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Speech disorders are in almost all speech pathology accompanied by a symptom. They usually occur during speech development. Baby. First TV describes itself as a provider of shows 'designed to inspire a baby's learning'. However, if a child is presented to a continental strangling program that does not serve the mother tongue, it can have a lot of difficulty in shaping the language of her speech and not understanding the words and sentences of her parents and the environment. The subjects in this study carried out the following diagnostic tests: pedagogical-psychological examination, logaoedic examination, and neurological examination. The results research shows that besides the worse results on non-verbal intelligence tests, children who were exposed to the influence of Baby-TV from their 2 to 4-year-olds have achieved worse results on nonverbal tests as well as children whose parents included the Baby-TV program of 9 months to the gosling of the day. They say the worst German letters such as ß, R, Ö, Ä, Ü and do not associate German spoken words with the environment. The aim of this research was to examine the negative influence of BABY TV on the speech of children with age child, sex, nonverbal, verbal abilities, and development scale of understanding speech. The ability to speak and understand speech in relation to Reynell was also explored development scale of speech. Average and below-average values were obtained.

Although mathematical modeling plays an important role in many curricula worldwide, significant discrepancies persist in the importance of mathematical modeling in ordinary mathematics classrooms and teacher education. This paper compares pre-service mathematics teachers' professional mathematical modeling competencies in three different regions--Germany, Mainland China, and Hong Kong--where educational and cultural traditions differ, including the role of mathematical modeling. In total, 232 pre-service mathematics teachers from the three regions completed a modeling task covering mathematics content knowledge (MCK) of modeling and mathematical pedagogical content knowledge (MPCK) of modeling. The results show that pre-service teachers from Germany demonstrated the strongest MCK and MPCK of mathematical modeling; by contrast, pre-service mathematics teachers from Mainland China and Hong Kong demonstrated relatively weaker MCK and MPCK of mathematical modeling. MCK and MPCK of mathematical modeling were also found to be unevenly developed at different competence levels for the three regions. These differences may be attributed to the history of mathematical modeling in mathematics curricula, teacher education, and teaching culture in these three regions.

The aim of this study was to determine the socialization goals related to the moral education taught by preschool teachers of children aged 2-6 years in two different cultures, Indonesia and Germany. Thirteen preschools with 138 teachers from Yogyakarta, Indonesia, and 20 preschools with 73 teachers from Bielefeld and Muenster, Germany answered a questionnaire containing the 6 socialization goals with 23 items. The results revealed a main effect of culture, F(1, 209) = 85.79, p < 0.001, = [partial eta-squared]=0.291, a main effect of socialization goals, F(5, 1045) = 127.58, p < 0.001, [partial eta-squared]=0.379 and an interaction effect between two, F(5, 1045) = 124.58, p < 0.001, [partial eta-squared]=0.373, indicating that there were significant differences between the moral socialization goals taught by Indonesian and German preschool teachers and within each country. However, we did not find differences in moral socialization goals between religious and non-religious preschools.

Background: Diabetes self-management education (DSME) is generally considered to be a key determinant of the treatment outcomes and related costs of diabetes mellitus. While DSME programmes generally have positive outcomes, their effects may depend on certain factors, such as the type of programmes provided and patients' level of health literacy (HL). Low HL has been associated with poorer self-management behaviours and poor medication adherence in diabetic patients, but its impact on the effects of DSME has not yet been systematically investigated. This study aimed to investigate the influence of HL on the self-reported effects of DSME programmes while taking the type of programme into consideration. Method: A total of 366 diabetic patients from nine countries completed a questionnaire measuring HL, self-management behaviours, problem perception, coping, perceived general health and well-being, before and after participating in a DSME programme. Results: DSME programmes were found to have positive effects on self-reported self-management behaviours and almost all psychological and health outcomes, regardless of HL level. Patients with high HL scored better on several diabetes outcomes than those with low HL, but all patients described benefiting from DSME. Individual and group-based programmes resulted in more positive effects on several diabetes outcomes than self-help groups, but no interaction with HL was found. Conclusion: Our findings confirm those of previous studies showing that DSME programmes have positive effects and that low HL is associated with lower diabetes outcomes but do not support the assumption that the effects of DSME programmes are influenced by the patient's HL. However, due to the limitations of this study, further investigation is necessary to support these findings and improve our understanding about the impact of HL on DSME programmes' effectiveness.

