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Background: Worldwide, the number of SARS-CoV-2 infections is increasing. Serological immunoglobulin tests may help to better understand the development of immune mechanisms against SARS-CoV-2 in COVID-19 cases and exposed but asymptomatic individuals. The aim of this study was to investigate exposure to SARS-CoV-2, symptoms, and antibody responses in a large sample of healthcare workers following a COVID-19 outbreak., Methods: A COVID-19 outbreak among staff members of a major German children's and women's hospital was followed by massive RT-PCR SARS-CoV-2 tests and provided the opportunity to study symptoms, chains of infection, and SARS-CoV-2-specific antibody responses (IgG and IgA) by ELISA. Study participants were classified as COVID-19 cases, and persons with close, moderate, or no exposure to SARS-CoV-2 in the clinical setting, respectively., Results: Out of 201 study participants, 31 were COVID-19 cases. While most study participants experienced many symptoms indicative for SARS-CoV-2 infection, anosmia and coughing were remarkably more frequent in COVID-19 cases. Approximately 80% of COVID-19 cases developed some specific antibody response (IgA and IgG) approximately 3 weeks after onset of symptoms. Subjects in the non-COVID-19 groups had also elevated IgG (1.8%) and IgA values (7.6%) irrespective of contact history with cases., Conclusion: We found that a significant number of diseased did not develop relevant antibody responses three weeks after symptom onset. Our data also suggest that exposure to COVID-19 positive co-workers in a hospital setting is not leading to the development of measurable immune responses in a significant proportion of asymptomatic contact persons., (© 2020 The Authors. Pediatric Allergy and Immunology published by John Wiley & Sons Ltd.)

Objective: Currently, little is known about the progression of an immune response against SARSCoV- 2 upon infection or sub-infection-exposure over time. We examined the serologic response in healthcare workers up to 12 weeks after a well-documented and contained outbreak and compared results with findings from earlier serologic testing in the same population., Methods: This study followed 166 health care workers of the University Perinatal Care Center, Regensburg, Germany, for up to 12 weeks. 27 of the subjects had previously tested positive for the presence of SARS-CoV-2 by PCR testing and developed COVID-19. Serologic responses were tested with two independent commercially available test kits., Results: 77.8 % of COVID-19 study subjects developed a specific IgG-response over the course of the 12-week study, while none of the COVID-19 contact groups had a detectable IgG response. Amongst most COVID-19 patients the values of detectable IgG-responses significantly increased over time as confirmed with both tests, while that of positive IgA responses decreased. Between the number of reported symptoms and antibody responses in COVID-19 patients no correlation was found and no new cases of seroconversion were identified in asymptomatic coworkers with negative PCR during the outbreak., Conclusions: Immune response after COVID-19 increases significantly over time but still approximately 22 % of COVID-19 patients did not mount a measurable serologic immune response within 60 days. Exposed co-workers did not develop any relevant antibody levels at all. We conclude that immunity after infection increases over time, but the antibody response does not develop reliably in all infected people., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Women with an elevated risk for breast cancer require intensified screening beginning at an early age. Such high risk screening differs considerably from screening in the general population. After an expert has evaluated the exact risk a breast MRI examination should be offered at least once a year and beginning latest at the age of 30 depending on the patients risk category. Complementary mammograms should not be performed before the age of 35. An additional ultrasound examination is no longer recommended. To ensure a high sensitivity and specificity high risk screening should be performed only at a nationally or regionally approved and audited service. Adequate knowledge about the phenotypical characteristics of familial breast cancer is essential. Besides the common malignant phenotypes, benign morphologies (round or oval shape and smooth margins) as well as a low prevalence of calcifications have been described. Using MRI benign contrast media kinetics as well as non-solid lesions with focal, regional and segmental enhancement can often be visualized.

Purpose: To analyze the cost-effectiveness of percutaneous image-guided CNBB (stereotactic-/ultrasound-guided; large/vacuum-assisted) of non-palpable breast lesions vs. OSB and to compare and discuss the results reported in the literature with results for German-speaking countries., Materials and Methods: A key word search in three databases, limited to the period from 1/1994 to 12/2006 was performed. Only original papers were selected. No published articles for German-speaking countries were identified; therefore a comprehensive data collection was made., Results: On the basis of 377 abstracts, nine studies were evaluated for final assessment. The data of German-speaking countries were compared with results reported in the literature. This study demonstrates that CNBB compared to OSB leads to reduction in cost ranging from 51-96 %. The cost reduction depends on biopsy modality and lesion type and is subject to national fluctuations. CNBB can replace a surgical procedure in 71-85 % of cases., Conclusion: Use of CNBB as an alternative to OSB has the potential to substantially reduce healthcare costs. The data are based almost exclusively on the North American literature. A potential cost reduction in the Netherlands and Switzerland confirms these findings. Future work must include cost evaluation studies for German-speaking countries since this is an issue with important national economic ramifications.

