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Aseptic loosening seems to have become a minor problem in total knee arthroplasty. In contrast to that, new challenges are defined by changing patients' expectations. Beside reduction of pain and improving mobility, modern implants should not be noticed as such and should not limit sports activities.In this paper, a summary of the development and the current situation of total knee arthroplasty (e.g., implantation numbers, hospitality, operation time, and infection rates) are provided. The data are compared in an international context. In addition, current trends and developments from recent years are shown and rated according to the literature.The paper is based on a literature search (PubMed) and analyses of published official statistical data and expert recommendations.Implantation numbers have been declining gradually in Germany since 2009. In 2013, 127,077 total knee arthroplasties were implanted. In contrast, the number of revision operations has increased gradually during the last decade. In addition, hospital stay and operation time have declined.The development of implants, instruments, and operation techniques results from changing patients' expectations. All innovations must be compared against the results of well-proven techniques. The arthroplasty register may be an instrument to evaluate the results of new techniques and implants in a broad clinical application in terms of survival.

This paper reports on selected results from the study "Health and Lifestyle in Rural Northeast Germany". A special characteristic of this study is the regional focus on peripheral rural communities and the trend study design. It was analyzed whether, and to what extent, associations exist between socioeconomic status and self-rated health in this regional context and over time. Thus, regression analyses were conducted using equivalent income, level of school education, and age as independent variables and self-rated health as the dependent variable. Analyses are based on paper-pencil surveys of the adult residents of 14 rural communities chosen at random in northeast Germany, performed in 1973, 1994, and 2004-2008. In all survey waves, a lower level of school education was associated with poor self-rated health. By contrast, associations between income and health were less consistent and constant over time. The associations between income and health are discussed as being specific to East Germany and as a consequence of social transformation in the context of reunification.

Men's sexual health can be impaired by a variety of sexual disorders, including numerous sexual dysfunctions (primary or due to general medical conditions or their treatment), but also paraphilias and gender identity disorders. These different disorders are often interwoven. This paper offers an overview of the prevalence, symptoms, and etiological factors of major sexual-medical disorders and of the basics of diagnostics and therapy. Special emphasis is given to the couple dimension and the biopsychosocial foundation of human sexuality, which requires an interdisciplinary approach. The paper argues for an improvement of continuing education in sexual medicine for healthcare providers in an effort to satisfy patients' needs for preservation or restoration of sexual health as a major component of quality of life.

The SF-36 is a widely used instrument to measure health-related quality of life that provides a profile of eight scales [Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role-Emotional (RE) and Mental Health (MH)]. To reduce the dimension of the profile, a principal component analysis with the data of the US SF-36 Survey was undertaken. As a result, the Physical Component Summary (PCS) and the Mental Component Summary (MCS) were gained by weighting and summing up of the original scales of the SF-36. The weights were assumed to be country specific. Comparing the weights from the representative samples of nine European countries with those from the USA it has been suggested that the weights gained from the US sample could be applied to all datasets for purposes of comparability and simplicity. In this paper, for a new representative German population sample completed in 1998, the calculation results are compared with those for the older German population sample from 1994. PCS and MCS are calculated using the weights from the new German population sample as well as using the American weights. In this paper, the calculations for the 1998 representative population sample were repeated based on the US weights developed in 1994. The German weights were also calculated based on the 1998 sample. The results were compared and the pro and cons of using the American weights are discussed. In essence, the American weights continue to be acceptable for international comparisons. The separate evaluation of physical and mental health for men and women allows additional insight into gender-specific changes. In this paper, the summary scales for the 1998 German normative population are calculated gender specific. The weights to be used in future studies are also published. With respect to gender mainstreaming, this approach should be taken into consideration in quality of life research. Regarding the methodological and factorial difficulties, the questions arise if the summary scales should be applied instead of the original scales of the SF-36 questionnaire.

Despite remarkable progress made in the fields of antiviral therapy and virological laboratory diagnosis, infections with the human cytomegalovirus (CMV) still pose considerable problems in certain patient groups. The variety of available test methods - mostly not standardised - with their different test characteristics, sample types etc. is often confusing for the clinician. There is often great uncertainty as to whether a given laboratory result is pathognomonic. In addition, not only is the diagnostic repertoire growing constantly - for instance through genome quantification and measurement of virus-specific T lymphocytes - but also the available antiviral therapeutic options with the need for adequate surveillance. This paper gives an up-to-date overview about the available diagnostic means with their specific advantages and disadvantages. Concrete recommendations regarding a rational and comprehensive, yet economic approach to CMV diagnosis have to be targeted at the individual patient group and specific diagnostic problem; this is beyond the scope of this paper and the reader is referred to the pertinent expert groups' publications. This review article deals with general and fundamental aspects.

