of mammals and birds are often conducted using captive-bred individuals and it is commonly assumed that the resulting data are representative of individuals living in the field. To investigate whether these assumptions are justified, we quantified morphological, behavioural, and physiological variables of the small marsupial feathertail glider (Acrobates pygmaeus). We compared three populations: (i) individuals from a cool-temperate, montane area, (ii) individuals form a subtropical, coastal area, and (iii) captive-bred individuals. Captive-bred gliders differed from the montane field gliders in morphology (longer tails and snouts), behaviour (longer activity periods) and physiology (less frequent torpor, shorter torpor, shallower torpor, higher metabolic rates during rest and torpor, and slower rates of rewarming). Most of these differences were also apparent between the captive-bred and the coastal field gliders. Unlike both field populations, captive-bred gliders often became hypothermic and were unable to rewarm. In contrast to the other physiological variables, the minimum body temperatures defended during torpor and the corresponding air temperatures differed between the montane and coastal field gliders, but were similar in coastal field and captive-bred gliders. Our study shows that morphology, behaviour and physiology can be strongly affected by breeding in or acclimation to captivity. The poor expression of torpor and thermal performance of the captive-bred gliders raises the question of whether they possess the physiological capability for survival in the wild. Even though captive breeding appears to have only minor effects on some physiological variables, data from captive-bred individuals should only be extrapolated to the field with caution.