The potential of a mindfulness-enhanced, integrative neuropsychotherapy program for treating fatigue following stroke: A preliminary Study

Fatigue is a frequently reported symptom after a stroke. Although the phenomenology of poststroke fatigue is well known, clear definitions as well as diagnostic and therapeutic guidelines are missing. Poststroke fatigue can be regarded as a multidimensional phenomenon that might be influenced by neurological, physical, psychological, and cognitive factors. It can range from mild to severe and can affect every area of the activities of daily life. The objective of our preliminary study was to outline aspects of a specific treatment program for the management of poststroke fatigue. Eight patients were recruited for a mindfulness-enhanced, integrative neuropsychotherapy program. The treatment was a combination of neuropsychological interventions, psychoeducation, cognitive-behavioral therapy, and mindfulness techniques. The main treatment foci were (a) to facilitate an increased awareness of fatigue symptoms, (b) to help the patient detect and manage triggers of fatigue, and (c) to equip the patient with multiple self-help tools. Measures were assessed at the beginning, during, and at the end of treatment using self-assessment questionnaire for mental fatigue and related symptoms after neurological disorders and injuries. Significant pre- to post-assessment differences were observed. These findings suggest that patients may benefit from a specific treatment program in order to better adapt to poststroke fatigue. These findings encourage further investigation of this integrative treatment in larger samples that include adequate control treatments.

Trade Governance in the Digital Age (Preface)

The development of new digital technologies has resulted in significant transformations in daily life, from the arrival of online shopping to more fundamental changes in the ways we work and communicate. Many of these changes raise questions that transcend market access and liberalisation and demand cooperation and coherent regulatory design. International trade regulation has hitherto not reacted in a forward-looking manner to the digital revolution; particularly at the multilateral level, legal engineering has yielded few tangible results. This book examines whether WTO laws possess the necessary flexibility and resilience to accommodate the changes brought about by burgeoning digital trade. By revealing both the potential and the limitations of the WTO framework, it provides a broad picture of the interaction between digital technologies and trade regulation, links the often disconnected discourses of international trade law, intellectual property and cyberlaw, and explores discrete problems in different domains of global trade regulation.

Between anxiety and hope: the experiences of women with vulval intraepithelial neoplasia during their illness trajectory - a qualitative approach

The vulvar intraepithelial neoplasia (VIN) is a rare chronic skin condition that may progress to an invasive carcinoma of the vulva. Major issues affecting women's health were occurring symptoms, negative influences on sexuality, uncertainty concerning the illness progression and changes in the body image. Despite this, there is little known about the lived experiences of the illness trajectory. Therefore, the aim of this study was to describe the experiences of women with VIN during the illness trajectory. In a secondary data analysis of the foregoing qualitative study we analysed eight narrative interviews with women with VIN by using thematic analysis in combination with critical hermeneutics. Central for these women during their course of illness was a sense of "Hope and Fear". This constitutive pattern reflects the fear of recurrence but also the trust in healing. The eight narratives showed women's experiences during their course of illness occurred in five phases: "there is something unknown"; "one knows, what IT is"; "IT is treated and should heal"; "IT has effects on daily life"; "meanwhile it works". Women's experiences were particularly influenced by the feeling of "embarrassment" and by "dealing with professionals". Current care seems to lack adequate support for women with VIN to manage these phases. We suggest, based on our study and the international literature, that new models of counselling and providing information need to be developed and evaluated.

A patient-reported outcome measure to identify occurrence and distress of post-surgery symptoms of WOMen with vulvAr Neoplasia (WOMAN-PRO) - a cross sectional study.

