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Background: There is considerable public and political interest in the use of cannabis products for medical purposes.Methods: The task force of the European Pain Federation (EFIC) conducted a survey with its national chapters representatives on the status of approval of all types of cannabis-based medicines, the covering of costs and the availability of a position paper of a national medical association on the use of medical cannabis for chronic pain and for symptom control in palliative/supportive care.Results: Thirty-one out of 37 contacted councillors responded. Plant-derived tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray is approved for spasticity in multiple sclerosis refractory to conventional treatment in 21 EFIC chapters. Plant-derived THC (dronabinol) is approved for some palliative care conditions in four EFIC chapters. Synthetic THC analogue (nabilone) is approved for chemotherapy-associated nausea and vomiting refractory to conventional treatment in four EFIC chapters'. Eight EFIC chapters' countries have an exceptional and six chapters an expanded access programme for medical cannabis. German and Israeli pain societies recommend the use of cannabis-based medicines as third-line drug therapies for chronic pain within a multicomponent approach. Conversely, the German medical association and a team of finish experts and officials do not recommend the prescription of medical cannabis due to the lack of high-quality evidence of efficacy and the potential harms.Conclusions: There are marked differences between the countries represented in EFIC in the approval and availability of cannabis-based products for medical use. EFIC countries are encouraged to collaborate with the European Medicines Agency to publish a common document on cannabis-based medicines.Significance: There are striking differences between European countries in the availability of plant-derived and synthetic cannabinoids and of medical cannabis for pain management and for symptom control in palliative care and in the covering of costs by health insurance companies or state social security systems. [ABSTRACT FROM AUTHOR]

Background Non-melanoma skin cancer ( NMSC) is an occupational disease for outdoor workers in Germany since 2015. Sustainable prevention is demanded and sunscreen promoted as an effective tool. However, studies on the satisfaction of sunscreen users are rare. Objective To evaluate the satisfaction of mountain guides using a high SPF sunscreen product as an appropriate prevention tool for mountain guides. Methods Motivating mountain and ski guides in Germany to use very high protection sunscreen ( SPF50+, Actinica Lotion) during a 4- to 8-h workday followed by the completion of a self-filled paper-based questionnaire about their experience and satisfaction with the product. Results Of 88 mountain and ski guides (61 men, 27 women) included in the study, 61.4% reported regular sunscreen use with the application of very high protection ( SPF50+) in 18.6% of all cases. At the end of the workday, 78.6% found the product convenient and easy to include into their daily work and 79.3% felt sufficiently protected against the sun. Conclusion Overall satisfaction with the use of high SPF products during work is high in mountain and ski guides and could be an effective tool in prevention campaigns. [ABSTRACT FROM AUTHOR]

Aims The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. Methods The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. Results Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. Conclusions German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated. [ABSTRACT FROM AUTHOR]

Aims and objectives. This review of the literature intended to get insight into the international standards of quality of life assessment in palliative care, the conceptual and research literature addressing illness related quality of life and an examination of how nurse researchers define and assess this concept in the context of terminally ill cancer patients. Clearly stated goals for measuring quality of life as well as an understanding of the pragmatic and theoretical explanations for current trends in quality of life measurement are fundamental to this focus. Background. Most clinicians and researchers agree that the primary goal of palliative care is to optimize the quality of life of patients with advanced incurable diseases through control of physical symptoms and attention to the patient's psychological, social and spiritual needs. Palliative care therefore is the achievement of the best quality of life for patients and their families. Consequently, the outcomes of care should be measured in terms of the extent to which this goal is achieved. Quality of life is difficult to define and measure; it is a multidimensional, dynamic and subjective concept. During the past decade, multidisciplinary research measuring the impact of cancer and its treatment on the quality of people's lives escalated rapidly in international literature but not in the German speaking European countries. This international escalation was accompanied by a proliferation of measurement strategies and tools. Nursing shared this interest and began to generate substantive research of the phenomenon. In the oncology and palliative care nursing societies quality of life and numerous closely related areas of symptom management rank among the highest research priorities. Method. This paper examines nursing literature published between 1990 and 2004, retrieved through a computer review of MEDLINE and Cumulative Index of Nursing and Allied Health Literature. The review includes reports that systematically describe or measure the quality of life of people with a terminal cancer in palliative care as a variable of interest. This article also describes conceptual and operational definitions of quality of life and explores the implicit and explicit goals of research. Results. Quality of life is a concept relevant to the discipline of nursing. Nurses, especially oncology and palliative care nurses, actively contributed to the development of the quality of life concept through instrument development and population description. Conclusion. Nurses working in German palliative care settings do change the quality of life of patients they care for, but there are no systematic standards of assessing these outcomes. Relevance to clinical practice. There are challenges related to measuring quality of life in patient-focused palliative care and research. Systematic quality of life assessment in all palliative care settings will establish quality assurance and the further development of this very young discipline in Germany. [ABSTRACT FROM AUTHOR]