Peptidylarginine deiminase type 4 (PADI4) genotypes were shown to influence susceptibility to rheumatoid arthritis (RA) in the Japanese population. Such an association could not previously be confirmed in different European populations. In the present study, we analysed exons 2-4 of PADI4 in 102 German RA patients and 102 healthy individuals to study the influence of PADI4 variability on RA susceptibility by means of haplotype-specific DNA sequencing. Analyses of the influence of PADI4 and HLA-DRB1 genotypes on disease activity and on levels of anti-cyclic citrullinated peptide antibodies were performed. Comparing the frequencies of PADI4 haplotype 4 (padi4_89*G, padi4_90*T, padi4_92*G, padi4_94*T, padi4_104*C, padi4_95*G, padi4_96*T) (patients, 14.7%; controls, 7.8%; odds ratio = 2.0, 95% confidence interval = 1.1-3.8) and carriers of this haplotype (patients, 27.5%; controls, 13.7%; odds ratio = 2.4, 95% confidence interval = 1.2-4.8), a significant positive association of PADI4 haplotype 4 with RA could be demonstrated. Other PADI4 haplotypes did not differ significantly between patients and controls. Regarding the individual PADI4 variants, padi4_89 (A-->G), padi4_90 (C-->T), and padi4_94 (C-->T) were significantly associated with RA (patients, 49.5%; controls, 38.7%; odds ratio = 1.6, 95% confidence interval = 1.1-2.3). Considering novel PADI4 variants located in or near to exons 2, 3, and 4, no quantitative or qualitative differences between RA patients (8.8%) and healthy controls (10.8%) could be demonstrated. While the PADI4 genotype did not influence disease activity and the anti-cyclic citrullinated peptide antibody level, the presence of the HLA-DRB1 shared epitope was significantly associated with higher anti-cyclic citrullinated peptide antibody levels (P = 0.033). The results of this small case-control study support the hypothesis that variability of the PADI4 gene may influence susceptibility to RA in the German population. Quantitative or qualitative differences in previously undefined PADI4 variants between patients and controls could not be demonstrated.

We evaluated the association of anti-cyclic citrullinated peptide (CCP) antibody titers with serological markers of disease activity. We also compared three different anti-CCP antibody ELISAs with an anti-citrullin ELISA and the IgM and the IgA rheumatoid factor (RF) in their performance of discriminating between rheumatoid arthritis (RA) and other rheumatic diseases. Sera from 333 consecutive patients of the Rheumaeinheit der Medizinischen Poliklinik Munchen, an outpatient clinic for rheumatic diseases, were collected and tested. Anti-CCP antibodies were assayed with three different commercially available ELISAs. Antifilaggrin antibodies were tested with a commercially available ELISA using in vitro deiminated recombinant rat filaggrin. IgA-RF was analyzed with an ELISA, whereas IgM-RF was measured by latex-enhanced turbidimetry. Rheumatoid arthritis (RA) was diagnosed in 87 patients according to the revised classification criteria of the American College of Rheumatology (ACR), probable RA was diagnosed in 23 patients in an early phase not (yet) fulfilling the ACR criteria, and 223 patients had other rheumatic diseases. Differences in sensitivity and specificity were calculated using McNemar's test. A measure of agreement (kappa statistic) was used to examine whether the tests tended to identify the same patients as positive or negative. Correlations between CCP titers and other tests were analyzed by Spearman nonparametric rank correlation. No significant differences in sensitivity and specificity were found between the tested CCP assays (80.0-80.9% and 97.3-98.1%, respectively). All three CCP tests were slightly but not significantly more sensitive and specific than the anti-citrullin assay (77% and 92%, respectively), comparably sensitive but significantly more specific compared with the IgM-RF (86% and 82%, respectively), and significantly more sensitive but comparably specific compared with the IgA-RF (63% and 94.4%, respectively) in detecting the patients with RA. There was no significant correlation between anti-CCP, anti-citrullin, or IgM-RF or IgA-RF antibody titers and C-reactive protein, erythrocyte sedimentation rate, or white blood cell count. A weak but significant linear correlation was found between anti-CCP titers and IgM-RF titers (r = 0.2, P = 0.03). We could not find a significant difference between the three tested anti-CCP assays and the anti-citrullin test in terms of sensitivity and specificity. Compared with the IgM-RF, all the anti-CCP assays were superior in specificity and comparable in sensitivity. Compared with the IgA-RF, they were more sensitive and comparably specific in the discrimination of patients with RA from other rheumatic diseases. No correlation of any tested autoantibody titer with serological parameters of inflammation was found.

