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Frühkindliche Karies ist eine vermeidbare Erkrankung, die bei Kindern unter 6 Jahren weiterhin verbreitet ist. Ihre Entstehung ist multifaktoriell und zeigt in allen Altersgruppen eine starke soziale Polarisierung. Für die Prävention ist eine frühzeitige gemeinsame Betreuung der Kinder durch alle Berufsgruppen entscheidend. Dabei sollten neben Kinder-/Jugendärzt*innen und Zahnärzt*innen auch Hebammen eingebunden werden.

SUMMARY OF RECOMMENDATIONS: 1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation). 2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation). 3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation). 4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation). 5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation). 6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Zusammenfassung Hebammen tragen weltweit zur perinatalen Gesundheit von Gebärenden und ihren Kindern bei. Das gilt für die körperlichen, aber auch für psychologische, emotionale und soziale Aspekte von Gesundheit. Die Beratung Schwangerer, die Begleitung von Gebärenden, die Unterstützung beim Übergang in die Lebensphase Mutterschaft/Elternschaft sind grundlegend primärpräventiv und ermöglichen idealerweise eine positive Erfahrung dieser Lebensphase. In Deutschland arbeiten Hebammen in allen Settings und in unterschiedlichen arbeitsorganisatorischen Strukturen.

Purpose This online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol. Methods We published an online questionnaire with 24 questions in German on midwives’ experiences and perceptions of different methods of induction of labour. Results The online survey was answered by 412 midwives between February 2016 and February 2017. At least 20% of the 24 questions were answered in 333 questionnaires, which were included in this analysis. Oral misoprostol was the most common induction method for primipara and for women with a previous vaginal birth and an unfavourable cervix. Apart from alternative methods for induction of labour like castor oil and complementary/alternative methods, oral misoprostol was the preferred method of induction of labour by midwives. Midwives described a wide range of dosage schedules concerning application intervals, starting doses, and the maximum daily dose of misoprostol. Approximately 50% of the participants of this study described prescriptions of more than 200 µg misoprostol daily for induction of labour. Conclusion Misoprostol is widely used in Germany and was one of the three preferred methods of induction of labour among midwives in our study next to castor oil and complementary/alternative methods. The preparation and dosage of misoprostol vary significantly among hospitals and do not adhere to international guidelines. Midwives voiced their concerns about inconsistent indications and heterogenous use of different methods and dosages of induction. They wished for more patience with late-term pregnancies and individualized shared decision-making between pregnant women and obstetricians.

Building on prior work on criminal stigma, this article presents empirical findings on how criminal stigma operates within a confined environment: a transitioning house in Chicago. The study adopts...