The aim of this study is to evaluate the benefit of chess in mathematics lessons for children with learning disabilities based on lower intelligence (IQ 70-85). School classes of four German schools for children with learning disabilities were randomly assigned to receive one hour of chess lesson instead of one hour of regular mathematics lessons per week for the duration of one school-year. Concentration and calculation abilities of children were measured before and after the year of study using standardised tests. The chess group was compared with the control group without chess lessons. Concentration abilities and calculation abilities for written tasks and gap tasks developed equally well in both groups. Calculation abilities for simple addition tasks and counting improved significantly more in the chess classes. We conclude that chess could be a valuable learning aid for children with learning disabilities. Transfer of chess lessons to improvement of basic mathematics skills has been observed. (Contains 2 figures and 4 tables.)

The time required to determine the larger of 2 digits decreases with their numerical distance, and, for a given distance, increases with their magnitude (Moyer & Landauer, 1967). One detailed quantitative framework to account for these effects is provided by random walk models. These chronometric models describe how number-related noisy partial evidence is accumulated over time; they assume that the drift rate of this stochastic process varies lawfully with the numerical magnitude of the digits presented. In a complete paired number comparison design we obtained saccadic choice responses of 43 participants, and analyzed mean saccadic latency, error rate, and the standard deviation of saccadic latency for each of the 72 digit pairs; we also obtained mean error latency for each numerical distance. Using only a small set of meaningfully interpretable parameters, we describe a variant of random walk models that accounts in considerable quantitative detail for many facets of our data, including previously untested aspects of latency standard deviation and error latencies. However, different from standard assumptions often made in random walk models, this account required that the distributions of step sizes of the induced random walks are asymmetric. We discuss how our findings can help in interpreting complex findings (e.g., conflicting speed vs. accuracy trends) in applied studies which use number comparison as a well-established diagnostic tool. Finally, we also describe a novel effect in number comparison, the decrease of saccadic response amplitude with numerical distance, and suggest an interpretation using the conceptual framework of random walk models.

This paper presents the course of events of a five-day summer camp on environmental chemistry with high emphasis on chemical analysis. The annual camp was optional and open for students of all disciplines and levels. The duration of the summer camp was five and a half days in the Feldberg Lake District in northeast Germany (federal state of Mecklenburg-Western Pomerania). The participants took part in the continuation of the examination of the lakes in the region, which leads back more than 50 years. They gained hands-on experience in environmental characterization of various lakes and classification by determining chemical, physical, and biological parameters such as phytoplankton, zooplankton, and macrophytes. Short lectures are presented by professionals covering a theoretical background of limnology, environmental chemistry, a variety of analytical methods, freshwater biology, and the specifics of the region. The camp in its present form was established in 1995, and about 20 students took part in the camp per year. Camp development, considerations regarding employed analytical methods, balance of theory, and other implications are discussed.

Purpose: School leadership is considered a central agent in the implementation of "New Governance" concepts which have been introduced in Germany by means of accountability measures, decentralization and a growth of autonomy and competition. With the adjustment of policies, rights and duties of school leaders have changed considerably. The purpose of this paper is to contribute to leadership research by providing descriptive evidence on the relevance of specific areas of leadership activity reported by school principals and their actual priorities in terms of day-to-day workload. In particular, the authors analyze whether individually reported priorities are reflected in the actual distribution of workload in a daily routine. Design/methodology/approach: The empirical analysis uses data collected in the German SHaRP study ("School leaders' activities between more responsibility and more power"). Based on a sample of 153 school leaders from six German federal states the authors perform regression models to determine the association between workload in specific fields of leadership activity, individually reported relevance of management tasks and systemic and contextual conditions at school. Findings: As expected, organizational and personnel management and development are stated to be most important for leadership activity. These priorities are not at least reflected in the observed distribution of workload over fields of activity. Rather, a vast amount of time--as far as it is not absorbed by lessons--is spent on administrative tasks. A shift of workload from teaching responsibilities to governmental tasks is mainly achieved by longer working hours and appears to depend primarily on the system context. Research limitations/implications: The results highlight the relevance of organizational skills and the need to develop conceptual foundations for strategic leadership at schools. Further research should focus not only on the contextual setting and system characteristics, but on the interplay of contextual characteristics and leadership strategies. In times of increasing budgetary constraints leadership research needs to consider outcome measures in terms of quality of schooling to identify determinants of effective leadership. Originality/value: The paper contributes to leadership research by a quantitative analysis of the individually reported relevance of organizational, curricular and human resources management and development for leadership activity. The authors provide descriptive evidence on a significant gap between these claims and reality in terms of actual day-to-day workload.