Management of immunodeficient patients includes monitoring of growth, diet, personal hygiene and life habits, including environmental factors. Major therapeutic stays are prevention, early detection and the decisive treatment of infections. Attenuated live vaccines, non-irradiated blood products and blood containing CMV antibodies should not be applied. In the case of antibody defects immunoglobulin substitution is a specific form of treatment. Enzyme replacement is a causal approach to an adenosine deaminase defect. For numerous primary immune defects, bone marrow transplantation represents the best causal therapeutic measure. In the absence of a bone marrow donor, alternative gene therapy is available for the management of severe combined immunodeficiency on the X-chromosome (X-SCID), and adenosine deaminase deficiency (ADA deficiency).

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Purpose: Dental implant abutments are defined as medical devices by their intended use. Surfaces of custom-made CAD/CAM two-piece abutments may become contaminated during the manufacturing process in the dental lab. Inadequate reprocessing prior to patient care may contribute to implant-associated complications. Risk-adapted hygiene management is required to meet the requirements for medical devices. Methods: A total of 49 CAD/CAM-manufactured zirconia copings were bonded to prefabricated titanium bases. One group was bonded, polished, and cleaned separately in dental laboratories throughout Germany (LA). Another group was left untreated (NC). Five groups received the following hygiene regimen: three-stage ultrasonic cleaning (CP and FP), steam (SC), argon–oxygen plasma (PL), and simple ultrasonic cleaning (UD). Contaminants were detected using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) and segmented and quantified using interactive machine learning (ML) and thresholding (SW). The data were statistically analysed using non-parametric tests (Kruskal–Wallis test, Dunn's test). Results: Significant differences in contamination levels with the different cleaning procedures were found (p ≤ 0.01). The FP–NC/LA groups showed the most significant difference in contamination levels for both measurement methods (ML, SW), followed by CP–LA/NC and UD–LA/NC for SW and CP–LA/NC and PL–LA/NC for ML (p ≤ 0.05). EDS revealed organic contamination in all specimens; traces of aluminum, silicon, and calcium were detected. Conclusions: Chemothermal cleaning methods based on ultrasound and argon–oxygen plasma effectively removed process-related contamination from zirconia surfaces. Machine learning is a promising assessment tool for quantifying and monitoring external contamination on zirconia abutments. [ABSTRACT FROM AUTHOR]

Background: This study compared the effect of various grafting materials on the area and volume of minerals attached to dental implants. Materials and Methods: In this animal study, 13 dogs were divided into three groups according to the time of sacrificing (2 months, 4 months, or 6 months). The implants were placed in oversized osteotomies, and the residual defects were filled with autograft, bovine bone graft (Cerabone), or a synthetic substitute (Osteon II). At the designated intervals, the dogs were sacrificed and the segmented implants underwent micro-computed tomography analysis. The bone-implant area (BIA) and bone-implant volume (BIV) of bone and graft material were calculated in the region of interest around the implant. The data were analyzed by two-way analysis of variance (ANOVA) at P < 0.05. Results: There was no significant difference in BIA and BIV between the healing intervals for any of the grafting materials (P > 0.05). ANOVA exhibited comparable BIA and BIV between the grafting materials at 2 and 4 months after surgery (P > 0.05), although a significant difference was observed after 6 months (P < 0.05). Pairwise comparisons revealed that BIA was significantly greater in the autograft-stabilized than the synthetic-grafted sites (P = 0.035). The samples augmented with autograft also showed significantly higher BIV than those treated by the xenogenic (P = 0.017) or synthetic (P = 0.002) particles. Conclusion: All graft materials showed comparable performance in providing mineral support for implants up to 4 months after surgery. At the long-term (6-month) interval, autogenous bone demonstrated significant superiority over xenogenic and synthetic substitutes concerning the bone area and volume around the implant. [ABSTRACT FROM AUTHOR]

To examine the relationship between regional socioeconomic deprivation and adherence to the 24-h movement guidelines among children and adolescents, a cross-sectional study was conducted. A total of 17,433 students aged 9–17 participated in a survey in winter 2021/2022. Daily screen time (ST), moderate-to-vigorous physical activity (MVPA), and sleep behavior were outcome variables. The German Index of Socioeconomic Deprivation (GISD), a regional socioeconomic objective measure, was the exposure variable. Associations between GISD and health behaviors were examined using regression models. Models were adjusted for age, gender, school type, and individual self-reported socioeconomic status (SES). The proportions of meeting the MVPA, ST, and sleep duration guidelines were 14%, 22%, and 34%, respectively. A total of 2.3% met all guidelines. Students from the most deprived communities were half as likely to meet all three guidelines compared to students from the most affluent regions (OR = 0.49 [0.28; −0.03], p = 0.010). There was a consistent relationship between GISD and lower levels of adherence to screen time guidelines (most deprived compared to most affluent: OR = 0.49 [0.38; 0.64], p < 0.001). There was no association between GISD and adherence to sleep time guidelines. We found mixed results for the association between GISD and MVPA. Regional SES appears to be an important factor associated with screen time. Screen time should be limited through intervention programs, especially in disadvantaged areas. Parents should be made aware of their children's increased media consumption. Recommendations for screen time should be clearly communicated, as should the health disadvantages of increased media consumption in childhood and adolescence. [ABSTRACT FROM AUTHOR]

