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In medical studies digital learning is often achieved by the use of learning management platforms, such as Ilias. Lecture presentations and organizational documents are typical contents. Students use multiple, mostly external learning options for acquisition of knowledge and competences. We present our updated ophthalmology e‑learning environment for medical students and its evaluation.Evaluation of an ophthalmology e‑learning platform for medical students, which considers prevalent learning habits.The platform should provide and link a selection of internal and external learning resources following anatomical structures of the eye. For every subject area the platform provides a text with essential matters, clinical cases, lecture presentations, multiple choice questions for practice, links to corresponding chapters of a textbook and the appropriate AMBOSS learning cards (Amboss GmbH, Berlin, Germany). At the end of the semester an evaluation of the platform was carried out. Different statements were rated by the students on ordinal scales and analyzed.The platform was rated with 1.47 ± 0.54 (mean ± standard deviation; n = 107) on a German school grade scale (1 = best, 6 = worst). It was perceived as helpful for the individual learning with 1.62 ± 0.77 (1 = very helpful, 7 = not helpful at all). The structuring of the internal and external learning resources was rated as very good 1.44 ± 0.66 (1 = very good, 7 = very bad). The median for subjective amount of usage was 1-5 h (ordinal scale1, 1-5, 6-10, 15-20,20 h).It appears to be meaningful to specifically link external learning resources corresponding to the own curricular structure in order to provide medical students with a modern basis for learning in ophthalmology.HINTERGRUND: Digitales Lernen wird in humanmedizinischen Studiengängen meist mittels Learning-Management-Plattformen wie „Ilias“ umgesetzt. Oft werden Vorlesungsfolien und Organisatorisches hierbei online gestellt. Allerdings nutzen Studierende auch externe Quellen und Lernformate in ihrem Lernprozess. Wir stellen hier die Neugestaltung unseres digitalen Lernangebotes und dessen Beurteilung durch die Studenten vor.Evaluation einer eLearning-Plattform für Studierende der Humanmedizin, welche übliches Lernverhalten berücksichtigt.Die Plattform sollte, geordnet nach Augenstrukturen, eine Auswahl an in- und externen Lernmaterialien verknüpfen. Zu jedem Thema erstellten wir ein Skript zu den jeweiligen zentralen Inhalten, Fallbeispiele, Vorlesungsfolien, Übungsfragen und Kapitel von Lehrbüchern sowie die entsprechende Amboss-Lernkarte (Amboss GmbH, Berlin, Deutschland). Am Semesterende erfolgte eine Evaluation der Plattform. In einem Fragebogen wurden verschiedene Aussagen auf Ordinalskalen von Studierenden bewertet.Die Plattform wurde mit 1,47 ± 0,54 (Mittelwert ± Standardabweichung) bewertet (n = 107; Schulnote 1 = sehr gut, 6 = ungenügend). Sie wurde mit 1,62 ± 0,77 als sehr hilfreich für das eigene Lernen empfunden (1 = sehr hilfreich, 7 = gar nicht hilfreich). Die Strukturierung der internen und externen Lernmaterialien wurde als sehr gut mit 1,44 ± 0,66 bewertet (1 = sehr gut, 7 = sehr schlecht). Im Median wurde eine Nutzungsdauer von 1–5 h angegeben (Ordinalskala1, 1–5, 6–10, 15–20,20 h).Es erscheint sinnvoll, häufig genutzte externe Lernmaterialien gezielt mit der eigenen curricularen Struktur und ihren Inhalten zu verknüpfen und digital auf einer Plattform zur Verfügung zu stellen, um eine zeitgemäße Basis für Wissenserwerb für Studierende in der Augenheilkunde zu schaffen.