Lay theories about the tell tale signs of deception include numerous nonverbal cues; empirically, however, a focus on message content results in better lie detection than a focus on nonverbal elements. Feelings-as-information theory (Schwarz, 1990, 2012) predicts that systematic processing of message content is more likely under sad than happy moods, whereas reliance on salient cues is more likely under happy than sad moods. If so, perceivers who are asked to evaluate the veracity of a message should (a) attend more to message content when they are in a negative mood, but (b) more to nonverbal cues when they are in a positive mood. This should (c) result in more accurate identification of true as well as false messages under sad mood, mediated by (d) mood-induced differences in processing style. Three experiments tested these predictions. In Experiments 1 and 2, participants in a negative mood achieved higher accuracy in classifying truthful as well as deceptive messages than participants in a positive mood. Experiment 3 crossed nonverbal cues (fidgety vs. calm movements) and message characteristics (low vs. high plausibility). Only the plausibility of the message influenced participants' credibility judgments under sad mood conditions, whereas only the nonverbal cues influenced participants' judgments of credibility under happy mood conditions. Implications for lie detection and the interplay of feeling and thinking are discussed. (Contains 2 tables and 4 figures.)

This study investigated whether the associations between (a) the quality of the parent-child relationship and peer acceptance and (b) early adolescents' life satisfaction differed depending on the importance of family values in the respective culture. As part of the Value of Children Study, data from a subsample of N = 1,034 adolescents (58% female, M age = 13.62 years, SD = 0.60 years) from 11 cultures was analyzed. Multilevel analyses revealed a positive relation between parental admiration and adolescents' life satisfaction independent of cultural membership. Further, the higher the importance of family values in a culture, the weaker was the positive effect of peer acceptance on adolescents' life satisfaction. The results highlight the universal importance of parental warmth and support in adolescence and underline the effect of culturally shared family values on the role of peer acceptance for adolescent development. (Contains 3 tables and 1 note.)

This study investigates how Chinese and German adult daughters evaluate the norm of reciprocity and the unbalanced exchange of support in relation to their aging parents. Women from rural and urban China (n = 292) and from Germany (n = 264) have participated in this study. Results show that for the German daughters, differently from rural Chinese daughters, perception of imbalance is strongly related to their intention to support their elderly parents. The results for the urban Chinese daughters are closer to those of the German sample than those of the rural Chinese daughters. The results are discussed in light of theoretical approaches to intergenerational relations taking into account the Confucian concept of filial piety and influences of social change. (Contains 2 notes and 4 tables.)

Purpose: The purpose of this paper is to describe the experiences of RCE Hamburg, one of the latest Regional Centres of Excellence (RCE) to be created. It outlines the activities performed by the RCE and describes its relationships with the various stakeholders. Design/methodology/approach: A description of the region where the RCE is located is provided, along with some facts and figures related to the site. In addition, a description of the structure and the activities of the RCE Hamburg is provided, complemented by a description of the engagement of various stakeholders. Findings: The paper shows that, by means of projects and action-based initiatives, synergies between regional centres of expertise on education for sustainable development and agencies based at the local level can be achieved. Originality/value: The RCE is characterised by an integrated approach where different target groups are involved (e.g. schools, NGOs and industry) and where a local university plays a catalyst role. (Contains 5 figures and 1 table.)

The current work investigated the effects of social influence on children's recall accuracy and metacognitive monitoring. Two studies were conducted in which 8-and 10-year-olds were confronted with postevent information in an interview situation. An interviewer (Study 1) or a confederate (Study 2) provided postevent information with two levels of assertiveness, inducing (a) a variation of conformity pressure and (b) a variation of information credibility. Afterwards, children's confidence judgments were assessed. The results revealed significant age differences in children's ability to adequately cope with variations of social influence. Although conformity pressure was especially important for the 8-year-olds, effects of informative social influence were independent of age. However, 10-year-olds were also able to act appropriately on low credibility, thereby demonstrating a more sophisticated consideration of social influence sources. Moreover, varying assertiveness also affected the quality of children's confidence judgments by improving their metacognitive differentiation skills.

