Search

Localisation of low- and high-frequency sounds in single-sided deaf cochlear implant users was investigated using noise stimuli designed to mitigate monaural localisation cues. Within subject design. Sound source localisation was tested in the horizontal plane using an array of seven loudspeakers along the azimuthal angle span from −90° to +90°. Stimuli were broadband noise and high- and low-frequency noise. Twelve adult subjects with single-sided deafness participated in the study. All had normal hearing in the healthy ear and were supplied with a cochlear implant (CI) in their deaf ear. With broadband noise, the mean angular localisation error was 39° in aided condition as compared to a median angular error of 83.6° when the speech processor was not worn. For high-frequency noise, the median angular error was 30° and for low-frequency noise, it was 46° in the CI-aided condition. Single-sided deaf CI users show the best sound localisation for high-frequency sounds. This supports the view that interaural level differences are dominant for sound localisation in these listeners. Nonetheless, a limited ability to localise low-frequency sounds was observed, which may be based on the supportive perception of interaural time differences. [ABSTRACT FROM AUTHOR]

Purpose: To analyze time-domain, spectral, and fractal properties of speed regulation during half-marathon racing. Methods: In 21 male experienced runners, high-resolution data on speed (V), stride frequency (SF), and stride length (SL) were assessed during half-marathon competition (21,098 m). Performance times, time-and frequency-domain variability, spectral-scaling exponent (beta), and fractal dimension (FD) of V, SF, and SL were analyzed. Results: V of 3.65 ± 0.41 m/s, SF of 1.41 ± 0.05 Hz, and SL of 2.58 ± 0.25 m occurred with higher (P < .05) individual variability in V and SL than in SF. Beta and FD were always 1.04-1.88 and 1.56-1.99, respectively. Beta and FD differed (P < .05) in SF and SL compared with V and were correlated in V and SL (r = .91, P < .05). Spectral peaks of V, SF, and SL occurred at wavelengths of 3-35 min, and those of V and SL were interrelated (r = .56, P < .05). Mean SF and mean SL were significantly correlated with performance (r = .59 and r = .95, P < .05). SL accounted for 84% ± 6% and SF for 16% ± 6% of speed variability. Conclusions: The observed nonrandom fluctuations in V, SF, and SL correspond to nonstationary fractional Brownian motion with inherent long-range correlations. This indicates a similar complex regulation process in experienced runners that is primarily mediated via SL. [ABSTRACT FROM AUTHOR]

Over the last years concerns have been raised about the health effects particulary on young climbers due to the observation of short stature with low body weight and body fat in sports climbers. The aim of this study was to investigate anthropometric and hormonal data for climbers of the German Junior national team. 16 climbers were compared with 14-age matched nonclimbers with respect to several anthropometric variables, leptin level, and climbing characteristics. Height, weight and body mass index (BMI) standard deviation scores (SDS) for boys were not significantly different from the controls, whereas girls had significantly lower SDS-values for weight and BMI. In comparison with the control group boys and girls had a lower skinfold thickness. The leptin values were lower than the calculated leptin levels but only reached significance for the girls. The young athletes of the GJNT were neither of short stature nor thin when compared with a physically active control group. The low body fat in boys and girls was within expected limits. The lower leptin levels might be attributed to a decrease in total body fat. [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]

Several studies suggest that pain is a trigger for challenging behaviour in older adults with cognitive impairment. However, such measured relationships might be confounded due to item overlap as instruments share similar or identical items. The purpose of this study was to examine whether the frequently observed association between pain and challenging behaviour might be traced back to item overlap. This multicentre cross-sectional study was conducted in 13 nursing homes and examined pain (measure: Pain Assessment in Advanced Dementia Scale) and challenging behaviour (measure: Cohen-Mansfield Agitation Inventory) in 150 residents with severe cognitive impairment. The extent of item overlap was determined by juxtaposition of both measures' original items. As expected, comparison between these instruments revealed an extensive item overlap. The statistical relationship between the two phenomena can be traced back mainly to the contribution of the overlapping items, which renders the frequently stated relationship between pain and challenging behaviour trivial. The status quo of measuring such associations must be contested: constructs' discrimination and instruments' discrimination have to be discussed critically as item overlap may lead to biased conclusions and assumptions in research as well as to inadequate care measures in nursing practice. [ABSTRACT FROM AUTHOR]

The inter-relationship of stuttering and bilingualism to functional cerebral hemispheric processing was examined on a dual-task paradigm. Eighty native German (L1) speakers, half of whom were sequential bilinguals (L2 = English), were recruited. The participants (mean age = 38.9 years) were organised into four different groups according to speech status and language ability: 20 bilinguals who stutter (BWS), 20 monolinguals who stutter (MWS), 20 bilinguals who do not stutter (BWNS), and 20 monolinguals who do not stutter (MWNS). All participants completed a dual-task paradigm involving simultaneous speaking and finger tapping. No performance differences between BWS and BWNS were found. In contrast, MWS showed greater dual-task interference compared to BWS and MWNS, as well as greater right- than left-hand disruption. A prevailing finding was that bilingualism seems to offset deficits in executive functioning associated with stuttering. Cognitive reserve may have been reflected in the present study, resulting in a bilingual advantage. [ABSTRACT FROM PUBLISHER]

Background: The oral application of vitamin B-12 may prevent its deficiency if the vitamin is absorbed via the mucosal barrier. Objectives: We studied the effect of the use of a vitamin B-12-fortified toothpaste on vitamin-status markers in vegans and assessed the efficiency of markers in the identification of vitamin-augmentation status. Design: In this 12-wk, double-blinded, randomized, placebocontrolled study, 76 vegans received either a placebo (n = 34) or vitamin B-12 (n = 42) toothpaste. Sixty-six subjects (n = 30 in the placebo arm; n = 36 in the vitamin B-12 arm) completed the intervention. Serum and plasma concentrations of vitamin B-12, holotranscobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA) were measured before and after the intervention. Results: Both postintervention concentrations of vitamin B-12 and holotranscobalamin and their changes over 12 wk were higher in the vitamin B-12 group (mean ± SD change: 81 ± 135 pmol/L for vitamin B-12 and 26 ± 34 pmol/L for holotranscobalamin) than in the placebo group (227 ± 64 and 25 ± 17 pmol/L, respectively) after adjustment for baseline concentrations. Postintervention concentrations of MMA and their changes differed significantly between groups (MMA changes: 20.169 ± 0.340 compared with 20.036 ± 0.544 µmol/L in vitamin B-12 and placebo groups, respectively; P < 0.001). After adjustment for baseline tHcy, postintervention concentrations of tHcy tended to be lower (P = 0.051), and the changes in tHcy (20.7 ± 4.4 compared with 2.0 ± 5.6 µmol/L, respectively) were greater in the vitamin B-12 group than in the placebo group. Changes in vitamin B-12 markers were more prominent in vegans who reported that they had not taken vitamin B-12 supplements. Conclusion: Vitamin B-12 that is applied to the oral cavity via toothpaste enters the circulation and corrects the vitamin B-12 markers in the blood of vegans who are at higher risk of vitamin B-12 deficiency. This trial was registered at clinicaltrials.gov as NCT02679833. [ABSTRACT FROM AUTHOR]

Behavioral inhibition (BI) is a suspected precursor of selective mutism. However, investigations on early behavioral inhibition of children with selective mutism are lacking. Children aged 3-18 with lifetime selective mutism ( n = 109), social phobia ( n = 61), internalizing behavior ( n = 46) and healthy controls ( n = 118) were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire. Analyses showed that children with lifetime selective mutism and social phobia were more inhibited as infants and toddlers than children of the internalizing and healthy control groups, who displayed similar low levels of behavioral inhibition. Moreover, behavioral inhibition was higher in infants with lifetime selective mutism than in participants with social phobia according to the Total BI score ( p = 0.012) and the Shyness subscale ( p < 0.001). Infant behavioral inhibition, particularly towards social stimuli, is a temperamental feature associated with a lifetime diagnosis of selective mutism. Results yield first evidence of the recently hypothesized temperamental origin of selective mutism. Children at risk should be screened for this debilitating child psychiatric condition. [ABSTRACT FROM AUTHOR]