The influence of smoking on survival in patients with HNSCC is well documented in the literature. There is little data on changes in smoking habits after diagnosis. Here, the effect on survival of the reduction of smoking compared to full smoking cessation is investigated.Patient records and tumor documentation of 643 consecutive HNSCC cases of the Head and Neck Tumor Center of the University Hospital Kiel are evaluated retrospectively: smoking habits before and after treatment and survival are evaluated.Change in smoking behavior at the initial diagnosis of HNSCC leads to a significant positive effect on the prognosis compared to continued smoking. There is no difference between smoke reduction and weaning. This effect is based solely on those patients who are treated exclusively by surgery. Lifelong non-smokers have a significant survival advantage over active and ex-smokers, with no difference between the latter two groups.The positive influence of changed smoking habits on the prognosis runs parallel to the negative direct effect of active smoking on therapy, which is attributed to peritumoral hypoxia with a negative effect on the effectiveness of R(C)T. The positive effect of the change in smoking behaviour during surgery alone is most likely due to reduced peri-operative complications. Patients should be encouraged to at least minimize smoking with the cancer diagnosis. In addition, former smokers should be considered active smokers for survival estimates and therapy planning.Der Einfluss des Rauchens auf das Überleben bei Patienten mit Kopf-Hals-Karzinomen ist in der Literatur gut belegt. Es gibt nur wenige Daten über Änderungen der Rauchgewohnheiten nach Diagnosestellung. Hier wird die Auswirkung der Reduktion der Rauchquantität im Vergleich zur vollen Entwöhnung auf das Überleben untersucht.Patientenakten und Tumordokumentationen von 643 konsekutiven Kopf-Hals-Karzinom-Fällen des Kopf-Hals-Tumorzentrums der Universitätsklinik Kiel werden retrospektiv ausgewertet: Rauchgewohnheiten vor und nach der Behandlung sowie das Überleben werden dabei ausgewertet.Eine Änderung des Rauchverhaltens bei der Erstdiagnose des Karzinoms führt zu signifikant positivem Effekt auf die Prognose im Vergleich zu fortgesetztem Rauchen. Es zeigt sich kein Unterschied zwischen Rauchreduktion und Entwöhnung. Dieser Effekt beruht alleinig auf solchen Patienten, die ausschließlich chirurgisch behandelt werden. Lebenslange Nichtraucher weisen einen signifikanten Überlebensvorteil gegenüber aktiven und ehemaligen Rauchern auf, ohne Unterschied zwischen den beiden letztgenannten Gruppen.Der positive Einfluss veränderter Rauchgewohnheiten auf die Prognose verläuft parallel zum negativen direkten Effekt des aktiven Rauchens auf die Therapie, was auf peritumorale Hypoxie mit negativer Auswirkung auf die Wirksamkeit der R(C)T zurückgeführt wird. Der positive Effekt der Rauchverhaltensänderung bei ausschließlicher Chirurgie liegt am ehesten in verminderter perioperativer Komplikation begründet. Patienten sollen ermutigt werden, das Rauchen mit der Krebsdiagnose zumindest zu minimieren. Darüber hinaus sollten ehemalige Raucher für Überlebensschätzungen und Therapieplanung als aktive Raucher betrachtet werden.

This pilot study investigates the effects of habit reversal training in a German-speaking population of children and young adults with chronic tic disorders on comorbid symptoms and subjective interference.16 children were treated using a manualized program. Comorbid-symptoms (ADHD, anxiety and OCD, depression) were assessed using parent and self-ratings. Additionally, the correlation of tic symptoms with comorbid symptoms at the beginning of the therapy was analyzed.We obtained positive results in reducing comorbid symptoms during a primary treatment of tic symptoms. We further found a correlation of tic symptoms and comorbid symptoms especially in parent ratings.These first findings show that a primary treatment of tics may be indicated in patients with comorbid symptoms, because a therapy of tic symptoms has also positive effects on comorbid symptoms.