Over several decades, the dental caries burden in the deciduous dentition has decreased in Germany. However, a dependency of the caries burden on social parameters, such as socio-economic status (SES) or migration background, is generally described. Therefore, the aim of the evaluation was to analyse to what extent children with a low social class affiliation or a migration background have participated in the caries decline. For the city of Hamburg, Germany, data from a series of five caries epidemiological surveys in day-care centres are available since 1977. Using the same methodology, the dmft values were determined, according to WHO criteria, and in addition including initial caries (IC). For the present evaluation, the data and the changes of caries load (caries prevalence and caries experience; dmft) over time were compared with reference to SES and a migration background. A decrease in the caries prevalence from 58.4% to 22.7% and in the dmft value from 2.6 to 0.8 was determined from 1977 to 2016 (WHO criteria). Including IC, the caries prevalence has decreased from 91.0% to 44.4%, and the caries experience shows a decline from 6.4 to 1.8. The caries reduction can be observed in children of all social classes and regardless of a migration background, although significant differences in caries prevalence and caries experience remain recognisable for each survey through 2016. In conclusion, preschool children from families with low SES or with a migration background have not been left behind in the improvement of dental health, but have also benefited from caries prevention measures in roughly the same order of magnitude as other children. [ABSTRACT FROM AUTHOR]

Background: The SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems (RPs) have been identified as early indicators of child socio-emotional development, strongly associated with maternal mental health and the early parent–infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic. Methods: As part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables. Results: Compared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs. Limitations: Due to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis. Conclusions: The pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged. [ABSTRACT FROM AUTHOR]

The article reports that since October 2021, all newborns in Germany have been screened for spinal muscular atrophy (SMA) and sickle cell disease (SCD) in addition to the previous several target diseases. Topics inlcude consideed that the introduction of SMA screening represents a fundamental paradigm shift because, for the first time, screening is carried out primarily and exclusively via genetic diagnostics.

Background: High continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited. Information continuity, on which our study focuses, is especially important when relational continuity is not given, which is often the case at hospital admission or hospital discharge. The aim of this study is to provide insight into the information flows between general practices and hospitals in Germany, and to identify factors associated with these flows of information. Methods: This is a qualitative interview study in a purposeful sample of staff from hospitals and general practices (general practitioners, care assistants in general practice, hospital management, hospital physicians, and nursing staff). Interviews were conducted via telephone or face-to-face using a self-developed semi-structured interview guide. Stepwise systematic content analysis was used to structure collected material into themes and sub-themes that related to the study aim. Data was analysed by two researchers in several cycles, alternating between inductive and deductive approaches. Results: A total of 49 interviews were conducted. Duration of the interviews varies between 21 and 78 min (mean duration 43 min). Across all groups, more than two thirds of participants were female (n = 34, 69%). The analysis highlighted six interdependent main themes regarding factors that affect information flows between hospitals and general practices: organisational, legal, financial, patient factors, individual characteristics, and emotional & social factors. The latter theme emerged as particularly rich and was therefore divided into four subthemes: appreciation and understanding of the respective other, (intrinsic) motivation, socialisation, and relationships. Organised meetings and events were mentioned as strategies to address emotional and social factors. Conclusions: Digitalisation can facilitate information flows between care providers. However, knowing each other and good personal relations remain important for effective collaboration. Cooperation between all stakeholders is needed to aim to achieve continuity of care. Trial registration: DRKS00015183 on DRKS/ Universal Trial Number (UTN): U1111-1218–0992. Date of registration 23/08/2018. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to determine whether there was a correlation between bone resorption and individual bone patterns in patients treated with implants restored conventionally or using the platform-switching concept. Materials and Methods: Ten patients (24 implants) were randomly assigned to receive implants with different platform diameters (3.8, 4.3, 4.8, or 5.5 mm), all of which were restored with standard 3.8-mm-diameter abutments. Biopsy specimens were obtained prior to implant placement, and histologic and immunohistochemical analyses were performed. Standardized radiographs were made at each site after implant placement and at 36 months after prosthetic loading and bone levels were determined. Results: One patient dropped out, resulting in a total of 9 patients and 22 implants. Mean bone resorption was 1.358 mm for non-platformswitched implants; mean resorption was 0.832, 0.486, and 0.375 mm for implant platforms of 4.3, 4.8, and 5.5 mm, respectively. After standardization of peri-implant bone remodeling values, a borderline direct correlation between peri-implant bone changes and levels of biglycans was found. At the same time, a borderline indirect correlation between bone changes and levels of tumor necrosis factor-? was found. Conclusions: Within the limit of this study, which was conducted in a small patient sample over a short observation period, an individual resorption trend wasdetected and paralleled by immunohistochemical findings. Individual local bone structure and quality seemed to be correlated to peri-implant bone resorption. Correlations between biglycan and tumor necrosis factor-? and bone resorption should be confirmed by a larger patient sample. [ABSTRACT FROM AUTHOR]