Background: The increased cardiovascular morbidity of adults with late repair of aortic coarctation (CoA) has been well documented. In contrast, successful CoA repair in early childhood has a generally good prognosis, though adverse vascular and ventricular characteristics may be abnormal, which could increase long-term risk. This study sought to perform a comprehensive analysis of aortic elasticity and left ventricular (LV) function in patients with aortic coarctation (CoA) using cardiovascular magnetic resonance (CMR). In a subgroup of patients, we assessed structure and function of the common carotid arteries to probe for signs of systemic vascular remodeling. Methods: Fifty-one patients (median age 17.3 years), 13.9 ± 7.5 years after CoA repair, and 54 controls (median age 19.8 years) underwent CMR. We determined distensibility and pulse wave velocity (PWV) at different aortic locations. In a subgroup, common carotid artery distensibility, PWV, wall thickness and wall area were measured. LV ejection fraction (EF), volumes, and mass were measured from short axis views. Left atrial (LA) volumes and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir) were assessed from axial cine images. Results: In patients distensibility of the whole thoracic aorta was reduced (p < 0.05) while PWV was only significantly higher in the aortic arch (p < 0.01). Distensibility of the descending aorta at the level of the pulmonary arteries and PWV in the descending aorta, both correlated negatively with age at CoA repair. LA volume before atrial contraction and minimal LA volume were higher in patients (p < 0.05). LAEFPassive and LAEFReservoir were reduced (p < 0.05), and LAEFReservoir correlated negatively with aortic arch PWV (p < 0.05). LVEF, volumes and mass were not different from controls. Carotid wall thickness and PWV were higher in patients compared to controls (p < 0.05). Conclusions: Patients after CoA repair have impaired bioelastic properties of the thoracic aorta with impact on LV diastolic function. Reduced descending aortic elasticity is associated with older age at time of CoA repair. The remodeling of the common carotid artery in our sub-study suggests systemic vessel wall changes. [ABSTRACT FROM AUTHOR]

Purpose: Unmetabolized folic acid (UMFA) is common in serum of elderly individuals receiving folic acid (FA)-fortified foods or supplements. We studied the effect of supplementing FA or B-complex on serum concentrations of (6 S)-5-methyltetrahydropteroylglutamate [(6S)-5-CH-HPte] and UMFA in elderly people and explored factors associated with detectable UMFA post-supplementation. Methods: This is a randomized single-blind non-controlled trial on 58 elderly people using daily 400 µg FA ( n = 31) or 400 µg FA, 10 µg cyanocob(III)alamin and 8 mg pyridoxine ( n = 27) for a median of 23 days. Main outcome includes changes in concentrations of serum (6S)-5-CH-HPte and UMFA. Results: Total homocysteine declined by a median of 1.6 ( p = 0.074) in the FA and 1.3 µmol/L ( p = 0.009) in the B-complex arms ( p = 0.66 between the arms). Serum (6S)-5-CH-HPte significantly ( p < 0.001 vs. baseline) increased by a median of 9.2 and 6.5 nmol/L in the FA and B-complex groups, respectively ( p = 0.152 between the groups). Compared to FA, B-complex reduced cystathionine and caused lower post-intervention serum UMFA, percentage of UMFA to (6S)-5-CH-HPte and prevalence of UMFA ≥ 0.21 nmol/L. Higher serum cystathionine and whole-blood folate predicted higher post-intervention serum UMFA. Conclusions: FA caused higher UMFA as compared to B-complex. Pyridoxine appears to improve folate recycling. Data on serum UMFA should be interpreted in relation to other vitamins involved in folate metabolism. Serum UMFA is suggested to play a sensory role through which the cell recognizes FA available for metabolism via dihydrofolate reductase. [ABSTRACT FROM AUTHOR]

Interference Frisian (IF) is a variety of Frisian, spoken by mostly younger speakers, which is heavily influenced by Dutch. IF exhibits all six logically possible word orders in a cluster of three verbs. This phenomenon has been researched by Koeneman and Postma (2006), who argue for a parameter theory, which leaves frequency differences between various orders unexplained. Rejecting Koeneman and Postma’s parameter theory, but accepting their conclusion that Dutch (and Frisian) data are input for the grammar of IF, we will argue that the word order preferences of speakers of IF are determined by frequency and similarity. More specifically, three-verb clusters in IF are sensitive to: their linear left-to-right similarity to two-verb clusters and three-verb clusters in Frisian and in Dutch; the (estimated) frequency of two- and three-verb clusters in Frisian and Dutch. The model will be shown to work best if Dutch and Frisian, and two- and three-verb clusters, have equal impact factors. If different impact factors are taken, the model’s predictions do not change substantially, testifying to its robustness. This analysis is in line with recent ideas that the sequential nature of human speech is more important to syntactic processes than commonly assumed, and that less burden need be put on the hierarchical dimension of syntactic structure. [ABSTRACT FROM AUTHOR]

Purpose: To assess rate of late presentation with HIV in Southwestern Germany and to identify patient characteristics correlated with CD4 nadir. Methods: Patients with primary diagnosis who presented to one of ten participating clinics rated on knowledge and behavior towards HIV testing on a self-developed questionnaire, whereas clinical data was assessed by the physician. Results: 161 patients were included. Risk factors were homosexual (59.5 %) or heterosexual contacts (26.8 %), drug use (2.0 %), migration (3.9 %), or others (7.8 %). 63.5 % had a CD4 T cell count < 350/µl. 52.5, 17.4, and 31.1 % were diagnosed in CDC stadium A, B or C, respectively. 209 disease episodes were reported, from whom 83.7 % had led to the diagnosis of HIV. 75.2 and 68.3 % said to have been well-informed about ways of transmission and testing offerings, respectively, and 20.4 % admitted to have psychologically repressed the possibility of being infected. 48 patients rated their personal behavioral risk as 'high' or 'very high'. Of these, however, only ten had performed at test in the precedent year. Performing a regression analysis, younger age and previous testing were correlated with a higher CD4 T cell nadir ( p = 0.005, and 0.018, resp.). Conclusion: The rate of late presentation in this region was even higher compared to national or European surveys. Most infected patients perceived to have had only a low risk. Several disease episodes did not lead to the initiation of HIV testing by the physician. [ABSTRACT FROM AUTHOR]