• A large proportion of forensically relevant wolf deaths are caused by humans. • Insect succession patterns on wolf cadavers resembles that of other animals. • The blowflies (Calliphoridae) are of particular importance for forensic issues. • Insect species richness increases until advanced decay and decreases in the dry phase. • Forensic entomology can be used for post-mortem interval estimation in wolf carcasses. Human-driven biodiversity loss is progressively becoming a problem with dramatic consequences for the conservation of vital ecosystems. The increasing number of illegal killings of the grey wolf (Canis lupus, Linnaeus, 1758), a threatened species, displays the need for investigation and prosecution of such offences. Forensic entomology makes use of the knowledge about necrophagous insects to estimate a minimum time-since-death interval of the deceased person or animal, which can give important information on a possible perpetrator. The cadaver fauna along five decomposition stages of wolves in Germany was investigated in the period 2014–2021. The insects from 70 wolf cadavers, originating from all over Germany, were provided by the Leibniz Institute for Zoo and Wildlife Research Berlin. The accumulated degree day (ADD) model was applied for the post-mortem interval estimation on wolf cadavers for the first time. A total of 20 coleopteran species and 14 different dipteran species were discovered and identified. Almost 99 % of all insect specimens were from the order of Diptera, and beetles (Coleoptera) accounted for only 1 % of the cadaver fauna. The blowflies (Calliphoridae) are of particular importance for forensic issues, accounting for about 66 % of all families. Carrion beetles (Silphidae) were found as the second most abundant family (about 21 %). In addition, combining all cases, a steadily increasing insect species richness S was detected from early decay to advanced decay (fresh S = 8; bloated S = 12; active decay S = 21; advanced decay S = 34). In the following remains stage, the species number decreased again (S = 24). However, no significant difference in the number of species was found between the stages of decay when the cases were considered individually. The temporal pattern of insect appearance was found to be congruent with those of previous studies. Furthermore, a time of death was determined for each case and compared to the pathologist's estimates. This study provides insights into the arthropod fauna of wolf remains for the first time, applies the ADD-Model for post-mortem interval estimation, and discusses the suitability of forensic entomology for wildlife death investigations. [ABSTRACT FROM AUTHOR]

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Copyright of Studies in Adult Education & Learning / Andragoška Spoznanja is the property of Andragoska Spoznanja and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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The article provides summaries and background information for several public lectures given by intellectual Theodor W. Adorno in Berlin, Germany, in the 1950s and 1960s. These include lectures on the works of writer Friedrich Hölderlin on June 7, 1963, on the music of composer Richard Wagner on September 30, 1963, and on the relationship between music and the visual arts on May 23, 1965.

Introduction: Sudomotor dysfunction is one of the earliest neurophysiologic abnormalities to manifest in distal small fiber neuropathy. SUDOSCAN® was developed to provide a non invasive, quick, simple and quantitative measurement of sweat function. The aim of this observational study was to assess sweat function in a diabetes outpatient consult clinic in Germany. Methods: The study was conducted from February 2009 to March 2011 on patients of a diabetes outpatient clinic in Germany with type 1 and type 2 diabetes, and was conducted parallel to standard care. Sweat function was evaluated by measuring the electrochemical conductance (ESC) of the hands and feet. The method's reproducibility between 2 devices and a follow-up according to insulin administration were also assessed. Results: 52 patients with type 1 diabetes and 115 patients with type 2 diabetes (69 receiving insulin) were involved in this observational study. Hand and foot conductances were lower in patients with type 2 diabetes when compared to patients with type 1 diabetes. A slight decrease in hand and foot conductances was observed in patients with type 2 diabetes without insulin, while an increase was observed in patients receiving insulin ( - 3.8 ± 9.7 vs. 1.0 ± 9.7 μS, p = 0.02 for the hands and - 2.2 ± 7.5 vs. 4.1 ± 8.8 μS, p < 0.001 for the feet). Coefficient of correlation between measurements performed with the 2 different devices was 0.85 for hands and 0.93 for feet, p < 0.001. No safety concern was reported and none of the subjects experienced discomfort during the tests. Conclusion: This preliminary study shows that the assessment of small C fiber neuropathy can be performed non invasively, quickly and effectively in standard diabetes outpatient practice with very good reproducibility. The observation that electrochemical skin conductance improves with intensified insulin treatment must be confirmed in a clinical study performed on a larger population. [ABSTRACT FROM AUTHOR]

The article analyzes the interaction between newly elected deputies and an established legislative culture. Legislative research has largely ignored the socialization processes among new legislators and their effects. These processes are studied for the state legislatures of Baden-Wurttemberg and North Rhine-Westphalia, based on a qualitative panel design. The interviews reveal both the new deputies' clear personal goals and their unclear expectations about parliamentary procedures. The gap between individual ideas and institutional norms is filled by the deputies' adapting to established rituals and rules of the game. As an expression of the legislative culture, these norms and rules are transmitted by the traditional socialization agents within the parties. [ABSTRACT FROM AUTHOR]