The family doctor has an increasingly important role to play as a "gatekeeper", with many advantages for the initiation and implementation of a successful weaning program. Controlled studies have demonstrated the effectiveness of a short-term intervention based on motivational talks by the family doctor together with the application of such weaning drugs as nicotine substitutes and bupropion. The latter substance should be offered to adult smokers consuming in excess of ten cigarettes daily. The chances that a smoker can successfully stop smoking is doubled by the use of weaning medication. Ideally,the physician should, at the same time, draw the patient's attention to the significance of a healthy diet and physical exercise.

It is the goal of this study to quantitatively assess the habit patterns of toothbrushing. In the course of nine sessions such variables as force, duration, technique (scrubbing, rotating, or sweeping) as well as the sequence of brush positions and the number of changes of brushing sites were determined in 85 men and women, who were neither motivated nor instructed to maintain oral hygiene. The "force of habit" was an unexpectedly dominant factor, the least variations being observed in the brushing technique. On the other hand, a comparison of the degrees of habit of patients with and without acute or chronic brush-induced lesions (gingival recession, Stillman's clefts, wedge-shaped defects) revealed that patients with gingival recessions had the highest degree of habit. Consequences of clinical relevance are pointed out.

This report is on the care of a temporary denture with gaps in the front area of the upper jaw with fixed and removable artificial dentures (children's prosthesis), covering aspects of gnathoorthopaedic necessity (support zone, tongue habit), aesthetic and speech functions.

223 lung cancer patients were observed from June 1974 to April 1976. The diagnosis was by histology (after biopsy, operation or autopsy). There were 125 (56%) squamous cell carcinomas (sqcc), 42 (19%) small cell carcinomas (smcc), 27 (12%) large cell carcinomas (lacc) and 29 (13%) adenocarcinomas (adec). There were only 6 women (2.7%) in the series (3adec, 2 smcc and 1 lacc). Heavy and very heavy smokers were common in each group; smoking habits--even of patients with adec - differed markedly (p less than 0.0005) from those of an age and sex matched control group of 90 asthmatic patients with atopy. Sqcc patients were evenly distributed over the rural and urban zones of our region. But smcc, lacc and adec were more often seen coming from urban zones (p less than 0.0025). The whole lung cancer group was divided into a small group of 6 non-smokers (2.7%), into a 6.7% group of 15 pipe smokers, into a large group of 69 cigar smokers (30.9%) and into a final group of 133 (59.6%) cigarette smokers. The cigar smokers usually had sqcc (p less than 0.0005). The cancer of cigar smokers is more often a central lesion than a peripheral one (p less than 0.025). A history of repeated airway infections on the one hand, and severe airway infection at the beginning of lung cancer history on the other, are a more frequent association in cigar smokers than in cigarette smokers (p less than 0.01). Therefore, the lung cancer of cigar smokers is especially difficult to recognize. Cigar smoking appears to be just as important a link in the chain of causative factors leading to lung cancer as cigarette smoking.

Ambient inhalable particulate matter (PM) is a serious health concern worldwide, but especially so in China where high PM concentrations affect huge populations. Atmospheric processes and emission sources cause spatial and temporal variations in PM concentration and chemical composition, but their influence on the toxicological characteristics of PM are still inadequately understood.In this study, we report an extensive chemical and toxicological characterization of size-segregated urban air inhalable PM collected in August and October 2013 from Nanjing, and assess the effects of atmospheric processes and likely emission sources. A549 human alveolar epithelial cells were exposed to day- and nighttime PM samples (25, 75, 150, 200, 300 mu g/ml) followed by analyses of cytotoxicity, genotoxicity, cell cycle, and inflammatory response.PM10-2.5 and PM0.2 caused the greatest toxicological responses for different endpoints, illustrating that particles with differing size and chemical composition activate distinct toxicological pathways in A549 cells. PM10-2.5 displayed the greatest oxidative stress and genotoxic responses; both were higher for the August samples compared with October. In contrast, PM0.2 and PM2.5-1.0 samples displayed high cytotoxicity and substantially disrupted cell cycle; August samples were more cytotoxic whereas October samples displayed higher cell cycle disruption. Several components associated with combustion, traffic, and industrial emissions displayed strong correlations with these toxicological responses. The lower responses for PM1.0-0.2 compared to PM0.2 and PM2.5-1.0 indicate diminished toxicological effects likely due to aerosol aging and lower proportion of fresh emission particles rich in highly reactive chemical components in the PM1.0-0.2 fraction.Different emission sources and atmospheric processes caused variations in the chemical composition and toxicological responses between PM fractions, sampling campaigns, and day and night. The results indicate different toxicological pathways for coarse-mode particles compared to the smaller particle fractions with typically higher content of combustion-derived components. The variable responses inside PM fractions demonstrate that differences in chemical composition influence the induced toxicological responses.

