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Background In cases of life-threatening maternal conditions in the periviable period, professionals may consider immediate delivery with fetal demise as a consequence of the treatment. We sought the opinion of involved medical professionals on management, reporting, and auditing in these cases. Methods We performed an online survey amongst all registered maternal-fetal medicine (MFM) specialists and neonatologists in the Netherlands. The survey presented two hypothetical cases of severe early-onset pre-eclampsia at periviable gestational ages. Management consisted of immediate termination or expectant management directed towards newborn survival. Findings In the case managed by immediate termination, 62% percent answered that fetal demise resulting from induction of labor for maternal indications should be audited only within the medical profession. In the case of expectant management, 17% of the participants agreed with this management. Some answers revealed a significant difference in opinion between the medical specialists. Conclusion Perspective of MFM specialists and neonatologists differs with regard to counseling prospect parents in case of severe early onset pre-eclampsia. The majority of professionals is willing to report late termination (after 24 weeks' gestation) for severe maternal disease to medical experts for internal audits but not for legal auditing.

SummaryObjectives Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to support the design of improved presentation of electronic health information.Methods We conducted a contextual analysis and visioning project. We used an eye-tracker to record 20 clinicians’ information use activities in critical care settings. We played video recordings back to clinicians in retrospective cued interviews and queried: 1) context and goals of information use, 2) impacts of current display design on use, and 3) processes related to information use. We analyzed interview transcripts using grounded theory-based content analysis techniques and identified emerging themes. From these, we conducted a visioning activity with a team of subject matter experts and identified key areas for focus of design and research for future display designs.Results Analyses revealed four unique critical care information use activities including new patient assessment, known patient status review, specific directed information seeking, and review and prioritization of multiple patients. Emerging themes were primarily related to a need for better representation of dynamic data such as vital signs and laboratory results, usability issues associated with reducing cognitive load and supporting efficient interaction, and processes for managing information. Visions for the future included designs that: 1) provide rapid access to new information, 2) organize by systems or problems as well as by current versus historical patient data, and 3) apply intelligence toward detecting and representing change and urgency.Conclusions The results from this study can be used to guide the design of future acute care electronic health information display. Additional research and collaboration is needed to refine and implement intelligent graphical user interfaces to improve clinical information organization and prioritization to support care decisions.Citation: Wright M, Dunbar S, Macpherson B, Moretti EW, Del Fiol G, Bolte J, Taekman JM, Segall, N. Toward designing information display to support critical care: A qualitative contextual evaluation and visioning effort.

Zusammenfassung Hintergrund: In Deutschland gibt es bisher wenige Daten zur gesundheitsbezogenen Lebensqualität von Einschulungskindern. Ziel: Ziel dieser Studie war es daher, die gesundheitsbezogene Lebensqualität von Einschulungskindern in Bayern zu untersuchen und, unter Berücksichtigung von Umweltfaktoren, Prädiktoren dafür zu finden. Methoden: Die analysierten Daten stammen aus dem fünften Survey (2010/2011) der in Bayern durchgeführten Gesundheits-Monitoring-Einheiten. Mittels eines Elternfragebogens wurden Informationen zur gesundheitsbezogenen Lebensqualität der Einschulungskinder (KINDL-R(evised)), zu Verhaltensauffälligkeiten und -stärken ( Strength and Difficulties Questionnaire (SDQ)), zu soziodemografischen Merkmalen sowie zu Umweltfaktoren erfasst. Ergebnisse: Es konnten 3 744 Kinder (45,9% Mädchen; Altersdurchschnitt 6,0 Jahre; SD=0,4) in die Analyse eingeschlossen werden. Mädchen hatten signifikant höherer Werte als Jungen sowohl im Gesamt KINDL-R (83,7 vs. 82,4; p≤0,0001) als auch in allen KINDL-R Subskalen mit Ausnahme der Bereiche „psychisches Wohlbefinden“ und „körperliches Wohlbefinden“. Für letzteres fanden sich bei Jungen signifikant höhere Werte als bei Mädchen (84,1 vs. 82,9; p=0,0103). Multiple lineare Regressionsanalysen zeigten, dass von Eltern berichtete Luftverschmutzung oder Lärmbelästigung, die Möglichkeit der Kinder sicher draußen zu spielen und die Zeit, die ein Kind im Sommer unter der Woche draußen verbringt, signifikante Prädiktoren der mit dem KINDL-R gemessenen gesundheitsbezogenen Lebensqualität sind. Adipositas stand nicht im Zusammenhang mit der gesundheitsbezogenen Lebensqualität. Kinder mit Migrationshintergrund hatten signifikant höhere Werte in den Subskalen „Familie“ und „Freunde“. Schlussfolgerung: Umweltfaktoren stehen im Zusammenhang mit der gesundheitsbezogenen Lebensqualität von Einschulungskindern in Bayern, sind jedoch nur teilweise von relevanter Bedeutung. Obwohl sich signifikante Assoziationen zeigen, ist ihre Aussagekraft aufgrund der geringen erklärten Varianz eher limitiert.