Background: Interprofessional teams and peer support are being increasingly considered in informed shared decision‐making. In Germany, there appear to be deficits in the implementation of informed shared decision‐making in the choice of renal replacement therapy, such as the lack of collaboration in interprofessional teams and the absence of structured peer support programmes for patients with chronic kidney disease. Objective: To explore nephrologists' and nurses' perspectives regarding their involvement in shared decision‐making when choosing renal replacement therapy. Design: Guideline‐based, problem‐centred interviews were used. Participants: A total of 20 nephrologists and 15 nurses were recruited from 21 dialysis units all over Germany. Approach: Interviews were audio‐recorded and transcribed. They were analysed thematically using structuring and summary content analysis, supported by the qualitative data analysis software MAXQDA 12. Results: The most important findings were the late or missing participation of nurses in the informed shared decision‐making process and the unstructured peer support. Along with time and financial factors, these aspects were seen as barriers to shared decision‐making with patients who are often overwhelmed by the diagnosis. Furthermore, informed shared decision‐making has been insufficiently considered in professional education and training. Conclusion: Shared decision‐making in the choice of renal replacement therapy is particularly challenging due to the patients' high disease burden. The greater incorporation of informed shared decision‐making in education and training as well as the consistent involvement of nursing staff and structured peer counselling already in the predialysis phase with adequate reimbursement can address the identified hurdles. [ABSTRACT FROM AUTHOR]

These IgG Abs can reduce cell activation by competing with IgE for allergen epitopes (allergen masking) or crosslinking the allergen/IgE/Fc RI complex with the inhibitory IgG receptor Fc RIIB. Allergen tolerance Type I allergy is a persisting dysregulated immune response to innocuous antigens characterized by increased levels of allergen-specific Th2 cells and IgE Abs. Allergies have become a major challenge for our health systems, affecting a constantly increasing population, which suffer either from life threatening anaphylaxis or chronic inflammatory diseases. [Extracted from the article]

Refugees and asylum seekers are exposed to multiple burdensome experiences and suffer from ongoing post‐migration stressors that are known to affect the physical and mental health. In psychological treatment offered to refugees and asylum seekers, dropout is an important challenge. The current practice‐oriented review aims to provide for the first time knowledge on the prevalence, prediction and prevention of dropout in psychological treatment for refugees and asylum seekers. Due to the limited empirical evidence for this specific population, we synthesized refugee‐specific research but also reviewed the existing evidence on dropout from treatment in general and specifically discuss how the findings can be adapted to refugee populations. The review integrates literature from online databases, grey literature, hand search and expert contacts. Prevalence rates of dropout from psychological treatment in Western samples are reported at about 20%. For refugees and asylum seekers, evidence from single efficacy trials showed considerable variability in dropout rates (0%–64.7%). Further, for refugees and asylum seekers, specific sociodemographic variables, high initial impairment, deviating expectations and perceptions of mental health and psychological treatment, as well as external barriers seem to be important predictors for dropout. To prevent dropout, it is important to develop and promote cultural competencies, adapt the treatment to refugee‐specific needs and focus on role induction, preparation for treatment, fostering the therapeutic alliance and strengthening hope. Future specific research on dropout in treatment offered to refugees and asylum seekers is needed. [ABSTRACT FROM AUTHOR]

Background: Medical rehabilitation plays an important role in the health care of chronically ill children and adolescents. During medical rehabilitation, supporting illness-related self-regulation is a central goal. Beliefs about illness and beliefs about treatment are core elements of patients' self-regulation, and there is evidence that these beliefs are relevant predictors of different health- and treatment-related outcomes such as adherence. However, little is known about adolescents' beliefs about rehabilitation. This study therefore explores adolescents' treatment beliefs in the context of inpatient medical rehabilitation. Methods: A qualitative study was conducted in a German rehabilitation clinic for children and adolescents. Using a purposive sampling method, 13 adolescents (12-16 years old) were recruited. Semi-structured, audiotaped interviews were conducted and analysed using content analysis. Results: Results demonstrate that adolescents have differentiated rehabilitation-related treatment beliefs. Twelve themes, with various subthemes, emerged, which include access to and knowledge about rehabilitation, the rehabilitation-related individual position and normative aspects, expectations of oneself, as well as in respect of the social context (fellow patients, contact with family and friends), expectations of the structure, process and outcome of rehabilitation, concerns and barriers and emotional aspects. Conclusions: Our explorative study revealed a broad range of rehabilitation-related treatment beliefs in adolescents, indicating parallels, but also differences, to research results with adults. Treatment beliefs are assumed to be an influencing factor for various health- and treatment-related outcomes. Thus, implications of our findings for clinical practice and further research are discussed. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence for efficacy of brief alcohol interventions (BAIs) is mainly limited to primary care and at‐risk drinkers. The aim was to test the efficacy of a BAI addressing the full spectrum of alcohol use in a general population sample and across alcohol risk groups. Design Two‐parallel‐group randomized controlled trial (allocation ratio 1:1) with post‐baseline assessments at months 3, 6 and 12. Setting: One municipal registry office in Germany responsible for registration, passport and vehicle admission issues. Participants: A total of 1646 proactively recruited 18–64‐year‐old adults with past year alcohol use (56% women, 66% low‐risk drinkers) were randomized to intervention (n = 815) or control (n = 831). Intervention and comparator: The intervention consisted of assessment plus computer‐generated individualized feedback letters at baseline and months 3 and 6. Comparator was assessment only. Measurements Primary outcome was change in the self‐reported number of drinks/week from baseline to 12 months. Changes at 3 and 6 months were secondary outcomes. Moderator was alcohol risk group (low‐risk versus at‐risk drinking) according to the Alcohol Use Disorders Identification Test–Consumption, with scores from 1‐3 (women) and from 1‐4 (men) indicating low‐risk drinking. Findings For the whole sample, significant group differences were observed neither at 12‐month follow‐up [incidence rate ratio (IRR) = 1.01, 95% confidence interval (CI) = 0.87–1.17, Bayes factor (BE) = 0.52] nor at previous assessments (month 3: IRR = 1.01, 95% CI = 0.92–1.12, BE = 0.41; month 6: IRR = 0.93, 95% CI = 0.81–1.07, BE = 1.10). Moderator analyses revealed that low‐risk drinkers were more likely to benefit from BAI only at month 6 than at‐risk drinkers (IRR = 0.77, 95% CI = 0.70–0.86). Conclusions: In a randomized controlled trial, there was no clear evidence for efficacy of a computer‐based brief alcohol intervention in a general population sample, but there was some evidence of medium‐term benefits in the large but understudied group of low‐risk drinkers. [ABSTRACT FROM AUTHOR]