Zusammenfassung Hintergrund Die Handsuche in Fachzeitschriften ist eine Moglichkeit, die Literaturrecherche im Rahmen systematischer Ubersichtsarbeiten und anderer Evidenzsynthesen zu erganzen. Sie ist angezeigt, wenn Fachzeitschriften mit potenziell relevanten Publikationen zur Beantwortung der Forschungsfrage nicht in einer Fachdatenbank indexiert sind. Haufig ist jedoch unklar, ob bzw. in welchen Fachdatenbanken diese Zeitschriften indexiert sind. Ebenso ist oft nicht bekannt, welche Fachzeitschriften nach Festlegung der zu durchsuchenden Fachdatenbanken mittels Handsuche erganzend durchsucht werden sollten. Ziel des Projekts war daher, gesundheitswissenschaftliche Fachzeitschriften hinsichtlich ihrer Fachdatenbankindexierung zu untersuchen und eine Indexierungsubersicht bereitzustellen, um den Planungsprozess der Handsuche zu erleichtern. Methode Es wurden Fachzeitschriften aus dem deutschsprachigen Raum aus acht gesundheitswissenschaftlichen Bereichen (biomedizinische Analytik/medizinisch-technische Laboratoriumsassistenz, Ergotherapie, Hebammenwesen, Logopadie, Pflege, Physiotherapie, Public Health und Rehabilitation) berucksichtigt, in denen wissenschaftliche Originalarbeiten oder systematische Ubersichtsarbeiten und andere Review-Arten in deutscher und/oder englischer Sprache publiziert werden. Je zwei Forschende pro Bereich identifizierten relevante Fachzeitschriften und analysierten die Indexierungsquellen unabhangig voneinander anhand der Zeitschriften-Websites. Bei fehlenden Informationen erfolgte eine direkte Anfrage an die Redaktionen. Ergebnisse Insgesamt 70 Fachzeitschriften wurden eingeschlossen – je Bereich 1-17 Fachzeitschriften. Die Fachzeitschriften sind in 1-29 Fachdatenbanken indexiert. Zwolf Zeitschriften sind nicht indexiert bzw. stellen keine Angaben hierzu zur Verfugung. Die Indexierung verteilt sich auf n = 74 verschiedene Fachdatenbanken. Die meisten Fachzeitschriften sind in LIVIVO (n = 55) und bibnet.org (n = 33) indexiert. Weitere haufige Indexierungsquellen sind Scopus (n = 18), Web of Science Core Collection (n = 16), PSYNDEX (n = 13) und Embase (n = 10). Schlussfolgerungen Die Ergebnisse deuten auf eine heterogene Indexierung der eingeschlossenen Fachzeitschriften hin. Lediglich eine geringe Anzahl ist in gangigen internationalen Fachdatenbanken wie MEDLINE oder CINAHL indexiert. Andererseits gibt es nur wenige Fachzeitschriften, die in keiner Datenbank indexiert sind. Die Ergebnisse konnen als Entscheidungsgrundlage dienen, um Fachdatenbanken fur die Literaturrecherche im Rahmen systematischer Ubersichtsarbeiten festzulegen. Daruber hinaus konnen sie bei der Auswahl von Fachzeitschriften fur die Handsuche nach entsprechender Festlegung der Fachdatenbanken leitend sein.

Background The possibility of partially replacing soybean meal (SBM) with Hermetia illucens (HI) defatted larvae meal in broiler nutrition has frequently been suggested. For sustainability reasons, however, the larvae fat produced during defatting should also be used and could be particularly beneficial regarding gut health due to its fatty acid composition. To evaluate the suitability of HI larvae as protein and fat source, a 2 × 3 factorial arrangement with two types of protein, i.e. SBM (S) or SBM and 15% of its crude protein replaced by HI larvae meal (L), and three levels of fat sources, namely 0 (0 L), 50% (50 L) or 100% HI larvae fat (100 L) at the expense of soybean oil was applied. Results In the starter phase, an interaction showed higher body weight (BW), average daily gain (ADG) and improved feed conversion ratio (FCR) if 50% or 100% HI larvae fat was fed with HI larvae meal. Moreover, BW, ADG and FCR improved when feeding HI larvae meal as protein source. Additionally, we observed an increased average daily feed intake in the grower, finisher, and overall phase in the L groups and an improved FCR in 0 L compared to 50 L groups during the overall period. Regarding apparent ileal digestibility, HI larvae meal feeding increased dry matter, organic matter, and fat digestibility. Feeding HI larvae meal as protein source decreased the concentrations of agmatine, spermidine, spermine and ammonia in the caecal digesta, whereas fat source affected agmatine with higher concentrations in 50 L compared to 0 L in the colonic digesta. In contrast, caecal ethanolamine concentrations increased in HI larvae meal groups compared to SBM. Caecal butyric acid concentrations decreased with HI larvae meal feeding. An interaction was found for the jejunal villus area, being higher in L + 100 L compared to S + 100 L. Furthermore, L groups had greater villus width. Conclusions A partial replacement of SBM with HI larvae meal and soybean oil with HI larvae fat in broiler diets without impairing animal performance or gut health seems possible. Feeding HI larvae meal affected broiler performance positively in the starter phase and improved apparent ileal digestibility.