In June 2015 the scientific academies "Leopoldina" and "acatech" and the union of the German academies of sciences and humanities published a statement on public and global health in Germany. The statement contains many valuable albeit generic and well-known recommendations. The few specific recommendations focus on centralizing research while weakening the role of universities and on the relative increase of research on public health genomics. These recommendations are not based on empirical or theoretical analyses and risk subverting successful developments of the recent past. To actually strengthen public and global health in Germany the existing institutions need to be backed up while designated funding of public and global health needs to be extended.

Contains fulltext : 152606.pdf (Publisher’s version ) (Open Access) Objective The aim of this study was to assess which characteristics and results of vaginal examination are predictive for delivery within 7 days, in women with threatened preterm labor after initial treatment. Study Design A secondary analysis of a randomized controlled trial on maintenance nifedipine includes women who remained undelivered after threatened preterm labor for 48 hours. We developed one model for women with premature prelabor rupture of membranes (PPROM) and one without PPROM. The predictors were identified by backward selection. We assessed calibration and discrimination and used bootstrapping techniques to correct for potential overfitting. Results For women with PPROM (model 1), nulliparity, history of preterm birth, and vaginal bleeding were included in the multivariable analysis. For women without PPROM (model 2), maternal age, vaginal bleeding, cervical length, and fetal fibronectin (fFN) status were in the multivariable analysis. Discriminative capability was moderate to good (c-statistic 0.68; 95% confidence interval [CI] 0.60-0.77 for model 1 and 0.89; 95% CI, 0.84-0.93 for model 2). Conclusion PPROM and vaginal bleeding in the current pregnancy are relevant predictive factors in all women, as are maternal age, cervical length, and fFN in women without PPROM and nulliparity, history of preterm birth in women with PPROM.

Ziel: Erhebung der Pravalenz der Bekanntheit von Sonnenschutzkampagnen bei Eltern in Bayern, Analyse der Bedeutung soziodemografischer Merkmale fur die Kampagnenkenntnis und der Assoziation zwischen Kampagnenkenntnis der Eltern und Sonnenschutzverhalten bei ihren Kindern. Methodik: Querschnittstudie 2010/2011 in Bayern mit Eltern von 4 579 Kindern im Alter 5–6 Jahre (Teilnahmerate 61%). Ergebnisse: Die Pravalenz der Bekanntheit von Sonnenschutzkampagnen bei Eltern betragt 13% und ist unabhangig von soziodemografischen Merkmalen. Die Unkenntnis von Sonnenschutzkampagnen ist mit unzureichendem Sonnenschutz von Kindern assoziiert, auch bei Berucksichtigung von soziodemografischen und auf die UV-Exposition bezogenen Faktoren. Schlussfolgerung: Die Bekanntheit von Sonnenschutzkampagnen ist bei Eltern gering. Das Wissen zu adaquatem Sonnenschutz von Kindern sollte auf Bevolkerungsebene unabhangig vom soziodemografischen Status weiter gesteigert werden.