Objective To correlate the amount and types of pain medications prescribed to CRPS patients, using the Medication Quantification Scale, and patients' subjective pain levels. Design An international, multisite, retrospective review. Setting University medical centers in the United States, Israel, Germany, and the Netherlands. Subjects/Methods A total of 89 subjects were enrolled from four different countries: 27 from the United States, 20 Germany, 18 Netherlands, and 24 Israel. The main outcome measures used were the Medication Quantification Scale III and numerical analog pain scale. Results There was no statistically significant correlation noted between the medication quantification scale and the visual analog scale for any site except for a moderate positive correlation at German sites. The medication quantification scale mean differences between the United States and Germany, the Netherlands, and Israel were 9.793 ( P < 0.002), 10.389 ( P < 0.001), and 4.984 ( P = 0.303), respectively. Conclusions There appears to be only a weak correlation between amount of pain medication prescribed and patients' reported subjective pain intensity within this limited patient population. The Medication Quantification Scale is a viable tool for the analysis of pharmaceutical treatment of CRPS patients and would be useful in further prospective studies of pain medication prescription practices in the CRPS population worldwide. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnoea (OSA) has interdependently been related to the onset and progression of a large portion of atherosclerotic cardiovascular disorders. In due consideration of OSA-mediated endothelial dysfunction, its impact on peripheral artery disease is conceivable, but undefined. Objectives: The aim of this study was to identify the prevalence of OSA in a lower extremity artery disease (LEAD) study population. Methods: A total of 91 patients receiving in- and outpatient treatment for LEAD were included in this prospectively conducted trial. In addition to an angiological examination, all patients underwent nocturnal screening for sleep-disordered breathing by use of SOMNOcheck micro® (SC micro) and - depending on the results obtained - polysomnography. Results: Patients were principally late middle-aged (69.3 ± 10.8 years), male (71.4%) and slightly overweight (BMI 26.8 ± 3.9). Overnight screening determined a sleep apnoea prevalence of 78.0%, of which 90.1% exhibited a predominantly obstructive genesis. The mean apnoea-hypopnoea index (AHI; events/h) and oxygen desaturation index (events/h) averaged 11.8 ± 13.4 and 8.9 ± 14.2, respectively. The individual AHI categories of non-pathological (<5), mild (5 to <15), moderate (15 to <30) and severe sleep apnoea (≥30) accounted for 22.0, 59.3, 13.2 and 5.5%, respectively. A distributive examination of AHI within LEAD severity groups evinced a significant association (p = 0.047). In cases of at least moderate sleep apnoea (AHI ≥15) polysomnography was performed (n = 17, 18.7% of the whole collective). Correlative analysis revealed a significant correlation between values obtained by SC micro recording and polysomnography, establishing the diagnostic accuracy of the screening results. Conclusions: OSA exhibits an important prevalence of 70.3% in LEAD patients with prior undiagnosed sleep-disordered breathing, indicating major OSA unawareness in this cardiovascular cohort. However, the impact of OSA treatment on LEAD propagation remains to be determined. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives The diagnosis of extrapulmonary tuberculous infections and nontuberculous mycobacterial ( NTM) infections is difficult because the symptoms are nonspecific and suitable specimens for bacterial culture are often not available. Recent publications reported the existence of autoantibodies in tuberculous infections. We screened for specific autoantibodies in mycobacterial infections. Methods We screened four in 29 patients with active mycobacterial infections and different controls using protein array technology. We could identify autoantibodies against ubiquitin-fold modifier-conjugating enzyme 1 ( Ufc1) and pleckstrin homology domain containing, family G (with Rho Gef domain) member 2 ( Plekhg2) in all four patients. Subsequently, we designed enzyme-linked immunosorbent assays ( ELISAs) for the detection of autoantibodies binding to Ufc1 and Plekhg2. Results Autoantibodies binding to Ufc1 and Plekhg2 were found in 19 of 29 patients (66%) with active mycobacterial infections. In comparison, we found these autoantibodies in one of 31 patients (3%) with successfully treated mycobacterial infections, in three of 40 (8%) HIV-infected patients not receiving combination antiretorviral therapy ( cART) and in six of 134 (5%) blood donors. Interestingly, six of eight (75%) patients with HIV-associated B-cell non-Hodgkin lymphoma ( B- NHL) at the onset of disease had autoantibodies against Ufc1 and Plekhg2, but none of nine (0%) patients after treatment of HIV-associated B- NHL, none of seven patients with non- HIV-associated B- NHL and 11 of 115 (10%) patients with other malignant diseases had autoantibodies against both proteins. Conclusions In view of the high frequency of these autoantibodies, we postulate that they might be of potential use for additional diagnostics for mycobacterial infections, and further studies may shed light on the pathomechanisms of these two autoantibodies. [ABSTRACT FROM AUTHOR]

The article presents research which discussed the use of subchondral drilling as an established marrow stimulation approach. Topics covered include the importance of osteochondral repair to enhance the condition of the subchondral bone as well as perforation of the bone with small drill holes to address articular cartilage defects. Also mentioned is the need for marrow stimulation to support bone-cutting devices.

Children can represent events in our everyday life in both non-linguistic and linguistic formats. We aimed to investigate whether non-linguistic representations are changed once children acquire their linguistic counterparts. In the present study, we explored whether and how language changes the perception of simple means-end actions using an eye-tracking paradigm. Children between 12 and 24 months of age heard a sentence containing a verb and subsequently watched an action video. Results show an interfering influence of language on action perception at 12 months and a facilitating influence at 24 months. However, this was only the case for verbs that are already in the toddlers' productive vocabulary but not for those that are acquired later. Taken together, the results suggest that a communication between non-linguistic and linguistic representations starts early and develops in the second year of life. The successful facilitatory influence depends on the productive repertoire of the language in question. [ABSTRACT FROM AUTHOR]

Background: Weight change affects resting energy expenditure (REE) and metabolic risk factors. The impact of changes in individual body components on metabolism is unclear. Objective: We investigated changes in detailed body composition to assess their impacts on REE and insulin resistance. Design: Eighty-three healthy subjects [body mass index (BMI; in kg/m²) range: 20.2-46.8; 50% obese] were investigated at 2 occasions with weight changes between -11.2 and +6.5 kg (follow-up periods between 23.5 and 43.5 mo). Detailed body composition was measured by using the 4-component model and whole-body magnetic resonance imaging. REE, plasma thyroid hormone concentrations, and insulin resistance were measured by using standard methods. Results: Weight loss was associated with decreases in fat mass (FM) and fat-free mass (FFM) by 72.0% and 28.0%, respectively. A total of 87.9% of weight gain was attributed to FM. With weight loss, sizes of skeletal muscle, kidneys, heart, and all fat depots decreased. With weight gain, skeletal muscle, liver, kidney masses, and several adipose tissue depots increased except for visceral adipose tissue (VAT). After adjustments for FM and FFM, REE decreased with weight loss (by 0.22 MJ/d) and increased with weight gain (by 0.11 MJ/d). In a multiple stepwise regression analysis, changes in skeletal muscle, plasma triiodothyronine, and kidney masses explained 34.9%, 5.3%, and 4.5%, respectively, of the variance in changes in REE. A reduction in subcutaneous adipose tissue rather than VAT was associated with the improvement of insulin sensitivity with weight loss. Weight gain had no effect on insulin resistance. Conclusion: Beyond a 2-compartment model, detailed changes in organ and tissue masses further add to explain changes in REE and insulin resistance. [ABSTRACT FROM AUTHOR]

Objective: Single mothers suffer more frequently from chronic diseases, depression, and elevated stress level. Their children display adaptation and behavior problems more often than children of dual-parent families. To prevent these risks, a parental training program (PALME) for single mothers and their preschool children was developed. The concept of PALME is based on attachment theory and psychodynamic-interactional approaches. Subject and methods: The efficacy of the program was evaluated in a randomized control intervention study with 58 single mothers. Outcomes from the revised version of the Symptom Checklist SCL-90-R, SF-12 Health Survey, Psychogenic Impairment Score (BSS), Scales on the Experience of Emotions (SEE) and Strengths and Difficulties Questionnaire SDQ were compared at baseline (t1), post-treatment (t2), and 6 months follow-up (t3) for statistical and clinical significance. Per-protocol analyses of variance were used to examine intervention effects. Results: Statistically significant group x time interaction effects in favor of the intervention group indicated intervention effects on the mothers' psychological symptom load GSI score of SCL-90 R, depression, psychological well-being and psychogenic impairment. Some aspects of maternal emotional competence and behavioral problems of their children improved only in the short term. Conclusion: The results suggest that PALME is an effective prevention program for the reduction of maternal depression and psychological symptom load and the improvement of well-being among single mothers. [ABSTRACT FROM AUTHOR]

Background: Patients with severe acute brain injury often suffer from prolonged limitations in the activities of daily living (ADL) after completion of initial neurorehabilitation. Objective: To analyse the efficacy of an inpatient interval rehabilitation programme (IRP) focused on patient goals in the chronic disease state. Methods: Retrospective longitudinal cohort study of IRP patients. Clinical scoring of ADLs was performed weekly during inpatient treatment. IRP success was rated with the Goal Attainment Scale. Regression analysis was used to identify factors that influence IRP success. Results: Data from 125 patients (50.4 years) were analysed. Delay between discharge from acute/sub-acute rehabilitation and admission to IRP was 552 days. IRP lasted for 46 days and 37% of rehabilitation attempts were rated as successful. A significant increase in FIM scores from 33 ± 22 to 36 ± 24 points ( p < 0.001) occurred. Higher ADL scores at discharge from acute/sub-acute rehabilitation and decannulation of a tracheostomy tube as the primary IRP goal made an IRP success more likely. Conclusions: Even several years after severe acute brain injury, an ICF-oriented IRP can lead to ADL improvements and achievement of specific goals. If confirmed by prospective trials, this strategy should be incorporated in healthcare systems. [ABSTRACT FROM AUTHOR]

The article presents a study on survival rates after combined osteochondral autologous transfer (OAT) and valgus high tibial osteotomy (HTO) in young and active patients with symptomatic osteochondral defects of the medial femoral condyle and concomitant varus malalignment. It mentions deep osteochondral defects of the medial femoral condyle in young patients that might lead to early osteoarthritis of the knee joint. Results showed combined OAT and valgus HTO can treat the disease.