OBJECTIVE The aim of the study was to describe the (a) symptom experience of women with vulvar intraepithelial neoplasia and vulvar cancer (vulvar neoplasia) during the first week after hospital discharge, and (b) associations between age, type of disease, stage of disease, the extent of surgical treatment and symptom experience. METHODS This cross-sectional study was conducted in eight hospitals in Germany and Switzerland (Clinical Trial ID: NCT01300663). Symptom experience after surgical treatment in women with vulvar neoplasia was measured with our newly developed WOMAN-PRO instrument. Outpatients (n=65) rated 31 items. We used descriptive statistics and regression analysis. RESULTS The average number of symptoms reported per patient was 20.2 (SD 5.77) with a range of 5 to 31 symptoms. The three most prevalent wound-related symptoms were 'swelling' (n=56), 'drainage' (n=54) and 'pain' (n=52). The three most prevalent difficulties in daily life were 'sitting' (n=63), 'wearing clothes' (n=56) and 'carrying out my daily activities' (n=51). 'Tiredness' (n=62), 'insecurity' (n=54) and 'feeling that my body has changed' (n=50) were the three most prevalent psychosocial symptoms/issues. The most distressing symptoms were 'sitting' (Mean 2.03, SD 0.88), 'open spot (e.g. opening of skin or suture)' (Mean 1.91, SD 0.93), and 'carrying out my daily activities' (Mean 1.86, SD 0.87), which were on average reported as 'quite a bit' distressing. Negative associations were found between psychosocial symptom experience and age. CONCLUSIONS WOMAN-PRO data showed a high symptom prevalence and distress, call for a comprehensive symptom assessment, and may allow identification of relevant areas in symptom management.

An fMRI-Study on context-specificity of inhibitory functions in alcohol-dependency: Preliminary results

Introduction: Alcohol-dependency is a common disease with many negative consequences in the daily life. A typical symptom of alcoholic-patients is the persistent and uncontrollable desire to consume alcohol. Inspite of different treatments, alcohol-dependency has a relapse rate of about 85%. This high rate is facilitated by a dysfunction of cognitive control-processes. In order to understand this disease sustaining factor, the present study investigated the neurophysiological correlates of inhibition of alcoholic-patients in a neutral as well as an alcohol-related context. Methods: A total of 18 participants, (9 alcohol-dependent-patients (age range: 27-62 years), 9 healthy controls (age range: 29-60 years)) have been measured with functional magnetic resonance imaging while they participated in an alcohol-specific Go/NoGo-Task. Neurophysiological correlates of inhibition in an alcohol-related as well as a neutral context were compared in both groups. Results: When comparing correct stop-trials in alcohol-related to neutral context, only alcohol-dependent patients showed significant hyperactivation in frontal regions (superior and medial gyrus frontalis, anterior gyrus cinguli, gyrus paracentralis and the gyrus praecentralis). No significant differences were found in any of the behavioral analyses. Discussion: These preliminary results thus indicate that successful inhibition in a drug-related context demands additional resources in patients. Especially the hyperactivation of the anterior gyrus cinguli might be important because of its involvement in decision-processes. In the absent of deficits in behavioral data, this suggests that alcohol-dependent patients need more neuronal activity to achieve the same performance-level like healthy controls.

Cancer's positive flip side: posttraumatic growth after childhood cancer.

BACKGROUND Surviving childhood cancer may result in positive psychological changes called posttraumatic growth (PTG). Knowing about the possibility of positive changes may facilitate survivors' reintegration in daily life. We aimed to (1) describe PTG in Swiss childhood cancer survivors including the most and the least common PTG phenomena on the subscale and item levels and (2) determine factors associated with PTG. METHOD Within the Swiss Childhood Cancer Survivor Study (SCCSS), we sent two questionnaires to childhood cancer survivors registered in the Swiss Childhood Cancer Registry (SCCR). Eligible survivors were diagnosed after 1990 at age ≤16 years, survived ≥5 years, and were aged ≥18 years at the time the second questionnaire was sent. We included the Posttraumatic Growth Inventory (PTGI) to assess five areas of PTG. We investigated the association of PTG with socio-demographic characteristics, self-reported late effects, and psychological distress, which were assessed in the SCCSS and clinical variables extracted from the SCCR. We used descriptive statistics to describe PTG and linear regressions to investigate factors associated with PTG. RESULTS We assessed PTG in 309 childhood cancer survivors. Most individuals reported to have experienced some PTG. The most endorsed change occurred in "relation with others," the least in "spiritual change." PTG was significantly higher in survivors with older age at diagnosis (p = 0.001) and those with a longer duration of treatment (p = 0.042), while it was lower in male survivors (p = 0.003). CONCLUSIONS Supporting experiences of PTG during follow-up may help survivors successfully return to daily life.