Abstract: Local climate regulation by urban green areas is an important urban ecosystem service, as it reduces the extent of the urban heat island and therefore enhances quality of life. Local and regional planning policies can control land use changes in an urban region, which in turn alter local climate regulation. Thus, this paper describes a method for estimating the impacts of current land uses as well as local and regional planning policies on local climate regulation, using evapotranspiration and land surface emissivity as indicators. This method can be used by practitioners to evaluate their policies. An application of this method is demonstrated for the case study Leipzig (Germany). Results for six selected planning policies in Leipzig indicate their distinct impacts on climate regulation and especially the role of their spatial extent. The proposed method was found to easily produce a qualitative assessment of impacts of planning policies on climate regulation. [ABSTRACT FROM AUTHOR]

Fluxes of polycyclic aromatic hydrocarbons (PAHs) were investigated along the route of transport in a south German karst system. Atmospheric deposition, seepage water in caves and spring water at the outlet of the catchment were monitored continuously over 1.5 years allowing the establishment of an input/output mass balance at the catchment scale. The results reveal that, even in the highly vulnerable karst catchment, PAHs are effectively retained in the soils. Only during high discharge events, such as snowmelt in spring, increasing PAH concentrations at the outlet of the catchment indicates a mobilization of the pollutants. These events are typically correlated with increasing particle concentrations. Based on our results, we conclude that particle-facilitated transport is the dominating cause of PAH mobilization. In summary, PAHs accumulate over time in soils and only occasionally high discharge events cause a short concentration pulse to be flushed through the karst system. [Copyright &y& Elsevier]

The more than 2000 years old viticulture tradition in steep slopes along the river valleys in Germany has a great social, economic, ecological and cultural value. It is important to conserve this unique cultural landscape and keep the chances of an increasing tourism in those regions. But the traditional manual cultivation under extreme conditions in steep slope vineyards takes no cost- covering profits. An improvement of economic efficiency by an increasing degree of mechanization is absolutely necessary. Since 2004 the government puts more effort in the development of special- purpose machines for viticulture in steep slopes. Actually there are two main technical systems to increase the power of impact in steep slopes: Cable winch pulled mechanization systems (SMS) and crawler based mechanization systems (RMS). Practical experiments give a detailed comparison of capacity, practicality, efficiency and costs of the most common systems. As a result the positive and negative factors of each system will be demonstrated and finally the limits of applicability of the two systems will be shown. [ABSTRACT FROM AUTHOR]

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Abstract: It can be observed that a growing number of German corporations are using futures studies and its methods in various ways. This evidence suggests that there is a strong ongoing interest in the field of management in futures studies. To assess how the future of futures studies might look like a Delphi study was carried out. The experts in this Delphi study were asked not only to state how futures studies are used in corporations but also what futures studies need to accomplish in order to find more acceptance. The Delphi study suggests that futures studies will become more important in German corporations. In particular, the improvement of methods like environmental scanning, trend research, trend monitoring, strategic early warning and the scenario technique were suggested. While the results of the Delphi study do not suggest that new methods are needed, implementation remains a major concern. [Copyright &y& Elsevier]

In this article we analyze the evolution of nonstore retailing in Germany. We examine the foundations of German e-commerce with a history of mail-order retailing, and analyze how its distinct regulatory environment and continuity in consumer practices affected the way in which e-commerce developed in Germany. In particular, regulations and the politics of retail trade in Germany played a role in shaping competition between the storefront and nonstore sectors. This study builds upon the analysis for Japan and the United States already conducted elsewhere, and shows how e-commerce evolved as an extension of the longstanding tradition of nonstore retailing and the competitive strength the sector developed vis-à-vis the storefront sector. [ABSTRACT FROM AUTHOR]

Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients' samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoforman s isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns. [ABSTRACT FROM AUTHOR]

Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested whether individuals with prediabetes with low risk (LR) benefit from conventional LI and individuals with high risk (HR) benefit from an intensification of LI in a multicenter randomized controlled intervention over 12 months with 2 years' follow-up. A total of 1,105 individuals with prediabetes based on American Diabetes Association glucose criteria were stratified into an HR or LR phenotype based on previously described thresholds of insulin secretion, insulin sensitivity, and liver fat content. LR individuals were randomly assigned to conventional LI according to the Diabetes Prevention Program (DPP) protocol or control (1:1) and HR individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In HR individuals, the difference between conventional and intensified LI in postchallenge glucose change was -0.29 mmol/L [95% CI -0.54; -0.04], P = 0.025. Liver fat (-1.34 percentage points [95% CI -2.17; -0.50], P = 0.002) and cardiovascular risk (-1.82 percentage points [95% CI -3.13; -0.50], P = 0.007) underwent larger reductions with intensified than with conventional LI. During a follow-up of 3 years, intensified compared with conventional LI had a higher probability of normalizing glucose tolerance ( P = 0.008). In conclusion, it is possible in HR individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk phenotype-based LI may be beneficial for the prevention of diabetes., (© 2021 by the American Diabetes Association.)