The aim of this study was to investigate the effect of cigarette smoking on the failure rates of orthodontic miniscrews. Our cohort consisted of 88 patients with a total of 110 orthodontic miniscrews. Based on their smoking habits, the patients were divided into three groups: the light smokers (≤ 10 cigarettes/day), heavy smokers (> 10 cigarettes/ day), and non-smokers. The light-smoker group consisted of 14 patients with 18 orthodontic miniscrews, and there were 15 patients with 19 miniscrews among the heavy smokers. The nonsmoker group contained 59 patients with a total of 73 miniscrews. The overall failure rate was 18.2% (n = 20). Heavy smokers revealed a significantly higher failure rate than light smokers (p = 0.005) or non-smokers (p < 0.001). No significant differences were observed between non-smokers and light smokers. Miniscrews in the heavy smoker group exhibited a significantly higher failure rate during the first 4 months after insertion than did the miniscrews in the light smokers (p = 0.008) or non-smokers (p < 0.001). Our results suggest that heavy smoking has a detrimental effect on the success rates of orthodontic miniscrews.

Shammah is a chewing tobacco, commonly used in Northern Africa. Leukoplakia-like lesions and oral cancer may be induced. In a 73-year-old male patient from Algeria leukoplakia-like lesions were observed in the anterior mandibular vestibulum and lower lip. The patient has been using shammah for 39 years. During the day three portions of shammah wrapped in a piece of paper tissue are prepared and rest in situ for 4-5 h. Due to its high alkalinity, shammah induces lesions resembling a burn.Clinically, a white homogeneous lesion was seen in the vestibulum and mucosa of the lower lip. The white lesions could not be wiped off. Gingival recessions were seen in the lower front teeth. Root surfaces showed black-brown discoloration. A brush biopsy did not reveal epithelial atypia. The oral cavity showed signs of denture stomatitis and erythematous candidiasis. Microbiologically, Candida albicans was demonstrated.Due to the possibility of oral cancer in association with this habit, leukoplakia-like lesions have to be followed up diligently. Since chewing tobacco is a rare habit in Germany, changes as observed in the present case report may only rarely be observed. Due to migration it seems likely that in the future oral habits may be observed which are atypical for Western Europe. This phenomenon has also been addressed as transcultural dentistry.

Smoking as a major public-health concern is still a widespread habit among nurses and young students of nursing. The hypothesis however, that professional environment positively influences smoking habit, could not be supported: smoking is less influenced by vocational training and practice than by the social environment of the students. The results of the survey also show, that a great part of the smokers have a critical attitude towards their habit and would agree to counteractions. Nursing schools could play an important role therein. The conception of nursing as a responsible health profession would demand to take over a more active part in considering the consequences, in smoking prevention and in supporting cessation.

The hypothenar hammer syndrome (HHS) is a rare form of secondary Raynaud's phenomenon in workers who frequently use the ulnar side of the palm as a hammer. Clinically the patient with HHS shows neurologic symptoms such as paresthesia, numbness and pain and signs of vascular insufficiency such as coldness, pallor, discoloration and blanching of the affected ulnar sided fingers. The diagnosis is verified by angiography, showing thrombosis or aneurysm of the distal ulnar artery. We report on the treatment and outcome of 5 patients with HHS. All patients were painfree after treatment. But with the ongoing working habit of using the hand as a hammer there is always the risk of a recurrence. Therefore the job environment has to be changed considerably and the most effort should go into prevention and prophylaxis. If the change of the working habit is not possible, the job is clearly at stake.