Enteric diseases in piglets, such as post-weaning diarrhea (PWD), often require antibiotic treatment of the entire litter. Grape polyphenols may help overcome PWD and thereby reduce the need for antibiotics. The potential of a grape extract (GE, continuous in-feed supplementation) on performance of weaning piglets, compared with both negative (NC, corn-based diet) and positive control (PC, NC + in-feed antibiotic (amoxicillin) in a therapeutic dosage for day 1–day 5 post weaning) was assessed. Apparent total tract digestibility (ATTD) and microbial metabolites were also evaluated on two sampling points (day 27/28 and day 55/56). We assigned 180 weaning piglets (6.9 ± 0.1 kg body weight (BW)) to 6 male and 6 female pens per treatment with 5 piglets each. Animals from PC showed higher BW on day 13 compared with NC and GE, and a tendency for higher BW on day 56 (p = 0.080) compared to NC. Furthermore, PC increased the average daily feed intake in the starter phase (day1–day13), and the average daily gain in the early grower phase (day 14–day 24). Overall, GE improved the ATTD at the same level as PC (ash, acid-hydrolyzed ether extract), or at a higher level than PC (dry matter, organic matter, gross energy, crude protein, P). There were no effects on microbial metabolites apart from minor trends for lactic acid and ammonia. Dietary inclusion of GE may have beneficial effects compared to therapeutic antibiotics, as frequently used at weaning.

OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar

In the absence of systematic data collection by the state and federal governments, efforts to collect information on officer-involved shootings (OIS) have been assumed by the public and news agencies. In a combination of journalistic reporting and what is known as crowdsourcing, media and masses of individuals volunteer their time to identify OIS incidents and enter them into online databases. These efforts are invaluable in describing interpersonal violence between citizens and law enforcement, but it is not well known to what extent the media-based datasets are comprehensive. In the present study, we compared data from three major media-based websites to official data from five police departments that made their data available—Dallas, Denver, Jacksonville, Orlando, and Knoxville. We found a higher rate of matches than discrepancies with regard to fatalities but a much lower rate with regard to non-fatal shootings. Systematically recording and reporting OIS incidents should be the function of the government. Before—and if—that happens, our findings add to the growing evidence that media-based efforts, combined with crowdsourcing, can be useful though limited alternatives.

1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++–; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation) 2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation). 3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++–; Strong recommendation). 4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation)

Journal hand searching offers the possibility to complement a literature search as part of systematic reviews and other evidence syntheses. Hand searching is indicated in cases where scientific journals with potentially relevant publications addressing the research question are not indexed in a literature database. However, it is often unclear whether these journals are actually indexed, and when they are, in which literature databases. In many cases, it is also unknown which journals should be searched by hand in addition to systematic literature search after databases to be searched have been specified. Therefore, the project aimed to investigate the indexation of selected scientific health science journals and to provide an overview of indexation in order to facilitate the hand search planning process.Journals from German-speaking countries covering eight professional fields (medical laboratory assistance, occupational therapy, midwifery, logopedics, nursing, physiotherapy, public health and rehabilitation) were considered that publish original research papers or systematic reviews or other review types in German and/or English. Two researchers per field identified relevant journals and independently analyzed the indexing locations using the journal websites. In case of missing information, we contacted the editors.A total of 70 journals were included: from 1 to 17 journals per field. These journals are indexed in 1 to 29 databases. Twelve journals are not indexed or do not offer information concerning indexation. Indexation is distributed across n=74 different literature databases. Most journals are indexed in LIVIVO (n=55) and bibnet.org (n=33). Other common indexing databases are Scopus (n=18), Web of Science Core Collection (n=16), PSYNDEX (n=13), and Embase (n=10).The results indicate a heterogeneous indexation of the included journals. Only a small number is indexed in common international literature databases such as MEDLINE or CINAHL. On the other hand, only a few journals are not indexed in any database. The results can be used as a basis to define databases for literature searches as part of systematic reviews. In addition, the findings might guide the selection of journals for hand searching after literature databases have been defined.