Multiple organizations like UN and WHO call for the collection of internationally comparable data on living and supply conditions of people with disabilities. Furthermore, reliable national data are necessary for ensuring appropriate care. Regarding patients with Spinal Cord Injury (SCI) in Germany, only data on diagnostics or therapeutic interventions is currently available. The International Spinal Cord Injury Survey aims at collecting reliable data of people with SCI in 21 countries and developing recommendations for actions to be taken by policy-makers and other decision-makers.In 2017, eight specialized SCI-centers across Germany sent a standardized questionnaire to their patients who had diagnosis of SCI, and were older than 18 years (n=5,598). The questionnaire could be completed paper-based or online.1,479 patients participated in the study and were included in data analysis. On average, participants were 55.3 years (SD=14.6) old, ¾ were male. The mean time of onset of paralysis was 13.9 years. Two thirds of the spinal cord injury causes were traumatic. In 51.2% SCI was classified as paraplegia. The most frequently cited health problem was sexual dysfunction. Medical treatment for this problem was rarely used. Serious environmental barriers were the inadequate accessibility of private households and public places. 42.5% of the respondents in working age were employed, which is 10% less than in Switzerland.Serious problems in environmental barriers, medical care and labor market participation were identified for people with SCI. The results will be reported to and discussed with political decision makers and further actors to create solutions. This requires extensive efforts, like modification in building law and home support.ZIEL: Im Rahmen eines global angelegten Projekts (InSCI) zum Vergleich der Lebens- und Versorgungssituation querschnittgelähmter Menschen in 21 Ländern, wurde in Deutschland eine umfassende schriftliche Datenerhebung (GerSCI) initiiert und durchgeführt. Ziel war die Erhebung belastbarer Daten als Legitimationsgrundlage gesundheitspolitischer Entscheidungen im Sinne des Learning Health Systems.Die nationale Erhebung war als prospektive Querschnittstudie angelegt. Zum Einsatz kam ein teilstandardisierter Fragebogen der sowohl schriftlich als auch online ausgefüllt werden konnte, Die Rekrutierung der Teilnehmenden erfolgte über die Krankenhausinformationssysteme von acht Spezialzentren für querschnittgelähmte Menschen.Die Studienpopulation (N=1479) war im Durchschnitt 55,3 Jahre alt (SD: 14,6) und zu 72,9% männlichen Geschlechts. Die Zeit seit Lähmungseintritt betrug im Mittel 13,9 Jahre. Die Ursache der Querschnittlähmung war zu zwei Dritteln traumatisch. Das Lähmungsmuster war in 51,2% eine Paraplegie. Das am häufigsten genannte querschnittlähmungsspezifische gesundheitliche Problem war die Störung der Sexualität. Medizinische Behandlungen zu dieser Problematik wurden nur selten in Anspruch genommen. Schwerwiegende Umweltbarrieren waren die unzureichende Zugänglichkeit von Privathaushalten und öffentlichen Orten. Von den befragten Personen im erwerbsfähigen Alter waren 42,5% berufstätig und damit ca. 10% weniger als bspw. in der Schweiz. Als die 2 belastendsten Situationen im Alltag wurden das Führen intimer Beziehungen und die Nutzung öffentlicher Verkehrsmittel angegeben.Die gesundheitlichen Probleme der betroffenen Personen sowie deren medizinische Versorgung, die Umweltbarrieren als auch die Erwerbstätigkeit und Schwierigkeiten bei Aktivitäten des täglichen Lebens werden an politische Entscheidungsträger und weitere Akteure herangetragen, um Lösungen zu erarbeiten.

Tonsillotomy procedures (TT) are being increasingly performed owing to the low postoperative morbidity compared with extracapsular tonsillectomy (TE). Patients may experience regrowth of tonsillar tissue or tonsillitis in the tonsillar remnants eventually resulting in a secondary tonsillectomy.A review of the literature was undertaken to evaluate the current indications and contraindications, surgical instruments, risks of surgery, and the need for further research related to TT.A search of the PubMed database was performed with the following terms: "tonsillotomy," "partial tonsillectomy," "subtotal tonsillectomy," "intracapsular tonsillectomy," "RFITT," and "tonsil ablation." Filters included language (English; German) and publication date (1960-2016). Articles were excluded if they were not related to tonsil surgery, did not provide clinical data, dealt with uncommon surgical techniques, or presented only data from polysomnographic studies.In all, 104 papers encompassing 97 studies and seven national surveys were eligible for analysis. In total, 13,270 patients had undergone TT and were compared with 11,485 patients after TE. Partial resection of the tonsils was most commonly accomplished with a microdebrider (51.5 %), and less frequently with coblation (20.5 %), radiofrequency (9.1 %), COTT is predominantly indicated for tonsillar hyperplasia, with or without tonsillitis. Restrictions related to age or surgical instruments are not reported in the literature data. Data concerning operation time, intraoperative bleeding, and outcome favor TT over TE. The median values for regrowth (3.0 %), postoperative tonsillitis (2.85 %), and secondary TE (1.37 %) emphasize the high success rate of TT. Further research utilizing a uniform terminology is mandatory to clarify the benefit of TT over TE in the long term and to resolve sleep-related breathing disorders resulting from tonsillar hyperplasia or tonsillitis.

