What Ethanol metabolites as biological markers tell us about alcohol use

Alcohol and tobacco related disorders are the two leading and most expensive causes of illness in central Europe. In addition to self reports and questionnaires, biomarkers are of relevance in diagnosis and therapy of alcohol use disorders.Traditional biomarkers such as gamma glutamyl transpeptidase or mean corpuscualr volume are indirect biomarkers and are subject to influence of age, gender and non alcohol related diseases, among others.Direct ethanol metabolites such as ethyl glucuronide (EtG), ethyl sulphate (EtS) and phosphatidylethanol (PEth) are direct metabolites of ethanol, that are positive after intake of ethyl alcohol. They represent useful diagnostic tools for identifying alcohol use even more accurately than traditional biomarkers. Each of these drinking indicators remains positive in serum and urine for a characteristic time spectrum after the cessation of ethanol intake-EtG and EtS in urine up to 7 days, EtG in hair for months after ethanol has left the body. Applications include clinical routine use, emergency room settings, proof of abstinence in alcohol rehabilitation programs, driving under influence offenders, workplace testing, assessment of alcohol intake in the context of liver transplantation and fetal alcohol syndrome.

Berufszufriedenheit von Schweizer Hausärzten mit und ohne Fähigkeitsausweis Homöopathie SVHA/SIWF

HINTERGRUND: Zur Berufszufriedenheit von Hausärzten gibt es zahlreiche Studien, die unter anderem zeigen, dass ein direkter Zusammenhang zwischen Behandlungsqualität und Gesundheitskosten besteht. In einer in Deutschland 2011 durchgeführten Untersuchung von Joos et al. ergaben sich Hinweise, dass Allgemeinmediziner, welche eine positive Einstellung zu komplementären Behandlungsmethoden haben und eine solche Methode auch selber ausüben, eine höhere Berufszufriedenheit aufweisen. Für die Schweiz existiert keine entsprechende Untersuchung.
 METHODE: Die Messung der Berufszufriedenheit erfolgte durch den von Bovier und Perneger 2003 in Genf validierten Fragebogen. Anhand von 17 Fragen werden die fünf Aspekte Patientenversorgung, Arbeitsbelastung, Einkommen/soziales Ansehen, persönlicher Gewinn und Beziehung zu KollegInnen evaluiert. Die Befragung erfolgte schriftlich bei den Teilnehmern der SwissFamilyDocs Conference in Bern 2013 (n=143) und via Onlinefragebogen bei Trägern des Fähigkeitsausweises Homöopathie SVHA (n=125).
 RESULTATE: Die beiden Gruppen unterscheiden sich nicht in der übergeordneten allgemeinen Berufszufriedenheit, jedoch kommt es bei 6 der 17 Antworten zu signifikanten Unterschieden. Höhere Zufriedenheitswerte ergaben sich für die Hausärzten mit Fähigkeitsausweis Homöopathie bei der Beziehung zu den betreuten Patienten, der Arbeitsbelastung und der Zeit für Familie, Freunde und Freizeitaktivität. Tiefere Zufriedenheitswerte zeigten sich beim Einkommen, den Fortbildungsmöglichkeiten und bei der beruflichen Beziehung/dem Austausch mit Kollegen. 
 DISKUSSION: Hausärzte mit Zusatzqualifikation in Homöopathie arbeiten durchschnittlich ungefähr 10h pro Woche weniger als Hausärzte in der Vergleichsgruppe. Es ist naheliegend, dass dies in der Umfrage einerseits dazu führte, dass die Zufriedenheit mit der Arbeitsbelastung und mit der Zeit für Familie, Freunde und Freizeitaktivitäten signifikant höher und anderseits die Zufriedenheit mit dem Einkommen signifikant tiefer ausfällt. Die höchsten Zufriedenheitswerte ergaben sich für beide Gruppen bei der Beziehung zu den betreuten Patienten und bei der Beziehung zum nicht-ärztlichen Praxispersonal. Dagegen waren beide Gruppen am wenigsten zufrieden mit dem Aufwand für Verwaltungsarbeit und mit der Vergütung für die hausärztliche Tätigkeit. Diese Ergebnisse zeigen auf, wo sich die Berufszufriedenheit der Schweizer Hausärzte und damit indirekt auch die Behandlungsqualität weiter verbessern liesse.

