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Zusammenfassung Anliegen Internationale Arbeiten legen nahe, dass psychiatrisch tätige Ärztinnen und Ärzte häufiger als somatisch Tätige von Burnout betroffen sind. Methoden Survey aller bei der Sächsischen Landesärztekammer gemeldeten Ärztinnen und Ärzte ≤ 40 Jahre. Ergebnisse Psychiatrisch und somatisch Tätige unterschieden sich nicht hinsichtlich emotionaler Erschöpfung und Depersonalisierung. Psychiatrisch Tätige zeigten ein höheres subjektives Kompetenzerleben. Eine psychiatrische Tätigkeit war mit einer geringeren Wahrscheinlichkeit für hohe Burnoutwerte auf der Subskala subjektives Kompetenzerleben assoziiert. Schlussfolgerungen Frühere Studien zu vermehrtem Burnout bei Psychiatern konnten nicht bestätigt werden.

Background: Studies exist that identify factors associated with higher professional satisfaction among clinicians. However, there are no reliable findings for clinicians with a migration background as to whether there is a correlation between particular dimensions of professional satisfaction and the desire to leave their current specialty or country of employment. For the first time, these data were collected within a questionnaire-based study from urological clinicians with a migration background (UCMBs) working in Germany. Material and Methods: A SurveyMonkey® with 101 items relating to characterizing features of the study participants and questions about job satisfaction (n = 39) was opened for UCMBs between August and October 2020. The influence of different dimensions of job satisfaction on the desire to quit the urological specialty/leave Germany was analyzed (group A: neither want to leave urology nor Germany; group B: can at least imagine leaving the urological profession and/or Germany). Results: Eighty-one UCMBs were distributed almost equally in groups A (50.6%) and B (49.4%). Occupational satisfaction was higher in several respects in group A. Three dimensions that differed significantly with regard to occupational satisfaction were used to create an aggregate score ranging from 3 to 15 points as follows: (1) relationship to superiors (p = 0.014), (2) career opportunities in the clinic (p < 0.001), and (3) opportunities for the further development of surgical skills (p = 0.006). For each point value of this aggregate score, the UCMB’s desire to quit urology or leave Germany (or at least uncertainty about this question) decreased by a relative value of 34.6% (odds ratio: 0.654, 95% confidence interval: 0.496–0.861, p = 0.002). Conclusions: Various dimensions of job satisfaction have been identified, the improvement of which could contribute to the long-term retention of UCMBs at German urological clinics.

Burnout is considered to be a major risk factor that can contribute secondary disorders due to persistent work related stress. International studies showed that physicians working in psychiatric care are more frequently affected by burnout than physicians working in somatic care. Studies from Germany are lacking.In a cross-sectional study all physicians 40 years and younger and registered with the State Chamber of Physicians of Saxony, Germany, received an anonymous paper-pencil questionnaire. Burnout was measured using the Maslach Burnout Inventory.Physicians working in psychiatric/psychosomatic care did not differ from physicians working in somatic care regarding the subscalesPrevious studies suggesting a higher prevalence of burnout among physicians working in psychiatric care could not be confirmed.Internationale Arbeiten legen nahe, dass psychiatrisch tätige Ärztinnen und Ärzte häufiger als somatisch Tätige von Burnout betroffen sind.Survey aller bei der Sächsischen Landesärztekammer gemeldeten Ärztinnen und Ärzte ≤ 40 Jahre.Psychiatrisch und somatisch Tätige unterschieden sich nicht hinsichtlichFrühere Studien zu vermehrtem Burnout bei Psychiatern konnten nicht bestätigt werden.

Research regarding people with visual, hearing, or physical disability and their experiences with partnership is sparse. Existing studies show that experiences with partnership and sexual activity occur both less frequently and later in life. Feelings of inferiority, common beauty standards, stigmatization, immobility, and overprotective parenting are cited as reasons for this. This paper analyzes the influence of gender and type of disability on the experiences young adults with visual, hearing, or physical disability have with partnership and sexuality. Eighty-four participants aged 18–25 years, with hearing disability (n = 40), visual disability (n = 18), or physical disability (n = 26) were interviewed face-to-face or by phone. Nine out of ten participants had been in a relationship at least once. Seven out of ten had had experience with sexual intercourse. Female participants had more experience with sexual intercourse than male participants. Men had overall more relationships and experienced their first coitus significantly earlier. Participants with physical disability reported fewer relationships and their first sexual intercourse took place at a later age. The participants with hearing disability had the most relationships and experienced their first sexual intercourse earliest. The results of this study show that the study participants have significant experience with partnership and sexuality. On the other hand, the results indicate that an inclusive school system, the reinforcement of a positive self-perception, and supportive parents and educators are crucial for the development of young adults with impairments and their ability to make independent and confident decisions with regards to partnerships and sexuality.

