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Distribution of dieback in Pinus nigra caused by Scleroderris Iagerbergii Gr. in the Federal Republic of Germany. In the Federal Republic of Germany dieback of Pinus nigra caused by Scleroderris lagerbergii was observed in almost all States both along the coast and also in the interior of the country, on flat and on hilly situations. Killing of single trees or of whole stands is observed mainly in 8-25 years old Pinus nigra plantations. [ABSTRACT FROM AUTHOR]

The West German Parliament in 1950 re-established a central German Audit Court (Rechnungshof), traditionally one of the most respected and useful institutions in the entire German governmental structure. This body and its work are not without interest to American accountants and students of government who, witnessing an astronomical growth in Federal expenditures and taxes, are today concerned with methods which might improve accountability to the U.S. Congress of the Federal departments and agencies for their million and billion-dollar programs. In fact, the main purpose of this article is to describe and appraise the work of the Rechnungshof in order to discover whether any features of this old established continental institution might possibly be adapted to the work of the U. S. General Accounting Office. The word adapted is used advisedly because of the difference in traditions and in governmental structure. Both the German and the U. S. Federal governments have much to learn from the experience of the Public Accounts Committee of the British House of Common. A serious gap in both governments is the absence within the parliament or Congress of a full-time, well staffed committee for the permanent and uninterrupted business of studying efficiency in government operations.

Abstract: Objectives: To systematically evaluate the long-term effectiveness and cost-effectiveness of HPV-based primary cervical cancer screening in the German health care context using a decision-analysis approach. Methods: A Markov-model for HPV-infection and cervical cancer was developed for the German health care context, and applied to evaluate various screening strategies that differ by screening interval and test algorithms, including HPV-testing alone or in combination with cytology. German clinical, epidemiological, and economic data, and test accuracy data from international meta-analyses were used. Outcomes predicted included the reduction in cervical cancer cases and deaths, life expectancy and discounted incremental cost-effectiveness ratios (ICER). The analysis was performed from the perspective of the healthcare system adopting a 3% annual discount rate for costs and outcomes. Extensive sensitivity analyses were performed. Results: HPV-based screening is more effective than cytology alone. It results in a 71–97% reduction in cervical cancer cases as compared to 53–93% for cytology alone. The ICER range from 2600 Euro/LYG (cytology, 5-year-interval) to 155,500 Euro/LYG (annual HPV-testing starting at age 30years, cytology age 20–29years). Annual cytology alone, the current recommended screening strategy in Germany, is dominated by HPV-strategies. Increasing the age at screening initiation from 20 to 25years does not result in a relevant loss in effectiveness but results in lower costs. Conclusions: Based on our analyses, HPV-based cervical cancer screening is more effective than cytology alone and could be cost-effective if performed at intervals of two years or longer. In the German context, an optimal screening strategy may be biennial HPV screening starting at age 30years preceded by biennial cytology for women aged 25–29years. Longer screening intervals may be considered in low-risk women with good screening adherence and in populations with low HPV-incidence. [Copyright &y& Elsevier]

Background: The reform of the German psychotherapy directive in 2017 resulted in several changes for non-hospital-based psychotherapists. We examined whether patients received psychotherapy following their initial consultation more frequently after the reform than before., Methods: Using records from psychotherapy practices in a retrospective cohort study, we investigated the frequency of a psychotherapy after the patients' initial consultation. We compared a time frame of three years before and after the reform. A potential association between reform and psychotherapy received was analysed via logistic regression., Results: Our analysis comprised 1548 records from 9 psychotherapy practices, consisting of 755 records before and 793 records after the reform. Before the reform, 40% (n=303) of the patients who had an initial consultation went on to receive psychotherapy. After the reform, 46% (n=360) of initial consultations were followed by psychotherapy (including acute care). The logistic regression analysis showed a 36% increased probability of receiving psychotherapy after an initial consultation after the reform in comparison to before the reform (odds ratio 1.36 after vs. before reform, 95% confidence interval 1.09 - 1.68)., Conclusion: Our results indicate a higher chance of receiving psychotherapy after an initial consultation after the reform compared to before the reform. Our data do not contain information as to whether the absolute number of psychotherapy appointments in the practices increased after the reform., Competing Interests: Für wissenschaftliche Vorträge und Gutachten wurde Susanne Singer von Boehringer-Ingelheim, Bristol-Myers Squibb, Lilly und Pfizer vergütet, wobei es keine Berührungspunkte der Vergütungen mit der hier vorgestellten Studie gab. Interessenskonflikte der anderen Autor*innen liegen nicht vor., (Thieme. All rights reserved.)