Aging in a neighborhood environment is considered to be important for well-being particularly in very old age.The project "This is my place" - On the importance of a place in the neighborhood for healthy aging (German acronym BEWOHNT) emphasises the role of out of home activities, neighborhood experiences and urban-related identity on well-being. The aim of this paper is to test the impact of person-environment exchange processes of "agency" (e.g., out-of-home activity) and "belonging" (e.g., urban related identity, social cohesion) on well-being (valuation of life) in addition to health effectsData are based on domestic diaries, mobility diaries and a survey including 595 community-dwelling elderly people from 3 urban districts of Frankfurt (Germany) stratified by age (70-79 years vs. 80-89 years) and household situation (e.g. living alone versus living with partner).The findings indicate substantial associations for "agency" and "belonging" indicators on well-being and differentiated effects for both age groups. Multigroup analyses show that particularly in very old age, out of home activities, social cohesion and urban-related identity considerably buffer the negative impacts of health on well-being.The findings underline the need for an age-differentiated understanding of person-environment interchange processes in later life and in particular the importance of the neighborhood in very old age in this respect.

Children and adolescents with inflammatory rheumatic diseases have a disease and treatment-related increased risk of infections. This risk includes vaccine-preventable diseases; therefore, vaccinations represent an important preventive measure against infection in these patients. However, approximately one in three patients with a juvenile rheumatic disease is nowadays still inadequately vaccinated, mostly due to uncertainty regarding the efficacy and safety of vaccination in these patients.This paper summarizes the available evidence regarding the efficacy and safety of vaccinations in children and adolescents with rheumatic diseases and gives recommendations for the clinical practice.Almost 2000 children and adolescents with rheumatic diseases were examined in the more than 30 previously published vaccination studies, comprising nearly all standard vaccinations in the immunization schedule. The immunogenicity was usually sufficient and there was no evidence of a relevant aggravation of the underlying disease. Recommendations for the clinical practice are given also considering data beyond pediatric rheumatology; however, a final benefit-risk assessment is not yet possible.

The average age of childbearing has risen markedly in Germany and other high-income countries during the past 2 decades. Women aged 35 years or older have an increase in pregnancy complications and in preexisting medical conditions including obesity, diabetes and hypertension as well as a significant increase in the gestational age-related rate of stillbirth compared to younger mothers. Additional individual risk factors for stillbirth are primiparity, body mass index30 and smoking. After exclusion of risk factors the absolute risk of stillbirth in women aged≥40 years old is 2-fold higher (1 in 503 maternities) at 39/40 weeks of gestation compared to women aged35 years (1 in 1 020 maternities) at the same gestational age. Women aged 40 years or older have a similar stillbirth risk at 39 weeks of gestation to 25-29-year-olds at 41 weeks gestation. The underlying mechanism for the excess risk of stillbirth in women of advanced maternal age after exclusion of congenital anomalies is unknown. Independent of maternal age the cumulative probability of perinatal death increases from 1.8/1 000 deliveries at 38 weeks of gestation to 9.3/1 000 deliveries at 42 weeks of gestation. Whether on the basis of these data induction of labour at 39 weeks of gestation should be recommended in women of advanced maternal age has recently been discussed in a Scientific Impact Paper of the Royal College of Obstetricians and Gynaecologists. In this context it should be taken into account that the rate of Caesarean sections in women aged 40 years or over is 40%, and, in particular, older nulliparous may request elective Caesaran section rather than elective induction of labour. Recent metaanalyses have shown that elective induction of labour before or after term is not associated with an increase of the Caesarean section rate compared to expectant management. Up to now no randomised controlled trials exist and consequently no -recommendations from current guidelines regarding induction of labour in women of advanced maternal age can be given. In any case, a careful consultation and an individual risk-benefit analysis regarding the obstetric management is mandatory, and the final decision should be made in agreement between the pregnant women and the obstetrician. Currently a randomised controlled trial in the U.K. comparing induction of labour at 39 weeks of gestation with expectant management in nulliparous women aged over 35 years is recruiting, with the aim to determine intrapartum complications and perinatal morbidity and mortality in both managements.