Unterschiede in der Tabakrauchbelastung von Kindern wurden durch migrationsspezifische Charakteristika, soziookonomische Faktoren und Wohnbedingungen, sowie Wissen und Einstellung der Eltern zu Tabakrauch untersucht. In einer Querschnittstudie wurden 2008/2009 Daten von 5 336 Vorschulkindern (29% Migrationshintergrund) uber einen Elternfragebogen erhoben (Teilnahmerate: 61%). Mittels multipler logistischer Regression wurde die Assoziation von Migrationshintergrund und Tabakrauchbelastung der Kinder analysiert. Kinder mit Migrationshintergrund sind in ihrem Zuhause einer erhohten Tabakrauchbelastung ausgesetzt. Multivariable Analysen zeigen, dass die Adjustierung fur soziookonomische Faktoren und Wissen der Eltern zu effektivem Schutzverhalten die Assoziationsmase der Migra­tionsvariablen deutlich vermindert. Im Vergleich zu Kindern ohne Migrationshintergrund bleibt die Chance einer Tabakrauchexposition fur Kinder mit Migrationshintergrund erhoht (OR [95% KI]: 1,57 [1,23–2,01]). Besonders durch Tabakrauch belastet sind Kinder aus turkischsprachigen Familien im Vergleich zu Kindern aus deutschsprachigen Familien (3,05 [2,18–4,26]). Um eine rauchfreie Lebenswelt fur Kinder zu schaffen, ist eine migrantensensible Tabakpravention in ausgewahlten Risikogruppen notwendig.

This position paper of the German Public Health Association describes current situation and perspectives of public health in Germany with emphasis on research and teaching. It outlines those measures necessary for strengthening of public health research in Germany.

Ziel: Die Computertomografie (CT) spielt in der Traumadiagnostik, insbesondere bei komplexen Frakturen, auch bei Kindern eine wichtige Rolle. Ziel dieser Studie war, die Aussagekraft von Ultra-low-dose-CT-Untersuchungen (ULD-CT) mit der effektiven Dosis von Rontgenaufnahmen im Modellversuch zu prufen und die Ergebnisse mit denen von Rontgenaufnahmen zu vergleichen. Material und Methoden: Als Modell fur kindliche Knochen wurden Extremitatenknochen von toten Ferkeln verwendet. Insgesamt 51 frakturierte und nicht frakturierte Knochen wurden mit einem 64-Zeilen-CT anhand eines Standarddosisprotokolls als Referenzstandard, zweier Ultra-low-dose-Protokolle und Standardrontgenaufnahmen mit verschiedenen Belichtungsparametern untersucht. Ergebnisse: Trotz hohen Bildrauschens waren die Untersuchungen des ULD-CT nur in 2 von 204 Fallen nicht ausreichend sicher zu beurteilen. Bezuglich der Frakturdetektion fanden sich geringe Vorteile des ULD-CT gegenuber den Rontgenaufnahmen. Die Frakturen konnten in der ULD-CT deutlich besser charakterisiert werden als anhand von Rontgenaufnahmen. Im Gesamtergebnis war die ULD-CT den Rontgenaufnahmen mit Standardbelichtungswerten signifikant uberlegen. Schlussfolgerung: Die ULD-CT mit der effektiven Dosis von Rontgenaufnahmen ist in der padiatrischen Frakturdiagnostik erfolgreich durchfuhrbar und im Gesamtergebnis Standardrontgenaufnahmen signifikant uberlegen.

Background and aim In Germany the risk for relative poverty has increased profoundly during the last 15 years, especially among single parent families. As poverty is often associated with bad health we examined the physical and mental health as well as health-related behaviour, housing and environmental conditions in children with lone mothers versus children in couple families. Study population and methods In 3 cross-sectional surveys conducted during 2004-2007 in 3 cities and 3 rural areas in Bavaria data on 19 039 pre-school children (47% female) were collected. Health, behaviour and exposure assessment was based on parental reports. The 18 327 cases with complete information on family status were analysed. 10% of the children grew up with single mothers. Results Single mothers evaluated the general state of health of their children more often as moderate to very poor than couple parents (OR [95% CI]: male: 1.37 [1.07-1.77], female 1.77 [1.33-2.35]). Sons with single mothers were more often obese (1.44 [1.09-1.90]). They scored significantly higher in the SDQ total difficulties score (1.94 [1.44-2.62]), on the emotional problem scale (1.91 [1.40-2.59]) as well as on the hyperactivity scale (1.82 [1.35-2.47]) compared to boys from couple families. No difference was found in prosocial behaviour. Girls with single mothers revealed more often conduct problems 1.36 [1.02-1.81] compared to those from couple families. They also showed a significantly higher prevalence of asthma (2.06 [1.29-3.30]). Children living with their single mothers were less often members of sports clubs and the boys were less physical active. No difference was found regarding the consumption of fruits and vegetables. Single mother family was associated with children's environmental tobacco smoke exposure at home (2.03 [1.79-2.29]). Single mothers perceived higher environmental exposures to noise and air pollution, suffered more often from a lack of accessible green spaces in the neighbourhood and reported a higher traffic load on the residential street. Conclusion Children with single mothers reveal increased health risks and live under significantly poorer housing and environmental conditions. Further analyses are necessary to identify the mediating factors.