A survey of 293 children in a pediatric practise showed that in 80% a pacifier was used. This spread is the result of a distribution in the hospital at birth on the one hand and appreciation of its tranquilizing effect by the parents on the other hand. According to the parents, the use of a pacifier is a habit. A sucking child can, thus, restore its emotional equilibrium. This self-control reappears in certain situations. With time the child learns to control its behavior by other means. Only few children have difficulties in giving up this habit. Children using an alternative to the pacifier have more dental and jaw deformations than those using a pacifier. Dental pacifiers cause far less deformations than the other types.1. Children who suck their fingers should be given a pacifier. 2. One should give a pacifier to babies with emotional problems up to the age of 6 months. Later on, an object harmless to the teeth should be given. 3. A pacifier should only be used if really necessary.

About 400 girls with non-obstructive urinary tract infection were submitted to special care for at least one year, mostly considerably longer, however. Being searched for functional micturition disturbances, more than one-half of them showed a habit of delaying the micturition until imperative desire to urinate. Girls with this habit had clearly more relapses of UTI than those voiding regularly.

Tic disorders typically start in early childhood and can be classified into provisional tic disorder (tics last12 months) and chronic tic disorders (tics last 12 months). The widely known chronic tic disorder Tourette's syndrome is featuring multiple motor and vocal tics. Tics are typically waxing and waning in frequency and intensity. Concentration and relaxation might decrease tics, whereas stress and excitement might increase tics. Psychiatric comorbidities, like obsessive-compulsive disorder, ADHD, depression and anxiety are common. The etiology is multifactorial with genetic and environmental interactions leading to a dysregulation of cortico-striato-pallido-thalamo-cortical networks.A correct diagnosis and psychoeducation are essential for patients as well as their relatives. Additional therapies are needed for patients with severe tics that cause physical impairment or great psychosocial stress. It is crucial to also treat psychiatric comorbidities. Psychotherapeutic interventions for tics include progressive muscle relaxation, habit reversal training, exposure and response prevention and comprehensive behavioral intervention for tics. First-line psychopharmacological treatment in Europe contains aripiprazole, tiapride and risperidone, which are all used off-label for tic disorders. Haloperidol remains the only approved medication for the pharmacotherapy of tics in Germany, but is rarely used due to its side effects. Cannabinoids gain interest as a new pharmacological option, but are mainly offered within the frame of studies.Das Bewusstsein der Öffentlichkeit für Tic-Störungen und insbesondere für das Tourette-Syndrom ist durch zahlreiche Medienbeiträge in den letzten Jahren gestiegen. Immer wieder wird in TV- oder Printmedien jedoch lediglich von schweren Fällen des Tourette-Syndroms berichtet, die nicht dem durchschnittlichen Krankheitsverlauf entsprechen. Eine umfangreiche Aufklärung über Symptome, Verlauf, Ursachen und Behandlungsmöglichkeiten ist daher wünschenswert 1.

In 1974 amphetaminil was included in the class of addictives or habit-forming drugs, although prescription of the drug is not requiring adherence to strict requirements. Whereas reports of abuse of, and addiction to, amphetaminil have been published in foreign countries since 1967, it was not considered a habit-forming drug in the G.D.R. Observations made by the author and his associates show that this may not be true; abuse of, and addiction to, this particular drug are possible in this country, too. The concern of this paper is to call the reader's attention to possible addiction to amphetamine type drugs. Prescription of amphetamines should always be with caution in order to prevent abuse. It is recommended that careful consideration be given to the question of limiting the amount of amphetaminil to be prescribed.