Background: Social networks are known to be a key factor associated with late-life depression. However, there is limited knowledge about the pathways linking social isolation to mental health. It has been proposed that health-related behaviors such as physical activity represent one pathway. This study examines the way out-of-home physical activity mediates between social isolation and depressive symptoms in older adults.Methods: A subsample of 334 older adults from the ActiFE Ulm study, Germany, was randomly selected. Older adults (M = 72.6 years; 60.8% male) were interviewed at baseline and 3 years later. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Social isolation was measured using the Lubben Social Network Scale (LSNS-6). Physical activity was measured by an accelerometer (activPAL) over 1 week. To identify out-of-home physical activity, a contemporary physical activity diary classified out-of-home physical activity.Results: A cross-lagged structural equation model supported an indirect effect (β = .014, 95% CI.002 to.039) which means that being socially isolated was associated with lower levels of out-of-home physical activity, and this predicted more depressive symptoms after 3 years. However, no direct relationship was observed between social isolation from friends and neighbors at the baseline and depressive symptoms 3 years later.Conclusions: Utilizing a longitudinal study design and accounting for reverse causality, this study extends prior work linking social isolation to depression by showing that a variety of neighbor and friendship ties are linked to fewer depressive symptoms by providing occasions for out-of-home physical activity. [ABSTRACT FROM AUTHOR]

Purpose: To describe age and time trends in eating occasion frequency (EOF), meal frequency (MF), snack frequency (SF) and duration of nightly fasting (DNF) in German children and adolescents. Methods: 9757 3-day dietary records of 1246 3-18-year-old participants of the open DONALD cohort study, collected 1985-2014, were analyzed for age and time trends using polynomial mixed-effects regression models. Eating occasions were either assigned to meals or snacks (>10 or ≤10 % of daily total energy intake per eating occasion). DNF was defined as the longest time span without energy intake within one night. Results: EOF, MF and SF decreased with age (EOF: linear, quadratic, cubic trend p < 0.0001; MF: linear trend p < 0.0001; SF: linear, quadratic trend p < 0.0001). Time trend analyses revealed a wavelike time course for EOF (linear trend p = 0.0580, quadratic trend = 0.0039, cubic trend = 0.0015) and SF (linear trend p = 0.0055, quadratic trend p = 0.0005, cubic trend p = 0.0003). MF slightly increased until 2000 and decreased thereafter (linear trend p = 0.0012, quadratic trend p = 0.0047). Effect sizes of time trends in EOF, MF and SF were small. Boys' and girls' DNF decreased with age (in both: linear, quadratic, cubic trend p < 0.0001) and increased over the study period (boys: linear trend p = 0.0011, interaction of age and time p < 0.0001; girls: linear trend p = 0.0167). Conclusion: EOF, MF and SF were higher in children than in adolescents, but, in contrast to other studies remained fairly stable over the study period. Decreasing DNF with age could reflect decreasing sleep durations. Additionally, DNF increased over the study period, probably due to an increase in breakfast skipping. [ABSTRACT FROM AUTHOR]

The link between symptoms of attention deficit hyperactivity disorder (ADHD) and increased body weight is well established, while the underlying mechanisms are not yet clear. Since increased body weight and ADHD symptoms have been found to be associated with psychosocial risk factors in childhood, we analyzed whether the psychosocial risks explain the association between the two conditions. The sample consisted of 360 children (age range 6-7 years, 173 boys) attending the obligatory medical health exam before school entry. The childrens' height and weight were measured during the examination. ADHD symptoms were ascertained by parent-report questionnaires. Psychosocial risks were ascertained by a structured interview. The link between ADHD symptoms and body weight could be completely explained by cumulative psychosocial risks while controlling for gender, symptoms of depression/anxiety and oppositional defiant disorder of the child, maternal smoking during pregnancy, parental body mass index, and potential diagnosis of ADHD in the parents. In current models pertaining to the etiology of overweight/obesity and ADHD, chronic stress caused by psychosocial adversity is assumed to act as a trigger for these conditions. Psychosocial risks experienced during childhood may activate processes that specifically lead to the combined ADHD-overweight phenotype. [ABSTRACT FROM AUTHOR]

Objective Evaluation of differences in the clinical performance and crestal bone levels between implants restored with single crowns with platform-matched or platform-switched abutments after 3 years. Material and Methods The study enrolled adult patients missing two or more adjacent teeth in the posterior mandible with natural teeth mesial to the implant site. Randomization followed open-flap implant insertion and the corresponding matching or switching healing abutments placed at surgery. Conventional loading was made with cemented crowns. Clinical follow-up took place annually after loading up to 3 years. Bone level changes were measured in standardized radiographs as the variation in crestal bone from one evaluation to the next. Results Sixty-three patients with a total of 135 implants (66 platform matching, 69 platform switching) were analysed. From surgery to 36 months, mean bone loss was 0.28 ± 0.56 mm for the platform-switching group and 0.68 ± 0.64 mm for the platform-matching group. A statistically significant difference was found between groups ( p = 0.002) with an estimate of 0.39 mm (0.15-0.64, 95% CI) in favour of platform switching. Conclusions After 3 years, platform-switching restorations showed a significant effect in the preservation of marginal bone levels compared to platform-matching restorations. [ABSTRACT FROM AUTHOR]