Background Until now, there is no consensus regarding the definition of a clinical response to cardiac resynchronization therapy ( CRT) in patients with chronic heart failure ( CHF) and systolic left ventricular ( LV) dysfunction. The aim of this study was to evaluate if echocardiography is predictive for an objective improvement in exercise capacity during long-term follow-up of CRT. Methods Each patient underwent echocardiography and spiroergometry both at baseline and at last follow-up. Left ventricular dyssynchrony ( LVD) before CRT was defined by tissue Doppler imaging ( TDI) as intra- LV delay ≥40 msec (septal-lateral or anterior-posterior). Clinical response to CRT was defined as increase of peak VO2 or as increase of maximal workload >10% as compared to baseline. Results Mean follow-up was 69 ± 37 months. From the 238 consecutive patients included in the study, 141 (59%) were classified as clinical responders and 97 (41%) as nonresponders. Baseline data of responders and nonresponders were comparable. However, clinical responders showed more often LVD (64%) than nonresponders (42%, P = 0.004). On multivariate regression analysis, nonischemic origin of CHF (β-coefficient in the final model 0.1, P = 0.04) and LVD at baseline (β-coefficient in the final model 0.2, P < 0.001) were independently associated with clinical response during long-term follow-up. Patients with LVD at baseline had significant more often an improvement of left ventricular ejection fraction >10% (P = 0.02) and a reduction of left ventricular end-diastolic diameter ( LVEDD) >10% (P < 0.01) than patients without LVD at baseline. Conclusions LVD at baseline as assessed by a straightforward echocardiographic approach predicts the long-term clinical response to CRT and is associated with a more pronounced reverse LV remodeling. [ABSTRACT FROM AUTHOR]

Previous studies suggest that a low-glycaemic index (LGI) diet may improve insulin sensitivity (IS). As IS has been shown to decrease during refeeding, we hypothesised that an LGI- v. high-GI (HGI) diet might have favourable effects during this phase. In a controlled nutritional intervention study, sixteen healthy men (aged 26·8 (sd 4·1) years, BMI 23·0 (sd 1·7) kg/m2) followed 1 week of overfeeding, 3 weeks of energy restriction and of 2 weeks refeeding at ± 50 % energy requirement (50 % carbohydrates, 35 % fat and 15 % protein). During refeeding, subjects were divided into two matched groups receiving either high-fibre LGI or lower-fibre HGI foods (GI 40 v. 74, fibre intake 65 (sd 6) v. 27 (sd 4) g/d). Body weight was equally regained in both groups with refeeding (mean regain 70·5 (sd 28·0) % of loss). IS was improved by energy restriction and decreased with refeeding. The decreases in IS were greater in the HGI than in the LGI group (group × time interactions for insulin, homeostasis model assessment of insulin resistance (HOMAIR), Matsuda IS index (MatsudaISI); all P< 0·05). Mean interstitial glucose profiles during the day were also higher in the HGI group (ΔAUCHGI-LGI of continuous interstitial glucose monitoring: 6·6 mmol/l per 14 h, P= 0·04). At the end of refeeding, parameters of IS did not differ from baseline values in either diet group (adiponectin, insulin, HOMAIR, MatsudaISI, M-value; all P>0·05). In conclusion, nutritional stress imposed by dietary restriction and refeeding reveals a GI/fibre effect in healthy non-obese subjects. LGI foods rich in fibre may improve glucose metabolism during the vulnerable refeeding phase of a weight cycle. [ABSTRACT FROM PUBLISHER]

Primary objectives: The primary aim was to investigate the impact of neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100b) on cognitive functioning after cardiopulmonary bypass (CPB). Research design: Prospective exploratory study. Setting: Psychiatric Consultation-Liaison Service, Ludwig-Maximilians-University Medical School, Munich, Germany. Participants: Thirty-four patients who underwent elective CPB. Measurements: Before the CPB and on the day before discharge neurocognitive tests based on the Syndrom Kurztest (SKT) were carried out. During the ICU stay and shortly after discharge from the ICU, the delirious state was evaluated daily using the Delirium-Rating-Scale. NSE and S100b levels were assayed before CPB, 24 hours and 48 hours post-operatively and on the day before discharge. Results: After the CPB, 1 day before discharge, six (17.6%) participants had sub-threshold cognitive deficits and seven (20.6%) had clinically significant cognitive deficits. A trend toward persistently high NSE levels at discharge indicates greater cognitive impairment at the time of discharge. After surgical intervention S100b is elevated in all patients, independent of cognitive status. Conclusions: Persistently high levels of NSE might be a useful biomarker to identify patients with cognitive performance impairments, while no significant correlation between levels of S100b and impaired cognitive function were found. [ABSTRACT FROM AUTHOR]

Background: Serum 25-hydroxyvitamin D [25(OH)D] concentration has been linked to mortality in several studies, but appropriate cutoffs to define risk categories are under debate. Objective: We aimed to conduct a repeated-measurements analysis on the association of serum 25(OH)D concentrations with all-cause and cause-specific mortality, with particular attention given to the shape of dose-response relations. Design: Concentrations of 25(OH)D were measured in n = 9578 baseline and n = 5469 5-y follow-up participants of the ESTHER study, which is a German population-based cohort aged 50-74 y at baseline. Deaths were recorded during 9.5 y of follow-up (median). Restricted cubic splines were used to assess dose-response relations, and Cox regression with time-dependent variables was used to estimate hazard ratios. Results: During follow-up, 1083 study participants died; of those, 350 individuals died of cardiovascular diseases, 433 individuals died of cancer, and 55 individuals died of respiratory diseases. The overall mortality [HR (95% CI)] of subjects with vitamin D deficiency [25(OH)D concentrations <30 nmol/L] or vitamin D insufficiency [25(OH)D concentrations from 30 to 50 nmol/L) was significantly increased [1.71 (1.43, 2.03) and 1.17 (1.02, 1.35), respectively] compared with that of subjects with sufficient 25(OH)D concentrations (>50 nmol/L)]. Vitamin D deficiency was also associated with increased cardiovascular mortality [1.39 (95% CI: 1.02, 1.89)], cancer mortality [1.42 (95% CI: 1.08, 1.88)] and respiratory disease mortality [2.50 (95% CI: 1.12, 5.56)]. The association of 25(OH)D concentrations with all-cause mortality proved to be a nonlinear inverse association with risk that started to increase at 25(OH)D concentrations <75 nmol/L. Conclusions: In this large cohort study, serum 25(OH)D concentrations were inversely associated with all-cause and cause-specific mortality. In particular, vitamin D deficiency [25(OH)D concentration <30 nmol/L] was strongly associated with mortality from all causes, cardiovascular diseases, cancer, and respiratory diseases. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the association between the representation of early attachment experiences and personality in a representative and non-clinical German adult sample. Adult attachment was assessed by means of the Adult Attachment Interview. One hundred and sixty-seven German adults completed the NEO-FFI and the TPQ. Three important findings emerged: (1) Adults with insecure attachment representation (dismissing versus preoccupied) differ from each other in Neuroticism and Harm Avoidance, (2) attachment security is independent of personality and (3) Adults with an unresolved attachment trauma do not differ from those without with respect to personality. Our results underline the interrelation between attachment experiences, the regulation of negative emotions and self-perceived personality traits in adulthood. Moreover, our findings support theoretical assumptions of attachment theory proposing that attachment security emerges within social relationships. We suggest that unresolved attachment, at least in non-clinical samples, occurs through attachment-related traumatic experiences rather than specific personality dispositions and invite researchers to further explore biological and environmental risk factors leading to an unresolved state-of-mind. [ABSTRACT FROM AUTHOR]