Psycho-oncological care in private practices: a survey among psychotherapists with and without licence for reimbursement with public health insurance Objective: Out of the list of psychotherapists held by the German Cancer Information Service, a random sample of practices was selected. They received a mailed questionnaire. Per practice, only one therapist was selected. The questionnaire was developed by a group of psychotherapists from two psycho-oncological associations in Germany. Practices with and without licence were compared using chi-square, ranksum tests and multivariate regression analyses (adjusting for professional qualification and school of therapy). Methods: Out of the list of psychotherapists held by the German Cancer Information Service, a random sample of practices was selected. They received a mailed questionnaire. Per practice, only one therapist was selected. The questionnaire was developed by a group of psychotherapists from two psycho-oncological associations in Germany. Practices with and without licence were compared using chi-square, ranksum tests and multivariate regression analyses (adjusting for professional qualification and school of therapy). Results: Of 257 contacted practices, 160 therapists participated, and 144 were certified and could be included (62 without and 82 with licence). Waiting times for a first consultation for cancer patients were on average 10 days in practices of therapists without licence and 18 days with licence (p < 0.01). Crisis intervention within 3 days was possible for 62 % of the therapists without and for 44 % with licence (p = 0.08). There was no evidence for differences in what treatment options both types of therapists offered. Both groups reported that more than half of the cancer patients (60 % without and 58 % with licence) had to cancel their appointments at least once every 3 months, and 64 % of the therapists did not ask a fee for that. Financing of the treatment happened most frequently via compensation from health insurance companies via their licence in therapists with licence and via private payment or so called "Kostenerstattung" in therapists without licence. Discussion: In psycho-oncological practices, waiting times for a first consultation for cancer patients are on average 4 weeks shorter than in general, especially short in practices without licence. Cancellation of appointments by patients are relatively frequent in both groups of therapists, which bears financial risks for them. Special methods of compensation for services such as selective contracts are infrequently used..