Zum April 2018 berief die Universität zu Lübeck Christiane Schwarz zur Professorin für Hebammenwissenschaft. Die promovierte Hebamme übernahm damit den ersten dualen Bachelorstudiengang für Hebammen an der medizinischen Fakultät einer Universität in Deutschland. Im Interview mit DIE HEBAMME verrät die engagierte Praktikerin und Wissenschaftlerin, was sie nach dem ersten Semester begeistert und welche Perspektiven sie in der neuen Rolle für die Berufsgruppe sieht.

The objectives of this study were to investigate the digestibility of pumpkin seed cake (PSC) for the rainbow trout, Oncorhynchus mykiss (Walbaum, 1792), and effects on performance and product quality traits of four different fish species when PSC partially replaced fishmeal in extruded diets. A digestibility trial was carried out to determine apparent digestibility coefficients (ADC) for crude protein (CP), ether extract (EE) and gross energy (GE) of PSC fed to rainbow trout. In subsequent growth trials, effects on performance and morphological traits and fillet colour values of four different fish species [rainbow trout; brook trout, Salvelinus fontinalis (Mitchill, 1814); African sharptooth catfish, Clarias gariepinus (Burchell, 1822); and wels catfish, Silurus glanis (Linnaeus, 1758)] were evaluated when 60% of fishmeal protein of a reference diet was replaced by PSC protein (based on digestible CP). Nutrient ADC of PSC were high (CP: 89%, EE: 88% and GE: 84%). No significant effects on growth and only minor effects on fillet colour were detected in the trials. However, replacing fishmeal with PSC at the chosen level affected morphological traits and feed conversion in all four species to different extents. Replacement effects of PSC should be tested at lower levels of inclusion before conclusions are drawn on its suitability in fish diets.

Zusammenfassung Hintergrund Gebären und geboren werden sind prinzipiell physiologische Vorgänge. Allerdings kann sich eine Geburt plötzlich in einen lebensbedrohlichen Notfall wandeln. Dann hängen Gesundheit von Mutter und Kind in starkem Maße von richtigen und rechtzeitigen Interventionen und effektiver Teamarbeit des medizinischen Personals ab. Um diesen komplexen Anforderungen gewachsen zu sein, wurden v. a. in englischsprachigen und skandinavischen Ländern Konzepte für interdisziplinäres Simulationstraining entwickelt und evaluiert. Dabei gelten Trainingskonzepte mit high fidelity Ausstattung (computergesteuerten Simulatoren) und solche mit low fidelity (einfache Hilfsmittel und SimulationspatientInnen*) als wirksam. Für den deutschsprachigen Raum gibt es kaum Nachweise für die Effektivität von interdisziplinärem Notfalltraining in der Geburtshilfe. Zielsetzung dieser Arbeit ist es herauszufinden, ob ein low fidelity Simulationstraining in Deutschland eine effektive Methode ist, um das geburtshilfliche Notfallmanagement zu verbessern. Methode Es wurden fragebogenbasiert, 4 Monate nach dem Training quantitative und qualitative Parameter vor und nach einem Simulationstraining erhoben und evaluiert. Wir fragten u. a. nach der Selbsteinschätzung der Teilnehmenden hinsichtlich ihrer Kompetenz und Sicherheit im Notfall; der Wahrnehmung von Kooperation und Kommunikation im Team; der Klarheit von Arbeitsabläufen und der Einschätzung der Patientinnenperspektive. Ergebnisse Es wurden 48 Fragebögen prä und post Training ausgewertet. Fast alle Indikatoren zeigten eine signifikante Änderung. Veränderungsvorschläge der Befragten in Bezug auf Struktur- und Prozessqualität im Kreißsaal wurden qualitativ beschreibend ausgewertet. Schlussfolgerungen Der Bedarf wird bei den Mitarbeitenden gesehen. Diese bewerten subjektiv die Bewältigung von Notfällen als verbessert.