The aim of this study was to investigate the prevalence of substance use of German apprentices in vocational schools, considering socio-demographic characteristics and vocational field.Cross-sectional study of 5,688 first year apprentices. These were 5,001 apprentices from 34 schools of the "Dual System" and 687 students from 15 vocational schools of the social and health sector. Sociodemographic characteristics and prevalence of tobacco, alcohol, cannabis, other illegal drugs, and pharmaceuticals were assessed. There was also a screening for problematic alcohol and cannabis use. The paper-pencil survey was conducted by trained research staff in 7 German federal states from September to December 2012.Half of the apprentices (49.9%) used tobacco in the 30 days prior to questioning, 40.7% reported daily smoking. Alcohol use in the past 30 days was reported by 68.9%, 45.0% of the sample had a positive screening result for problematic alcohol use. Prevalence rates for the use of cannabis and other illegal drugs in the last 30 days were 7.5% and 2.6%, taking pharmaceuticals was reported by 20.7%. Significant correlates of substance use were gender and socio-economic status. Differences between vocational clusters were also found, with higher average rates in service-based and commercial-technical professions. However, these differences could mostly be explained by sociodemographic differences in the composition of the vocational clusters.Use of psychotropic substances is a widespread activity in German apprentices. Prevalence rates are higher than in the same age total population. The highest proportion of variance was explained by differences in gender and socio-economic status.

In this paper, tobacco and alcohol consumption among adolescents in Germany was analyzed. In addition to the current situation, we report temporal developments and trends. Data were obtained from the first follow-up of the KiGGS study (KiGGS Wave 1) conducted from 2009 to 2012. All girls and boys aged 11-17 years (n = 5,258) were included. The results show that currently 12.0% of 11- to 17-year-old adolescents in Germany smoke, 5.4% of them on a daily basis. At-risk drinking (AUDIT-C total score) was prevalent among 15.8% of adolescents, heavy episodic drinking (six or more alcoholic standard drinks on a single occasion at least once a month) among 11.5%. No significant gender differences were found for most indicators. However, among adolescents aged 14-17 years, boys revealed a greater inclination toward heavy episodic drinking than girls did (23.1 vs. 16.5 %, p 0.01). Regarding smoking, distinct socioeconomic differences were observed. For example, adolescents from families with a low socioeconomic status (SES) smoke significantly more often on a regular or daily basis compared with their peers from high-SES families (OR = 1.95, 95% CI = 1.16-3.27 and OR = 3.71, 95% CI = 2.05-6.69, respectively). The relationship between SES and alcohol consumption is rather weak. Significant differences emerged only regarding lifetime prevalence of alcohol consumption, and indicate lower consumption rates among low-SES compared with high-SES adolescents (OR = 0.47, 95% CI = 0.33-0.68). Consideration of the KiGGS baseline study data (2003-2006) shows that smoking prevalence has dropped almost by half from 20.4 to 12.0%. The percentage of adolescents who have ever drunk alcohol has decreased from 62.8 to 54.4%. These results are consistent with the findings of other studies on adolescent tobacco and alcohol consumption and should be considered in the context of preventive efforts that have been strengthened in recent years, especially regarding tobacco use.

Within the context of demographic change, the development of morbidity among the older population has increasingly gained importance. In this respect, three different scenarios of the development of morbidity are discussed: the compression of morbidity, the dynamic equilibrium, and the expansion of morbidity.This paper investigates in which way subjective and functional health have developed among the older population between 1997 and 2010.Using German Socio-Economic Panel (GSOEP) data, the developments of subjective and functional health are examined in cross-sectional comparisons. The age groups between 65 and 89 are considered. Analyses are stratified according to gender and age.In comparing different cohorts, men and women from younger cohorts report better subjective and functional health compared to people born before them. Concerning subjective health, this trend mostly affects younger people (65-74 years). Elderly subjects (aged 75-89 years) in the cohort comparison between 1997 and 2010 report no improvements in subjective health. In contrast, functional health between the cohorts affected all age groups in a similar manner.Results for subjective and functional health are consistent with the compression of morbidity and the dynamic equilibrium and they do not point towards an expansion of morbidity.