Background: During the last decades, pharmaceutical care services have been developed and implemented to optimize drug therapies and ensure medication safety. To investigate the need for pharmaceutical care services, drug-related problems can be measured.Objective: Thus, the aim of this study was to analyse number, type and occurrence of drug-related problems in different clinical departments.Setting: A pharmaceutical care service was established on general wards in Urology, Neurology and Gastroenterology at the University Hospital RWTH Aachen, Germany.Method: For each of a total of 306 patients, a pharmacist conducted an extended medication history, performed medication reconciliation, conducted medication safety checks and if drug-related problems were discovered, gave valid recommendations to the attending healthcare team. Drug-related problems were classified using the APS-Doc system. For statistical analyses, SAS(®) 9.1.3, SAS Institute, Cary NC, USA was applied. The project was approved by the local ethics committee.Main Outcome Measure: Type, occurrence and frequency of DRP in different medical departments.Results: On average, 2.3 drug-related problems per patient were documented for all three departments. Drug-related problems were found in each category of the APS-Doc system. The most pronounced drug-related problems found were drug-drug interactions (34.6 %). 37 % of the identified drug-related problems occurred before hospital admission, 27 % during transitional care, and 36 % on the ward. Subgroup analysis revealed specific drug-related problem patterns for each clinical department. The number of drug-related problems was found to be associated with the number of drugs and age.Conclusion: Drug-related problems frequently occur in all investigated clinical departments. A holistic pharmaceutical care service could be an option to address this issue. In case of limited resources, individual drug-related problem patterns can be used as a basis for a tailored pharmaceutical care service. As number of drugs and age have been shown to be significant risk factors, it is crucial that the healthcare team including the pharmacist pays special attention to elderly patients and those with polymedication. [ABSTRACT FROM AUTHOR]

Background and Objectives: Uromodulin is exclusively produced by tubular epithelial cells and released into urine and serum. Higher serum uromodulin has been associated with lower risk for kidney failure in Chinese patients with CKD and with lower risk for mortality in the elderly and in patients undergoing coronary angiography. We hypothesized that lower serum uromodulin is associated with mortality, cardiovascular events, and kidney failure in white patients with CKD., Design, Setting, Participants, & Measurements: We measured serum uromodulin in 5143 participants enrolled in the German CKD (GCKD) study. The associations of baseline serum uromodulin with all-cause mortality, major adverse cardiovascular events (MACE; a composite of cardiovascular mortality, nonfatal myocardial infarction or stroke, or incident peripheral vascular disease), and kidney failure (dialysis or transplantation) were evaluated using multivariable Cox proportional hazard regression analyses in a cohort study design, adjusting for demographics, eGFR, albuminuria, cardiovascular risk factors, and medication., Results: The mean age of participants was 60±12 years, 60% were male. Mean serum uromodulin concentration was 98±60 ng/ml, eGFR was 49±18 ml/min per 1.73 m 2 , and 78% had eGFR <60 ml/min per 1.73 m 2 . Participants in lower serum uromodulin quartiles had lower eGFR and higher albuminuria, prevalence of diabetes, hypertension, coronary artery disease, and more frequent history of stroke at baseline. During a follow-up of 4 years, 335 participants died, 417 developed MACE, and 229 developed kidney failure. In multivariable analysis, the highest serum uromodulin quartile was associated with lower hazard for mortality (hazard ratio [HR], 0.57; 95% CI, 0.38 to 0.87), MACE (HR, 0.63; 95% CI, 0.45 to 0.90), and kidney failure (HR, 0.24; 95% CI, 0.10 to 0.55) compared with the lowest quartile., Conclusions: Higher serum uromodulin is independently associated with lower risk for mortality, cardiovascular events, and kidney failure in white patients with CKD., Clinical Trial Registry Name and Registration Number: Deutsches Register für Klinische Studien (DRKS; German national database of clinical studies), DRKS00003971., (Copyright © 2020 by the American Society of Nephrology.)