Aims: To investigate the intra- and interrater variability of expert users in the interpretation of handheld echocardiographic studies (HAND). Methods: We scanned 320 consecutive patients with both HAND and high-end (HIGH) scanners. Images were interpreted independently by two blinded level III echocardiographers. Readings from the HIGH scanner served as the gold standard. Segmental endocardial-border delineation was scored to describe image quality. Assessment of left ventricular (LV) dimensions and regional/global LV function, and grading of valve disease were compared. Results: We obtained correlations of r > 0.8 (P < 0.01) for intrarater variability for both expert readers when they analyzed HAND and HIGH images in relation to image quality, wall-motion abnormalities, and LV measurements. For intrarater variability of LVEF assessment, the correlations were at least moderate (r > 0.6, P < 0.01). Interrater variability for HIGH images was r = 0.9 (P < 0.01) for all parameters. Interrater variability for HAND images was less favorable for all parameters, but was at least moderate (r > 0.6, P < 0.01). All cases of pericardial effusion were detected. The agreement for the detection and grading of mitral and aortic regurgitation was at least moderate (κ > 0.6, P < 0.01). Detection of tricuspid regurgitation was less favorable, but only cases of mild regurgitation were missed. All cases of aortic stenosis were detected by both echocardiographers. Conclusions: In relation to the basic assessment of cardiac morphology and function, the interpretation by experienced echocardiographers of images obtained using handheld echocardiographic devices showed a moderate to very good correlation with standard echocardiography. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate gender differences and similarities in patients with borderline personality disorder (BPD) with respect to Axis I comorbidity, Axis II comorbidity, general psychopathology (Symptom Checklist 90-Revised), and dimensional personality traits (NEO-Personality-Inventory Revised [NEO-PI-R] and the Dimensional Assessment of Personality Profile Basic questionnaire [DAPP-BQ]). Fifty-seven men and 114 women with BPD were included in the study. Regarding Axis I and II disorders in an exploratory analysis, men with BPD more often fulfilled the diagnostic criteria for binge eating disorder, antisocial personality disorder, narcissistic personality disorder, and conduct disorder in childhood, whereas women had higher frequencies of bulimia nervosa, posttraumatic stress disorder, and panic disorder with agoraphobia. After correcting for multiple tests, only the gender differences in narcissistic and antisocial personality disorder remained significant. In the SCL-90-R profile, no significant gender differences could be identified. In the exploratory analysis of the dimensional personality traits, women showed higher rates on the NEO-PI-R main factors (Neuroticism and Agreeableness) compared to men. In the DAPP-BQ profile, men reached higher sores on the main factor, Dissocial Behavior. When correcting for multiple tests, gender differences still existed for Neuroticism and Dissocial Behavior. Our results argue for gender differences in Axis I and II comorbidity and dimensional personality traits in BPD. However, in general, more similarities than differences were shown in this study. [ABSTRACT FROM AUTHOR]

Background: Early studies suggested that coffee consumption may increase the risk of chronic disease. Objective: We investigated prospectively the association between coffee consumption and the risk of chronic diseases, including type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer. Design: We used data from 42,659 participants in the European Pro-spective Investigation into Cancer and Nutrition (EPIC)-GenTiany study. Coffee consumption was assessed by self-administered food-frequency questionnaire at baseline, and data on medically verified incident chronic diseases were collected by active and passive follow-up procedures. HRs and 95% CIs were calculated with multivariate Cox regression models and compared by competing risk analysis. Results: During 8.9 y of follow-up, we observed 1432 cases of T2D, 394 of MI, 310 of stroke, and 1801 of cancer as first qualify-ing events. Caffeinated (HR: 0.94; 95% CI: 0.84, 1.05) or decaf-feinated (HR: 1.05; 95% CI: 0.84, 1.31) coffee consumption (>4 cups/d compared with < 1 cup/d; 1 cup was defined as 150 mL) was not associated with the overall risk of chronic disease. A lower risk of T2D was associated with caffeinated (HR: 0.77; 95% CI: 0.63, 0.94; P-trend 0.009) and decaffeinated (HR: 0.70; 95% CI: 0.46, 1.06; P-trend: 0.043) coffee consumption (>4 cups/d compared with < 1 cup/d), but cardiovascular disease and cancer risk were not. The competing risk analysis showed no significant differences between the risk associations of individual diseases. Conclusion: Our findings suggest that coffee consumption does not increase the risk of chronic disease, but it may be linked to a lower risk of T2D. [ABSTRACT FROM AUTHOR]

Objectives: Little data are available on palliative home care for children. The objective of this study was to evaluate the effectiveness of a specialized pediatric palliative home care team (PPHCT) as experienced by parents and health care professionals (HCPs). Methods: Parents and HCPs involved in the care of terminally ill children who died and whom the PPHCT was in charge of were surveyed with questionnaires focusing on satisfaction with the PPHCT, satisfaction with the course of the dying phase, and the development of anxiety, depression, and prolonged grief disorder. Results: Forty-three parent dyads participated (return rate, 88%). Satisfaction with the PPHCT scored a median of 10 (numeric rating scale, 0-10). The child's death was predominantly experienced as very peaceful (median, 9); 71% died at home. According to parents, involvement of the PPHCT led to highly significant ( p<0.001) improvements in the children's symptoms and quality of life, as well as in aspects of communication and administrative barrier reduction. Anxiety was detected in 25% of parents, depression in 19%, and prolonged grief disorder in 13%. HCPs (return rate, 83%) evaluated all investigated care domains (particularly cooperation/communication/family support) as being significantly improved ( p<0.001). Thirty-five percent of HCPs felt uncertain concerning pediatric palliative care; 79% would welcome specific training opportunities. Conclusions: Involvement of a PPHCT is experienced as a substantial improvement of care by parents and HCPs. Coordination of palliative care during the last phase of life appears to be an important quality factor for the home care of dying children and their families. [ABSTRACT FROM AUTHOR]

Context and objective Shared decision making is especially advocated for preference-sensitive decisions. We investigated whether physicians' recommendations pull patients away from their preferred treatment option when making a preference-sensitive decision. Design, participants and methods Inpatients ( N = 102 with schizophrenia, N = 101 with multiple sclerosis) were presented with a hypothetical scenario (the choice between two drugs). They were first asked about their preferences concerning the two drugs and then they received a (fictitious) clinician's recommendation that was contrary to their preferences. Subsequently they made a final choice between the two drugs. Main outcome measures The main outcome measure was whether the patient followed the physician's advice in the hypothetical scenario. Thereby patient's (pre-recommendation) preferences served as a baseline. Results In the decision scenario, about 48% of the patients with schizophrenia and 26% of the patients with multiple sclerosis followed the advice of their physician and thus chose the treatment option that went against their initial preferences. Patients who followed their physician's advice were less satisfied with their decision than patients not following their physician's advice (schizophrenia: t = 2.61, P = 0.01; multiple sclerosis: t = 2.67, P = 0.009). Discussion and conclusions When sharing decisions with patients, physicians should be aware that their advice might influence patients' decisions away from their preferred treatment option. They should encourage their patients to identify their own preferences and help to find the treatment option most consistent with them. [ABSTRACT FROM AUTHOR]

Aims: The teachers' perspectives of the educational environment have as yet only been sparsely considered. This study aimed at validating the first German version of the Dundee Ready Education Environment Measure (DREEM) from the points of view of both students and teachers. Methods: Data from 1119 students and 258 teachers were available for analysis. Psychometric validation included the analysis of homogeneity and discrimination at item level as well as reliability (Cronbach's α), criterion and construct validity at test level. Effect sizes were calculated and the independent samples t-test was used for statistical inference testing of mean differences between two groups. Results: Item characteristics were satisfactory in both samples. Reliability was high with α == 0.92 (students) and 0.94 (teachers), respectively. Factor analyses revealed five dimensions which slightly diverged from the five subscales postulated by the DREEM authors though. The environment was evaluated significantly ( p < 0.001) more positively by teachers ( M == 117.63) than by students ( M == 109.75). Further significant differences were observed with regard to gender, mother language, stage of studies and previous professional training among others. Conclusions: With convincing psychometric properties at item and test levels, the suitability of DREEM not only for students but also for teachers to assess the educational environment has been demonstrated. [ABSTRACT FROM AUTHOR]