The German health interview and examination survey for adults (DEGS1) with the mental health module (DEGS1-MH) is the successor to the last survey of mental disorders in the general German population 15 years ago (GHS-MHS). This paper reports the basic findings on the 12-month prevalence of mental disorders, associated disabilities and self-reported healthcare utilization.A representative national cohort (age range 18-79 years, n = 5,317) was selected and individuals were personally examined (87.5 % face to face and 12.5 % via telephone) by a comprehensive clinical interview using the composite international diagnostic interview (CIDI) questionnaire.The overall 12-month prevalence of mental disorders was 27.7 % with substantial differences between subgroups (e.g. sex, age, socioeconomic status). Mental disorders were found to be particularly impairing (elevated number of disability days). Less than 50 % of those affected reported to be in contact with health services due to mental health problems within the last 12 months (range 10-40 % depending on the number of diagnoses).Mental disorders were found to be commonplace with a prevalence level comparable to that found in the 1998 predecessor study but several further adjustments will have to be made for a sound methodological comparison between the studies. Apart from individual distress, elevated self-reported disability indicated a high societal disease burden of mental disorders (also in comparison with many somatic diseases). Despite a relatively comprehensive and well developed mental healthcare system in Germany there are still optimisation needs for treatment rates.

Measles is a vaccine-preventable disease that could be eliminated by global vaccination strategies with two-dose measles vaccination. The World Health Organization (WHO) European Region aims at achieving measles elimination by 2015. Target control is mainly based on verification of 95 % vaccination coverage. In Germany, target verification cannot be based on data from centrally collected registers on vaccination and seroprevalence of measles-specific antibodies.This paper provides an overview of measles vaccination coverage and the timeliness of measles vaccination in birth cohorts 1989-2008. In addition, factors associated with vaccination gaps are described.Primary data on vaccination coverage (annual school entrance health examination) and on vaccination coverage and immune status (population-based German Health Interview and Examination Survey for Children and Adolescents - KiGGS) and secondary data (insurance refund claim data) are described and discussed.The measles immunization coverage (two doses) obtained in the 2010 school entrance examinations was 91.5 %. The range was 87.6-95.3 % between Federal States. Regional differences were even more pronounced between districts. The timeliness of the two-dose measles immunization increased from 41 % (birth cohorts 2001/2002) to 66 % (birth cohorts 2006/2008). Despite progress in recent years, measles vaccination coverage is still inadequate in adolescents, young adults, and young children. The German Standing Committee on Vaccination (STIKO) recommends a combined MMR vaccination of adults who were born after 1970 and who were not fully vaccinated against measles during childhood. Successful implementation of this recommendation is crucial just as it is important to step up efforts to improve the timeliness of measles vaccination in young children. Regional vaccination gaps and susceptible clusters defined by age or sociodemographic parameters are of particular importance to the epidemiology of measles disease. Knowledge of the factors associated with nonimmunization should be used to tailor vaccination strategies.

The aim of this paper is to identify characteristics that inhibit or encourage the diffusion of novel implants in the German health care system using the example of drug-eluting stents (DES). After their introduction in the early 2000s, DES were considered as an effective innovative technology. Hypotheses that link the use of DES to characteristics on patient-level, hospital-level, regional-level as well as on state-level are generated on existing literature. These hypotheses are tested using administrative data from a German sickness fund.The analysis is based on the administrative sickness fund data of 6 777 patients with a hospital admission due to an acute myocardial infarction (AMI) and an implantation of either a DES or a bare-metal stent. The sickness fund data was merged with information on reimbursement surcharges for DES implantations, information from the German Hospital Registry and information on county level provided by the German National Statistical Office. Logistic regressions with random intercepts on hospital and county level as well as fixed effects on state level were estimated to identify characteristics that are correlated with DES use.All levels do have an impact on the treatment decision whereas the patient-level is of major importance. In particular, young age, admission to a university or a privately owned hospital and a hospital located in a county with a low level of bankruptcies are positively correlated with DES use.Although individual characteristics are of major importance for DES use in the German health care system, characteristics at the hospital and regional level do have an impact on the use of DES. Further research on the influence of reimbursement mechanisms in the German setting is needed.

The social and political participation of elderly people is characterized by social inequality. Participation processes normally consolidate and intensify the exclusion of senior citizens having low incomes and low educational qualifications. In the research and development project "Quality of Life of Elderly People in Living Quarters" being conducted by Dortmund University of Applied Sciences and Arts, one of the questions being examined is whether and to what extent socially disadvantaged elderly people in a social space typical of the Ruhr region (reference area Gelsenkirchen-Schalke) can be included in the shaping of their quarter. This paper is based on the results of a quantitative, written survey (cross-section) on the subjects of quality of life and participation, and on a trend analysis measuring the effects of participation processes initiated on the elderly persons involved. The results of the study show that it is possible to involve socially disadvantaged elderly people in participation processes geared to the specific social space. They also indicate that elderly people from different income groups increase their social capital in the context of enabling structures.