Anliegen: Arbeitszufriedenheit, Ausstiegs- und Auswanderungswunsche psychiatrisch/psychosomatisch tatiger verglichen mit der somatisch tatiger Arztinnen und Arzte. Methoden: Vollerhebung aller bei der Sachsischen Landesarztekammer registrierten Arztinnen und Arzten ≤ 40 Jahre. Ergebnisse: Psychiatrisch/psychosomatisch Tatige waren, wie somatisch Tatige, mit der Arbeitssituation insgesamt eher zufrieden und nur mit 2 von 20 Teilaspekten unzufriedener. Fast ein Viertel hatte Ausstiegs- oder Auswanderungswunsche, was sich nicht von den somatisch Tatigen unterschied. Schlussfolgerungen: Internationale Befunde zu einer geringeren Arbeitszufriedenheit von Psychiatern konnten nicht bestatigt werden.

Hintergrund: Die Sorge vor einem Arztemangel in bestimmten Regionen Deutschlands wachst. Als moglicher Grund wird die Abwanderung von Arzten in nicht-klinische Tatigkeitsbereiche diskutiert. Um dieser entgegenwirken zu konnen, braucht es Informationen zur Verbreitung von Ausstiegswunschen und uber die Grunde fur ­einen Ausstieg. Methoden: Alle bei der Sachsischen Landesarztekammer gemeldeten Arztinnen und Arzte bis einschlieslich 40 Jahre (n=5 956) wurden postalisch zu Soziodemografie, Berufszufriedenheit, Ausstiegswunschen und entsprechenden Grunden befragt. Die Rucklaufquote betrug 40% (n=2 357). Ergebnisse: Fast ein Viertel der klinisch tatigen Arzte und Arztinnen hatte den Wunsch, aus der klinischen Tatigkeit auszusteigen. Eine stationare Tatigkeit und das Vorhandensein von Kindern waren signifikant mit dem Vorliegen eines Ausstiegswunsches assoziiert. Von den Teilnehmenden mit Ausstiegswunsch hielten 71% aus personlichen und 44% aus beruflichen Grunden einen befristeten Ausstieg und 16% aus personlichen sowie 31% aus beruflichen Grunden einen unbefristeten Ausstieg in den nachsten 5 Jahren fur wahrscheinlich. Als haufigste Grunde wurden Schwierigkeiten bei der Vereinbarkeit von Beruf und Familie, eine hohe Belastung durch Dienste, eine hohe Arbeitsbelastung und regelmasige Uberstunden genannt. Schlussfolgerung: Eine Optimierung des Arbeitsklimas unter Berucksichtigung der Zusammenarbeit zwischen den einzelnen Hierarchieebenen, ein verbessertes Management der hohen Arbeitsbeanspruchung sowie die Unterstutzung der besseren Vereinbarkeit von Beruf und Familie von klinisch tatigen Arztinnen und Arzten versprechen eine Steigerung der Zufriedenheit der Betroffenen im Beruf und konnten einen substantiellen Beitrag gegen dauerhafte Ausstiege aus der klinischen Tatigkeit leisten.

Background Physician migration is gaining attention worldwide. Despite increasing numbers of foreign physicians in Germany, their perceptions on working in Germany remain unexplored. Within a large survey on Saxon physicians, the aim of this study was to elucidate whether foreign-national physicians’ job satisfaction differed from German physicians’ job satisfaction. Methods The study was designed as a comprehensive cross-sectional survey. All physicians ≤40 years and registered with the State Chamber of Physicians of Saxony (n = 5956) were mailed a paper-pencil questionnaire, of which 2357 were returned (response rate = 40 %). Questionnaires addressed socio-demographics and assessed job satisfaction by asking participants to rate their satisfaction with the overall job situation and 20 different aspects on a 5-point Likert scale (1 = very dissatisfied to 5 = very satisfied). Results Ten percent of participants were foreign-national physicians. The three main countries of origin were the Czech Republic, Slovakia, and Poland. Foreign-national physicians were more satisfied with aspects related to patient care, such as “possibility to treat patients as you deem optimal” and “relationship with patients”. However, they were less satisfied with aspects related to human relations, such as “work atmosphere”, relationship with co-workers, and “social status”. Foreign-national physicians were also less satisfied with the aspect “work enjoyment”. Conclusions Further research on determinants promoting foreign-national physicians’ job satisfaction is needed as their professional well-being may influence quality of patient care. Measures teaching cross-cultural competence and awareness may be beneficial for both foreign-national and German physicians. Electronic supplementary material The online version of this article (doi:10.1186/s12995-016-0129-2) contains supplementary material, which is available to authorized users.