Background: Atopic dermatitis (AD) is characterized by epidermal barrier failure and immune-mediated inflammation. Evidence on AD as a potential risk factor for inflammatory comorbidities is scarce., Objectives: We sought to test the hypothesis that prevalent AD is a risk factor for incident rheumatoid arthritis (RA) and inflammatory bowel disease (IBD; Crohn disease [CD], ulcerative colitis [UC]) and is inversely related to type 1 diabetes (T1D) and to investigate established RA, IBD, and T1D susceptibility loci in AD., Methods: This cohort study used data from German National Health Insurance beneficiaries aged 40 years or younger (n = 655,815) from 2005 through 2011. Prevalent AD in the period 2005 to 2006 was defined as primary exposure, and incident RA, IBD, and T1D in the period 2007 to 2011 were defined as primary outcomes. Risk ratios were calculated with generalized linear models. Established RA, IBD, and T1D loci were explored in high-density genotyping data from 2,425 cases with AD and 5,449 controls., Results: Patients with AD (n = 49,847) were at increased risk for incident RA (risk ratio [RR], 1.72; 95% CI, 1.25-2.37) and/or IBD (CD: RR, 1.34; 95% CI, 1.11-1.61; UC: RR, 1.25; 95% CI, 1.03-1.53). After adjusting for health care utilization, there was a nominally significant inverse effect on T1D risk (RR, 0.72; 95% CI, 0.53-0.998). There was no disproportionate occurrence of known RA, CD, UC, or T1D risk alleles in AD., Conclusions: AD is a risk factor for the development of RA and IBD. This excess comorbidity cannot be attributed to major known IBD and RA genetic risk factors., (Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

A valid and efficient screening for individual diabetes risk is a highly welcomed tool in primary care and specialist medical practice. It is needed to detect early stages of diabetes risk and prediabetes and to start interventions that have the aim to prevent diabetes and also other chronic diseases from developing. The oral glucose tolerance test is the gold standard, but it is difficult to perform in an evidence-based manner in primary care. Furthermore, measuring fasting and 2-h postprandial glucose values detects only late stages of the pathophysiological development of type 2 diabetes. Interestingly, the 1-h glucose value is highly predictive of future diabetes risk, but is rarely used in primary care. Therefore, risk scores are commonly used to evaluate diabetes risk, but unfortunately, they generally do not mirror the relevance of increased risk due to the person's own lifestyle. Measuring waist circumference is another possibility, because the waist is directly associated with the amount of visceral fat, which again directly correlates with the pathophysiology of diabetes development. A further possibility is the EZSCAN™ technology. The EZSCAN™ is based on reverse iontophoresis, a new technology to detect very early forms of peripheral neuropathies, which are commonly associated with early diabetes risk stages. It is important to perform diabetes screening in a targeted manner, in both medical and paramedical environments, and it is mandatory to add targeted interventions, based on the screening evaluated diabetes risk.

People with severe mental disorders have a reduction in life expectancy of 13-30 % compared with the general population. This severe disadvantage is primarily due to an increased prevalence of cardiac and metabolic disorders, especially coronary heart disease (CHD) and type 2 diabetes mellitus and are the result of untoward health behavior characterized by smoking, low levels of physical activity and unhealthy dietary habits. Obesity, arterial hypertension and lipid disorders are also associated with this behavior and further increase the risk of CHD and type 2 diabetes. Thus, people with mental disorders constitute a population with a high risk of cardiovascular events. Appropriate measures for prevention and therapy are urgently indicated but rarely applied. This article presents new organizational structures to overcome this deficit with a prevention manager playing a central role in organizing and applying preventive and therapeutic care. Results from cardiology and diabetic medicine have shown the effectiveness of pooling this responsibility. The measure has the potential to reduce the increased mortality of people with severe mental disorders.

Type II diabetes mellitus is currently globally one of the fastest growing non-communicable diseases, especially in developing countries. This investigation reports on a meta-analysis undertaken of the C-11377G locus within the adiponectin gene in a black South African, a Cuban Hispanic and a German Caucasian cohort. Genotyping was performed via a real-time PCR strategy. Both fixed- and random-effects models were tested to describe the diabetes risk at both the cohort and population levels. The 2,2 genotype may only be associated with increased diabetes risk in the Cuban Hispanic cohort. Population-specific effects may have masked these associations upon meta-analytical analysis, as no significant odds ratio could be determined. Thus, to examine diabetes risk, a more global approach including the design of population-specific experimental strategies should be used, which will be crucial in developing health education and policies in a global health programme.