Wenn das Herz es nicht mehr schafft, die benotigte Menge Blut in den Organismus zu pumpen, kann ein Unterstutzungssystem den Kreislauf mechanisch unterstutzen – auch langfristig. Bei der Betreuung der Patienten mit einem Ventricular Assist Device (VAD) spielt besonders die Vermeidung einer Infektion an der Driveline des Systems eine Rolle. Das Klinikum Oldenburg hat eine explorative Studie durchgefuhrt, die Aufschluss uber infektionsbegunstigende Faktoren und deren Zusammenhange geben soll.

Background The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions. Study design A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention. Results Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each). Conclusion Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.

Objective The aim of this study was to assess the association between excessive media consumption (TV, video games usw) of more than three hours per day and behavioural problems in 5- to 6-year-old children. Methods Data from 5 155 preschool children were collected within the second health monitoring units (GME survey) during 2005/2006 in Bavaria, Germany. Parentally reported behavioural problems ('normal', 'borderline' or 'abnormal') were assessed from the Strengths and Difficulties Questionnaire. Daily media consumption was assessed for both weekend and weekdays and classified into three categories (rarely, medium, excessive). A multivariate logistic regression analysis was performed to control potential confounders. Results Boys showed more abnormal values on the total difficulties score of the SDQ than girls (8.2 vs. 4.1). Boys were more often excessive media consumers than girls. The association between excessive media consumption and abnormal values on the SDQ was significant in girls (OR: 2.2; 95% CI: 1.3-3.7) for both total difficulties score and subscales in the multivariate analysis. In boys, however, this association was less pronounced (OR: 1.5; 95% CI: 1.0-2.1) and not consistently significant for all subscales. Conclusion Our study has shown a significant association between excessive media consumption and abnormal SDQ values, especially among 5- to 6-year-old girls, but which is less pronounced in boys. Parents of preschool children with excessive media consumption should be informed and the children should undergo a screening for behavioural problems.

Nitrile groups are suitable precursors for amino functions to which various other groups can be attached. Thus, the reaction of the 1,3-bis(3-bromopropyl ether) or 1,3-bis(4-bromobutyl ether) of tert-butylcalix[4]arene with methylmalononitrile has been studied in order to attach four nitrile groups to the narrow rim. Bimacrocyclic dinitriles were formed in 70% yield with malononitrile, and tetranitriles in 85% yield with methylmalononitrile. Subsequent alkylation of the tetranitriles with cobalt dioxane―bis(dicarbollide) gave dianionic calix[4]arenes, isolated as the cesium salts in 68% and 89% yield. Two compounds were characterized by single crystal X-ray analysis.

Secondhand smoke was classified by national and international organisations as a known cause of cancer in humans and has many adverse health effects, especially cardiovascular diseases and lung tumours. Global studies have clearly shown that hospitality venues have the highest levels of indoor air pollution containing different substances that are clearly carcinogenic − such as tobacco-related chemicals − compared with other, smoke-free indoor spaces. Data from the human biomonitoring of non-smoking employees in the food service industry confirm this high exposure level. Non-smokers exposed to secondhand smoke in these environments are at increased risk for adverse health effects. The consistent protection of non-smokers in public places such as restaurants and bars through a smoking ban results in a significant reduction of the pollutants in the air (mostly > 90%) and clearly reduces the internal body burden for users and employees. Furthermore, health complaints by non-smoking employees are reduced and the higher risk for lung tumours of employees in the food service industry compared with the general population can be effectively reduced as well. According to current standards of knowledge, other measures such as spatial separation of smoking areas or the use of mechanical venting systems do not achieve a comparably high and effective pollutant reduction under field conditions. Studies concerning the economic effects of prohibiting smoking in public places conducted in various countries have shown that beverage-focused gastronomical enterprises experience a short-term downtrend but that food-focused gastronomical enterprises do not experience any negative or even positive effects. The positive effects of a ban on smoking in public places on the general population are a decline in cigarette consump-tion and the reduction of secondhand smoke exposure by non-smokers. Smoking bans in hospitality venues are not necessarily linked with a shift of the tobacco consumption to private rooms and an associated increase of secondhand smoke exposure. A comprehensive smoking ban in public spaces without exemption is therefore an easy and targeted measure for gastronomical enterprises from a health perspective.

