Role of illness representations and coping in patients with atopic dermatitis: a cross-sectional study.

BACKGROUND: Atopic dermatitis (AD) is a skin disease accompanied by psychological burden. It has been shown for other chronic diseases that illness representations and coping strategies are associated with disease-related burden and other outcome variables like time until patients return to work or health care use. OBJECTIVE: The goal of this cross-sectional study was to investigate whether illness representations and coping strategies are correlated with the severity of AD and self-rated physical impairment of the patients. METHODS: A total of 109 AD patients were examined at the beginning of their stay at a rehabilitation centre. They filled in validated questionnaires to measure illness perceptions (IPQ), coping strategies (EBS) and self-rated physical well-being (FEW). In addition, the severity of AD (SCORAD) was determined by a doctor. RESULTS: Linear regression analysis revealed that a considerable amount of the variance in self-rated physical well-being (51%) could be predicted by particular illness perceptions and coping. Subsequent multiple mediation analyses indicated that certain coping strategies (active problem solving and depressive reactions) mediated the effect of illness representations on self-rated physical well-being. In contrast, only 7.4% of the SCORAD could be predicted by the IPQ scale illness identity. CONCLUSION: This study showed that illness representations and coping are highly associated with self-rated physical impairment in AD patients. Therefore, this patient group might profit from cognitive behavioural interventions designed to alter patients' illness perceptions. The hypothesis that a modification in illness perceptions leads to a faster recovery and a more rapid return to work should be tested in future randomized controlled trials.

Phorbol ester-stimulated adherence of neutrophils to endothelial cells is reduced by adenosine A2 receptor agonists.

In this study we investigated the effect of adenosine receptor agonists on the adherence of PMA-stimulated human neutrophils to cultured porcine aortic endothelial cells. Additionally, we studied the influence of adenosine analogues on the second messenger cAMP in neutrophils and cultured endothelial cells. In the presence of 10 ng/ml PMA, there was a rapid and stable increase on adherence of neutrophils to the endothelial layer. The adenosine A2 receptor agonists, 2-(p-(2-carboxylethyl)phenethylamino)-5' N-ethylcarboxamido-adenosine (CGS 21680) (0.01 to 1 microM) and 5' N-ethylcarboxamidoadenosine (NECA) (0.01 to 1 microM) decreased the adherence of PMA-stimulated neutrophils maximally by 43% and 34%, respectively. In contrast the adenosine A1 receptor agonist 2-chloro-N6-cyclopentyladenosine (0.01 to 1 microM) showed a 30% increase in PMA-stimulated adherence of neutrophils to endothelial cells. CGS 21680 (0.01 to 1 microM) and NECA (0.01 to 1 microM) were without detectable effect on the formation of cAMP in neutrophils and endothelial cells; however, in the presence of the phosphodiesterase inhibitor Ro 20-1724 (70 microM), CGS 21680 and NECA maximally increased cAMP level 20-fold and 10-fold, respectively, in neutrophils, and 1.8-fold and 2-fold, respectively, in cultured endothelial cells. However, addition of 70 microM Ro 20-1724 to the adherence assay did not potentiate the inhibitory effects of CGS 21680 and NECA on PMA-stimulated neutrophil adherence. On the other hand, 2-chloro-N6-cyclopentyladenosine (0.01 to 1 microM) did not significantly alter cAMP level in neutrophils and endothelial cells in the presence of 4(3-butoxy-4-methoxyphenyl)methyl)-2-imidazolidinone (Ro 20-1724). Our results indicate that adenosine A2 receptor agonists decrease phorbol ester-stimulated adherence of neutrophils to cultured endothelial cells. This effect is possibly independent of adenosine A2 receptor-mediated stimulation of adenylate cyclase in neutrophils and cultured endothelial cells.

Adenosine A1 and A2 receptor agonists alter cardiac functions and prostacyclin release in the isolated guinea-pig heart.

The actions of the adenosine A1 receptor agonist CCPA (2-chloro-N6-cyclopentyladenosine) and the adenosine A2 receptor agonist CGS 21680 (2-[p-(2-carboxyethyl(phenethylamino]-5'-N- ethylcarboxamidoadenosine) on myocardial functions and prostacyclin release were studied in Langendorff-perfused guinea-pig hearts. In spontaneously beating hearts, perfused at constant pressure, CCPA reduced heart rate and left ventricular actively developed pressure with EC50 values of 54.4 +/- 8.7 nM and 81 +/- 6.2 nM, respectively. The adenosine A1 receptor antagonist PACPX (1,3-dipropyl-8-(2-amino-4-chloro)phenylxanthine, 1 microM) antagonized the effects of CCPA on heart rate and left ventricular actively developed pressure and increased the EC50 values 11-fold and 8-fold, respectively. CGS 21680 caused vasodilatation and doubled the coronary flow rate (EC50 of 5.77 +/- 3 nM). The potent but non-selective adenosine receptor antagonist CGS 15943A (9-chloro-2-(2-furanyl)-5,6-dihydro-1,2,4-triazolo(1,5-c)quinazolin++ +-5-imine, 0.1 microM) caused a shift to the right of the concentration-response curve of CGS 21680 for coronary flow rate and increased the EC50 value 52-fold. In electrically paced hearts, perfused at constant flow rate, CCPA (1-100 nM) and CGS 21680 (10-1000 nM) increased the 6-oxo-prostaglandin F1 alpha release (stable non-enzymatic hydrolysis product of prostacyclin) into the cardiac effluent to a maximum of 170 +/- 16% and 184 +/- 6%, respectively. The effects of CCPA and CGS 21680 on cardiac functions indicate a high selectivity of both agonists for adenosine A1 and A2 receptor subtypes of the isolated guinea-pig heart, respectively. The elevation of 6-oxo-prostaglandin F1 alpha in the effluent of guinea-pig hearts by CCPA and CGS 21680 is possibly independent of stimulation of adenosine receptors on the vascular endothelium.

Ramiprilat prevents PAF-induced myocellular and endothelial injury in a neutrophil-perfused heart preparation.

This study investigates the action of PAF-stimulated human polymorphonuclear leukocytes (PMN) on myocardial integrity and function in Langendorff-perfused guinea-pig hearts. Infusion of 10(6) PMN/ml resulted in a negative inotropic effect without larger biochemical evidence for myocardial tissue injury while infusion of PAF (1 microM) did not cause any permanent effect at all. However, the combined administration of PAF-stimulated PMN resulted in severely depressed myocardial contractile function and biochemical evidence for myocardial tissue injury. This was probably due to an enhanced uptake of PMN from the coronary perfusate and accumulation within the myocardial tissue. Ramiprilat, (10 microM) significantly improved left ventricular function and myocardial cell integrity. Similar results were obtained with bradykinin (1 nM). The data suggest a PAF-induced, PMN-mediated myocardial tissue injury as well as cardioprotective actions of ACE inhibition which are possibly related to stimulation of the kinin/prostacyclin axis.