Objective: Transcription factor Neurogenin 3 (NGN3) is considered as a candidate gene for the development of type 2 diabetes. The aim of the current study was to investigate the relevance of NGN3 variants for the clinical spectrum of diabetes development and disease progressions., Research Design and Methods: A total of 552 subjects with increased risk of type 2 diabetes were investigated. They underwent a 75 g OGTT with measurements of plasma glucose, insulin and proinsulin at fasting and at 30, 60, 90 and 120 minutes after the glucose challenge, repeated after 3 years. The NGN3 SNPs, Gly167Arg and Ser199Phe were genotyped., Result: Patients with type 2 diabetes carrying the variant genotype at SNP199 presented with significantly higher proinsulin levels. Proinsulin level was also associated with progression of diabetes mellitus. There was a discrete association of the Ser199Phe variant with evolution of the disease status., Conclusion: A genetic variation in NGN3 gene may be among the genetic determinants involved in the pathogenesis of diabetes.

Introduction: Germany developed today into a country of immigration, which creates an additional burden for the social security system and results in a new challenge for the healthcare. In the last 17 years more than two million "Russia Germans" have been repatriated and about two hundred thousand Jewish refugees have resettled in Germany from the former Soviet Union. Nevertheless relevant data concerning migration-related public health care are very scare., Methods: Search of PubMed and Journals extracts combined with the own researches, analysing the health status indices of the Russian-speaking immigrants in Germany., Results: Both repatriates of German origin and Jewish refugees demonstrated higher prevalence of impaired lipid metabolism in comparison with native population. 42 % of the 503,040 HBsAg (hepatitis B s-Antigen) carriers in Germany were migrants. The Jewish refugees demonstrated the highest rates of depression and anxiety and the highest levels of awakening cortisol. On the other side German resettlers showed lower cardiovascular as well as all-cause death rates compared to the native Germans., Conclusion: The development of adequate health care programmes to address migratory aspects as well as the establishment of quality standards will realistically enhance the capability of responding rapidly to migrant health aspects and help to tackle inequalities in health.

Aims: The FINDRISC questionnaire is a screening tool to estimate the risks for type 2 diabetes as well as asymptomatic type 2 diabetes. We aimed to evaluate its performance to predict diabetes in a German population and to compare its predictive and detective ability in the same population., Methods: A total of 552 subjects with increased risk of type 2 diabetes were investigated. All individuals completed the FINDRISC questionnaires and underwent an oral glucose tolerance test (OGTT). All individuals were followed for 3 years and underwent an OGTT again. The performance of the opportunistic screening was assessed with the area under the receiver operating characteristics curve (AUC). An intervention program was carried out for all diabetic and IFG/IGT patients at baseline., Results: For identification, the asymptomatic type 2 DM was named Condition 1; prediction of type 2 DM risk in the follow-up survey as Condition 2; and diabetes risk predicting in a hypothetical case of survey without intervention program as Condition 3. The ROC-AUC in the three condition were AUC (FINDRISC1)=0.745, AUC (FINDRISC2)=0.789, and AUC (FINDRISC3)=0.775, respectively. A significant association between FINDRISC and evolution of disease was found, but the variation of plasma glucose during the three years follow-up was not associated with FINDRISC. People in the intervention group with an improvement of glucose tolerance had a smaller FINDRISC score than persons with an unchanged or progressive condition of disease., Conclusion: FINDRISC was validated in our study as a simple tool with high performance to predict diabetes risk and less efficient to identify asymptomatic type 2 diabetes. People with lower FINDRISC score will benefit easier from preventive intervention.

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise as well as pharmacologic preventive strategies reduced the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes these studies offer a compelling evidence-base for the important translation of the research findings into community-based prevention strategies and the development of a National Diabetes Prevention Program. The workgroup "diabetes prevention" from the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a National Program. This comprises a 3-step-intervention: in a first step individuals at high risk to develop type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.