Abstract: Background: SAPS—‘Sprachsystematisches Aphasiescreening’—is a novel language‐systematic aphasia screening developed for the German language, which already had been positively evaluated. It offers a fast assessment of modality‐specific psycholinguistic components at different levels of complexity and the derivation of impairment‐based treatment foci from the individual performance profile. However, SAPS has not yet been evaluated in combination with the new SAPS‐based treatment. Aims: To replicate the practicality of SAPS and to investigate the effectiveness of a SAPS‐based face‐to‐face therapy combined with computerised home training in a feasibility study. To examine the soundness of the treatment design, to determine treatment‐induced changes in patient performance as measured by SAPS, to assess parallel changes in communicative abilities, and to differentiate therapy effects achieved by face‐to‐face therapy versus add‐on effects achieved by later home training. Methods & Procedures: Sixteen participants with post‐stroke aphasia (PWAs) were included into the study. They were administered the SAPS and communicative testing before and after the treatment regimen. Each PWA received one therapy session followed by home training per day, with the individual treatment foci being determined according to initial SAPS profile, and duration of treatment and possible change of focus dependent on performance assessed by continuous therapy monitoring. Outcomes & Results: The combination of therapy and home training based on the SAPS was effective for all participants. We showed significant improvements for impairment‐based SAPS performance and, with high inter‐individual variability, in everyday communication. These two main targets of speech and language therapy were correlated and SAPS improvements after therapy were significantly higher than after home training. Conclusions & Implications: SAPS offers the assessment of an individual performance profile in order to derive sufficiently diversified, well‐founded and specific treatment foci and to follow up changes in performance. The appending treatment regimen has shown to be effective for our participants. Thus, the study revealed feasibility of our approach. [ABSTRACT FROM AUTHOR]

Objective: To examine the causal effect of a hospital's experience with treating hip fractures (volume) on patient treatment outcomes.Data Sources: We use a full sample of administrative data from German hospitals for 2007. The data provide detailed information on patients and hospitals. We also reference the hospitals' addresses and the zip codes of patients' place of residence.Study Design: We apply an instrumental variable approach to address endogeneity concerns due to reverse causality and unobserved patient heterogeneity. As instruments for case volume, we use the number of potential patients and number of other hospitals in the region surrounding each hospital.Principal Findings: Our results indicate that after applying an instrumental variables (IV) regression of volume on outcome, volume significantly increases quality.Conclusions: We provide evidence for the practice-makes-perfect hypothesis by showing that volume is a driving factor for quality. [ABSTRACT FROM AUTHOR]

Background: Delirium is a serious complication in patients in intensive care units. Previous surveys on delirium management in daily practice showed low adherence to published guidelines. Aim: To evaluate delirium management in nurses and physicians working in intensive care units in German-speaking countries and to identify related differences between nurses and physicians. Design: The study used an open online survey with multiple-choice responses. Methods: An invitation for participation was spread via journals and electronic resources using a snowball system. Apart from recording socio-demographical characteristics, the survey collected data on delirium assessment, delirium-related processes, non-pharmacological prevention and treatment and barriers for implementation. Differences between nurses and physicians were tested by Fisher's exact test with sequential Bonferroni correction. Results: The survey was conducted in autumn 2016, and 559 clinicians participated. More nurses than physicians reported screening for delirium. The majority of clinicians reported screening for delirium when this was suspected; more than 50% used validated instruments. Half of the clinicians had delirium-related structures implemented, such as two thirds reporting delirium-related processes. Most cited barriers were lack of time and missing knowledge about delirium and its assessment. With significant difference, physicians recommended more than nurses early removal of catheters and daily interprofessional goals for patients. Conclusion: In German-speaking countries, assessment of delirium needs further improvement, leading to accurate assessment. Delirium-related structures and processes appear to be implemented widely, with only a few differences between nurses and physicians. Relevance to clinical practice: Nurses and physicians in this survey reported similar perceptions and attitudes towards management of delirium. Both professions need more knowledge and inter-professional training on when and how to use validated assessment instruments. [ABSTRACT FROM AUTHOR]

