[show abstract][hide abstract] ABSTRACT: Cell-free DNA (cfDNA) in body tissues or fluids is extensively investigated in clinical medicine and other research fields. In this article we provide a direct quantitative real-time PCR (qPCR) as a sensitive tool for the measurement of cfDNA from plasma without previous DNA extraction, which is known to be accompanied by a reduction of DNA yield. The primer sets were designed to amplify a 90 and 222 bp multi-locus L1PA2 sequence. In the first module, cfDNA concentrations in unpurified plasma were compared to cfDNA concentrations in the eluate and the flow-through of the QIAamp DNA Blood Mini Kit and in the eluate of a phenol-chloroform isoamyl (PCI) based DNA extraction, to elucidate the DNA losses during extraction. The analyses revealed 2.79-fold higher cfDNA concentrations in unpurified plasma compared to the eluate of the QIAamp DNA Blood Mini Kit, while 36.7% of the total cfDNA were found in the flow-through. The PCI procedure only performed well on samples with high cfDNA concentrations, showing 87.4% of the concentrations measured in plasma. The DNA integrity strongly depended on the sample treatment. Further qualitative analyses indicated differing fractions of cfDNA fragment lengths in the eluate of both extraction methods. In the second module, cfDNA concentrations in the plasma of 74 coronary heart disease patients were compared to cfDNA concentrations of 74 healthy controls, using the direct L1PA2 qPCR for cfDNA quantification. The patient collective showed significantly higher cfDNA levels (mean (SD) 20.1 (23.8) ng/ml; range 5.1-183.0 ng/ml) compared to the healthy controls (9.7 (4.2) ng/ml; range 1.6-23.7 ng/ml). With our direct qPCR, we recommend a simple, economic and sensitive procedure for the quantification of cfDNA concentrations from plasma that might find broad applicability, if cfDNA became an established marker in the assessment of pathophysiological conditions.
PLoS ONE 01/2014; 9(3):e87838. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the extent to which geriatric patients with diabetes mellitus experience psychological insulin resistance (PIR).
A total of 67 unselected geriatric patients with diabetes (mean age 82.8±6.7 years, diabetes duration 12.2 [0.04-47.2] years, 70.1% female) were recruited in a geriatric care center of a university hospital. A comprehensive geriatric assessment (CGA) was performed including WHO-5, Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE) and Barthel-Index. We assessed PIR using the Barriers of Insulin Treatment Questionnaire (BIT) and the Insulin Treatment Appraisal Scale in a face-to-face interview.
Insulin-naïve patients (INP) showed higher PIR scores than patients already on insulin therapy (BIT-sum score: 4.3±1.4 vs. 3.2±1.0; p<0.001). INP reported in the BIT increased fear of injection and self-testing (2.4±2.4 vs. 1.3±0.8; p=0.016), expect disadvantages from insulin treatment (2.7±1.6 vs. 1.9±1.4; p=0.04), and fear of stigmatization by insulin injection (5.2±2.3 vs. 3.6±2.6; p=0.008). Fear of hypoglycemia, however, did not differ significantly (6.3±2.8 vs. 5.1±3.1; p=0.11). Depression was not shown to be a barrier to insulin therapy.
INP with diabetes have a significantly more negative attitude toward insulin therapy in comparison to patients already on insulin.
Systematic assessment of barriers of insulin therapy, individualized diabetes treatment plans and information of patients may help to overcome such negative attitudes, leading to quicker initiation of therapy, improved adherence to treatment and a better quality of life.
Patient Education and Counseling 12/2013; · 2.37 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: Self-regulatory executive function theory (Wells and Matthews, 1994; Wells, 2008) stresses the role of metacognitions in the development of emotional disorders. Within this metacognitive model, positive beliefs about ruminative thinking are thought to be a risk factor for engaging in rumination and subsequently for depression. However, most of the existing research relies on retrospective self-report trait measures. Aims: The aim of the present study was to examine the theory's predictions with an Ecological Momentary Assessment approach capturing rumination as it occurs in daily life. Method: Non-clinical participants (N = 93) were equipped with electronic diaries and completed four signal-contingent momentary self-reports per day for 4 weeks. A multilevel mediation model was computed to examine associations between positive beliefs about rumination and ruminative thinking and negative affect in daily life. Results: Positive beliefs about rumination were significantly associated with ruminative thinking as it occurs in daily life. We further found evidence for a negative association with positive affect that was completely mediated via ruminative thinking in daily life occurring in response to negative emotions. Conclusions: Our results add ecologically valid corroborating evidence for the metacognitive model of emotional disorders within the framework of self-regulatory executive function theory.