Acute kidney injury in three dogs after ingestion of a descaling agent containing maleic acid

Maleic acid (MA) is a common component of descaling products and is widely used in daily life. Accidental ingestion in relevant amounts does not play a major role in human beings; however, it seems to be highly toxic for dogs. It has been commonly used experimentally to induce Fanconi syndrome in dogs or small rodents. Two dogs were presented for acute kidney injury (AKI) after accidental ingestion of a descaling agent containing MA at an estimated amount of 70 mg/kg each. The third dog involved was euthanased by the referring veterinarian, and postmortem pathological analysis revealed severe acute tubular necrosis consistent with toxic nephropathy. The other dogs received symptomatic therapy for AKI including treatment with haemodialysis and showed complete normalisation of serum creatinine at a follow-up after five months. Renal damage can be very severe, but seems to be at least partially reversible and an attempt to treatment is warranted.

Resilience as a correlate of acute stress disorder symptoms in patients with acute myocardial infarction

OBJECTIVES Myocardial infarction (MI) may be experienced as a traumatic event causing acute stress disorder (ASD). This mental disorder has an impact on the daily life of patients and is associated with the development of post-traumatic stress disorder. Trait resilience has been shown to be a protective factor for post-traumatic stress disorder, but its association with ASD in patients with MI is elusive and was examined in this study. METHODS We investigated 71 consecutive patients with acute MI within 48 h of having stable haemodynamic conditions established and for 3 months thereafter. All patients completed the Acute Stress Disorder Scale and the Resilience Scale to self-rate the severity of ASD symptoms and trait resilience, respectively. RESULTS Hierarchical regression analysis showed that greater resilience was associated with lower symptoms of ASD independent of covariates (b=-0.22, p<0.05). Post hoc analysis revealed resilience level to be inversely associated with the ASD symptom clusters of re-experiencing (b=-0.05, p<0.05) and arousal (b=-0.09, p<0.05), but not with dissociation and avoidance. CONCLUSIONS The findings suggest that patients with acute MI with higher trait resilience experience relatively fewer symptoms of ASD during MI. Resilience was particularly associated with re-experiencing and arousal symptoms. Our findings contribute to a better understanding of resilience as a potentially important correlate of ASD in the context of traumatic situations such as acute MI. These results emphasise the importance of identifying patients with low resilience in medical settings and to offer them adequate support.

Das Repertorium Academicum Germanicum (RAG). Ein digitales Forschungsvorhaben zur Geschichte der Gelehrten des alten Reiches (1250-1550)

This article aims at presenting an already existing research project. The Repertorium Academicum Germanicum (RAG) is supposed to be a "Who’s who" of the graduated and noble scholars of the late medieval Empire. It is designed to record biographical and social data of graduated theologians, jurists, physicians and Masters of Art as well as data of nobles from universities between 1250 and 1550. Furthermore, the project focuses on their examinations, networks, fields of activity in ecclesiastical and secular offices as well as their achievements and legacies (books, treatises, tombs etc). Right now, over 49.000 prosopographic entries are stored in the RAG database, partly available online (www.rag-online.org) and combined with digital maps (infographics), which already provide a basis for research in academic mobility determined by the top scholars of the time. In a next step, it should be possible to draw conclusions not only about personnel and knowledge transfer from university to society, its effects on political systems, daily life, the emergence of new occupational groups and professions, but also about cultural exchange within Europe.