Context: Recent studies support a bidirectional interaction between aldosterone and parathyroid hormone (PTH), possibly increasing the individual cardiovascular risk. Primary aldosteronism (PA) and primary hyperparathyroidism can occur simultaneously., Objective: Our aim was to investigate the prevalence of hyperparathyroidism in PA., Patients: We performed a case finding of primary hyperparathyroidism in a retrospective series of 503 patients with PA (cohort 1). We analysed primary and secondary hyperparathyroidism in 141 prospective PA patients who underwent PTH, serum calcium and phosphate measurements at time of diagnosis of PA (cohort 2)., Results: The prevalence for primary hyperparathyroidism was 1.2% in cohort 1, and 2.1% in cohort 2. Secondary hyperparathyroidism was found in 54.6% of the patients. Patients with secondary hyperparathyroidism had significantly higher aldosterone and lower potassium levels and took more antihypertensive medications compared to those with normal PTH levels. In multivariate analysis, aldosterone and 25-hydroxyvitamin D levels were significantly correlated with serum PTH levels. There was a nonsignificant trend to a higher cardiovascular morbidity in patients with secondary hyperparathyroidism. Patients with aldosterone producing adenoma had significantly higher PTH levels compared to patients with bilateral adrenal hyperplasia. After treatment, there was a significant decrease of PTH levels in both groups., Conclusion: Patients with PA frequently have primary or secondary hyperparathyroidism, which is alleviated by correction of PA by surgical or medical means. Patients affected by secondary hyperparathyroidism seem to have a more severe phenotype of PA and have a trend towards more cardiovascular co-morbidities., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In order to prevent child abuse, instruments measuring child abuse potential (CAP) need to be appropriate, reliable and valid., Objective: This study aimed to confirm the 6-factor structure of the Brief Child Abuse Potential Inventory (BCAPI) in a German sample of mothers and fathers, and to examine longitudinal predictors of CAP., Participants and Setting: Two waves of data were collected from 197 mothers and 191 fathers of children aged 10-21 months for the "Kinder in Deutschland - KiD 0-3" in-depth study. Families were stratified based on prior self-report data for screening purposes., Methods: 138 fathers and 147 mothers were included in the analysis (invalid: 25% mothers, 30% fathers). First, validity of reporting was examined. Second, confirmatory factor analysis (CFA) was employed to assess factor structure. Third, internal reliability and criterion validity were examined. Finally, multivariate poisson regressions investigated longitudinal predictors of CAP in mothers., Results: A previously established six-factor structure was confirmed for mothers but not fathers. CFA failed for fathers due to large numbers of variables with zero variance. For mothers, internal consistency and criterion validity were good. BCAPI score at follow-up was associated with baseline BCAPI score (β = 00.08), stress (β = 0.06), education (β=-0.19) and alcohol use (β = .58)., Conclusions: Findings confirm the six-factor structure of the BCAPI among German mothers. The clinical use of the BCAPI in fathers is not recommended as it might produce data that are hard to interpret. Further research with fathers is needed to establish if this is due to limitations with this dataset or with the questionnaire., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In Germany, almost 70 000 children are living in foster families (Statistisches Bundesamt, 2016). Many foster children show mental health problems as they were exposed to an accumulation of risk factors. Hence, foster parents are often faced with challenging parenting situations. The current study focuses on the predictors of foster parents' stress and examines longitudinally whether parenting stress is associated with foster parents' sensitivity. The sample consisted of 55 children (aged from 1 to 6 years) and their foster caregivers. Foster parents' sensitivity was observed during home visits. Caregiver reports were used to assess parenting stress (Parenting Stress Index) as well as foster children's externalizing behavior problems (Child Behavior Checklist). For main caregivers' stress at the beginning of placement, regression analyses revealed both, foster children's externalizing problems as well as partners' stress as predictive. For main caregivers' stress one year after, only initial parenting stress and partners' stress were predictive. Foster parents' sensitivity was correlated with their parenting stress one year after placement. Regression analyses revealed no longitudinal effects of initial parenting stress on overall sensitivity. However, supportive presence was predicted by initial supportive presence and by the interaction between parenting stress and children's externalizing problems at placement. The findings highlight the role of the partner in experiencing parenting stress when taking care of a foster child. Furthermore, they emphasize that foster parents who care for children with behavior problems need adequate support that can buffer initial parenting stress and thereby promote sensitive caregiving., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In comparison with essential hypertension, primary aldosteronism (PA) is associated with an increased risk of cardiovascular morbidity. To date, no data on mortality have been published. We assessed mortality of patients treated for PA within the German Conn's registry and identified risk factors for adverse outcome in a case-control study. Patients with confirmed PA treated in 3 university centers in Germany since 1994 were included in the analysis. All of the patients were contacted in 2009 and 2010 to verify life status. Subjects from the population-based F3 survey of the Cooperative Health Research in the Region of Augsburg served as controls. Final analyses were based on 600 normotensive controls, 600 hypertensive controls, and 300 patients with PA. Kaplan-Meyer survival curves were calculated for both cohorts. Ten-year overall survival was 95% in normotensive controls, 90% in hypertensive controls, and 90% in patients with PA (P value not significant). In multivariate analysis, age (hazard ratio, 1.09 per year [95% CI, 1.03-1.14]), angina pectoris (hazard ratio, 3.6 [95% CI, 1.04-12.04]), and diabetes mellitus (hazard ratio, 2.55 [95% CI, 1.07-6.09]) were associated with an increase in all-cause mortality, whereas hypokalemia (hazard ratio, 0.41 per mmol/L [95% CI, 0.17-0.99]) was associated with reduced mortality. Cardiovascular mortality was the main cause of death in PA (50% versus 34% in hypertensive controls; P<0.05). These data indicate that cardiovascular mortality is increased in patients treated for PA, whereas all-cause mortality is not different from matched hypertensive controls.

In recent years, the development of new educational concepts in palliative care was necessary due to (1) the growing number of institutions providing palliative care, (2) the introduction of the supplementary term palliative medicine and (3) the integration of palliative care modules in other educational programs in medicine and nursing. Already in the 1990s, dedicated professional societies devised learning target and objective catalogues that are widely acknowledged. In German law, these developments became visible with the introduction of the medical degree 'palliative medicine' in 2003 as well in the nursing law of 2004, where palliative care became part of all nursing education. Together with the existing objective catalogues, these laws stimulated recent publication activities of training manuals, which allow efficient and high quality teaching in palliative care. This paper gives an overview on the development and the current situation of education and training in palliative care in the Federal Republic of Germany.