Since the late 1990s several measures have been introduced in Germany to curb tobacco use and to protect non-smokers. Smoking bans in public spaces, including restaurants and pubs, are part of them. It is the aim of the paper to analyse the change in smoking prevalence and attitudes towards smoking bans in the population of Düsseldorf, Germany, over time.Random samples from the population register of the city of Düsseldorf of persons with German nationality, 18 years onwards were approached. Mail surveys were sent with up to 3 reminders in the years 1997, 1998, 2004, 2007 and 2009. Response rates were between 52% and 59% (N per date of comparison ca. 700-1 200).The number of daily smokers has declined between 1997/98 and 2009 from 33% to 21%. Likewise, the number of cigarettes smoked per day has declined. The number of respondents who favour smoking bans has increased. Rather than favouring a total ban, a partial ban is often preferred (with a zone for smokers). Whether a smoking ban is favoured depends on whether the respondent is using tobacco and whether dangers are ascribed to tobacco use and tobacco smoke. Self-rated health does not exert an impact on attitudes towards smoking bans with the exception of the most recent survey, done in 2009. Here those respondents were most often in favour of bans who considered their health as being very good. Possibly this reflects a new situation where the acceptance of smoking bans has become part of a self-perceived healthy lifestyle.

Municipalities in Germany have to advance health care structures to be resistant to demographic transitions and to the changing health care needs of the regional population in upcoming years. Therefore, it is important to note that needs vary from region to region and that care structures have to be differentiated according to this. Indeed regionality and community care have been increasingly referred to in current debate on improving care structures. But the discussed approaches remain relatively unclear and, moreover, fail to overcome care fragmentation and legal or sectoral perspectives. This paper points out the current lack of systematic knowledge about regional health disparities as well as knowledge about models of health care that are appropriate especially for disadvantaged communities and also rural regions. Moreover, knowledge of steering mechanisms that enforce the development of regional care systems are not developed yet.

For demographic reasons, the German labor force will decrease dramatically and it will be much older on average. However, labor demand, especially for qualified workers, is expected to remain high. This paper focuses on the possibilities of expanding the labor force by increasing the participation rates of women and older persons. Herein, the change in the labor force is decomposed with respect to population and labor participation and, moreover, the effects of higher participation rates are simulated. The decomposition and simulation scenarios are based on data published by the Institute for Employment Research. The analysis clearly reveals that the effect of a considerably higher labor participation of women and older workers will disappear over time when the working-age population shrinks more and more. In addition, individuals who are currently unemployed or out of the labor force are not skilled enough. Since it seems difficult to get more qualified workers in the short and even in the medium term, improving the conditions for women and older people to take up jobs should be tackled soon. This includes investments in education and health care.

Research into the associations between work, age, and health and the impact of these associations on employment status has focused on health as a crucial determinant of staying on the job. In our paper, we ask whether concentrating on health is still feasible, particularly when considering the change in demographics and the increasing proportion of older people in the workplace. We introduce a theoretical model describing health as a variable that indirectly influences leaving employment. According to our model, the immediate decision to leave employment is due to work motivation and work ability. These two factors may require intervention activities different from those needed to improve health. Our model explains employment participation as a result of complex associations between work, socioeconomic status, lifestyle, and health especially with work ability and work motivation. The complexity of these processes should be considered in studies by conducting longitudinal investigations like the German lidA study (http://www.lida-studie.de). If the model is verified in scientific studies like lidA, it can be used as a basis for preventive and intervening activities in practice, i.e., in politics, enterprises, and science.

Depression in old age is common and has severe consequences. The paper reviews the most recent results of population-based and primary care-based studies reporting the prevalence, course and risk factors for depression in old age. Consequences of late life depression for the individual and for the society in terms of costs of illness are outlined. Studies of health service utilization and costs showed homogeneously that healthcare costs for depressive elderly individuals are one third higher compared to non-depressive individuals even though most do not receive depression-specific treatment. Late life depression is underrecognized and undertreated and data from Germany are rare. Improvement strategies, such as collaborative care models are discussed; however, adaptation and implementation to the German context are still pending. Future demographic changes will facilitate mental health service research into late life depression.