The risks associated with alcohol intoxication are rarely discussed during pre-travel counselling. However, alcohol immoderation abroad may increase the exposure to health risks. Few studies have addressed alcohol consumption and risk taking behaviour in travellers to South America. From October to December of 2004, travellers leaving the city of Cusco in Peru were asked to fill out anonymous questionnaires regarding demographics, self-reported alcohol consumption, illness and risk behaviour for sexually-transmitted infection (STI) and travellers diarrhoea. Most travellers (87.2%) consumed alcohol and 20.4% reported inebriation in Cusco. Those admitting inebriation were more likely to be male, single

Intracellular protozoans of the genus Cryptosporidium are a major cause of diarrheal illness worldwide, especially in immunocompromised individuals. CD4(+) T cells and interferon-gamma are key factors in the control of cryptosporidiosis in human and murine models. Previous studies led us to hypothesize that CD8(+) T cells contribute to clearance of intestinal epithelial Cryptosporidium infection in humans. We report here that antigen expanded sensitized CD8(+) T cells reduce the parasite load in infected intestinal epithelial cell cultures and lyse infected intestinal epithelial cells. These effects are most likely mediated by the release of cytotoxic granules. Elimination of parasites seems to require antigen presentation through both human leukocyte antigen (HLA)-A and HLA-B. These data suggest that cytotoxic CD8(+) T cells play a role in clearing Cryptosporidium from the intestine, a previously unrecognized feature of the human immune response against this parasite.

Cryptosporidium parasites are pathogens of human intestinal epithelial cells. To determine which genes are regulated during early infection, human ileal mucosa cultured as explants was infected with C. parvum or C. hominis, and gene expression was analyzed by microarray. The gene for osteoprotegerin (OPG) was up-regulated by both parasites. OPG mRNA was also significantly increased in biopsy specimens obtained from a volunteer experimentally infected with C. meleagridis, compared with levels in a prechallenge biopsy specimen. After in vitro infection of HCT-8 cells, there was an early peak in production of OPG mRNA protein. Treatment of infected cells with the OPG ligand tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induced epithelial cell apoptosis and reduced parasite numbers, and recombinant OPG blocked these effects. These results suggest a novel TRAIL-mediated pathway for elimination of Cryptosporidium infection and a role for OPG in modulating this host response.

Background Concerns about burnout, and its consequences, among German physicians are rising. However, data on burnout among German physicians are scarce. Also, a suspected association between burnout and German physicians’ wishes to leave remains to be studied. Therefore, the extent of burnout, and the association between burnout and wishes to leave clinical practice or to go abroad for clinical work was studied in a sample of young physicians in Saxony. Methods In a cross-sectional survey, all physicians ≤40 years and registered with the State Chamber of Physicians of Saxony, Germany (n = 5956) received a paper-pencil questionnaire inquiring about socio-demographics, job satisfaction, and wishes to leave clinical practice or to go abroad for clinical work. Response rate was 40 % (n = 2357). Burnout was measured with the German version of the Maslach Burnout Inventory - Human Services Survey (MBI) consisting of the subscales emotional exhaustion (feeling emotionally drained), depersonalization (feelings of cynicsm) and personal accomplishment (feelings of personal achievement in job). Variables associated with burnout, and the association between burnout and wishes to leave were assessed in multivariate logistic regression analyses. Results For emotional exhaustion participants reached a mean of 21.3 [standard deviation = 9.74], for depersonalization a mean of 9.9 [5.92], and for personal accomplishment a mean of 36.3 [6.77]. Men exhibited significantly higher depersonalization than women (11.3 [6.11] versus 9 [5.62], p