summary The objective of the current study was to determine the applicability of wheat-corn-distillers dried grains with solubles (DDGS) as protein source with and without non-starch polysaccharides (NSP)-hydrolyzing enzymes in diets of broiler chicks. In addition to the performance and carcass characteristics, the effect on energy parameters (energy intake per day, energy per kilogram feed), digestibility, as well as sensory aspects and fatty acid profile of breast meat were determined. In a 3×2-factorial approach, a total of 360 broiler chickens (Ross 308) were allocated to six treatment groups (8%, 16%, and 24% DDGS, with or without NSP-hydrolyzing enzymes). The zootechnical performance was not influenced by increasing DDGS concentrations over the whole fattening period, whereas supplementation of the NSP-hydrolyzing enzyme improved feed conversion ratio in the grower phase and increased average daily gain (ADG) in the finisher phase (p < 0.05). Energy and dry matter (DM) digestibility as well as apparent N retention did not differ between treatments. The substitution of soybean meal and corn with DDGS and vegetable oil showed a trend of increased tenderness of broiler breast meat. Nevertheless, the intramuscular amount of polyunsaturated fatty acids increased with increasing inclusion rate of DDGS and vegetable oil (p < 0.01).

Plant-derived mycotoxin conjugates like deoxynivalenol-3-glucoside can be partly hydrolyzed to their aglycones in vivo, albeit to different extent depending on the mycotoxin conjugate and on the animal species. The aim of this work was to investigate the metabolization of the trichothecene mycotoxin nivalenol (NIV) and the fate of its modified form NIV-3-glucoside (NIV3G) in rats. To that end, 350 μg/kg body weight of NIV and the equimolar dose of NIV3G were administered to six rats by gavage in a 5 × 6 design and excreta were collected for 2 days after each treatment. For further analysis of NIV and NIV3G metabolites in rat urine and feces, seven novel NIV- and NIV3G metabolites including NIV sulfonates (NIVS) 1, 2 and 3, deepoxy-NIV (DNIV), DNIV sulfonate 2, NIV3G sulfonate (NIV3GS) 2 and NIV-3-glucuronide were produced, isolated and characterized. Subsequently, LC–MS/MS based methods for determination of NIV, NIV3G and their metabolites in excreta samples were developed, validated and applied. The biological recoveries of administered toxins in the form of their fecal and urinary metabolites were 57 ± 21% for NIV and 94 ± 36% for NIV3G. The majority of NIV and NIV3G metabolites was excreted into feces, with DNIV and NIVS 2 as major NIV metabolites and NIV3GS 2 and DNIV as major metabolites of NIV3G. Only 1.5% of the administered NIV3G was recovered in urine, with NIV3G itself as major urinary metabolite. The biological recovery of free NIV in urine was approximately 30 times lower after treatment with NIV3G than after administration of NIV, indicating that exposure of rats to NIV3G results in lower toxicity than exposure to NIV.

Die fetale Mortalitat steigt vermutlich nach Uberschreiten des Geburtstermins an. Diskutiert wird, ob eine Geburt eingeleitet werden soll oder ob es besser ist, beobachtend abzuwarten, sobald eine Schwangere den Geburtstermin erreicht hat. Daruber hinaus gibt es unterschiedliche Ansatze zur Berechnung des Risikos fur eine Totgeburt. Um angemessen uber die Risiken der Terminuberschreitung diskutieren zu konnen, werden aktuelle relevante Daten benotigt.

Wenn ein Saugetier ein Junges geboren hat, folgt nach einer gewissen Zeit die Plazenta. Das geht mit einer mehr oder weniger starken Blutung einher. Soweit, so gut. Wie lange darf es dauern? Wie stark darf die Blutung sein? Hat die Evolution hier alles richtig gemacht, oder gibt es Verbesserungsbedarf? Und falls ja: was, wann und bei wem?