The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an "occupational disease". This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part I addresses the general factors and possible concurrent factors of CTS. These results may be helpful in later experts' reviews of the "occupational disease CTS".A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random effects model.The CTS prevalence in all studies independent of study type was 10.6 % (95 % CI 7.8-14.2). The crude incidence calculated from the longitudinal studies was 10.4 (95 % CI 8.9-11.9)/1000 person years. Female patients more frequently suffered from CTS [OR = 1.9 (95 % CI 1.6-2.2), p 0.001]. The prevalence of CTS was correlated with an increase in age. The highest prevalence was observed in middle-aged patients (40 to 60 years old). Other significant CTS-associated factors were overweight or obesity [OR = 1.4 (95 % CI 1.3-1.6), p 0.001]. CTS more frequently occurred in the dominant hand [OR = 1.8 (95 % CI 1.4-2.3), p 0.001] and in persons of "non-white race" [OR = 1.6 (95 % CI 1.2-1.9), p 0.001]. Furthermore, CTS was often associated with numerous other general diseases. Real risk factors (results from longitudinal studies) were the following: female gender [OR = 3.7 (95 % CI 2.6-5.2), p 0.001], middle age [OR = 2.2 (95 % CI 0.9-4.9), p 0.001], overweight or obesity [OR = 1.5 (95 % CI 1.1-1.9), p 0.001], diabetes mellitus [OR = 5.3 (95 % CI 1.6-16.8), p 0.001], and excessive alcohol abuse [OR = 2.3 (95 % CI 0.7-2.3), p 0.001].CTS is an extremely frequent disease. Independent of occupational burden, many patients are suffering from this frequent peripheral nervous compressive syndrome. These data will be essential in later experts' reviews of the "occupational disease CTS".

The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an "occupational disease". This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part II addresses the occupational factors of CTS.A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random-effects model.The prevalence of CTS in working populations [10.9 % (95 % CI 7.9-14 : 9)] was significantly higher than in the general population [8.2 % (95 % CI 2.3-25.1), p 0.001]. Working people had a CTS incidence of 17.3 (95 % CI 14.5-20.1)/1,000 person years. In contrast, the crude incidence in the general population was 1.8 (95 % CI 1.4-2.2)/1.000 person years (p 0.001). The heterogeneity of the different study designs made it impossible to detect concrete prevalence or incidence rates for specific job groups. However, "blue-collar work" was a significant risk factor for CTS [OR = 3.1 (95 % CI 1.9-5.3), p 0.001]. Thus, it makes sense to evaluate concrete hand burdens. In numerous studies, some factors were associated with CTS: repetition [OR = 2.7 (95 % CI 1.8-39), p 0.001), chronic wrist flexion [OR = 1.7 (95 % CI 1.0-2.6), p = 0.033], powerful grip [OR = 4.4 (95 % CI 1.4-13.6), p = 0.009], and chronic vibration load [OR = 2.6 (95 % CI 1.7-4.0)]. Primarily, combined hand loadings were estimated. For this evaluation, the hand activity level threshold limit values (HAL TLVs®) of the ACGIH (American Conference of Governmental Hygienists) were useful. Manual work in the 4th quartile of this score was significantly associated with the prevalence of CTS [OR = 2.9 (95 % CI 1.5-5.7), p = 0.001]. These score values were identified as a significant risk factor for occupational CTS.It was impossible to define exact prevalences or incidences of CTS for specific job titles. However, it was possible to identify manual loadings with a significantly higher risk or association with CTS, including repetition, wrist flexion, powerful grip, and vibration. These loadings are usually combined during occupational work. Subsequent experts' reviews have to respect these complex hand loadings. It may be useful to use instruments, such as HAL TLVs®.

Externalising behavior problems involve a huge developmental risk potential as they can substantially interface with the parallel process of establishing and forming identity in peer groups during adolescence while simultaneously coping with expectations regarding academic achievement and behaviour. Therefore adolescents with externalising behavior constitute a potential target audience for health promotion.The purpose of this paper is to clarify in what kind of social contexts externalising behavior problems are associated with decreased subjective health in adolescence.An analysis of secondary data from the KiGGS study (Robert Koch-Institute, 2009) was undertaken. Calculations of logistic regression models for boys and girls were performed on the basis of preceding stratifications using the indicator subjective health and including relevant social demographic factors.Externalising adolescents face a higher risk of decreased subjective health than inconspicuous adolescents of the same age group, while there is a gender-specific difference (boys OR 2.76; girls OR 1.48). The gender-specific differences in subjective health appraisal found in inconspicuous adolescents cannot be verified in adolescents with externalising behaviour. Related to social demographic predictors a classic social gradient for girls is verified whereas externalising behaviour in boys is predominantly associated from high social class and decreased subjective health. In multivariate procedures a higher odds ratio for decreased subjective health becomes apparent for adolescents who ascend or descend in relation to their education level as well as for adolescents from higher social classes who had to repeat a school year.Adolescents with externalising behavior frequently rate their health situation as being bad. The fact that it is primarily boys with behavior problems and boys who are intergenerational mobile educationwise who exhibit decreased psychosocial well-being, indicates that an increased context related exclusion risk (ostracism) is an essential health risk factor. Micro-groups of adolescents facing risk of being ostracised appear to be an essential target group for prevention and health promotion which so far is not being taken into consideration on the basis of school type related recommendations.