Polychlorinated biphenyls (PCB) were widely used in numerous industrial and commercial applications in high quantities in the past. Based on their persistence in the environment, their tendency to accumulate in the organism and their specific health effects, PCBs have to be assessed as critical substances. Because the dietary intake was assumed to be the main intake route, the Integrated Exposure Assessment Survey (INES) aimed to measure the recent exposure to PCBs in Germany. The study consisted of 10 female and 10 male participants living in Munich and surroundings. The participants collected dietary duplicates of all food consumed and prepared as for consumption over 7 consecutive days. Altogether the 6 non-dioxin-like PCB congeners 28, 52, 101, 138, 153 and 180 ndl-PCB or, respectively, indicator PCB and furthermore the congener 118 were detected using a gas chromatographic method. Dietary intake was calculated using the amount of food eaten daily and the results from the duplicates. Using the sum of PCB 138, 153 and 180 multiplied by 4, the daily intake ranged from 4.0 to 24.1 ng/kg b.w. (median: 9.5 ng/kg b.w.). On the contrary, the daily intake was 2.9 to 20.6 ng/kg b.w. (median: 11.2 ng/kg b.w.) if the sum of the 6 indicator PCBs multiplied by factor 2 was used for quantification. No sex-related difference of the dietary intake was observable. Overall, it can be concluded that the dietary PCB intake has further decreased in the last years in Germany. At present, the toxicological database is not suitable to assess the risks coming solely from the non-dioxin-like PCBs because it is not possible to differentiate between non dioxin-like and dioxin-like effects in toxicological studies. Nevertheless, a further reduction of PCB exposure via food by searching for possible sources is needed.

During the past years smoking bans in public places including hospitality venues have been introduced in several countries. Up to now, eight ecological studies on hospital admission rates due to acute myocardial infarction or coronary events after introduction of a smoking ban in the United States, Canada, and Italy have been published. This article reviews these studies and discusses their significance and potential sources of error from an epidemiological point of view. The chronological order of reduction in acute myocardial infarction rates following the smoking ban, the consistency of this association in several countries, and the biological plausibility because of the known acute cardiovascular effects of secondhand smoke suggest a causal association. Thus, if this turns out to be true public smoking bans will be a very effective public health measure.

Out of a total of 1640 consecutive left heart catheterizations, 70 (58 males and 12 females; mean age 56 +/- 8 years) were performed via the right brachial artery, in most instances because of occlusive disease of the arteries in the pelvic region. 5F catheters were then successfully used for both the coronary and left-ventricular angiographies. Noninvasive examinations after two days (Doppler ultrasound, oscillography at rest and on exercise, acral plethysmography and colour-coded duplex sonography) revealed small haematomas in the region of the arterial puncture in four and a haemodynamically insignificant fistula between brachial artery and vein in one patient but no aneurysm, stenosis or thrombosis at the puncture site. This procedure is thus a valuable addition to invasive cardiological diagnosis.

Two women had four supervised pregnancies after renal transplantation. A striking feature was that the children had fetal growth retardation which led to premature termination of pregnancy by section. Likely causes of the growth retardation are, in the first instance, long-term treatment with corticosteroids and increased incidence of toxaemia. There is no evidence for a significant rise in the risk of teratogenicity for the embryo by the immunosuppressive treatment. However, an increased mutagenicity risk must remain a possibility in view of the one case of Turner's syndrome. Close interdisciplinary control of mother and child makes it possible to reduce risks to a reasonable level in case of pregnancy after renal transplantation.