Due to changes in the age structure of the population the number of frail elderly diabetics is rising. This change is accompanied by an increase in nursing care efforts and requirements in both home care services and nursing homes. The aim of this study was to evaluate the quality of care in the home care and nursing home setting concerning the structure, the process and the outcome quality at the institutional and patient level. This is an observational transversal study. At the institutional level a standardised questionnaire of the German Diabetes Research Institute was sent to all nursing homes (37) and home care services (88) in Dresden. At the patient level 37 homebound patients and 46 residents were recruited. A Geriatric assessment and a clinical examination were performed and a blood sample was analysed. Patients with moderate or severe cognitive impairment were excluded. The prevalence of diabetes in home care services was 27.2% and in nursing homes 36.1%. The participation rate among the institutions was 21.6% (n = 27). In 14% (n = 12) of the diabetic patients the HbA1c was above 8% (poor metabolic control) and in 24% (20) it was between 7% and 8% (regular metabolic control). 56.6% (n = 21) of the homebound elderly diabetics and 46.7% (n = 21) of the nursing home residents with diabetes were hospitalized at least once during the last 12 months. Our study showed a high prevalence of diabetes in both types of institutions in Dresden and a high hospitalisation rate of the elderly diabetics, although 62% of the patients had an optimum metabolic control. These facts indicate that the quality of care of frail elderly diabetics concerning the multimorbidity might be further improved.

Adiponectin, which is encoded by the ADIPOQ gene, has been shown to modulate insulin sensitivity and glucose homeostasis. Plasma adiponectin levels are decreased in type 2 diabetes and obesity. Genetic variations within the ADIPOQ gene are associated with decreased adiponectin hormone levels. To analyze specific single-nucleotide polymorphisms (SNPs) and their association with T2D, 365 German subjects with T2D and 323 control subjects were screened. Three common SNPs - +45T>G in exon 2, and 2 promoter variants SNPs -11391G>A and -11377C>G - were analyzed. We found that the variant allele of SNP -11391G>A was significantly more frequent in the diabetic patient group than in the control group (p=0.003). Carrying the haplotype of SNP -11391A and SNP -11377C was associated with a 1.50-fold (p=0.03) increase in diabetes risk. The combination of the A-C haplotype and the G-C haplotype was associated with significantly elevated diabetes risk (OR=2.82 (95% CI: 1.35-5.91), p=0.006) after correction for BMI and age. Our observations suggest that diploid combinations of haplotype in the adiponectin gene promoter region contribute to the genetic risk of T2D in individuals from a German Caucasian population.

Background: N-terminal brain natriuretic peptide (NT-proBNP) is a neurohormonal substance secreted mainly by the cardiac myocytes of the left ventricle and to a less degree of the left atrium. The releasing mechanism is induced by an increased wall stress on the base of volume or pressure load of the ventricle. The physiologic actions of BNP are prohibition of the sympathetic activity, vasodilatation, natriuresis, diureses and inhibition of the renin-angiotensin system. Because of its high sensitivity and specifity in relation to the left ventricular incompetence, BNP as well as NTproBNP are well accepted markers of ventricular dysfunction. It was the aim of the study to establish reference values of NT-proBNP serum concentrations throughout childhood, in particular in the newborn age group., Methods: In a cross sectional study, serum NT-proBNP concentrations were measured by an ElectroChemiLuminescenceImmunoAssay ("ECLIA" Roche) in the umbilical cord blood of 62 healthy full-term neonates and in 222 healthy probands from birth up to the age of 18 years., Results: The concentration of NT-proBNP in the cord blood samples ranged from 281 to 2595 pg/ml (mean: 818 pg/ml). There was a significant increase in the first days of life followed by a rapid decrease during the first year and a further gradual decrease throughout infancy; beyond the 10(th) year of age normal adult values were approached., Conclusions: The knowledge of the normal range of plasma NT-proBNP levels in healthy subjects during childhood serves as a non-invasive marker for differentiation of pathologic conditions such as acute myocarditis, hypertrophic or dilated cardiomyopathy, tachyarrhythmias and pulmonary hypertension.

Mutations in the hepatocyte nuclear factor - 1 beta (HNF-1 beta) gene cause maturity onset diabetes of the young type 5 (MODY 5). A clinical feature of the resulting phenotype besides impaired glucose tolerance is a variety of renal abnormalities, ranging from renal cysts to end-stage renal failure. Using a candidate gene approach we investigated the prevalence of mutations in the HNF-1 beta gene in a group of 63 patients from two different European populations (33 Germans, 30 Czechs) with type 2 diabetes mellitus and diabetic nephropathy diagnosed by increased albuminuria (39 patients) or end-stage renal failure (24 patients). No mutations were found in any of the 9 exons or in a minimal promoter region. Three intronic variants (single nucleotide polymorphisms - SNPs) were detected. The frequencies of these variants showed no difference between the two studied populations and were comparable to data reported from healthy subjects. No association between SNPs or formed haplotypes and any clinical parameters (like age of disease onset, BMI and severity of renal failure) was found. The results confirm that the genetic variations in the HNF-1 beta gene would be a very uncommon cause of progressive nephropathy in patients with type 2 diabetes mellitus.