Behavioural and Cognitive Psychotherapy 05/2013; · 1.69 Impact Factor
[show abstract][hide abstract] ABSTRACT: The Polyvagal Theory (Porges, 2007) represents a biobehavioral model that relates autonomic functioning to self-regulation and social engagement. The aim of the two presented studies was to test the proposed association of cardiac vagal tone (CVT), assessed via resting high-frequency heart rate variability (respiratory sinus arrhythmia, RSA), with coping, emotion-regulation, and social engagement in young adults. In Study 1 (retrospective self-report), RSA was positively associated with engagement coping (situation control, response control, positive self-instructions, social-support seeking) and aspects of social well-being. In Study 2 (ecological momentary assessment), for 28 days following the initial assessment, RSA predicted less use of disengagement strategies (acceptance and avoidance) for regulating negative emotions and more use of socially adaptive emotion-regulation strategies (i.e., social-support seeking as a reaction to sadness and making a concession as a reaction to anger caused by others). Furthermore, RSA was higher in participants who reported no anger episodes compared to those who reported at least one anger episode and was positively associated with reported episodes of negative emotions. Results support the association proposed by the PVT between CVT and self-regulatory behavior, which promotes social bonds.
[show abstract][hide abstract] ABSTRACT: Diabetes mellitus is a known risk factor for cognitive dysfunction and dementia. Chronic hyperglycemia, genetic predisposition, arterial hypertension, hyperlipoproteinemia, micro- and macrovascular diseases, and depression play a major role in the development of cognitive dysfunction. Both pathophysiology of diabetes and dementia and the specifics of diabetes therapy in patients with dementia are presented in this review.
[show abstract][hide abstract] ABSTRACT: In this study, we examined the relationship between discrepancies between desired and received support and subjective well-being, as indicated by negative affect and perceived stress, in daily life. Participants were 30 undergraduates who were equipped with hand-held computers for seven days. Results showed that underprovision of support predicted lower well-being, whereas overprovision was related to higher well-being, suggesting a linear relationship. Emotional support proved to be more influential than practical and informational support. In contrast to previous research, perceived social support turned out to be unrelated to well-being in daily life.
Journal of Health Psychology 03/2011; 16(4):621-31. · 1.22 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this study, we examined whether people’s social well-being is influenced by hostile versus nonhostile goals that people report pursuing when experiencing anger-associated rumination. Moreover, we investigated the impact of trait anger and trait anger rumination on the relationship between anger rumination and perceived social well-being. Participants were 93 students who were equipped with hand-held computers for 28 days to assess anger-related rumination and its social consequences in daily life. Results showed that hostile goal pursuit per se did not affect perceived social well-being. However, impairment of social well-being following hostile rumination was moderated by trait anger. Findings are consistent with recent cognitive models of trait anger and anger rumination.Highlights► We examined the influence of anger-associated rumination on perceived social well-being in daily life. ► We distinguished between hostile versus nonhostile goals that people pursue with their rumination following anger incidents. ► Hostile goal pursuit per se did not affect perceived social well-being. ► Impairment of social well-being following hostile rumination was moderated by trait anger.