Background Recent studies have suggested substantial fluctuations of cognitive performance in adults both across and within days, but very little is known about such fluctuations in children. Children's sleep behavior might have an important influence on their daily cognitive resources, but so far this has not been investigated in terms of naturally occurring within-person variations in children's everyday lives. Methods In an ambulatory assessment study, 110 elementary school children (8-11 years old) completed sleep items and working memory tasks on smartphones several times per day in school and at home for 4 weeks. Parents provided general information about the children and their sleep habits. Results We identified substantial fluctuations in the children's daily cognitive performance, self-reported nightly sleep quality, time in bed, and daytime tiredness. All three facets were predictive of performance fluctuations in children's school and daily life. Sleep quality and time in bed were predictive of performance in the morning, and afternoon performance was related to current tiredness. The children with a lower average performance level showed a higher within-person coupling between morning performance and sleep quality. Conclusions Our findings contribute important insights regarding a potential source of performance fluctuations in children. The effect of varying cognitive resources should be investigated further because it might impact children's daily social, emotional, and learning-related functioning. Theories about children's cognitive and educational development should consider fluctuations on micro-longitudinal scales (e.g., day-to-day) to identify possible mechanisms behind long-term changes. [ABSTRACT FROM AUTHOR]

Objective: Debatable disadvantages of preset differential pressure valves in treating pediatric hydrocephalus are the inability to treat over- and underdrainage after implantation without further surgery. This survey aims to retrospectively determine whether adjustments were performed and effectively used for the individual adaptation of CSF drainage from the shunted patients' and families' perspective. Methods: In a series of 132 consecutive patients (59girls; 73boys, 0-29 years), families, caretakers, or the patients themselves were interviewed about their experiences after using the proGAV (Miethke-Aesculap, Germany) within a CSF-diverting shunt system. Thereby, the necessity and amounts of adjustments were evaluated. The subjective experiences of the adjustment process as well as the subsequent surgical interventions were documented with a follow-up period of 25.6 ± 9 months. Results: In 87.9 % of the cases, clinical symptoms improved subjectively after valve implantation. A total of 103 adjustments in 69 patients were performed. In 30 % of patients, more than one readjustment was done. As subjective experience, the adjustment process was described by 85 % of patients as painless or merely uncomfortable. Symptoms improved in 91 % in connection to a new pressure setting. During the entire follow-up period, 61 % of all patients remained free of surgery. Conclusion: The recently used adjustable valves provide good clinical results and seem to lead to satisfactory treatment from the perspective of the affected patients or caretakers. Although a mechanical manipulation of the skin is necessary, the mechanism of the integrated adjustment unit was mostly well tolerated and allows for a noninvasive and MRI stable treatment of over- and underdrainage. [ABSTRACT FROM AUTHOR]

Therapy for adverse drug reactions ( ADRs) often results in the application of blood components. This study aims to assess the demand for blood components and the resulting economic burden (hospital perspective) in German hospitals induced by ADRs leading to admissions to departments of internal medicine. In this prospective study, ADRs leading to hospitalization were surveyed in four regional pharmacovigilance centres in Germany during the years 2000-2007. ADRs assessed as 'possible', 'likely' or 'very likely' were included. Market prices for blood components and hospitalization data were determined by desktop research. A probabilistic sensitivity analysis was performed. A total of 6099 patients were admitted to internal medicine departments because of an outpatient ADR of whom 1165 patients (19.1%; mean age, 73.0 ± 13.0 years) required treatment with blood components owing to major bleeding events. Overall consumption was 4185 erythrocyte concentrates ( EC), 426 fresh frozen plasma ( FFP) and 48 thrombocyte ( TC) units. On the basis of statistical hospital data, we estimated a nationwide demand of approximately 132,020 EC, 13,440 FFP and 1515 TC units, resulting in total costs of €12.66 million per year for all German hospitals. Some 19.2% of all ADR cases were assessed as preventable. Theoretically, a nationwide decreased demand for blood components and a savings potential of €2.43 million per year could be achieved by preventing ADRs in Germany. Blood components are used in one-fifth (mainly gastrointestinal bleeding) of all ADRs, leading to hospitalizations in internal medicine departments. Both blood demand and hospital procurement costs can be significantly lowered by preventing ADRs. [ABSTRACT FROM AUTHOR]

