Adverse reactions to the antiarrhythmic medication amiodarone are severe, potentially life-threatening, and not rare. One in three patients on long-term therapy experience elevated liver enzymes, and clinically apparent liver toxicity occurs in 1% of patients treated. We report the case of a 76-year-old patient with amiodarone-induced intrahepatic cholestasis and prolonged hyperbilirubinemia despite the discontinuation of the offending agent. Current research hypothesizes that amiodarone leads to hepatic injury both by direct hepatotoxicity and by increasing the likelihood of hepatocytes to create abnormal, toxic metabolites. Increased awareness of such an adverse effect can guide clinicians toward the possible underlying etiologies of prolonged jaundice.

Bakgrund: Diabetes är en allvarlig folkhälsosjukdom som påverkar kroppens egen möjlighet till att reglera blodets glukosvärde. Den största riskgruppen för att utveckla diabetes typ 2 är individer med övervikt. Regelbunden fysisk aktivitet har visat positiv inverkan på såväl glukosvärden. Vilken effekt korta pauser med fysisk aktivitet har på glukosvärde i blodet vid långvarigt stillasittande är inte lika utforskat. Det kan vara värdefullt som fysioterapeut att kunna ge relevanta rekommendationer angående fysisk aktivitet till individer med diabetes typ 2 eller övervikt för att kunna minska komplikationer. Syfte: Systematiskt granska enskilda studier och sammanväga tillförlitligheten för effekten på glukosvärde i blodet av korta pauser med fysisk aktivitet i samband med stillasittande hos individer med diabetes typ 2 och övervikt.  Metod: Litteratursökningen genomfördes i databasen Pubmed och resulterade i åtta studier inkluderades. Studierna kvalitétgranskades enligt PEDro scale och evidens graderingen genomfördes genom GRADEstud. Resultat: Korta pauser av fysisk aktivitet i samband med stillasittande resulterar i en signifikant minskning av glukosvärde hos individer med diabetes typ 2 eller övervikt. Kvalitétsgranskningen enligt PEDro visar att sex studier anses vara av måttlig kvalitét och två studier av hög kvalitét. Den sammanlagda tillförlitligheten enligt GRADEstud av underlaget bedömdes vara låg (++).  Konklusion: Effekten av fysisk aktivitet hos stillasittande individer med diabetes typ 2 eller övervikt visade ett minskat glukosvärde jämfört med dem som var långvarigt stillasittande. Evidensen bedömdes vara låg vilket visade på ett behov av fler högkvalitativa studier inom området för att kunna bekräfta resultatet. / Background: Diabetes is a public health disease that affects the body's own ability to regulate the blood's glucose. Overweight individuals have the highest risk of developing type 2 diabetes. The effect that physical activity has on glucose levels in conjunction with sedentary sitting is not as explored as regular interventions of physical activity. It can be valuable as a physiotherapist to be able to give recommendations to individuals with type 2 diabetes or overweight to reduce complications.  Purpose: Systematically review studies and their reliability on the effect of physical activity on blood glucose in conjunction with sedentary sitting on individuals with type 2 diabetes or overweight. Method: The literature search was conducted on the database Pubmed and resulted in eight studies. The studies quality was reviewed with PEDro scale and the evidence reviewed with GRADEstud. Results: Short breaks of physical activity in conjunction with sedentary sitting resulted in a significant decrease of glucose levels on individuals with diabetes type 2 and overweight. The quality review with PEDro showed that six studies were of moderate quality and two studies of high quality. The overall reliability according to GRADEstud was rated low(++). Conclusion: The effect of short breaks of physical activity in conjunction with sedentary sitting on individuals with diabetes type 2 or overweight shows decreased glucose levels compared with sedentary sitting. The evidence was rated low which shows a need for more high quality studies in the subject to confirm the results .

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Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability.  Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP.  Both modern living and contemporary work involve increased sedentary lifestyles, including more frequent and prolonged sitting.  At present, however, the causal role of sitting on LBP development is controversial due to the contribution of several moderating factors (e.g., task demands, duration of exposures, and presence of muscle fatigue).  A few studies have assessed low back loads in seated postures, but none has investigated the effects of prolonged sitting or time-dependent variations on spinal structure and spinal loading.  Adverse effects of muscle fatigue on low back pain are well documented, yet the specific relationship between muscle fatigue and sitting-related low back pain are not fully established.  In addition to these fundamental limitations in our understanding of the physical consequences of sitting, there is also little evidence regarding the effects of task requirements on muscle fatigue and spine loading.   Therefore, the main objectives of this work were, in the context of sitting, to: 1) develop and evaluate a method to assess paraspinal muscle fatigue using electrical stimulation; 2) develop and evaluate a method (model) to quantify biomechanical loads on the lumbar spine in a seated posture; and 3) quantify the effects of prolonged seated tasks on low back loads, body discomfort, and localized muscle fatigue (LMF).  The primary hypothesis was that exposure to sitting-related LBP risks is influenced by task requirements and sitting duration.   A muscle stimulation protocol was developed to measure stimulation responses in the lumbar extensors.  A stimulation protocol, which included one conditioning train along with three 16-second stimulation train at 2 Hz, was recommended as appropriate to measure those muscles potentially fatigued during prolonged seated tasks.  A three-dimensional, sitting-specific, fatigue-sensitive, time-dependent, electromyography (EMG)-based biomechanical model of the trunk was developed to investigate the effects of seated tasks and time-dependent variations on lumbosacral loading during sitting. Reasonable levels of correspondence were found between measured and predicted lumbosacral moments under a range of seated tasks.  Lastly, the effects of prolonged sitting and psychosocial work stress on low back were quantitatively identified.  Only prolonged sitting significantly increased trunk flexion angles and led to muscle fatigue.  Relatively weak correlations were found between subjective and objective measures, though the two fatigue measurement methods (based on EMG and stimulated responses) showed a good level of correspondence.   Overall, this work provides a quantitative assessment of biomechanical exposures associated with seated tasks.  The methods developed in this work make a contribution in terms of measurement/modeling approaches that can be used to assess LBP-relevant risks during prolonged sitting.  The results of this work provide a better understanding of the effects of prolonged sitting on the risk of developing sitting-related LBP.  Finally, results regarding the influences of prolonged sitting and psychosocial demands can be used to guide future job design. / Ph. D.