Personality and Individual Differences 01/2011; 51(6):769-774. · 1.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objectives To develop and psychometrically evaluate a domain-specific questionnaire to assess subtle but clinically relevant differences in treatment experiences and satisfaction over a wide range of currently available insulin therapy regimens. The study focussed on patients with type 2 diabetes mellitus and placed particular attention on the impact of different forms of insulin therapy on diabetes self-management.Methods The development of the Insulin Treatment Experience Questionnaire (ITEQ) was conducted in three steps: (i) a qualitative phase to generate relevant items and identify relevant domains; (ii) a pilot study to reduce the number of generated items; and (iii) a validation study to assess major psychometric properties of the final ITEQ version.Results The final version of the questionnaire comprised 28 items with the subscales `leisure activities' (four items), `psychological barriers' (two items), `handling' (five items), `diabetes control' (six items), `dependence' (five items), `weight control' (three items), `sleep' (two items), and one further item assessing general treatment satisfaction. The subscales' internal consistencies (Cronbach's alpha) ranged from 0.52 to 0.83. Motivated by the homogenous structure of inter-scale-correlations (range 0.10-0.46), a summary composite score was calculated (alpha = 0.86). Construct validity showed statistically significant correlations with other scales (ITEQ vs the Problem Areas in Diabetes [PAID] questionnaire total score −0.60, ITEQ vs the Diabetes Treatment Satisfaction Questionnaire [DTSQ] total score 0.52).Conclusion The newly developed ITEQ displayed satisfactory to good psychometric properties, thereby allowing the assessment of everyday life experience and treatment satisfaction in patients with insulin-treated type 2 diabetes. Additional research is needed to assess test-retest reliability and sensitivity to change.
The patient 02/2010; 3(1):45-58. · 1.57 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this issue of Journal of Diabetes Science and Technology, Valgimigli and colleagues present promising data on the clinical accuracy of the new microdialysis-based continuous glucose monitoring device GlucoMen®Day. In this analysis, two issues are addressed: first, the established way data analyses may obscure interindividual variability in terms of a glucose monitoring system's accuracy; and second, to fully appreciate the future merits of the new system, data on accuracy, while a clearly necessary prerequisite, are not sufficient and need to be augmented by patient-reported outcome data as highlighted by recent U.S. Food and Drug Administration guidelines.
Journal of diabetes science and technology 01/2010; 4(5):1193-4.
[show abstract][hide abstract] ABSTRACT: Resting heart rate variability (HRV) can serve as an index of self-regulatory strength. In the present study we tested the hypotheses that HRV, indexing adaptive self-regulation, is associated with subjective well-being, and that this association is mediated by the habitual use of strategies of emotion regulation that involve executive functions. In addition to measuring heart rate at rest, subjective well-being – as indicated by positive habitual mood and satisfaction with life – and habitual emotion regulation were assessed via self-reports. The findings were largely consistent with our predictions. HRV was positively associated with cheerfulness and calmness, and these effects were mediated by executive emotion regulation. Mediated by these strategies, HRV was also associated with satisfaction with life. Together, the results support the use of HRV as an index of self-regulatory strength.
Personality and Individual Differences - PERS INDIV DIFFER. 01/2010; 49(7):723-728.
[show abstract][hide abstract] ABSTRACT: evaluation of the effectiveness of a new structured diabetes teaching and treatment programme (DTTP) with specific didactical approaches and topics for geriatric patients with diabetes mellitus.
a prospective randomised controlled multi-centre trial.
a total of 155 geriatric patients were randomly admitted to either the new DTTP SGS (n = 83) or the standard DTTP (n = 72) for insulin-treated patients with type 2 diabetes mellitus (HbA1c 8.0 +/- 1.4%, age 76.2 +/- 6.3 years).
biometrical data, metabolic control, acute complications, diabetes knowledge, self-management.
SGS participants showed improved levels of HbA1c 6 months after the DTTP, and less acute complications than the standard group (P<0.009). Both groups demonstrated a good capacity for diabetes self-management and improvement in diabetes knowledge after the DTTP (P<0.01).
the new SGS diabetes education programme, focusing on the learning capabilities and the particular needs of older persons, is effective in improving metabolic control and in maintaining auto-sufficiency in geriatric patients with diabetes mellitus.
Age and Ageing 06/2009; 38(4):390-6. · 3.82 Impact Factor
[show abstract][hide abstract] ABSTRACT: Emotional eating is conceptualized as eating in response to negative affect or distress and is discussed as a mechanism leading to eating binges. Recent evidence suggests that eating may not only be triggered by negative affect, but also ruminative thinking. We report results of an experience sampling study examining the role of rumination for emotional eating in 16 obese adolescents (M=15.5 years, S.D.=1.4; range 14-17, body mass index M = 31.1 kgm(-2), S.D.=5.5) under restricted dietary conditions. We hypothesized that daily hassles type of stress predicted the individuals' desire to eat, with the predictive value further increased when negative affect and rumination were accounted for. The results of mixed regression modeling were in line with our predictions, suggesting a significant contribution of ruminative thinking to the mechanisms of negative affect induced eating.