Background: Studies from the USA have identified medical students as a major source of stigmatizing attitudes towards overweight and obese individuals. As data from Europe is scarce, medical students' attitudes were investigated at the University of Leipzig in Leipzig, Germany. Material/Methods:[for full text, please go to the a.m. URL], 4. Wissenschaftlicher Kongress der Deutschen Gesellschaft für Essstörungen

Childhood diarrhea is an important cause of malnutrition, which can be worsened when caretakers limit nutritional support. We queried 390 caregivers and their children in a peri-urban community in Lima, Peru regarding general perceptions of feeding and feeding practices during diarrhea. Overall, 22.1% of caregivers perceived feeding during diarrhea to be harmful. At baseline, 71.9% of caregivers would discontinue normal feeding or give less food. Most would withhold milk, eggs, and meats. Approximately 40% of caregivers would withhold vegetables and fruits. A pilot educational intervention was performed to improve feeding during diarrhea. At follow-up survey 3 months later, none of the caregivers would recommend withholding food. Only 23.2% would recommend discontinuing normal feeding and 1.8% perceived food to be damaging. Misperceptions of the role of feeding during diarrhea pose a significant health risk for children, but a simple educational intervention might have a major impact on these perceptions and practices.

Cryptosporidium is an obligate intracellular protozoan parasite that is a major cause of diarrheal illness worldwide. Cryptosporidium primarily infects the distal small intestine. Immunocompetent hosts control and eliminate the infection, which typically causes acute, self-limited watery diarrhea lasting 5 to 10 days. However, in patients with defects in cellular immune responses (e.g., AIDS, malnutrition, or defects in the CD40-CD154 system), Cryptosporidium frequently causes persistent or chronic diarrhea and may also involve the biliary tract (40). In malnourished children, persistent diarrhea is associated with increased susceptibility to recurrent diarrheal episodes, which can lead to death or chronic nutritional and cognitive sequelae (1, 9, 33). Thus, the host immune response plays a critical role in the control of human cryptosporidiosis. Although extensive studies with various animal models have provided important insight into the host immune response towards Cryptosporidium parvum, the ability of these models to explain the human immune response is limited. The clinical picture in rodents differs from that in humans, as mice do not get diarrhea after infection. Nonhuman primates, although probably the best in vivo model to mimic human disease, are difficult to work with, expensive, and not widely available. Cryptosporidium hominis, the pathogen causing most human cryptosporidiosis, infects only humans and gnotobiotic pigs, thus limiting data from animal models. Most importantly, comparison of animal and human data has shown that the immune response towards Cryptosporidium in humans differs significantly from that in animals; for example, in mice gamma interferon (IFN-γ) production seems to be associated with the innate and primary immune responses (35, 47), whereas in humans it is most probably associated with the memory response towards the parasite (93). Conducting studies to elucidate human mucosal immune responses is difficult. Patients with a natural infection would be the ideal subjects to study, but it is difficult to identify cases. Healthy human volunteers can be studied, but they typically experience a milder illness than malnourished children and AIDS patients. Human intestinal tissue samples can be obtained only by invasive procedures, limiting the numbers of subjects and samples available. Some data can be obtained from in vitro infections, but most of the target cells are immortalized and may not be ideal for studying mechanisms involving apoptosis. Furthermore, the immune cells in the peripheral blood may exhibit properties different from the properties of cells found in the intestinal compartment. Thus, knowledge about the human immune response towards Cryptosporidium infection is far from complete. Still, important recent advances have been made. The goal of this paper is to review the current literature to provide an understanding of the human immune response towards the parasite. We include some relevant data from other models only when the data shed light on studies performed with human cells or tissues.

Aluminum hydroxide and incomplete Freund's adjuvant (IFA) are the only adjuvants approved for human use. Both are T helper 2 (Th2) adjuvants, however, T helper 1 (Th1) immunity is induced if microbial products such as mycobacteria, CpG's, or bacterial toxins are included in the adjuvant preparation. The usefulness of bacterial toxins, such as Pertussis toxin (PT) or Cholera toxin (CT), as adjuvants for human vaccination is limited by toxic side effects and high immunogenicity. Hence, we asked whether or not the adjuvant activity of bacterial toxins on Th1 and Th2 immunity could be mimicked by chemical compounds of small molecular weight and less immunogenicity. In the present study, we show that Suramin, a small molecular weight naphthylurea, which mainly acts on G-proteins and on P2X/P2Y receptors, promotes expansion of hen eggwhite lysozyme (HEL)-specific Th1 and Th2 cells upon immunization of BALB/c mice with HEL in aluminum hydroxide (alum). The results indicated that the adjuvant effects of Suramin on T cell responses were mediated by enhancing the expression of MHC class II and costimulatory molecules on antigen presenting cells (APCs), and by increasing their pro-inflammatory cytokine production. Together, the results suggest that small molecular weight compounds such as Suramin could be used as alternative vaccine adjuvants.