Laut Statistischem Bundesamt (Destatis) starben allein im Jahr 2020 zirka 985.500 Menschen. Die häufigsten Todesursachen waren Herz-Kreislauf- und Krebs-Erkrankungen (vgl. Destatis 2020). Die meisten Menschen haben den Wunsch zuhause zu sterben, doch die Mehrheit stirbt in Krankenhäusern, Alten- und Pflegeheimen (vgl. DHPV 2017; Dasch et al. 2015). Der Tod eines nahestehenden Menschen kann bei Hinterbliebenen zu großen Belastungen, gesundheitlichen Problemen sowie einer gesteigerten Mortalität führen (vgl. Stroebe et al. 2007). Ziel dieser Arbeit war es, mit Hilfe von halbstandardisierten Interviews mit 30 Trauernden Faktoren herauszuarbeiten, die sich förderlich oder hinderlich auf den Trauerprozess auswirken können. Die Interviews wurden mit der Transkriptionssoftware f4transkript verschriftlicht und mittels qualitativer Inhaltsanalyse nach Mayring ausgewertet. Es entstand ein Kategoriensystem mit je vier Oberkategorien innerhalb der zwei Hauptkategorien, Förderliche und Hinderliche Faktoren. Folgende Faktoren konnten identifiziert werden: Förderliche Faktoren in der Oberkategorie Betreuung der erkrankten und trauernden Person sind eine gute Symptomkontrolle sowie der verständnisvolle Umgang mit den Nahestehenden, während mangelhafte Kommunikation wiederum hinderlich für eine positive Trauerbewältigung ist. In der Oberkategorie Intrapersonale Faktoren sind die Antizipation des Todes sowie die Auseinandersetzung mit der Trauer förderlich, während negative Gefühle (z.B. Schuldgefühle, Hilfslosigkeit) sich in besagter Hinsicht hinderlich auswirken. In der Oberkategorie Beziehung zur verstorbenen Person können die optimale Nutzung der verbliebenen Zeit sowie der offene Umgang mit der Erkrankung förderliche Faktoren darstellen, während ein “schwieriger“ Abschied sowie ungeklärte Konflikte oder offene Fragen Hindernisse für den Trauerprozess sein können. In der Oberkategorie Soziales Umfeld sind die unaufgeforderte Unterstützung, die emotionale Begleitung sowie ein flexibler Arbeitgeber förderlich. Streitigkeiten innerhalb der Familie und Unverständnis der Mitmenschen dagegen sind hinderlich. Eine gute und würdevolle Sterbebegleitung, wie sie in der Palliativmedizin in der Regel gewährleistet ist, ist von großer Bedeutung für einen gelingenden Trauerprozess. Daher sollte eine palliative Haltung disziplinübergreifend vorangebracht und ausgebaut werden. In der Gesellschaft sollte Trauernden mehr Toleranz und Verständnis entgegengebracht und offen mit dem Thema Tod und Sterben umgegangen werden. / According to the German Federal Statistical Office (Destatis), approximately 985,500 people died in the year 2020 in Germany. The most common causes of death were cardiovascular diseases and cancer (cf. Destatis 2020). Most people wish to die at home, but the majority die in hospitals and care facilities (cf. DHPV 2017; Dasch et al. 2015). The death of a close person can lead to significant difficulties, health problems, and increased mortality among the bereaved (cf. Stroebe et al. 2007). The aim of this study was to identify factors that can have a supporting or hindering effect on the grieving process by conducting semi-structured interviews with 30 mourners. The interviews were transcribed using the f4transkript transcription software and evaluated using qualitative content analysis according to Mayring. A category system was developed with four subcategories within the two main categories, Supporting and Hindering Factors. The following factors were identified: Supporting factors in the subcategory "Care of the sick and grieving person" include good symptom control and understanding treatment of the relatives, while poor communication, in turn, is a hindrance to positive grief coping. In the subcategory "Intrapersonal factors", the anticipation of death and dealing with grief are supportive, while negative emotions (e.g., feelings of guilt, helplessness) have a hindering effect in this regard. In the subcategory "Relationship with the deceased person", optimal use of the remaining time and open handling of the illness can be supporting factors, while a "difficult" farewell and unresolved conflicts or open questions can be obstacles to the grieving process. In the subcategory "Social environment", unsolicited support, emotional companionship, and a flexible employer are supporting. Family disputes and a lack of understanding from others, on the other hand, are hindering. Good and dignified end-of-life care, as is generally ensured in palliative medicine, is of great importance for a successful grieving process. Therefore, a palliative attitude should be promoted and expanded across disciplines. In society, more tolerance and understanding should be shown to mourners, and the topic of death and dying should be dealt with openly.