Abstract: This study assessed adherence to prolonged‐release tacrolimus (PR‐T)‐based immunosuppression during routine maintenance of renal transplant recipients in Germany. Patients had received PR‐T for ≥1 month at inclusion. Data were collected during four visits (V): baseline (V1), 6 (V2), 12 (V3), and 18 (V4) months. Composite primary endpoint: nonadherence at V4, defined as self‐reported nonadherence on the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS©), investigator‐rated nonadherence, and/or V4 tacrolimus trough level outside a predefined range. Secondary endpoints: individual BAASIS items, incidence of rejection, kidney function, and safety. Overall, 153 adult kidney recipients (mean [standard deviation] time post‐transplant 5.8 [4.6] years) were included. Nonadherence was high at V4 (67.7% [95% confidence interval 58.9%, 75.6%]). Medication‐taking adherence was 86.9% and 91.3% at V1 and V4, respectively; adherence to timing of medication intake was 58.2% and 58.3%, with little evidence of missed doses/drug holidays. Investigators rated adherence “good” in 85.6% of patients (V4). Two (1.3%) patients had acute rejection episodes. Kidney function remained stable (mean creatinine clearance, V1: 62.1 mL/min; V4: 65.3 mL/min). Investigators rated effectiveness of PR‐T as “very good”/“good” in 91.5% of patients. Most patients (94.7%) found PR‐T dosing more convenient than immediate‐release tacrolimus. PR‐T was well tolerated with high medication persistence. [ABSTRACT FROM AUTHOR]

Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects. [ABSTRACT FROM AUTHOR]

Background Anesthesia for pediatric cardiac surgery requires a high level of expert knowledge. There are currently no recommendations and standards for anesthetic management for congenital cardiac surgery in Germany. Aim The aim of the present study was to assess the current status of structural and personnel anesthetic standards at pediatric cardiac surgery centers in Germany. Methods All cardiac surgical centers in Germany were reviewed for an active program for congenital heart surgery. Centers with an active program were invited to respond to an online survey. The questionnaire containing 55 items in 16 categories assessed current practice in pediatric cardiac anesthesia. Results An active program for pediatric cardiac surgery was identified at 27 centers. The response rate to the survey was 96.3%. A specialized group of anesthesiologists for pediatric cardiac anesthesia was reported from 26 centers (92.3%). The mean size of this group was 4.8 anesthesiologists per center. However, the annual case load of centers and relative annual case load per specialized anesthesiologist varied considerably between 12.5 and 250. Nonanesthesiologists performed sedation and general anesthesia for diagnostic and therapeutic interventions outside the operating theater in children with congenital heart diseases in 24 centers (77%). Although special equipment, for example, pediatric TEE, near-infrared spectroscopy, and devices for mechanical auto transfusion were available in most centers, their routine use was not always part of standard operating procedures. The proposal for mean adequate training in pediatric cardiac anesthesia as estimated by the participating centers was 10.8 months. Conclusion The present study represents the current structural situation for anesthesia at German pediatric cardiac surgery centers. [ABSTRACT FROM AUTHOR]

Objective: Although one-third of cancer patients are perceived to have a need for psychological support based on the percentage of mental disorders, little is known about the actual utilization of psychological care in cancer. We aimed to assess cancer patients' reported use of psychological care and its correlates in a large, representative sample.Methods: In a multicenter, cross-sectional study in Germany, 4020 cancer patients (mean age 58 years, 51% women) were evaluated. We obtained self-reports of use of psychotherapy and psychological counseling. We measured distress with the Distress Thermometer, symptoms of depression with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder Scale, and social support with the Illness-specific Social Support Scale. In a subsample of 2141, we evaluated the presence of a mental disorder using the Composite International Diagnostic Interview.Results: In total, 28.9% (95% confidence interval 27.4%-30.4%) reported having used psychotherapy or psychological counseling or both because of distress due to cancer. Independent correlates of utilization included age (odds ratio [OR] = 0.97 per year], sex (male, OR = 0.55), social support (OR = 0.96), symptoms of depression (OR = 1.04) and anxiety (OR = 1.08), the diagnosis of a mental disorder (OR = 1.68), and a positive attitude toward psychosocial support (OR = 1.27). Less than half of those currently diagnosed with a mental disorder reported having taken up psychological support offers.Conclusion: Special efforts should be made to reach populations that report low utilization of psychological care in spite of having a need for support. [ABSTRACT FROM AUTHOR]

Purpose The German retinopathy of prematurity ( ROP) Registry collects data on treated ROP in a multicentre approach to analyse epidemiology and treatment patterns of severe ROP. Methods Nine centres entered data from 90 treated ROP infants (born between January 2011 and December 2013) into a central database. Analysis included incidence rate of severe ROP, demographic data, stage of ROP, treatment patterns, recurrence rates, relevant comorbidities and ophthalmological or systemic complications associated with treatment. Results Treatment rate for ROP was 3.2% of the screened population. The most frequent ROP stage at time of treatment was zone II, stage 3 + (137 eyes). Treatment was bilateral in 97% of infants. Treatment patterns changed over time from 7% anti-vascular endothelial growth factor (VEGF) monotherapy in 2011 to 32% in 2014. Overall, laser treatment was the predominant treatment. However, all infants with zone I disease received anti- VEGF treatment. About 19% of infants required retreatment (16% of laser-treated and 21% of anti- VEGF treated infants). Mean time between first and second treatment was 3.8 weeks (± 11 days) for laser-treated and 10.4 weeks (± 60 days) for anti- VEGF-treated infants. Conclusion This study is the first multicentre analysis of severe ROP in Germany. The identified treatment patterns find laser as the most prevalent form of therapy, with an increasing use of anti- VEGF therapy over recent years. Recurrence rates were relatively high overall with slightly higher recurrence rates and later recurrence times in the anti- VEGF group. Anti- VEGF was predominantly used for high-risk stages like AP- ROP and zone I disease. [ABSTRACT FROM AUTHOR]