Purpose: Phenprocoumon is the most frequently used vitamin K antagonist in Germany. The aim of this study was to estimate the risk of serious bleeding as a result of the use of drugs with potential interaction with phenprocoumon. Methods: We conducted a nested case-control study in a cohort of 246,220 phenprocoumon users in the German Pharmacoepidemiological Research Database. Cases were patients hospitalised for haemorrhage of different kinds. Ten controls were matched to each case by health insurance, birth year and sex using incidence density sampling. Odds ratios (OR) with 95% confidence intervals (CI) of the risk of serious bleeding associated with combined use of phenprocoumon and potentially interacting drugs versus phenprocoumon alone were estimated using conditional logistic regression analysis. Our analyses considered multiple risk factors, such as bleeding history, other comorbidities or co-medication. Results: Our study included 2,553 cases and 25,348 matched controls. An increased risk of bleeding was observed for the combined use of phenprocoumon and clopidogrel vs phenprocoumon use alone (OR: 1.83, 95% CI: 1.41-2.36). Antibiotic drugs associated with an increased risk of haemorrhage in the population of phenprocoumon users included the group of quinolones with ORs ranging from 2.74 (95% CI: 1.80-4.18) for ciprofloxacin to 4.40 (95% CI: 2.45-7.89) for levofloxacin, amoxicillin plus clavulanic acid (OR: 2.99, 95% CI: 1.39-6.42) and cotrimoxazole (OR 3.57, 95% CI: 2.36-5.40). Among non-steroidal anti-inflammatory drugs (NSAIDs), ketoprofen and naproxen were associated with the highest risks. Conclusion: Significantly elevated risks of major bleeding were mainly observed for drugs with known pharmacodynamic interaction with phenprocoumon, and less for drugs with possible pharmacokinetic interaction. [ABSTRACT FROM AUTHOR]

Background: Circumscribed cartilage defects are considered as prearthritic lesions and lead to differential intra-articular cytokine expression. Mechanisms of associated pain development and influence of smoking behavior are not yet fully understood in humans.Purpose: This study aimed to reveal relations between synovial cytokine levels in knees with circumscribed cartilage defects and pain sensation.Study Design: Descriptive laboratory study.Methods: In a clinical trial, knee lavage fluids of 42 patients with circumscribed cartilage lesions treated by either microfracturing (n = 19) or by autologous chondrocyte implantation (n = 23) and fluids of 5 healthy control individuals were prospectively collected. Preoperative knee pain was evaluated according to frequency and strength; subjective knee function was assessed using a visual analog scale and the International Knee Documentation Committee (IKDC) score. Synovial concentrations of aggrecan, insulin-like growth factor (IGF)-I, basic fibroblast growth factor (bFGF), interleukin (IL)-1β, bone morphogenetic protein (BMP)-2, and BMP-7 were determined by enzyme-linked immunosorbent assay.Results: Pain strength showed a highly significant association with intra-articular IGF-1 levels (ρ = .48, P < .01), but no correlation with synovial concentrations of aggrecan, bFGF, IL-1β, BMP-2, and BMP-7. Although pain strength and frequency demonstrated a statistically significant relationship, no substantial association between pain frequency and any of the examined cytokine levels was found. Intra-articular IGF-1 concentrations significantly correlated with the area of cartilage damage (ρ = .35, P < .02); the other investigated cytokines failed to show this association. Neither of the determined intra-articular mediators demonstrated statistically significant correlations with subjective knee function or IKDC score. Only intra-articular concentrations of IGF-1 and BMP-2 statistically significantly correlated with age; total protein content was negatively associated with body mass index (P < .05). In smokers, synovial expression of total protein content, IGF-1, and bFGF was significantly diminished compared to nonsmokers (P < .05).Conclusion: Insulin-like growth factor–I is present in knees with circumscribed cartilage lesions in a size-dependent manner. IGF-1 levels correlated with indicators of pain perception; smoking negatively influenced synovial cytokine expression related to cartilage metabolism, but pain perception was not altered. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews have confirmed the effectiveness of work-related rehabilitation with significant cognitive-behavioural components for patients with musculoskeletal disorders (MSDs). In Germany, however, work-related rehabilitation focuses mainly on functional capacity training and less on psychosocial work demands. Objective: To evaluate the efficacy of multimodal work hardening (MWH) with a cognitive-behavioural approach. Methods: Patients with MSDs resulting in severe restriction of work ability were randomly assigned to treatment by either MWH or conventional musculoskeletal rehabilitation (controls). The primary outcome was work status. The work status at 6 months of follow-up was defined as positive if the patient was working and had &les; 6 weeks of sick leave, and that at 12 months was defined as positive if the patient was working and had &les;12 weeks of sick leave. Follow-up data were collected by postal questionnaires. Results: 236 patients consented to participate. Follow-up data were obtained from 169 (71.6%) participants at 6 months and 146 (61.9%) participants at 12 months. At 6 months, participants in the MWH group had a 2.4 times higher chance of a positive work status than the controls (OR=2.363; 95% CI: 1.266 to 4.410; p=0.007). At 12 months, the chances of a positive work status were still higher, but this difference was not statistically significant (OR=1.914; 95% CI: 0.849 to 4.317; p=0.118). Significance of the interaction term of treatment and time indicated more favourable outcomes for depression and anxiety, mental and physical health-related quality of life, and pain management in the MWH group. Conclusions: MWH improves health-related quality of life and is able to enhance the mid-term chances of work-life participation. [ABSTRACT FROM AUTHOR]

Physical activity during childhood and adolescence is of major importance with regard to an individual's engagement with sports in later life. Apart from the physical trauma, sports injuries often have negative effects on the motivation to remain physically active. This study evaluates data to gain detailed knowledge on 1-year incidence and risk groups with the aim of providing information for the development of preventive measures. Our data analysis is based on a net sample from a national study in Germany including 7697 children and adolescents aged 11 to 17 years. Within the statistical analyses, we developed weighting factors and calculated group differences as well as regression models for sports injury incidence. A total of 7.7% of the children and adolescents reported a sport injury during the last 12 months. Bivariate analyses showed significant associations between sports injuries and several social and lifestyle-related covariates. After adjustment for participation in leisure time physical activity, age, non-migrant status and residence in a large city remained positively associated with the incidence of sports injuries. In comparison with other results for developed countries, the incidence seems rather high. It remains to be clarified whether this is because of our use of more accurate population-based data. The results suggest that while developing preventive measures, the interaction between preferences for high-risk sports and physical as well as psychological development has to be considered. [ABSTRACT FROM AUTHOR]

im: How children grow up differs from country to country. The aim of the present investigation was to compare childhood experiences, family characteristics and psychological features during the post-World War II period in Poland and Germany. Subject and methods: A questionnaire regarding various childhood experiences and family circumstances was administered to two samples, one each in Poland and Germany ( n = 500 each) via the Internet. Comparisons between Poland and Germany were performed using analysis of variance (ANOVA) and χ tests, and logistic regressions were performed to compare the effects of risk factors. Results: Probands from Poland described almost all aspects of their lives, their families and their childhoods as having been better than did probands from Germany. Risk factors for suicide attempts were childhood physical abuse, and for alcohol abuse gender and childhood sexual abuse in both countries. Conclusion: There is some evidence for idealisation of the past in Poland, which might be due to the fact that almost 90% of the Poles were Christians. Germans seem to be more realistic in their views of the past but possibly deny their personal weaknesses. [ABSTRACT FROM AUTHOR]