Gasoline and leukemia: A review

Gasoline is perhaps one of the most familiar substances to people in our society. Benzene is a component of gasoline and it is hemotoxic and carcinogenic at high concentrations. With increased governmental regulation of gasoline and benzene exposure, the hazardous effects of benzene on public health are very limited. As long as environmental conditions meet OSHA regulation standards, most individuals are not aware of the hazardous effect of benzene. However, recent studies have found that less than 1ppm benzene exposure which is below OSHA exposure regulatory standard may cause hematological damage. This paper reviews the relationship among gasoline-related work, daily life gasoline exposure, public health and new updated research in this field. We searched for relevant publications from 1966 through 2006 in three databases: Ovid Medline, PubMed and TOXNET. This review is a means toward educating people about exposure to benzene in different environments. Although government has developed good monitoring and prevention methods to decrease the harm from gasoline, we are aware that the problem is still there. The primary public health message is the benzene may cause hematological effects even at or below the U.S occupational standard of 1ppm.^

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

Mario Benedetti: Montevideo, una estética urbana

La narrativa de Mario Benedetti se ha caracterizado por una clara inclinación hacia el tema urbano. El escritor rastrea elementos de la cotidianidad y a través de ellos construye una estética del asfalto que se revela no sólo a nivel temático, sino mediante el lenguaje, la estructura de los relatos e incluso en el modo de ser de sus personajes. El análisis de algunos de sus cuentos nos permitirá verificar la permanencia de estos elementos.

Prevención de complicaciones orales en personas con discapacidad severa

La salud, como derecho primordial de toda persona, adquiere una connotación especial cuando la persona tiene una discapacidad. El término Discapacidad describe una restricción o ausencia, debido a una deficiencia, de la capacidad de realizar una actividad en la forma o dentro del margen que se considera normal para el ser humano. Si nos referimos concretamente a la salud bucal, podemos decir, que presentan alta incidencia de patologías por lo que constituyen un grupo de riesgo con una gran necesidad de cuidados dentales. Es importante destacar que gran parte de las personas con Discapacidad, no pueden expresar en palabras o determinar claramente su proceso patológico y así toleran importantes dolores demostrados mediante el aumento de la irritabilidad, la inactividad, la pérdida de apetito, los problemas de sueño, la autoagresión, etc. Esta falta de certeza y reacciones adversas genera una situación familiar de alteración de la vida cotidiana y desconcierto, además de comenzar a realizar una serie de consultas a psiquiatra, otorrinolaringólogo, neurólogo, clínico, entre otros especialistas. Dicha situación puede ser previsible mediante controles odontológicos periódicos, derivación temprana a exámenes bucales por parte de médicos y/u otros especialistas tratantes, interconsulta con odontólogo ante cambios de conducta o autoagresión. La prevención y el cuidado de la salud dental en los pacientes con discapacidad favorecen el mantenimiento de la salud general y proporcionan una mayor calidad de vida. La intervención del odontólogo en patologías ya instaladas consiste en la eliminación de la sintomatología, detención y tratamiento de las lesiones, restauración de la función y la estética.

¿Cómo mejorar la bioseguridad en hospitales y servicios de salud?

Bioseguridad en un sentido amplio es definida como: vida libre de peligros. Medidas de bioseguridad son acciones que contribuyen para la seguridad de la vida, en el dia a dia de las personas (ej. Cinturon de seguridad, senda peatonal). Las normas de bioseguridad engloban todas las medidas que buscan evitar riesgos fisicos (radiacion o temperatura), ergonomicos (posturales), quimicos (sustancias toxicas), biologicos (agentes infecciosos) y psicologicos (como el estres). Cada tanto, cuando hay conflictos gremiales, aparecen en las noticias hospitales que tienen ratas o cucarachas, y recien ahi se toman algunas medidas correctivas, per0 la mayoria de las instalaciones de servicios de salud no cuentan con servicios de control de plagas, o si 10s tienen no son efectivos, mas por causas administrativas que tecnicas. Es inadmisible la presencia de invertebrados y vertebrados (no humanos) en hospitales y centros de salud. Se proponen algunas medidas para mejorar la bioseguridad en esas instalaciones.

Consentimiento informado

La profesión de odontólogo se ejerce a través de numerosos actos que requieren de la responsabilidad del profesional, relacionado con distintos problemas que ocurren en el quehacer diario en relación a la aprobación por parte del paciente. El consentimiento informado constituye un acto jurídico que debe reunir características propias.