Renewal of Religious Leadership According to an Ancient Model. Bishop Joseph Hubert Reinkens and Bishop Martin of Tours

Im Jahr 1866 verfasste der damals in Breslau lehrende römisch-katholische Kirchenhistoriker Joseph Hubert Reinkens eine der ersten historisch-kritischen Studien in deutscher Sprache über Martin von Tours, in der er sich u.a. mit Martins bischöflichem Leitungsdienst befasste. Nach dem Ersten Vatikanischen Konzil (1870) wurde Reinkens 1873 der erste Bischof für die Alt-Katholiken im Deutschen Reich. Der Beitrag beschreibt den Einfluss, den Reinkens' Martin-Rezeption auf sein theologisches und praktisches Verständnis des Bischofsamts hatte.

Access to specialized pediatric cancer care in Switzerland

Specialized pediatric cancer centers (PCCs) are thought to be essential to obtain state-of-the-art care for children and adolescents. We determined the proportion of childhood cancer patients not treated in a PCC, and described their characteristics and place of treatment.

[Characteristics of patients suffering from chronic pain with depressive symptoms in three different treatment settings]

Only few studies considered demographic and medical characteristics of pain patients with depressive symptoms.

Regional origin and decrease of pain in patients with depressive symptoms under treatment with venlafaxine

Patient's language, tradition, conventions, and customs may all determine integration into a society and are also part of the doctor-patient relationship that influences diagnostic and therapeutic outcome. Language barrier and sociocultural disparity of Eastern and Southern European patients may hamper recovery from pain and depression compared to Middle European patients in Switzerland.

Phosphatidylethanol: normalization during detoxification, gender aspects and correlation with other biomarkers and self-reports

Phosphatidylethanol (PEth) is a direct ethanol metabolite, and has recently attracted attention as biomarker of ethanol intake. The aims of the current study are: (1) to characterize the normalization time of PEth in larger samples than previously conducted; (2) to elucidate potential gender differences; and (3) to report the correlation of PEth with other biomarkers and self-reported alcohol consumption. Fifty-seven alcohol-dependent patients (ICD 10 F 10.25; 9 females, 48 males) entering medical detoxification at three study sites were enrolled. The study sample was comprised of 48 males and 9 females, with mean age 43.5. Mean gamma glutamyl transpeptidase (GGT) was 209.61 U/l, average mean corpuscular volume (MCV) was 97.35 fl, mean carbohydrate deficient transferrin (%CDT) was 8.68, and mean total ethanol intake in the last 7 days was 1653 g. PEth was measured in heparinized whole blood with a high-pressure liquid chromatography method, while GGT, MCV and %CDT were measured using routine methods. PEth levels at day 1 of detoxification ranged between 0.63 and 26.95 micromol/l (6.22 mean, 4.70 median, SD 4.97). There were no false negatives at day 1. Sensitivities for the other biomarkers were 40.4% for MCV, 73.1% for GGT and 69.2% for %CDT, respectively. No gender differences were found for PEth levels at any time point. Our data suggest that PEth is (1) a suitable intermediate term marker of ethanol intake in both sexes; and (2) sensitivity is extraordinary high in alcohol dependent patients. The results add further evidence to the data that suggest that PEth has potential as a candidate for a sensitive and specific biomarker, which reflects longer-lasting intake of higher amounts of alcohol and seemingly has the above mentioned certain advantages over traditional biomarkers.

