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Zusammenfassung Ziel der Studie Die Studie verfolgt das Ziel, die Effekte der psychischen Belastung auf die Höhe und die Zusammensetzung der Krankheitskosten (ambulante Kosten, Krankenhauskosten, Rehabilitationskosten, Arzneimittelkosten) im Zeitverlauf zu überprüfen. Methodik Im Längsschnittdesign untersuchten wir die psychische Belastung von 3.287 Studienteilnehmern der erwachsenen Allgemeinbevölkerung anhand der Hospital Anxiety and Depression Scale (HADS) und ihren Effekt auf die Höhe und die Zusammensetzung der Krankheitskosten aufgrund von psychischen Erkrankungen im Jahr der Befragung t0 und den beiden Folgejahren [t1] {t2}. Ergebnisse Im Vergleich zur Referenzgruppe, die keine psychischen Belastungen aufweist, waren die Krankheitskosten in der Gruppe mit geringen psychischen Belastungen um den Faktor 2,0 [2,2] {1,5}, bei jenen mit moderater psychischer Belastung um den Faktor 3,7 [4,2] {3,1} und bei jenen mit schweren psychischen Belastungen um den Faktor 7,5 [9,0] {5,2} signifikant erhöht. Im Zeitverlauf zeigten sich signifikante Effekte auf die Krankheitskosten nur an den beiden äußeren Rändern der psychischen Belastungsgrade (keine und schwere psychische Belastungen) mit einer Tendenz zur Mitte. Mit zunehmendem Grad psychischer Belastung dominierten Krankenhauskosten die Gesamtkosten aufgrund psychischer Belastung und der Anteil der ambulanten Krankheitskosten an den Gesamtkosten nahm ab. Schlussfolgerung Mit dem Grad psychischer Belastung steigen die Krankheitskosten steil an. Die Progredienz psychischer Erkrankungen zu verhindern, ist deshalb nicht nur aus individueller, sondern auch aus gesundheitsökonomischer Perspektive bedeutsam.

ZusammenfassungMetabolische Anpassungsprozesse, vermittelt durch sog. Hypoxie-induzierbare Faktoren und deren Zielgene, spielen in zahlreichen Malignomen eine wichtige Rolle. Rasch wachsende Tumoren können ihre Stoffwechselvorgänge an eine auftretende Hypoxie anpassen. So werden beispielsweise nach der Aktivierung des „Hypoxia inducible-factors-1α“ Modifikationen am Glukosestoffwechsel, der intrazellulären pH-Regulation oder der Angiogenese initiiert. In dieser immunhistochemischen Pilotstudie analysierten wir primär kutane Melanome mit positivem und negativem Schildwächterlymphknotenstatus im Hinblick auf mögliche Unterschiede ihrer metabolischen Signatur. Hierbei konnten wir unter anderem zeigen, dass die Expression von Glukosetransporter‑1 (GLUT-1) sowohl in allen Melanomen ohne Subgruppenanalyse, als auch in der Subgruppe mit negativem Schildwächterlymphknoten positiv mit der Tumordicke sowie dem Vorliegen einer Ulzeration korrelierte. Zudem korrelierte bei Melanomen mit positivem Schildwächterlymphknoten die Expression von vaskulärem endothelialem Wachstumsfaktor (VEGF) positiv mit dem Vorliegen einer Ulzeration.

Metabolic reprogramming mediated by hypoxia-inducible factors play a crucial role in many human cancers. HIF-1α is activated under hypoxic conditions and is considered a key regulator of oxygen homoeostasis during tumor proliferation under hypoxia. Aim of this research was to analyze the immunohistochemical expression of HIF-1α, VEGF-A, Glut-1, MCT4, and CAIX in atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). 21 paraffin-embedded AFX and 22 PDS were analysed by immunohistochemistry, namely HIF-1α, VEGF-A (referred to as VEGF throughout the manuscript), Glut-1, MCT4, and CAIX. To quantify the protein expression, we considered the percentage of positive tumor cells (0: 0%, 1: up to 1%, 2: 2-10%, 3: 11-50%, 4:50%) in relation to the staining intensity (0: negative, 1: low, 2: medium, 3: strong). HIF-1α expression (mean ± SD) in AFX (9.33±2.92) was significantly stronger than that in PDS (5.90±4.38; P= 0.007), whereas the expression of VEGF, Glut-1, MCT4, and CAIX did not show differences between AFX and PDS. When comparing all tumors without subgroup stratification, the expression of HIF-1α (P= 0.044) and MCT4 (P= 0.036) was significantly stronger in ulcerated tumors than in tumors without ulceration. Our findings provide the first evidence that HIF-1α-induced metabolic reprogramming may contribute to the pathogenesis of AFX and PDS. HIF-1α expression seems to be higher in AFX than in PDS, and ulcerated tumors show higher expression levels of HIF-1α and MCT4 irrespective of the diagnosis.

Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by guiding hydroxyapatite regeneration within the lesion. The objective was to assess the effectiveness in a practical clinical setting. Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 between May 2015 and October 2020 were retrospectively analyzed at the lesion and child levels by bitewing radiography for changes in lesion stage, opacity, and cavitation/restoration. 225 children aged 10–19 years with a total of 413 proximal lesions in posterior teeth, were followed for 0.4–5.5 years (mean (standard deviation): 13 (7) months). Regression occurred in 39% of E1, 37% of E2, and 40% of D1 caries lesions. The proportion of lesions surviving after one year was 0.96 (95% CI: 0.94–0.98), and after two years, it was 0.91 (95% CI: 0.88–0.94). SAP P11-4 is a safe, biomimetic treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of a caries lesion and can easily be introduced into routine dental practice. Present real-world clinical data complement and confirm previously published clinical trials, demonstrating that SAP P11-4 is tooth-preserving and can lead to recovery to a healthy tooth stage.

The aim of this study was to examine the effects of mental illness on the level and composition of medical costs (outpatient costs, hospital costs, rehabilitation costs, drug costs) over time.In a longitudinal design, we examined the psychological distress of 3,287 study participants from the adult general population using the Hospital Anxiety and Depression Scale (HADS) and its effect on the level and composition of medical costs resulting from mental illness in the year of survey t0 and the two subsequent years [t1] {t2}.Compared to the reference group with no mental distress, the cost of illness was significantly increased by a factor of 2.0 [2.2] {1.5} in the low mental distress group, by a factor of 3.7 [4.2] {3.1} in those with moderate mental distress, and by a factor of 7.5 [9.0] {5.2} in those with severe mental distress. Over time, significant effects on illness costs appeared only at the two outer edges of psychological distress levels (no and severe distress levels). As the level of mental distress increased, hospital costs dominated total costs due to mental distress and the proportion of outpatient medical costs in total costs decreased.The costs of illness rise steeply with the degree of mental stress. Preventing the progression of mental illness is therefore important not only from an individual but also from a health economic perspective.Die Studie verfolgt das Ziel, die Effekte der psychischen Belastung auf die Höhe und die Zusammensetzung der Krankheitskosten (ambulante Kosten, Krankenhauskosten, Rehabilitationskosten, Arzneimittelkosten) im Zeitverlauf zu überprüfen.Im Längsschnittdesign untersuchten wir die psychische Belastung von 3.287 Studienteilnehmern der erwachsenen Allgemeinbevölkerung anhand der Hospital Anxiety and Depression Scale (HADS) und ihren Effekt auf die Höhe und die Zusammensetzung der Krankheitskosten aufgrund von psychischen Erkrankungen im Jahr der Befragung t0 und den beiden Folgejahren [t1] {t2}.Im Vergleich zur Referenzgruppe, die keine psychischen Belastungen aufweist, waren die Krankheitskosten in der Gruppe mit geringen psychischen Belastungen um den Faktor 2,0 [2,2] {1,5}, bei jenen mit moderater psychischer Belastung um den Faktor 3,7 [4,2] {3,1} und bei jenen mit schweren psychischen Belastungen um den Faktor 7,5 [9,0] {5,2} signifikant erhöht. Im Zeitverlauf zeigten sich signifikante Effekte auf die Krankheitskosten nur an den beiden äußeren Rändern der psychischen Belastungsgrade (keine und schwere psychische Belastungen) mit einer Tendenz zur Mitte. Mit zunehmendem Grad psychischer Belastung dominierten Krankenhauskosten die Gesamtkosten aufgrund psychischer Belastung und der Anteil der ambulanten Krankheitskosten an den Gesamtkosten nahm ab.Mit dem Grad psychischer Belastung steigen die Krankheitskosten steil an. Die Progredienz psychischer Erkrankungen zu verhindern, ist deshalb nicht nur aus individueller, sondern auch aus gesundheitsökonomischer Perspektive bedeutsam.