The present study investigated the effect of hydrothermic maize processing and supplementation of amino acids (AA) in two experiments. In total, 60 barrows and 384 broilers were fed four diets including either unprocessed (T1), or hydrothermically processed maize, that is short- (T2), or long-term conditioned (LC) (T3), and subsequently expanded maize of the same batch. Assuming a higher metabolizable energy (ME) content after processing, the fourth diet (T4) contains maize processed as treatment T3, but AA were supplemented to maintain the ideal protein value. Performance, digestibility and product quality in both species were assessed. Results show that in pigs receiving T4 the average daily feed intake was lower compared with the other treatments, whereas no difference was observed in broilers. The T3 improved the feed conversion rate compared with T1 (P

Falle-fur-Alle ist ein berufsgruppeninternes Fallberichts- und Lernsystem fur kritische Ereignisse aus der geburtshilflichen Praxis fur Hebammen. Mittels qualitativer Textanalyse von 15 Interviews mit Hebammen aus Osterreich, Deutschland und der Schweiz wurde untersucht, welche Faktoren die Nutzung von Falle-fur-Alle fordern bzw. hemmen konnen. Falle-fur-Alle ist ein wichtiger Beitrag zur Etablierung einer offenen und konstruktiven Fehlerkultur.

Fumonisin B 1 (FB 1 ) is a Fusarium mycotoxin frequently occurring in maize-based food and feed. Alkaline processing like nixtamalisation of maize generates partially and fully hydrolysed FB 1 (pHFB 1 and HFB 1 ) and thermal treatment in the presence of reducing sugars leads to formation of N- (1-deoxy-D-fructos-1-yl) fumonisin B 1 (NDF). The toxicity of these metabolites, in particular their effect on the sphingolipid metabolism, is either unknown or discussed controversially. We produced high purity FB 1 , pHFB 1 a+b, HFB 1 and NDF and fed them to male Sprague Dawley rats for three weeks. Once a week, urine and faeces samples were collected over 24 h and analysed for fumonisin metabolites as well as for the sphinganine (Sa) to sphingosine (So) ratio by validated LC–MS/MS based methods. While the latter was significantly increased in the FB 1 positive control group, the Sa/So ratios of the partially and fully hydrolysed fumonisins were indifferent from the negative control group. Although NDF was partly cleaved during digestion, the liberated amounts of FB 1 did not raise the Sa/So ratio. These results show that the investigated alkaline and thermal processing products of FB 1 were, at the tested concentrations, non-toxic for rats, and suggest that according food processing can reduce fumonisin toxicity for humans.

Phosphorus (P) is primarily stored in the form of phytates in plant seeds, thus being poorly available for monogastric livestock, such as pigs and poultry. As phytate is a polyanionic molecule, it has the capacity to chelate positively charged cations, especially calcium, iron and zinc. Furthermore, it probably compromises the utilization of other dietary nutrients, including protein, starch and lipids. Reduced efficiency of utilization implies both higher levels of supplementation and increased discharge of the undigested nutrients to the environment. The enzyme phytase catalyses the stepwise hydrolysis of phytate. In respect to livestock nutrition, there are four possible sources of this enzyme available for the animals: endogenous mucosal phytase, gut microfloral phytase, plant phytase and exogenous microbial phytase. As the endogenous mucosal phytase in monogastric organisms appears incapable of hydrolysing sufficient amounts of phytate-bound P, supplementation of exogenous microbial phytase in diets is a common method to increase mineral and nutrient absorption. Plant phytase activity varies greatly among species of plants, resulting in differing gastrointestinal phytate hydrolysis in monogastric animals. Besides the supplementation of microbial phytase, processing techniques are alternative approaches to reduce phytate contents. Thus, techniques such as germination, soaking and fermentation enable activation of naturally occurring plant phytase among others. However, further research is needed to tap the potential of these technologies. The main focus herein is to review the available literature on the role of phytate in pig and poultry nutrition, its degradation throughout the gut and opportunities to enhance the utilization of P as well as other minerals and nutrients which might be complexed by phytates.