Background In order to investigate correlations between specific parameters and dental caries, it is useful to record incipient and dentine lesions. Aim The aim of this study was to evaluate the effect of a selective intensified preventive program ( SIP) on oral health of fourth graders using ICDAS. Design A cohort study was performed. ICDAS and DMFT index were recorded. Prevention and social factors were collected with psychometric questionnaires. The test group and the control group were parallelized using sociodemographic variables. Results The participants in the fluoride varnish program in the test region showed a significantly lower caries experience than pupils in the control region. The bivariate analysis revealed that a migrant background had a negative impact on oral health whereas fissure sealants, use of fluoridated table salt, use of fluoride tablets, early start of toothbrushing and high social status exerted a positive influence on dental health. Stepwise backward logistic regression analysis confirmed that fissure sealants, a high social status and an early start of toothbrushing had a significant positive impact on dental health. Conclusion The results of our study suggest that a SIP impedes the primary occurrence of incipient lesions and the transition from incipient to advanced lesions. [ABSTRACT FROM AUTHOR]

The Behavioral Activation for Depression Scale (BADS) was developed to measure core concepts of behavioural activation for depression. A number of studies, mostly based on analogue samples, have provided initial support for the BADS. In the present study, we examined the psychometric properties of the German version of the scale more broadly, including change sensitivity and clinical treatment data. A mixed sample of students ( N = 312) and depressed outpatients in partial remission undergoing cognitive-behavioural group treatment for depressive rumination ( N = 59) was examined. To analyze construct validity, a set of theoretically relevant constructs such as perseverative thinking, distraction and mindfulness was also assessed. Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Furthermore, the BADS proved to be sensitive to changes in participants undergoing treatment for depression. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Behavioural activation (BA) is an effective treatment for patients suffering from unipolar depression., The Behavioral Activation for Depression Scale (BADS) can be used to measure core elements of the BA treatment rationale. It is useful to track changes in activation within treatment., The BADS is available in different languages and has shown to possess good psychometric properties. [ABSTRACT FROM AUTHOR]

Discusses reearch papers submitted to the 7th World Congress of Biological Psychiatry held in Berlin, Germany, in July 2001. Two methods of controlling depression; New treatment for controlling acute psychotic illness.

Aim The purpose of the present study was to assess the cost-effectiveness of various alternatives of non-surgical peri-implantitis treatment. Materials and Methods A decision analytical model was constructed and populated with parameter estimates from recent literature for reduction in pocket probing depth ( PPD) in response to eight different treatment alternatives. A micro-costing approach combined with an online expert survey was applied to simulate a decision-making scenario taking place in Germany. The treatment alternatives providing the most advantageous cost/outcome combinations were identified according to the net benefit criterion. Uncertainties regarding model input parameters were incorporated via simple and probabilistic sensitivity analysis based on Monte Carlo simulation. Results In the base case scenario, debridement alone, Air-Flow®, debridement combined with PerioChip®, and debridement combined with local antibiotics were identified as treatment strategies with comparably better value for money than Er: YAG laser monotherapy, Vector™ System, debridement combined with CHX, and photodynamic therapy. Sensitivity analysis revealed considerable decision uncertainty corresponding to limited evidence about different treatment alternatives for peri-implantitis treatment. Conclusions Derivation of robust treatment recommendations for peri-implantitis requires more comprehensive and patient-centred evidence on peri-implantitis treatments. [ABSTRACT FROM AUTHOR]

Objective A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated, immunological and microbiological parameters. Methods Thirty subjects were included in this controlled clinical trial (patients with generalized chronic periodontitis and controls without clinical attachment loss; each n = 15). Before oral prophylaxis and 14 days after (including tongue cleaning) volatile sulphur compounds ( VSC), organoleptic scores and a tongue coating index were evaluated. The levels of IL-1β, IL-8, IL-10 and MMP-8 were measured in GCF, and also major periodontal pathogens were detected. Data were statistically analysed using anova and paired t-test. Results Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly ( P < 0.05) the VSC values in both groups (no significant differences between both groups). Two weeks after periodontal debridement, the VSC values were observed in the periodontitis group, but not in the control group, similar to the baseline values. The difference between the groups was statistically significant ( P < 0.05). Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline ( P < 0.05). Organoleptic scores (10 and 30 cm) were significantly different ( P < 0.05) between both groups before and after the treatment. Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session. Conclusions Oral prophylaxis may result in a significant decrease in VSC values. However, in periodontal diseases, a more complex treatment seems to be necessary. [ABSTRACT FROM AUTHOR]