Zusammenfassung Hintergrund Die Kontrollgruppenbildung stellt in Evaluationen der gesetzlichen Krankenversicherungen (GKVen) ein zentrales Problem dar. Randomisierung ist bei gesetzlich zugesicherten Leistungen ethisch und rechtlich problematisch. Matchingverfahren zur Kontrollgruppenbildung stellen hier eine Alternative dar. Basis dieser Matchings sind haufig die den GKVen vorliegende Sekundardaten (beispielsweise Alter, Geschlecht, Krankheitskosten, Arbeitsunfahigkeitstage). In dieser Studie wurde gepruft, inwieweit Matchings ausschlieslich auf Basis von Sekundardaten zu einem Selektionsbias fuhren konnen. Methodik In Sensitivitatsanalysen von drei grosen Praventionsstudien wurden die Ergebnisse von Propensity Score Matchings zur Kontrollgruppenbildung auf Basis von Sekundardaten mit den Ergebnissen auf Basis von Sekundar- und Primardaten verglichen. In Kovarianzanalysen wurde der Effekt eines potenziellen Selektionsbias auf Kosteneffekte gepruft. Ergebnisse Matchings, die ausschlieslich auf Sekundardaten basieren, fuhren zu Kontrollgruppen mit vergleichbaren Auspragungen in den Sekundardaten, nicht aber in den Primardaten: Die so gebildeten Kontrollgruppen haben im Vergleich zu den Interventionsgruppen einen signifikant besseren Gesundheitszustand (geringere Schmerzen, geringere psychische Belastung, hohere Lebensqualitat). Dieser Selektionsbias hatte zu einer systematischen Unterschatzung der durch die Praventionsmasnahmen erzielten Kostenreduzierungen gefuhrt. Diskussion Praventionskursteilnehmer*innen scheinen vom Durchschnitt der Bevolkerung abweichende Eigenschaften zu haben (hohere Gesundheitsorientierung, Substitution von medizinischen Leistungen durch Praventionsmasnahmen u.a.), die durch Sekundardaten nicht ausreichend abgebildet werden und damit zu einem Selektionsbias fuhren, wenn die Matchings ausschlieslich auf Basis von Sekundardaten durchgefuhrt werden. Schlussfolgerung Neben Sekundardaten auch Primardaten in das Matching einzubeziehen, verringert die Gefahr eines Selektionsbias in Praventionsstudien. Die Robustheit der Ergebnisse gegenuber einem Selektionsbias lasst sich in Sensitivitatsanalysen mit dem E-value uberprufen.

Background Metabolic reprogramming and altered gene expression mediated by hypoxia-inducible factors play crucial roles during tumour growth and progression. Nevertheless, studies analysing the expression of hypoxia-inducible factor-1α and its downstream targets in Merkel cell carcinoma (MCC) are lacking but are warranted to shed more light on MCC pathogenesis and to potentially provide new therapeutic options. Objectives To analyse the immunohistochemical expression of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor-A (referred to as VEGF throughout the manuscript), VEGF receptor-2 (VEGFR-2), VEGF receptor-3 (VEGFR-3), glucose transporter-1 (Glut-1), monocarboxylate transporter 4 (MCT4) and carbonic anhydrase IX (CAIX) in primary cutaneous MCC. Methods The 16 paraffin-embedded primary cutaneous MCCs (Merkel cell polyomavirus (McPyV) positive/negative: 11/5) were analysed by immunohistochemistry, namely HIF-1α, VEGF, VEGFR-2 (KDR), VEGFR-3 (FLT4), Glut-1, MCT4 and CAIX. An established quantification score (QS) was applied to quantitate the protein expression by considering the percentage of positive tumour cells (0: 0%; 1: up to 1%; 2: 2-10%; 3: 11-50%; 4: >50%) in relation to the staining intensity (0: negative; 1: low; 2: medium; 3: strong). Results HIF-1α was expressed in all MCCs and predominantly found at the invading edges of tumour margins. The HIF-1α downstream factors Glut-1, MCT4 and CAIX were expressed in 13 of 16 MCC (81%), 14 of 16 MCC (88%) and 16 of 16 MCC (100%), respectively. Interestingly, VEGF and VEGFR-2 were not expressed in tumour cells, whereas VEGFR-3 was expressed in all MCCs. HIF-1α was expressed significantly stronger in McPyV+ tumours (QS: 10.36 ± 2.41) than in McPyV- tumours (QS: 5.40 ± 1.34; P = 0.002). Similarly, VEGFR-3 was also expressed significantly stronger in McPyV+ tumours (QS: 10.00 ± 2.52) than in McPyV- tumours (QS: 5.40 ± 3.43, P = 0.019). Conclusions Our data provide first evidence for a role of HIF-1α in induced metabolic reprogramming contributing to MCC pathogenesis. The metabolic signatures of McPyV+ and McPyV- tumours seem to show relevant differences.