A digestibility trial was conducted to investigate the effects of different maize conservation techniques on the nutrient digestibility of a commercial maize–soybean meal diet fed to growing pigs. The influence on the content of biogenic amines, volatile fatty acids (VFAs) and ammonia in the faeces was also determined. Maize was either dried (dried maize), ensiled after milling (maize silage) or tight-closed-stored (TCS-maize) as a whole grain. Nine growing pigs (35.1 ± 0.8 kg) were used in a 3 × 3 Latin square experiment. They were fed diets based on the different maize conserves, barley and soybean meal to ensure the same content of N, energy and digestible phosphorus (P) in the diet. The apparent total tract digestibility (ATTD) of the DM, ash and starch was improved (P

Introduction Induction of labour is common, with a large variety of indications and methods. Women’s views and experiences still need to be explored in more depth. This study evaluated outcomes and childbirth experiences with different induction methods as perceived by women. Methods A secondary data analysis of an online-survey with 698 participants comprising closed-ended and open-ended questions evaluating method and reason for induction, gestational age, mode of birth, assessment of received information, support and participation in decision-making, as well as the individual experience of labour and birth, was performed in 2015. Answers to open-ended questions were coded and assigned to main categories by inductive-content analysis. Subgroup analyses comparing frequencies of answer options or main categories dependent on induction methods and indications were conducted. Results Women frequently expressed a need for more information and participation, and reported negative childbirth experiences. Women being offered castor oil or other complementary and alternative methods less often lacked information. However, these methods were markedly less effective to induce labour, but when successful were associated with reduced rates of epidural pain relieve and caesarean sections. Moreover, compared with prostaglandins, complementary methods were associated with significantly more positive personal experiences and fewer burdensome or traumatic births. Conclusions Our findings revealed a substantial lack of information and participation associated with many women perceiving negatively labour and childbirth following induction. Adequate honest information that gives way to realistic expectations about labour induction and enablement of participation are important prerequisites to improve personal experience and need to be enhanced in order to raise childbirth satisfaction.

Increasing antibiotic resistance is a major public health concern. Fluoroquinolones are used to treat and prevent poultry diseases worldwide. Fluoroquinolone resistance rates are high in their countries of use. The aim of this study was to evaluate the effect of an acids-based feed additive, as well as fluoroquinolone antibiotics, on the prevalence of antibiotic-resistant E. coli. A total of 480 broiler chickens (Ross 308) were randomly assigned to 3 treatments: a control group receiving a basal diet; a group receiving a feed additive (FA) based on formic acid, acetic acid and propionic acid; and an antibiotic enrofloxacin (AB) group given the same diet, but supplemented with enrofloxacin in water. A pooled fecal sample of one-day-old chicks was collected upon arrival at the experimental farm. On d 17 and d 38 of the trial, cecal samples from each of the 8 pens were taken, and the count of E. coli and antibiotic-resistant E. coli was determined. The results of the present study show a high prevalence of antibiotic-resistant E. coli in one-day-old chicks. Supplementation of the diet with FA and treatment of broilers with AB did not have a significant influence on the total number of E. coli in the cecal content on d 17 and d 38 of the trial. Supplementation with FA contributed to better growth performance and to a significant decrease (P ≤ 0.05) in E. coli resistant to ampicillin and tetracycline compared to the control and AB groups, as well as to a decrease (P ≤ 0.05) in sulfamethoxazole and ciprofloxacin-resistant E. coli compared to the AB group. Treatment with AB increased (P ≤ 0.05) the average daily weight compared to the control group and increased (P ≤ 0.05) the number of E. coli resistant to ciprofloxacin, streptomycin, sulfamethoxazole and tetracycline; it also decreased (P ≤ 0.05) the number of E. coli resistant to cefotaxime and extended spectrum beta-lactamase- (ESBL-) producing E. coli in the ceca of broilers.

In der vorherigen Ausgabe von Die Hebamme (2/2014) hat Christiane Schwarz die aktuellen US-amerikanischen Empfehlungen vorgestellt unter dem Titel „Dem Wahnsinn Einhalt gebieten?“ und mit der Prognose, dass sie die geburtshilfliche Welt verandern. Wir haben Hebammen und Frauenarzte gefragt, wie sie die Bedeutung dieser Leitlinie fur Deutschland einschatzen. Wir freuen uns auf eine rege Fachdiskussion.