Objectives The antibacterial activity of two different formulations of a chlorhexidine/thymol varnish should be elucidated in vitro and in vivo. Methods The agar diffusion assay with Cervitec® and CervitecPlus® and three reference strains each of streptococci, lactobacilli, actinomyces and periodontal pathogens was performed. In a split-mouth study, 40 volunteers applied the test (CervitecPlus®, solvent water and ethanol) and control (Cervitec®, solvent ethyl acetate) varnish at buccal recessions of premolar teeth at baseline as well as after two, four and seven days. Supra- and subgingival plaques were collected 2 weeks before baseline and at the screening appointments. Supragingival plaque was analysed for mutans streptococci and lactobacilli and subgingival samples for Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis and Porphyromonas intermedia. Friedman/Wilcoxon tests and U-test were used for statistical analysis ( P < 0.05). Results Most reference strains were susceptible with inhibition zones (mm) as follows: Cervitec®/CervitecPlus® streptococci 27 ± 1.7/21.3 ± 2.5, lactobacilli 26 ± 9.2/23.7 ± 4.9, actinomyces 36.3 ± 6.6/27.3 ± 1.5, periodontal pathogens 18.7 ± 7.6/18 ± 1.7. Both varnishes reduced significantly the counts of mutans streptococci and lactobacilli in the patients. However, no significant differences were found between test and control sides at any time. The total counts of periodontal pathogens were low. A tendency to higher counts of A. actinomycetemcomitans at the control side could be shown; the test side did not harbour significantly higher counts. Conclusion Both varnishes may influence the plaque formation and reduce mutans streptococci in supragingival plaque. [ABSTRACT FROM AUTHOR]

Objectives To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy ( APT) and further influencing factors. Material & Methods Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. Results At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses ( OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels ( CAL) ≥6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). Conclusion In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL. [ABSTRACT FROM AUTHOR]

Objective The purpose of this ongoing randomized study was to assess differences in bone level changes and success rates using implants supporting single crowns in the posterior mandible either with platform matched or platform switched abutments. Material and Methods Patients aged 18 and above, missing at least two teeth in the posterior mandible and with a natural tooth mesial to the most proximal implant site were enrolled. Randomization followed implant placement. Definitive restorations were placed after a minimum transgingival healing period of 8 weeks. Changes in crestal bone level from surgery and loading (baseline) to 12-month post-loading were radiographically measured. Implant survival and success were determined. Results Sixty-eight patients received 74 implants in the platform switching group and 72 in the other one. The difference of mean marginal bone level change from surgery to 12 months was significant between groups ( p < 0.004). Radiographical mean bone gain or no bone loss from loading was noted for 67.1% of the platform switching and 49.2% of the platform matching implants. Implant success rates were 97.3% and 100%, respectively. Conclusions Within the same implant system the platform switching concept showed a positive effect on marginal bone levels when compared with restorations with platform matching. [ABSTRACT FROM AUTHOR]

Objective Aim of this in vitro study was to compare self-etch adhesives regarding microtensile bond strength (μ- TBS) to dentin of primary teeth. Methods Fifty freshly extracted primary molars were ground to expose caries-free dentin. Specimens were bonded with ten self-etch adhesives (i Bond self-etch/ Heraeus, Xeno V+/ Dentsply, G- Bond, Gaenial Bond/ GC, BeautiBond/ Shofu, Adhe SE One F/ Ivoclar Vivadent, Adper Easy Bond/3 M ESPE, Clearfil SE Bond/ Kuraray, Opti Bond XTR/ Kerr Hawe, Prime& Bond NT/ Dentsply). After 24-h storage (distilled water, 37°C), resin-dentin beams were cut and 848 resin-dentin sticks were subjected to μ- TBS tests. Fracture analysis was carried out at 40× magnification under a fluorescence microscope and under a SEM. Results Three adhesives (i Bond SE, Clearfil SE Bond, Prime& Bond NT) did not suffer pre-test failures ( PTF). Adhe SE One F revealed the largest portion of PTF (28%; P < 0.05). Clearfil SE Bond and Opti Bond XTR exhibited more cohesive fractures than the other adhesives (77.3% vs 64.8%; P < 0.05). i Bond SE, Gaenial Bond, Clearfil SE, and Opti Bond XTR achieved μ- TBS of >60 MPa, whereas Xeno V+ and Adhe SE One F ranged only at ~20 MPa ( P < 0.05). Conclusion Within the limits of this study, the self-etch adhesives under investigation proved different extents of initial μ- TBS to primary dentin with i Bond SE, Gaenial Bond, Clearfil SE, and Opti Bond XTR having been most successful. [ABSTRACT FROM AUTHOR]

Introduction Atrioventricular (AV) block is a frequent complication of transcatheter aortic valve implantation (TAVI). TAVI is routinely performed under anticoagulation using heparin, which potentially may lead to an increased bleeding rate in patients who undergo permanent pacemaker (PPM) implantation immediately after TAVI. As the number of TAVI procedures continues to rise, data on the optimal management of TAVI-related AV block are needed. Therefore, the aim of our study was to analyze PPM implantation-related complications after TAVI. Methods We retrospectively collected data on PPM implantations after TAVI in our center from January 2010 to December 2012. In total, we included 30 patients who received a PPM for TAVI-related AV block. Twelve patients (group A) underwent PPM implantation on the day of TAVI. In 18 patients (group B), PPM implantation was performed at least 1 day after TAVI (3.8 ± 4.5 days). Since all patients undergoing TAVI receive dual antiplatelet therapy (DA-therapy), we compared all implantations after TAVI with a historic patient cohort that underwent PPM implantation under DA-therapy. Results Procedure times, fluid loss via drainage systems, and drainage times were neither significantly different between groups A and B nor between all PPM implantations after TAVI compared to the historic control group. Conclusion PPM implantation immediately after TAVI is safe and can be performed without increased rate of complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Tooth wear in younger patients is perceived worldwide as an increasing problem. Its etiology is multifactorial (erosion, abrasion, attrition), and its treatment is challenging for the dental practitioner specifically when a great loss of the vertical dimension of occlusion has occurred. The aim of this article is to present a treatment approach for complex cases with high loss of tooth structure using computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated temporary high-density polymer restorations without any preparations. New manufacturing technologies and innovative materials such as high-density polymers offer good possibilities for restorations during the pretreatment period. This is especially important in circumstances requiring massive corrections of color, form, or position. Pretreatment periods are indispensable in refining important factors such as lip-position dynamics as well as the correct position of the smile line, which cannot be adequately assessed in the dental laboratory. In the presented case report, CAD/CAM-fabricated non-preparation restorations were adhesively placed on the worn dentition without any further loss of tooth structure. Such an approach provides the opportunity to 'test-drive' the new restoration design in terms of function, phonetics, and esthetics, thus improving the predictability of the definitive restorations design. If any change in the design is required, it can be cost-effectively achieved through simple modification or replacement of the restorations. CLINICAL SIGNIFICANCE The prolonged pretreatment phase using CAD/CAM-fabricated high-density polymer temporaries can help the practitioner turn challenging treatments into more predictable ones with respect to function and esthetics. (J Esthet Restor Dent ••:••-••, 2011) [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2011; 22: 60-67 Background. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. Aim. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. Design. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. Results. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. Conclusions. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety. [ABSTRACT FROM AUTHOR]