[show abstract][hide abstract] ABSTRACT: The objective of this study was to evaluate the impact of initiation of insulin therapy, metabolic control and structured patient education on the diabetes-related quality of life (QoL) in insulin-treated patients with type 2 diabetes mellitus.
This prospective study was conducted with 71 consecutively recruited patients with insulin-treated diabetes at the University hospital. All patients participated an inpatient diabetes treatment and teaching program (DTTP) for conventional insulin therapy (mean age 68.9 years, HbA1c 10.1+/-1.4%, diabetes duration 11.2 years (range: 0-25.5 years), body-mass-index 28.7+/-5.7 kg/m(2). Diabetes-related quality of life was assessed before and 6 months after participation in the DTTP using the standardized questionnaire of Lohr analysing the subscales: social relations, physical complaints, worries about the future, dietary restrictions, fear of hypoglycaemia, and daily struggles.
Only patients switched on insulin therapy showed significant improvement in diabetes-related quality of life 6 months after participation in the DTTP (p=0.03), fewer physical complaints (p=0.03), fewer worries about the future (p=0.02), fewer daily struggles (p=0.01) and less fear of hypoglycaemia (p<0.001), while patients, who were already on insulin therapy showed no improvements in diabetes-related quality of life. Though, residual analysis reveals that effects on patients' QoL are mainly caused by improvements in metabolic control.
Improvements in metabolic control have a significant effect on different diabetes-related quality of life domains in patients with diabetes mellitus.
Appropriate interventions resulting in better metabolic control, such as starting on insulin therapy within a structured patient education program seem to be an effective approach to improve patients' diabetes-related quality of life.
Patient Education and Counseling 06/2008; 73(1):50-9. · 2.37 Impact Factor
[show abstract][hide abstract] ABSTRACT: In a randomized, prospective multi-centre trial, the effect of a specific training programme (HyPOS) for patients with hypoglycaemia problems was compared with a control group (CG), receiving a standardized education programme aiming at avoidance of hypoglycaemia by optimization of insulin therapy.
A total of 164 type 1 diabetes patients (age 46.0 +/- 12.5 yrs, HbA(1c) 7.3 +/- 1.0%, 50% male) were randomized. Hypoglycaemia awareness was measured by the hypoglycaemia awareness questionnaire (HAQ) and by a visual analogue scale (VAS). There were no baseline differences.
After a 6-month follow-up, hypoglycaemia awareness significantly improved in HyPOS compared to that in the CG (Delta HAQ 0.7 [95% CL 0.1-1.2], p = 0.024, Delta VAS 0.8 [95% CL 0.2 - 1.2], p = 0.015). In HyPOS, the threshold for detection of low blood glucose (Delta 0.2 mmol/L [95% CL 0.03 - 0.04], p = 0.02) and the treatment of low blood glucose (Delta 4.6 g [95% CL 1.6 - 7.6], p = 0.03) increased significantly. The number of undetected hypogylcaemic episodes (Delta - 1.4 episodes per week [95% CL 0.4-2.5], p = 0.01) and the rate of mild hypoglycaemia dropped significantly in HyPOS (Delta 2.1% [95% CL 0.5-5.3], p = 0.015). The numbers of severe (Delta 0.3 events per patient per year [95% CL - 0.04-1.0], p = 0.037) and very severe hypoglycaemic episodes (Delta 0.3 events per patient per year [95% CL - 0.1-0.7], p = 0.09) were lower in HyPOS, but these differences were not significant.
Compared to the CG, HyPOS demonstrates additional benefits in terms of improving impaired hypoglycaemia awareness, reducing mild hypoglycaemia, detecting low blood glucose, and treating low blood glucose.
Diabetes/Metabolism Research and Reviews 11/2007; 23(7):528-38. · 2.97 Impact Factor