Objectives: This study was done to analyze the frequency of use of acupuncture and other complementary and alternative medicine (CAM) methods during labor and to investigate the different characteristics of women being treated with or without acupuncture and CAM methods, as well as try to analyze birth-related outcome measures. Study design: Data were analyzed from 409,413 deliveries, registered between 2001 and 2008 by the agency for quality assurance in Hesse (the Hessian Perinatal Registry [HEPE] survey), which made up more than 95% of all deliveries in this German state during the given time period. Results: Interest in the use of CAM seems to have decreased within the given time period. On average, acupuncture was used in 3.7% (15,345/409,295) of all deliveries and other CAM methods in 4.8% (19,507/409,295). The most important determinant for the use of one or both methods was the type of hospital. It was also found that German women with higher job qualifications were more likely to receive CAM treatment during delivery. Interestingly, application of CAM methods was associated with a higher use of analgesics during labor. The risk status of the pregnancy or the delivery was of minor importance. Conclusions: This analysis shows that the determinants of CAM use are similar to those in the field of oncology. In order to assess the efficacy of acupuncture or other CAM methods in the field of obstetrics, it seems necessary to extend the HEPE survey to cover these areas. [ABSTRACT FROM AUTHOR]

Objective and methods: The crucial symptom of atopic eczema is itch. Acupuncture has been shown to exhibit a significant effect on experimental itch; however, studies focusing on clinical itch in atopic eczema and corresponding mechanisms are lacking. The study design was a unicenter, single-blinded (observer), prospective, randomized clinical pilot trial with an additional experimental part. In 10 patients with atopic eczema, we investigated the effect of acupuncture treatment ( n = 5) compared to no treatment ( n = 5) on itch intensity and in vitro basophil CD63 expression upon allergen stimulation (house dust mite and timothy grass pollen) in a pilot trial. Results: Mean itch intensity in a visual analog scale was rated significantly lower in the acupuncture group (−25% ± 26% [day 15-day 0]; −24% ± 31% [day 33-day 0]) than in the control group (15% ± 6% [day 15-day 0]; 29% ± 9% [day 33-day 0]). From day 0 (before treatment) to day 15 (after 5 acupuncture treatments) as well as day 33 (after 10 acupuncture treatments), the acupuncture group showed less CD63 positive basophils than the control group regarding stimulation with house dust mite and grass pollen allergen at various concentrations (5 ng/mL, 1 ng/mL, 0.5 ng/mL, or 0.25 ng/mL). Conclusions: Our results show a reduction of itch intensity and of in vitro allergen-induced basophil activation in patients with atopic eczema after acupuncture treatment. Reducing basophil activation can be a further tool in investigating the mechanisms of action of acupuncture in immunoglobulin E-mediated allergy. Due to the limited number of patients included in our pilot trial, further studies are needed to strengthen the hypothesis. [ABSTRACT FROM AUTHOR]

We sought to determine the level of agreement and the reproducibility of two-dimensional (2D) transthoracic (2D-TTE), 2D transesophageal (2D-TEE) and real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) for measurement of aortic annulus size in patients referred for transcatheter aortic valve implantation (TAVI). Accurate preoperative assessment of the dimensions of the aortic annulus is critical for patient selection and successful implantation in those undergoing TAVI for severe aortic stenosis (AS). Annulus size was measured using 2D-TTE, 2D-TEE and RT3D-TEE in 105 patients with severe AS referred for TAVI. Agreement between echocardiographic methods and interobserver variability was assessed using the Bland-Altman method and regression analysis, respectively. The mean aortic annuli were 21,7 ±± 3 mm measured with 2D-TTE, 22,6 ±± 2,8 mm with 2D-TEE and 22,3 ±± 2,9 mm with RT3D-TEE. The results showed a small but significant mean difference and a strong correlation between the three measurement techniques (2D-TTE vs. 2D-TEE mean difference 0,84 ±± 1,85 mm, r == 0,8, p < 0,0001; 2D-TEE vs. 3D-TEE 0,27 ±± 1,14 mm, r == 0,91, p < 0,02; 2D-TTE vs. 3D-TEE 0,58 ±± 2,21 mm, r == 0,72, p == 0,02); however, differences between measurements amounted up to 6,1 mm. Interobserver variability for 2D-TTE and 2D-TEE was substantially higher compared with RT3D-TEE. We found significant differences in the dimensions of the aortic annulus measured by 2D-TTE, 2D-TEE and RT3D-TEE. Thus, in patients referred for TAVI, the echocardiographic method used may have an impact on TAVI strategy. [ABSTRACT FROM AUTHOR]

Objective: Studies on cognitive function in paediatric patients suffering head trauma suggest neuropsychological impairment even after mild traumatic brain injury (MTBI). The present study examined the feasibility of abbreviated neuropsychological testing in different settings in children and adolescents following MTBI. Methods: Within the scope of two prospective studies on psychosocial and cognitive outcome, 71 school-aged children with mild, moderate or severe TBI were assessed. In addition, 15 healthy children were included in the study. The abbreviated instrument comprises three standardized tests measuring attention and memory functions (Digit Symbol, Digit Span, learning trials of the German Auditory Verbal Learning Test). Impairment rates were calculated according to a defined cut-off score for clinically significant cognitive impairment. Results: Abbreviated testing could easily be implemented both in the acute and post-acute clinical setting. Out of the children with MTBI, 12%% (shortly after injury) and 30%% (2 months after injury), respectively, were classified as cognitively impaired. Following moderate or severe TBI, impairment occurred in 50%% of the patients. Healthy children showed the best performance, while children with severe TBI performed worst. Conclusion: Results suggest that abbreviated testing allows detection of MTBI-related cognitive dysfunction. Identified children should be referred to a clinical neuropsychologist for comprehensive assessment. [ABSTRACT FROM AUTHOR]

Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self-esteem and low self-concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self-esteem and self-concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self-esteem, self-concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self-concept clarity compared with those on the waiting list. Further, the scales of global self-esteem and, more specifically, the facets of self-esteem self-regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self-esteem in this group. On the other hand, the scale of earning self-esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self-esteem and self-concept clarity, and thus on identity disturbance, in women with BPD. Copyright © 2010 John Wiley & Sons, Ltd. • Self-concept clarity, which refers to the BPD criterion identity disturbance, and facets of self-esteem, are impaired in patients with BPD compared with reference data from healthy controls. • Our study replicates that depressive symptoms and general psychopathology are improved after a 12-week DBT programme in BPD patients compared with a waiting list. • The 12-week inpatient DBT treatment programme shows significant enhancement in self-concept clarity and facets of self-esteem compared with the waiting list. • Thus, in BPD patients, self-esteem and the diagnostic criteria identity disturbance, captured by self-concept clarity, can be influenced with short-term psychotherapy. [ABSTRACT FROM AUTHOR]

The article presents research on the relationship between the social capital and health promotion willingness (HPW) of companies as perceived by their chief executive officers (CEOs). It says that data were collected through telephone interviews with one CEO from selected companies within the German information and communication technology sector, and that logistic regression analysis of data was performed. It suggests that higher values of perceived social capital could help promote HPW.