Background Cutaneous angiosarcoma (AS) is a rare aggressive malignant vascular tumour of the skin. Methods We analysed the cases of cutaneous AS in two large dermatological departments of Saxony during the last 10 years. Results A total of eight AS cases were identified, mostly with head and neck involvement. Because of age and late diagnosis, only a minor part was completely resectable. As a palliative therapy pegylated liposomal doxorubicin was used. The drug was well tolerated. Our cases and those published in the literature suggest a high rate of responses and a possible sensitisation to subsequent radiation therapy. Conclusions Although complete surgical resection followed by wide-field radiation therapy has been established as a therapeutic standard for AS, delay in diagnosis and older age with comorbidities warrant for a safe and effective adjuvant treatment. Pegylated liposomal doxorubicin combined with radiotherapy seems to be a useful and safe alternative. [ABSTRACT FROM AUTHOR]

Objectives: Comparison of the clinical and radiographic outcomes of a combination of enamel matrix derivatives (EMD) and a synthetic bone graft (EMD/SBG) with EMD alone in wide (≥2 mm) and deep (≥4 mm) one- and two- wall intra-bony defects 12 months after treatment. Materials and Methods: Seventy-three patients with chronic periodontitis and one wide (≥2 mm) and deep (≥4 mm) intra-bony defect were recruited in five centres in Germany. During surgery, defects were randomly assigned to EMD/SBG (test) or EMD (control). Assessments at baseline, after 6 and 12 months included bone sounding, attachment levels, probing pocket depths, bleeding on probing, and recessions. Changes in defect fill were recorded radiographically. Results: Both treatment modalities led to significant clinical improvements. In the EMD/SBG group a mean defect fill of 2.7 ± 1.9mm was calculated, in the EMD group the defect fill was 2.8 ± 1.6 mm. A mean gain in clinical attachment of 1.7 ± 2.1mm in the test group and 1.9 ± 1.7mm in the control group after 1 year was observed. Radiographic analysis confirmed for both groups that deeper defects were associated with greater defect fill. Conclusion: The results show comparable clinical and radiographic outcomes following both treatment modalities 12 months after treatment. [ABSTRACT FROM AUTHOR]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

Many women are prescribed oestrogen-containing contraceptives for whom oestrogen-containing methods may be less suitable. Two surveys examining contraceptive prescription practices among doctors ( n = 419) and attitudes towards contraception among women ( n = 1623) in France, Germany, Spain, Italy and Russia were evaluated. Progestin-only pills and hormone-free intrauterine devices were the most commonly prescribed contraceptives for women with medical conditions for which oestrogen-containing methods are not preferred (40% and 20%, respectively), those suffering from oestrogen-related side effects (32% and 21%) and those with concerns about the safety of oestrogen-containing methods (28% and 24%). Combined oral contraceptives (COC) were prescribed to ≥10% in these two groups. One-quarter of contraceptive users had asked to be switched from one COC to another because of oestrogen-related side effects; a similar proportion had been switched by their doctor for this reason. Half of the women surveyed did not want or had concerns about foreign/additional oestrogen, and about 80% said that they would consider switching to a different hormonal contraceptive to minimize oestrogen exposure. Although most doctors were aware of the World Health Organization medical eligibility criteria for contraceptive use, they still prescribed COCs or other oestrogen-containing contraceptives to women with medical conditions for which oestrogen-containing options are not favoured, suggesting a need for additional education. By complying with guidelines and heeding women's concerns, doctors can individualize their contraceptive recommendation to improve safety, acceptance and compliance and, ultimately, reduce the risk of an unintended pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The purposes of this study were to evaluate the use of an online guided self-treatment programme for bulimia bulimia nervosa (BN) and to determine predictors of outcome. Data were collected in four European countries where the programme was simultaneously used. Method: One hundred and twenty-seven BN or subthreshold BN female patients (mean age of 24.7 years) participated in a 4-month intervention using a CBT based online-guided self-help programme. Contact during the treatment period included weekly e-mails with a coach. Assessment: Measures included the Eating Disorders Inventory-2 (EDI-2) and the Symptom Check List-Revised (SCL-90R). Results: Severity of eating disorders symptoms and general psychopathology improved significantly. Twenty-three per cent of patients were symptom free at the end of treatment. The dropout rate was 25.2%. A better score of general psychological health was a predictor of a better outcome. Conclusions: This study encourages further developments and research on innovative therapy approaches, particularly for those disorders such as BN, with difficult therapy and unclear prognosis. [ABSTRACT FROM AUTHOR]