Alloreactive T lymphocytes can be primed through direct presentation of donor MHC:peptide complexes on graft cells and through indirect presentation of donor-derived determinants expressed by recipient APCs. The large numbers of determinants on an allograft and the high frequency of the alloreactive repertoire has further led to speculation that exposure to environmental Ags may prime T cells that cross-react with alloantigens. We sought to develop a model in which to test this hypothesis. We found that CD4+ T cells obtained from C57BL/6 (B6) mice that clinically resolved Leishmania major infection exhibited statistically significant cross-reactivity toward P/J (H-2p) Ags compared with the response to other haplotypes. B6 animals that were previously infected with L. major specifically rejected P/J skin grafts with second set kinetics compared with naive animals. Although donor-specific transfusion combined with costimulatory blockade (anti-CD40 ligand Ab) induced prolonged graft survival in naive animals, the same treatment was ineffective in mice previously infected with L. major. The studies demonstrate that cross-reactive priming of alloreactive T cells can occur and provide direct evidence that such T cells can have a significant impact on the outcome of an allograft. The results have important implications for human transplant recipients whose immune repertoires may contain cross-reactively primed allospecific T cells.

Costimulatory blockade can induce long-term allograft survival in naive animals, but may not be as effective in animals with previously primed immune repertoires. We attempted to induce long-term graft survival in B10.D2 recipients of B10.A cardiac allografts using donor-specific transfusion (DST) plus anti-CD40 ligand antibody (alphaCD40L). Recipients were either naive mice, or mice previously primed to B10.A or third party alloantigens through engraftment and rejection of skin transplants. Untreated naive mice rejected cardiac transplants by day 15 and contained a high frequency of primed, donor-reactive T cells. Donor-specific transfusion/alphaCD4OL treatment of naive animals induced long-term graft survival associated with low frequencies of donor-reactive T cells. Previous priming of donor-specific T cells through rejection of B10.A, but not third party, skin grafts prevented the effects of DST/alphaCD40L on prolonging survival of B10.A hearts. Moreover, adoptive transfer of CD3+, CD4+ or CD8+ T cells from B10.A skin-graft-primed animals prevented the effects of DST/alphaCD40L. The data demonstrate that animals with immune repertoires containing previously primed, donor-reactive T cells are resistant to the effects of costimulatory blockade. The findings have important implications for ongoing, costimulatory blockade-based trials in humans, whose T-cell repertoires are known to contain memory alloreactive T cells.

INTRODUCTION: A key factor in the human adaptive immune response towards Cryptosporidium, associated with resistance to infection, is IFNg. Its function and the cells involved in clearing the parasite from the human intestinal epithelium are unknown. As CD4+ and CD8+ cells produce IFNg after re-stimulation with parasite antigens in vitro we hypothesized that CD8+ cells contribute to control of the infection. METHODS: We studied CD8+ cell cytotoxicity by 51Chromium (51Cr) release assay and fluorescent microscopy. Targets were 51Cr labeled CaCo2 cells. Effectors were CD8+ cells isolated from peripheral blood mononuclear cells of sensitized or naïve volunteers after 6 day culture with IL-2 + IL-15 +/- C. hominis glycoprotein 15 (gp15). RESULTS: Gp15 stimulated CD8+ cells from a sensitized donor matched at HLA-A and HLA-B killed infected cells, with killing increasing with effector numbers, in contrast to CD8+ cells from a naïve donor. In microscopy experiments the same primed CD8+ cells released cytolytic granules into infected cells. CD8+ cells from sensitized donors matched at HLA-A, but not at HLA-B did not kill infected targets as efficiently. HLA-A and HLA-B antibodies inhibited cytotoxicity. CONCLUSION: The data suggest that re-stimulated CD8+ cells from sensitized individuals kill infected cells through release of cytotoxic granules. HLA-B seems to be at least partially required for peptide recognition.