Stavropoulos A, Becker J, Capsius B, Açil Y, Wagner W, Terheyden H: Histological evaluation of maxillary sinus floor augmentation with recombinant human growth and differentiation factor-5-coated β-tricalcium phosphate: results of a multicenter randomized clinical trial. J Clin Periodontol 2011; 38: 966-974. doi: 10.1111/j.1600-051X.2011.01754.x. Abstract Objectives: The aim of this prospective, multicenter, randomized clinical trial was to evaluate histologically the outcome of maxillary sinus lift augmentation with a recombinant human growth and differentiation factor-5-coated β-tricalcium phosphate (rhGDF-5/β-TCP) or with a β-TCP and autogenous bone (β-TCP/AB) composite. Material and Methods: Thirty-one patients requiring unilateral maxillary sinus floor augmentation (residual alveolar bone height <5 mm) were randomly allocated in three treatment groups: (a) rhGDF-5/β-TCP and a 3-month healing period, (b) rhGDF-5/β-TCP and a 4-month healing period, and (c) β-TCP and intra-oral corticocancellous autologous bone (at 1:1) and a 4-month healing period. Cylindrical biopsies were harvested by means of a trephine bur during implant site preparation and evaluated histologically and histometrically. Results: One patient withdrew from the study before implant placement; 66 implants were inserted in the remaining 30 patients. Four out of 47 (8.5%) implants failed in patients treated with rhGDF-5/β-TCP. The proportion of newly formed bone was similar among groups and averaged 31.4% (± 17%) in the rhGDF-5/β-TCP/3-month healing group, 28% (± 15.5%) in the rhGDF-5/β-TCP/4-month healing group, and 31.8% (± 17.9%) in the β-TCP/AB group. The proportion of remaining β-TCP averaged 12.6% (± 14.4%) in the rhGDF-5/b-TCP/3-month group, 6.6% (± 6.3%) in the rhGDF-5/b-TCP/4-month group, and 16.5% (± 12.3%) in the β-TCP/AB group. The new bone was primarily woven and characterized by slender trabeculae and narrow osteoid zones, and in many instances bone was in contact with residual biomaterial particles. Presence of AB particle remnants was only trivial, while minimal amounts of inflammation were observed only in a few cases. Conclusion: Sinus augmentation with rhGDF-5/β-TCP resulted in comparable amounts of new bone and of similar quality as those obtained with a β-TCP/AB composite graft. [ABSTRACT FROM AUTHOR]

Lucid dreams occur when a person is aware that he is dreaming while he is dreaming. In a representative sample of German adults (N = 919), 51% of the participants reported that they had experienced a lucid dream at least once. Lucid dream recall was significantly higher in women and negatively correlated with age. However, these effects might be explained by the frequency of dream recall, as there was a correlation of .57 between frequency of dream recall and frequency of lucid dreams. Other sociodemographic variables like education, marital status, or monthly income were not related to lucid dream frequency. Given the relatively high prevalence of lucid dreaming reported in the present study, research on lucid dreams might be pursued in the sleep laboratory to expand the knowledge about sleep, dreaming, and consciousness processes in general. [ABSTRACT FROM AUTHOR]

This article uses field visits (including photographs) to examine the construction of religious memory in the commemoration of Kristallnacht (Crystal Night) in contemporary German society. Over the last two decades there has been a proliferation of Kristallnacht memorials to the synagogues that were destroyed during the pogroms of November 9, 1938. Based on research at 50 of these memorial sites, I explore the way in which violence against the synagogue (and Jewish sacred objects) has become the symbol of Jewish genocide in German Holocaust remembrance. The findings strongly suggest that the missing synagogue and its destroyed relics have replaced the murdered Jewish citizenry as the predominant subject of memory in public monuments and memorials throughout the country. However, this visual trope as a representation of the sacred is complicated by other attempts at humanizing (and thus implicitly Christianizing) the suffering and sacrifice of the Holocaust. [ABSTRACT FROM AUTHOR]

The article previews the 33rd annual meeting of the Arbeitsgemeinschaft Dermatologische Forschung that will be held on March 23-25, 2006 in Aachen, Germany. It lists the names of the local organizers and program committee heads including Jorge Frank, Susanne Jacobs, Ralf Paus.

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Chinese, German, and US. American 4- to 6-year-old boys and girls were asked to select videos of children stories that they would most like to see. Choices were either between pairs of story videos presenting aggressive versus peaceful, nurturing con- tent, with male or female sex of story protagonists held constant, or between pairs of videos featuring male versus female protagonists, with aggressive or peaceful story content held constant. Across countries/cultures, boys showed a strong preference for aggressive stories; girls for peaceful, nurturing ones. Again across countries/cultures, both sexes favored stories featuring protagonists of their own sex. However, the preference for same-sex story protagonists was particularly strong in American and Chinese girls. In comparison, American and Chinese boys showed only a moderate preference for male characters. [ABSTRACT FROM AUTHOR]

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Integrated care is regarded as a key for care delivery to persons with chronic long-term conditions such as Parkinson's disease. For persons with Parkinson's disease, obtaining self-management support is a top priority in the context of integrated care. Self-management is regarded as a crucial competence in chronic diseases since the affected persons and their caregivers inevitably take up the main responsibility when it comes to day-to-day management. Formal self-management education programs with the focus on behavioral skills relevant to the induction and maintenance of behavioral change have been implemented as a standard in many chronic long-term conditions. However, besides the example of the Swedish National Parkinson School, the offers for persons with Parkinson's disease remain fragmented and limited in availability. Today, no such program is implemented as a nationwide standard in Germany. This paper provides (1) a systematic review on structured self-management education programs specifically designed or adopted for persons with Parkinson's disease, (2) presents the Swedish National Parkinson School as an example for a successfully implemented nationwide program and (3) presents a concept for the design, evaluation and long-term implementation of a future-orientated self-management education program for persons with Parkinson's disease in Germany. [ABSTRACT FROM AUTHOR]