The effect of arts speech therapy on cerebral oxygenation and low frequency hemodynamic oscillations measured using functional near-infrared spectroscopy

Introduction: As a previous study revealed, arts speech therapy (AST) affects cardiorespiratory interaction [1]. The aim of the present study was to investigate whether AST also has effects on brain oxygenation and hemodynamics measured non-invasively using near-infrared spectroscopy (NIRS). Material and methods: NIRS measurements were performed on 17 subjects (8 men and 9 women, mean age: 35.6 ± 12.7 y) during AST. Each measurement lasted 35 min, comprising 8 min pre-baseline, 10 min recitation and 20 min post-baseline. For each subject, measurements were performed for three different AST recitation tasks (recitation of alliterative, hexameter and prose verse). Relative concentration changes of oxyhemoglobin (Δ[O2Hb]) and deoxyhemoglobin (Δ[HHb]) as well as the tissue oxygenation index (TOI) were measured using a Hamamatsu NIRO300 NIRS device and a sensor placed on the subjects forehead. Movement artifacts were removed using a novel method [2]. Statistical analysis (Wilcoxon test) was applied to the data to investigate (i) if the recitation causes changes in the median values and/or in the Mayer wave power spectral density (MW-PSD, range: 0.07–0.13 Hz) of Δ[O2Hb], Δ[HHb] or TOI, and (ii) if these changes vary between the 3 recitation forms. Results: For all three recitation styles a significant (p < 0.05) decrease in Δ[O2Hb] and TOI was found, indicating a decrease in blood flow. These decreases did not vary significantly between the three styles. MW-PSD increased significantly for Δ[O2Hb] when reciting the hexameter and prose verse, and for Δ[HHb] and TOI when reciting alliterations and hexameter, representing an increase in Mayer waves. The MW-PSD increase for Δ[O2Hb] was significantly larger for the hexameter verse compared to alliterative and prose verse Conclusion: The study showed that AST affects brain hemodynamics (oxygenation, blood flow and Mayer waves). Recitation caused a significant decrease in cerebral blood flow for all recitation styles as well as an increase in Mayer waves, particularly for the hexameter, which may indicate a sympathetic activation. References 1. D. Cysarz, D. von Bonin, H. Lackner, P. Heusser, M. Moser, H. Bettermann. Am J Physiol Heart Circ Physiol, 287 (2) (2004), pp. H579–H587 2. F. Scholkmann, S. Spichtig, T. Muehlemann, M. Wolf. Physiol Meas, 31 (5) (2010), pp. 649–662

Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures

The aim of this study was to evaluate a new surgical concept for the treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases.

Childhood cancer and nuclear power plants in Switzerland: a census-based cohort study

Background Previous studies on childhood cancer and nuclear power plants (NPPs) produced conflicting results. We used a cohort approach to examine whether residence near NPPs was associated with leukaemia or any childhood cancer in Switzerland. Methods We computed person-years at risk for children aged 0–15 years born in Switzerland from 1985 to 2009, based on the Swiss censuses 1990 and 2000 and identified cancer cases from the Swiss Childhood Cancer Registry. We geo-coded place of residence at birth and calculated incidence rate ratios (IRRs) with 95% confidence intervals (CIs) comparing the risk of cancer in children born <5 km, 5–10 km and 10–15 km from the nearest NPP with children born >15 km away, using Poisson regression models. Results We included 2925 children diagnosed with cancer during 21 117 524 person-years of follow-up; 953 (32.6%) had leukaemia. Eight and 12 children diagnosed with leukaemia at ages 0–4 and 0–15 years, and 18 and 31 children diagnosed with any cancer were born <5 km from a NPP. Compared with children born >15 km away, the IRRs (95% CI) for leukaemia in 0–4 and 0–15 year olds were 1.20 (0.60–2.41) and 1.05 (0.60–1.86), respectively. For any cancer, corresponding IRRs were 0.97 (0.61–1.54) and 0.89 (0.63–1.27). There was no evidence of a dose–response relationship with distance (P > 0.30). Results were similar for residence at diagnosis and at birth, and when adjusted for potential confounders. Results from sensitivity analyses were consistent with main results. Conclusions This nationwide cohort study found little evidence of an association between residence near NPPs and the risk of leukaemia or any childhood cancer.