BACKGROUND AND RESEARCH QUESTIONS: In the current paper, it is analyzed whether the extent of loneliness of adults in the second half of their lives has changed between 1996 and 2008 in Germany. Because patterns of objective social integration have evolved differently in different birth cohorts (familial integration in earlier birth cohorts more fragile, more solid in later birth cohorts), we expected different trends in the extent of loneliness in different birth cohorts.The three waves of the German Ageing Survey (DEAS) constitute the database for the analysis: 1996 (n = 3,979), 2002 (n = 2,766) and 2008 (n = 4,392). Loneliness was measured with the de Jong Gierveld Loneliness Scale. The German Ageing Survey (DEAS) is a nationwide representative survey of the German population aged 40-85 years.Only a minority of people report being very lonely in the second part of life. Between 1996 and 2008, there is a positive trend in the extent of loneliness in the second half of life, i.e., the prevalence of loneliness decreased during this period of time. From 1996 to 2008, the youngest respondents (40-54 years of age) and the middle aged respondents (55-69 years) demonstrated a decline from 1996 to 2002 followed by an increase in loneliness between 2002 and 2008. The oldest respondents (70-85 years of age) experienced a steady decline in loneliness. Gender differences (men are somewhat lonelier than women) remain stable between 1996 and 2008.While people who are currently old are socially well integrated and, hence, experience loneliness only to a small degree, there is a higher risk for persons who are currently in middle adulthood because their social networks have become increasingly more fragile. Further changes have to be observed.

The Kiel Obesity Prevention Study (KOPS) has been performed since 1996. Examinations were performed at age 6, 10 and 14 years. In addition, birth weight as well as height and weight at age 2 years were collected retrospectively. For the study 4,997, 1,671 and 748 children were recruited at baseline (at age 6 years) as well as at 4 and 8-year follow-up, respectively. In this paper we will analyze and discuss (i) the important time period for preventive measures, (ii) effect sizes needed for successful interventions and (iii) suitable approaches for preventive measures. The main results were: (i) at age 6 years persistence of overweight was 69% while at younger ages persistence was 21% only. Thus, school entry was shown to be an important period for preventive measures. (ii) Interventions have to reduce energy balance by 140 kcal/day to prevent overweight (e.g. a reduction of energy intake). (iii) Prevention programs should involve the family and focus on increasing physical activity.

Ceramics have been used in dentistry for many years. Especially during the last few years, the development of ceramic-related technology has steadily increased, and all-ceramic crowns are in the process of replacing traditional gold restorations on the market. Despite the relatively long experience with the material and technology, there are still only afew clinical studies on the long-term success rates. For this paper, three different ceramic systems (In-Ceram, Empress 2, and Cergo) were examined and results compared with the findings of the existing literature. Furthermore, the clinical follow-up examinations intended to determine the extent to which subgingival restoration margins influence the periodontium.

While the number of fatal accidents decreases every year, there is still need for improvement and action to prevent these deaths. The basis for this purpose has to be an analysis about the factors influencing the car crash mortality.This multivariate analysis is based on 2,609 cases collected by the accident research units in Dresden and Hanover during the years 1999-2003. This paper presents a multivariate model containing ten different variables which detects 93% of these cases properly as"survived" or"dead."The variable"energy equivalent speed" (EES) has the most important effect on car crash mortality. Values greater than 60 km/h lead to a 248-fold higher mortality risk. The mortality is not related to gender, but rather to the value of EES. Younger persons (18-25 years) have no significantly higher risk for death, but for persons older than 60 years the risk was threefold higher.Univariate assessments may be falsified by bias; this effect can be uncovered by multivariate models.

This contribution discusses the outpatient and inpatient medical care of elderly patients in Germany. The paper first focuses on the increasing utilization of the two care sectors especially by the very old in the sense of a "geriatrization" of the system followed by a detailed analysis of the costs associated with a higher frequency of contact with the medical care system. On the one hand, the determining factor for outpatient treatment costs is more likely to be the patient's age rather than the type of disease. On the other hand it was found that inpatient treatment costs are associated more with closeness to death than with patient's age. A third central point beside these quantitative aspects continues to be the discussion about current deficits in the care of elderly patients. While the discussion on the outpatient medical care centers on physician-related factors and their influence on the quality of care exemplified by depression and dementia, the discussion on inpatient care focuses on structural problems. This is followed by the discussion of central organizational and research needs in the medical care of the elderly.