Summary To date, most studies published were carried out on broilers of the same sex, and possible gender-specific effects of phytogenic substances have not been investigated so far. A 3 × 2 factorial study was performed to examine gender-specific effects of a PFA at two dietary levels (150, 1500 ppm) on growth performance, carcass traits and gastrointestinal attributes in broiler chickens versus an untreated control group. The addition of 150 ppm of the PFA led to a downregulation of trypsinogen mRNA in pancreas compared with the control group (p

Die neue Leitlinie der US-amerikanischen Geburtshelfer zur Senkung der Kaiserschnittrate hat das Potenzial, die geburtshilfliche Welt zu verandern. Man kann es kaum glauben: als im Marz 2014 die US-amerikanischen Geburtshelfer ihr Konsensuspapier zur Senkung der Kaiserschnittrate veroffentlichten, war es das erste Mal seit vielen Jahren, dass von diesem Gremium selbstkritische Uberlegungen zur medikalisierten Geburtshilfe der vergangenen 20 Jahre laut wurden. Wir machen zu viele Kaiserschnitte und wir retten damit weder Mutter noch Kinder [ 1 ], so der Tenor.

It is important that professionals using electronic fetal monitoring are aware of various aspects regarding interpretation and clinical value of the trace. In practice, there are some typical misunderstandings and mistakes, which can lead to unexpected and sometimes adverse outcomes. One of the most frequent errors is the recording of maternal blood vessel pulsation (maternal insertion), instead of the fetal heart. In this article, a case of maternal insertion is presented and implications for practice are discussed.

Two experiments were carried out to investigate the effect of different maize conservation techniques and phytase addition on coefficients of total tract apparent digestibility (CTTAD) of phosphorus (P), calcium (Ca), ash, dry matter (DM), organic matter (OM) and crude protein (CP). In the first experiment, 9 growing pigs were allotted to a triplicate 3 × 3 Latin square design to measure CTTAD of P in three different maize conserves. Maize was either dried (dried maize), ensiled after milling (maize silage) or tight-closed-stored as whole grain (TCS-maize). Diets consisted of the differently conserved maize alone supplemented with amino acids and a mineral and vitamin source. To achieve P-deficient diets, no P was added. In experiment 2 same experimental design, diet composition and feedstuffs were used as in the first study. However, in this study diets were supplemented with 750 FTU phytase kg −1 diet from Schizosaccharomyces pombe . To evaluate the effect of phytase supplementation, results of both experiments were pooled for statistical analysis. The obtained results show that the CTTAD of P was greater (P The CTTAD of DM and OM were not influenced by fermentation. The CTTAD of CP was lower in fermented maize (P In conclusion, maize fermentation in the form of ensiling increases CTTAD of P in growing pigs. Therefore lower P supplementations are required and P excretions with manure can be reduced. Although CTTAD of P is improved when phytase is added, fermentation still offers advantages compared to dried maize.

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Data are scarce regarding combined high Se and Mn supplementation in livestock diets, however, as Se and Mn are functionally related as cofactors of glutathione peroxidase (GPx) and Mn-superoxide dismutase (SOD), respectively, beneficial synergistic effects on oxidative stability of tissues may result. This experiment evaluated the effect of an oversupply of Se and Mn within European legal limits compared with recommendations on performance, oxidative stability of the organism and meat quality in a randomised complete block design. A total of 60 crossbred gilts were fed maize–barley–soya bean meal diets formulated in a 2×2 factorial approach with inorganic Se (0.2 v. 0.5 mg/kg Se dry matter (DM)) or inorganic Mn (20 v. 150 mg/kg Mn DM) from 31 to 116 kg BW. Se supplementation reduced feed intake, whereas high Mn diets impaired average daily gain (P