Objectives Patients' self-report of medicine taking is a feasible method of assessing their adherence to prescribed pharmacological treatment. Aim of this study was to assess whether the German version of the Medication Adherence Report Scale (MARS-D) is an appropriate instrument for measuring patient adherence. Methods After translation into German, the questionnaire was sent to 1488 patients with chronic diseases and patients with risk factors of cardiovascular disease. Reliability and validity of the MARS-D were assessed and compared with the psychometric properties of the original English version. The relationship between patients' characteristics and adherent behaviour was estimated using bivariate correlation and a linear regression model. Results The MARS-D was analysed if patients were taking medicines and the MARS-D was complete leaving 523 (35.1%) analysable questionnaires. Internal consistency of the MARS-D (Cronbach's α 0.60–0.69) was satisfactory and comparable to the English original (Cronbach's α 0.69–0.90). Test–retest reliability was satisfactory (Pearson's r 0.61–0.63), however, lower than in the English sample ( r = 0.97). Convergent validity was low but showed statistical significance. Patient socio-demographic characteristics had weak influence on MARS-D score indicating high reported adherence for older patients ( P < 0.05), patients with German mother tongue ( P < 0.05) and high number of medicines ( P < 0.01). Conclusions Preliminary psychometric evaluation of the MARS-D is encouraging. MARS-D is an appropriate measure to detect patients at risk of non-adherence. The MARS-D could be used in routine care to support communication about the medication taking behaviour, as self-report of non-adherent behaviour corresponds to the facts. [ABSTRACT FROM AUTHOR]

Background: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. Aim: It was investigated whether a systematic difference of treatment quality between smaller (1000–2000 births/year; ≤20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. Methods: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (≤1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. Results: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Württemberg, a predominately rural state, with different medical infrastructure than Berlin. Conclusion: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure. [ABSTRACT FROM AUTHOR]

Background: Advanced peri-implant intrabony defects require comprehensive surgical treatment regimens different from periodontal therapy strategies. The purpose of this longitudinal trial was to evaluate the peri-implant outcomes following guided bone regeneration with 3 treatment protocols. Methods: In 25 patients, 41 peri-implant defects with supporting bone loss >50% of the implant length were treated with flap surgery plus autogenous bone grafts alone (FG) (controls, n = 12) plus non-resorbable (FGM) (test 1, n = 20) or bioabsorbable barriers (FGRM) (test 2, n = 9) and supportive antimicrobial therapy. Following submerged healing, the membranes were removed (FGM), and the peri-implant probing depths (PD), probing bone levels (BL), mobility scores (PT), and intrabony defect height (DH) were radiographically evaluated at baseline, 6 months, and 1 and 3 years post-therapy. Results: Non-surgical/anti-infective therapy resulted in a limited improvement of PD scores after 6 months. At the 3-year visit, surgical treatment revealed significant changes from baseline for the controls and both of the test groups for PD: 5.1 +/- 2.7 mm (FG), 5.4 +/- 3.0 mm (FGM), and 2.6 +/- 1.6 mm (FGRM), and for BL: 3.2 +/- 2.4 mm (FG), 3.4 +/- 2.4 mm (FGM), and 2.3 +/- 1.6 mm (FGRM), Mann-Whitney test, P < or = 0.05. The changes for DH and PT were significant only for FG- and FGM-treated subjects. The overall improvement for FGRM-treated patients during the 3-year observation was less marked. However, the differences between the 3 surgical treatment protocols did not affect the treatment outcomes after 3 years. Conclusions: Autogenous bone grafting is an appropriate treatment regimen to augment open crater-formed peri-implant defects. Although certain clinical situations require an additional fixation of barrier membranes, their routine application should be approached with caution. [ABSTRACT FROM AUTHOR]

A risk assessment was undertaken to assess the likelihood of importation of dogs infected with Echinococcus multilocularis should the requirement for treatment with praziquantel be relaxed under the Pet Travel Scheme. The analysis suggested that for every 10,000 dogs going on a short trip to Germany, the probability of at least one returning to the UK infected is approximately 98 per cent. If the dogs had been longer-term residents, this probability rises to over 99 per cent. This indicates that if praziquantel treatment of dogs on importation into the UK is abandoned, then it is almost inevitable that E multilocularis will be introduced. [ABSTRACT FROM AUTHOR]

The author responds to the article "Long-term effects of heroin-assisted treatment in Germany," by U. Verthein and K. Bonorden-Kleij, published within the journal. The article presents the results of a two year follow-up of patients enrolled in a clinical trial of heroin-assisted drug treatment (HAT) in Germany. The author considers evidence that the trial's initial benefits were maintained over a two year period and offers suggestions for how HAT can be made more accessible and cost effective.

The article reports on the study of German researchers on high-dose adjuvant chemotherapy for women having breast cancer. They wrote that their regimen of rapidly cycled tandem high-dose chemotherapy and autologous peripheral stem cell support offered a better disease-free and overall survival compared to the traditional dose-dense chemotherapy. The outcome of their study is contrary to many previous studies that showed no benefit to high-dose chemotherapy.