"Social marketing" is the use of marketing principles to design and implement programmes to promote socially beneficial behaviour changes. In the field of health promotion and prevention, the systematic planning process of social marketing can offer new ideas and perspectives to the traditions of social science. Major characteristics of social marketing encompass continuous market research focussing on attitudes, motives and behavioural patterns of the target group, an integrated mix of strategic key elements, and the perpetual evaluation of all procedures. So far, however, it is unclear in how far social marketing is actually more effective than other concepts of programme planning. Furthermore, it has to be discussed whether the underlying philosophy of social marketing and its implicit understanding of relationships to the public are reconcilable with health promotion principles. In Anglo-Saxon countries, the social marketing concept has achieved widespread application and is subject to controversial scientific discussions, whereas this approach is hardly considered in German health promotion research and practice. Given the increasing call for quality management and evaluation of health promotion interventions, the social marketing concept may contribute useful insights at an operational level and thus add to a discussion on effective approaches for programme planning.

The migration of tumor cells is a prerequisite for tumor cell invasion and metastasis development, which accounts for over 90% of cancer mortality. Therefore a major focus of current tumor biological research is the study of those factors that regulate tumor cell migration. Those chemokines and neurotransmitters that bind to G-protein coupled receptors (also known as serpentine receptors) are the most prominent of these factors. Neurotransmitters have been identified that have not only a stimulatory (e.g. norepinephrine) effect, but an inhibitory effect (e.g. GABA) as well. This is an especially fortuitous development, because many known agonists and antagonists of neurotransmitter receptors are currently being successfully used in the treatment of other pathological conditions (e.g. beta-blockers in the treatment of cardiovascular diseases). Likewise, chemokine receptor antagonists, which are under development for the treatment of HIV or rheumatoid arthritis, may be effective tools for the inhibition of chemokine-driven tumor cell migration as well. A further approach to inhibit tumor cell migration arises from the investigation of the relevant signal transduction pathways. The PKC alpha, for example, is a key enzyme in the regulation of tumor cell migration, but not of leukocyte migration. It thus offers a selective target opportunity for specific pharmacological agents to interfere with tumor cell migration. In this review we therefore summarize the current findings on those serpentine receptors involved in the neurotransmitter- and chemokine-regulated tumor cell migration, on the underlying signal transduction pathways, and on the opportunities to inhibit tumor cell migration and ultimately metastasis development with pharmaceutical agents.

Objective: Recent research on predictors of resource use in inpatient psychotherapy indicates that various patient characteristics as well as therapeutic factors may influence resource use. The aim of our study was to examine the relationship between patient attributes and psychotherapeutic costs in German inpatient psychotherapy. The amount of variance explained in resource use was calculated., Method: The existing sample used in this study consists of sociodemographic and clinical variables of 2375 patients treated in various inpatient psychosomatic clinics. Resource use was measured on the basis of clinical staff activities (Klassifikation Therapeutischer Leistungen, KTL, BfA 2000). Regression Tree Analysis was performed to classify patient attributes based on resource use., Results: The model assigns patients to 20 classes, accounting for 17.5 % of variance. Those patients with single status and personality or eating disorder consume more resources than those patients with non-single status, low motivation for psychotherapy, comorbidity of physical illness and lower levels on symptom severity., Conclusions: Implications of the results for the development of a patient classification system in inpatient psychotherapy will be discussed.

Premature termination of inpatient psychotherapy can have multiple, mostly negative, effects for patients, therapists, clinics, insurance companies, and employers, but research regarding inpatient settings is still deficient. The analysis of two sets of data of four different rehabilitation clinics from two different hospital companies (2699 and 2215 patients, respectively), aimed at possible predictors and outcomes of premature termination. We found ratios of premature termination of 8.3% and 14.7%, respectively. Especially young patients under 30 years of age and patients with eating and personality disorders were more likely to terminate inpatient treatment prematurely. Treatment outcome as rated by therapists was in significantly fewer cases among premature terminators than among successful terminators improved. The results seem to indicate, that assignment to inpatient psychotherapy can be optimized. For a better understanding of the process of premature termination more theory guided prospective and followup studies are necessary.

This paper describes the design and realisation of a knowledge-based system and a clinical documentation system linked via a data dictionary. The software was developed as a shell with object oriented methods and C++ for IBM-compatible PC's and WINDOWS 3.1/95. The data dictionary covers terminology and document objects with relations to external classifications. It controls the terminology in the documentation program with form-based entry of clinical documents and in the knowledge-based system with scores and rules. The software was applied to the clinical field of acute abdominal pain by implementing a data dictionary with 580 terminology objects, 501 document objects, and 2136 links; a documentation module with 8 clinical documents and a knowledge-based system with 10 scores and 7 sets of rules.