BackgroundMany patients with schizophrenia exhibit neurocognitive impairments, namely, in attentional, mnestic and executive functions. While these deficits limit psychosocial rehabilitation, their effect on psychoeducation is unknown. Within the framework of the longitudinal Munich Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses (COGPIP) study, we examined: (a) whether illness knowledge after psychoeducation could be predicted more precisely from the neurocognitive than from the psychopathological status of the patients; (b) which neurocognitive domains are best predictors.MethodA total of 116 in-patients with schizophrenic or schizoaffective disorders were randomized to a neurocognitive training or control condition (2 weeks) followed by a manualized psychoeducational group programme (4 weeks) and then observed over a 9-month follow-up. Repeated measurements included – among others – the Positive and Negative Syndrome Scale and a comprehensive neuropsychological test battery from which normative T scores were used to calculate one global and five domain-specific neurocognitive composite scores. Illness knowledge was measured by a questionnaire (WFB-52) tailored to the psychoeducational programme.ResultsMultiple linear regression analyses showed that, apart from baseline illness knowledge, neurocognition significantly predicted knowledge outcome as well as knowledge gain (measured by reliable change indices) after psychoeducation. This was not true for psychopathology. Among the domain-specific neurocognitive composite scores, only memory acquisition was a significant predictor of knowledge outcome and gain.ConclusionsNeurocognition, not psychopathology, is a significant predictor of illness knowledge after psychoeducation in schizophrenia. This finding should guide efforts to tailor psychoeducational interventions more closely to the patient's needs and resources. [ABSTRACT FROM PUBLISHER]

Objective: To study the effects of the dietary fat content on cardiovascular disease risk factors in humans when the fatty acid composition and types of carbohydrates are kept constant. Methods: A controlled dietary study in healthy volunteers with 2 dietary groups and a parallel design consisting of 2 dietary periods was conducted. First, participants received a 2-week wash-in diet rich in saturated fatty acids (SFA; 47% of total fatty acids) and were then randomly assigned to either a high-fat (40% of energy) or a low-fat diet (29% of energy) for 4 weeks. Both diets were isocaloric, rich in monounsaturated fatty acids (MUFA; 51% of total fatty acids) and had similar fatty acid and carbohydrate compositions. Results: Compared to the wash-in diet, the high-fat and low-fat diets significantly lowered LDL-cholesterol (−0.34 and −0.41 mmol/l, respectively; P < 0.001 for time effect in RM-ANOVA), and HDL-cholesterol (−0.13 and −0.18 mmol/l, respectively; P < 0.001 for time), without any differences between the high-fat and low-fat diets ( P = 0.112 and P = 0.085 for time × group interaction in RM-ANOVA, respectively). The size of the major LDL fraction, the LDL susceptibility to oxidation and the plasma concentrations of oxidized LDL (ox-LDL) were significantly reduced by both the high-fat and low-fat diet, again without significant differences between the diets. The ratio of ox-LDL/LDL-cholesterol, serum triacylglycerols and urinary F2-isoprostanes were not significantly affected by the diets. Conclusion: A high-fat and a low-fat diet, both rich in MUFA, had similar effects on lipid-related cardiovascular disease risk factors in metabolically healthy men and women. [ABSTRACT FROM AUTHOR]

Background: Autologous chondrocyte implantation (ACI) is an accepted surgical treatment in patients with isolated cartilage defects of the knee. Age has been considered as a limiting factor and the technique has not been recommended in patients older than 40 to 50 years. Nevertheless, some more recent studies report satisfying clinical results in middle-aged patients.Hypothesis: Analogous to the microfracture technique, age over 40 years is associated with inferior clinical outcome after ACI.Study Design: Cohort study; Level of evidence, 2.Methods: Thirty-seven patients with an average age of 47.8 years (group 1) were matched with 37 patients with an average age of 31 years (group 2). Both groups underwent ACI for treatment of isolated cartilage defects of the knee. All patients were enrolled prospectively and followed for a period of 24 months using International Knee Documentation Committee (IKDC), Lysholm scale, Cincinnati sports scale, and Tegner activity evaluation instruments.Results: Statistical analysis revealed a significant increase in function after ACI in both groups as early as 6 months after surgery until the end of the study period. There was only a slight tendency for better clinical outcome in younger patients (IKDC at 24 months: group 1, 72.2 ± 15.8 [standard deviation]; group 2: 76.1 ± 14.1; P = .261; Lysholm at 24 months: group 1: 80.42 ± 15.37; group 2: 80.65 ± 12.01), no statistical significant differences were found between patients of group 1 and group 2 at any of the time points investigated.Conclusion: In contrast to other cartilage repair techniques, patients 40 years and older do not have an inferior outcome up to 24 months after ACI for isolated cartilage defects when compared with younger patients. [ABSTRACT FROM AUTHOR]

MEHNERT A., LEHMANN C., GRAEFEN M., HULAND H. & KOCH U. (2010) European Journal of Cancer Care 19, 736-745 Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients The aim of this study is to identify anxiety, depression and post-traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health-related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow-up care for an average of 27 months after surgery using standardised self-report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist - Civilian Version, Illness-Specific Social Support Scale, Short-Form Health Survey). Seventy-six per cent of patients evaluated their disease as 'not' or a 'little threatening'. The cancer diagnosis and uncertainty were most frequently reported as 'distressing', while medical treatment and doctor-patient interaction were most frequently evaluated as 'most helpful'. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age-adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co-morbidity ( P < 0.001). Lack of positive support, detrimental interactions, threat of cancer, disease stage and age significantly predicted mental health ( P < 0.001), whereas the impact of social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening. [ABSTRACT FROM AUTHOR]

Recent studies suggest that even infants attend to others' beliefs in order to make sense of their behavior. To warrant the assumption of early belief understanding, corresponding competences need to be demonstrated in a variety of different belief-inducing situations. The present study provides corresponding evidence, using a completely nonverbal object-transfer task based on the general violation-of-expectation paradigm. A total of n = 36 infants (15-month-olds) participated in one of three conditions. Infants saw an actor who either observed an object's location change, did not observe it, or performed the location change manually without seeing it (i.e., variations in the actor's information access). Results are in accordance with the assumption that 15-month-old infants master different belief-inducing situations in a highly flexible way, accepting visual as well as manual information access as a proper basis for belief induction. [ABSTRACT FROM AUTHOR]

Background: Although the percentage of obese nursing home residents is increasing, few longitudinal studies have reported on functionality and mortality in this subpopulation. The aim of the present study was to explore functionality and mortality in obese nursing home residents during a 1-year follow-up and to compare these results with those of residents within the normal and low BMI range. Methods: Two hundred residents (147 female, 53 male, mean age 85.6 ± 7.8 years) from 2 Nuremberg nursing homes were included. Body weight and height were measured in all participants. BMI was calculated and categorized as low (<20 kg/m2), normal (20–30 kg/m2), and high (>30 kg/m2). Handgrip strength, timed “up and go” test, and Barthel''s Activities of Daily Living were applied as functional parameters. All measurements were done at baseline and after a 1-year follow-up. Results: At baseline, the prevalence of obesity was 23.5%, whereas low BMI values were present in 8.5% of the residents. After 1 year, there was no significant decline of functionality in the obese group, whereas functional parameters deteriorated significantly in study participants with normal BMI. One-year mortality was lowest in the obese (12.8%), with no deaths in residents with BMI of 35 kg/m2 or higher. Mortality was highest in residents with low BMI (58.8%). Conclusion: In nursing home residents, obesity is associated with increased survival and stable functionality. These observations may therefore be regarded as an expression of “risk factor paradox” in this specific population of older individuals. [Copyright &y& Elsevier]

Aims and objectives. To describe oral health utilisation patterns of frail older people and contrast these with attitudes and utilisation patterns of nursing staff who are caring for them. Background. In view of widespread poor oral health of frail older people in long-term care, staff attitudes have been identified as an area of interest. In addition to data on attitudes, the current study contributes a description of aspects of oral health related behaviour of staff and clients. Design. Cross-sectional study. Methods. Structured interviews of a random selection of long-term care staff ( n = 320) and frail older people ( n = 172), within the two groups of home-care services (HCS) and long-term care facilities (LTCF). Results. Of staff members, 55·3% attach the same importance to their own oral health compared to that of clients and 35·7% regard their own oral health as more important; 98·4% of staff attended two or more dental examinations per year; 3·4% of HCS and 37·1% of LTCF routinely arranged oral examinations. In 81·4% HCS and in 34·4% of LTCF, there was no routine dental service available. Patterns of oral health service attendance greatly differ between staff and clients. Conclusion. The oral health awareness of the majority of long-term care staff did not translate into adequate oral health care for clients. A gap exists between attitudes supportive of oral health, adequate and prevention driven own oral health related behaviour of staff and actual oral health care delivered to clients. Relevance to clinical practice. To bridge the gap identified, a concept is suggested for nursing educators and managers of LTCF targeting educational measures while taking into account individual attitudes. [ABSTRACT FROM AUTHOR]