Search

Sophie de Boer,1,2 Felix Klewitz,1,2 Maximilian Bauer-Hohmann,1,2 Lena Schiffer,2,3 Uwe Tegtbur,2,4 Lars Pape,2,3 Mario Schiffer,2,5,6 Martina de Zwaan,1,2 Mariel Nöhre1,2 1Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany; 2Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany; 3Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany; 4Department of Sports Medicine, Hannover Medical School, Hannover, Germany; 5Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany; 6Department of Nephrology and Hypertension, Hannover Medical School, Hannover, GermanyCorrespondence: Mariel Nöhre Department of Psychosomatic Medicine and PsychotherapyHannover Medical School, Carl-Neuberg-Strasse 1, Hannover 30625, GermanyTel +49 511 532 3932Fax +49 511 532 3190Email noehre.mariel@mh-hannover.dePurpose: After organ transplantation, adherence to immunosuppressive medication (ISM) is crucial to prevent organ rejection. To enable adherence, patients need to be well informed about the different aspects associated with their ISM. However, literature suggests that knowledge regarding ISM is often inadequate.Patients and Methods: In a cross-sectional study, 702 patients after kidney transplantation participating in a structured multimodal follow-up program (KTx360°) were evaluated. We utilized a self-developed questionnaire which has been successfully used before to measure patients’ knowledge about the ISM. Above that we aimed to evaluate potential associations between sociodemographic, medical, donation-specific, and psychosocial variables including adherence, levels of depression and anxiety, perceived social support, and cognitive functioning with the knowledge level.Results: The mean age of the patients was 52.4 years, 58.1% were men, and 66.6% were living in a partnership. The mean time since transplantation was 65.1 months. On average, patients answered 70.9% of the questions correctly. The percentage of correct answers per question differed considerably (54%– 92%). In univariate analyses, knowledge levels were positively associated with female gender, current partnership, German as first language and better cognitive functioning. However, the effect sizes were small.Conclusion: Taking into account that the patients after KTx can be expected to answer all questions correctly as they aim at basic knowledge, an average result of 70.9% corresponds to a moderate knowledge level. Consequently, the current educational approaches do not seem to be sufficient to inform all patients adequately. Further research is necessary on how to improve health knowledge in the long term.Keywords: health literacy, kidney transplantation, renal transplantation, adherence, immunosuppressive medication

Achieving and maintaining happiness can be difficult, especially when people are not engaging in the activities they know facilitate it. ‘Flow’ activities require clear rules, challenge, a high investment of energy, and have been shown to promote long-term happiness better than low investment, passive activities. Do people know this? In two studies, we found that, despite recognizing that flow activities are more likely to facilitate happiness, people nevertheless participated in passive leisure significantly more often in a typical week. Participants rated passive activities as being significantly more enjoyable, requiring less effort, and being less daunting to get started than flow activities. Participants’ engagement in flow activities was significantly predicted by how enjoyable the activities were perceived to be, whereas how daunting those activities were rated predicted non-engagement. Passive activity engagement was only significantly predicted by enjoyment. Suggestions for enabling people to rise above the barriers to flow activities are offered. [ABSTRACT FROM AUTHOR]

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recent studies have demonstrated that CXCL13 serum levels correlate significantly with systemic lupus erythematosus (SLE) disease activity. However, experimental studies show that CXCL13 production can also be induced by bacterial exposure as well as in response to inflammatory cytokines. This report asks whether CXCL13 serum levels are elevated in patients with evidence of bacterial infections and whether there is a correlation with the C-reactive protein (CRP) levels or the severity of illness in critically ill patients. CXCL13 levels were compared in 39 patients with active SLE (without concomitant infection), 40 non-SLE patients with sepsis, and 40 healthy controls by enzyme-linked immunosorbent assay (ELISA) methodology. We also tested storage conditions and freeze–thaw cycles for stability of CXCL13 in serum samples. Our studies demonstrated that the median CXCL13 serum levels were significantly elevated in patients with SLE [median 83 pg/ml (interquartile range 38–366)] or sepsis [359 pg/ml (151–459)] compared with healthy controls [32 pg/ml (27–41), p < 0.001]. The CXCL13 serum levels correlated with disease activity in SLE (CXCL13 vs. SLEDAI r = 0.65, p < 0.001), but were not associated with severity of illness score in critically ill patients (CXCL13 vs. SOFA r = −0.15, p = 0.35). However, CXCL13 serum levels were clearly associated with CRP levels in both sepsis (r = 0.45, p = 0.003) and SLE (r = 0.39, p = 0.02). In conclusion, CXCL13 is a stable serum marker for disease activity in SLE patients, but concomitant infections can also lead to increased CXCL13 levels. [ABSTRACT FROM AUTHOR]