Non-invasive caries treatment is a major focus in modern dentistry. The present study was designed to evaluate the effectiveness of monomeric self-assembling peptide P11-4 (SAP P11-4) in combination with fluoride varnish or polymeric self-assembling peptide matrix (SAPM) in treatment of non-cavitated occlusal caries. Ninety children and adolescents were included in this randomized, gold-standard-controlled clinical trial. Test Group 1 received SAP P11-4 and twice fluoride varnish at baseline and Day 180, Test Group 2 received SAP P11-4 on baseline and twice weekly SAPM (home-application), and Control Group received fluoride varnish on baseline and Day 180. Caries progression was measured by laser fluorescence, Nyvad Caries Activity, ICDAS-II-codes, and investigator assessments. Laser fluorescence changes demonstrated superior results for Test Group 1 and 2, as values decreased compared to an increase for the Control Group (p 11-4, applied either in combination with fluoride varnish or twice weekly SAPM, was a superior treatment for early caries compared to fluoride varnish alone.

Purpose For surgical treatment of inguinal hernia, large-pore, lightweight mesh has been shown to offer advantages over small-pore, heavyweight options in terms of chronic post-operative inguinal pain, but without the disadvantage of having to deal with an increased recurrence rate. Limited data are available for the mesh plug repair technique. Therefore, the primary aim of this study is to compare large-pore, lightweight mesh versus small-pore, heavyweight mesh for mesh plug repair with regard to chronic pain and recurrences in elective primary unilateral hernias. In addition, we report our experience in repairing recurrent hernias. Methods Using a modified version of the questionnaire from the Danish Hernia Registry, two groups were surveyed: elective primary unilateral hernias and recurrent unilateral hernias. In both groups small-pore, heavyweight mesh (HWM) and lightweight, large-pore mesh (LWM) were compared with respect to chronic pain and recurrences. Propensity score matching (PS) was carried out on a pool of 1,782 patients. Effect sizes were assessed by using Cohen's d and Cramer's V. Results If the questionnaire item ‘lump/swelling’ is considered as a surrogate for recurrence (clinically verified in our study), the results in primary hernias after HWM show a 6.0% recurrence rate and 7.3% after LWM (p = 0.487) with a mean follow up of 31,3 months in HWM and 29,2 months in LWM respectively. The questionnaire item ‘pain impacting on work/leisure activities’ was answered with Yes in 11.5% following HWM and in 10.5% following LWM (p = 0.665). After the evaluation of the overall surgical results, we did not find differences. Comparing primary and recurrent hernia repair we found below small effect size differences with respect to the items of the questionnaire. Conclusions The use of LWM in repairing elective unilateral primary hernias by the mesh plug technique does not result in less chronic pain and more recurrences when compared with HWM. Recurrent hernias repaired by the mesh plug technique may have same outcomes like in primary hernia repair when considering the magnitude of effect sizes.

Metabolic reprogramming mediated by hypoxia-inducible factors and its downstream targets plays a crucial role in many human malignancies. Excessive proliferation of tumor cells under hypoxic conditions leads to metabolic reprogramming and altered gene expression enabling tumors to adapt to their hypoxic environment. Here we analyzed the metabolic signatures of primary cutaneous melanomas with positive and negative sentinel node status in order to evaluate potential differences in their metabolic signature. We found a positive correlation of the expression of glucose transporter 1 (GLUT-1) with tumor thickness and ulceration in all melanomas with subgroup analyses as well as in the subgroup with a negative sentinel node. Furthermore, the expression of vascular endothelial growth factor (VEGF) was positively correlated with the presence of ulceration in melanomas with positive sentinel node.Metabolische Anpassungsprozesse, vermittelt durch sog. Hypoxie-induzierbare Faktoren und deren Zielgene, spielen in zahlreichen Malignomen eine wichtige Rolle. Rasch wachsende Tumoren können ihre Stoffwechselvorgänge an eine auftretende Hypoxie anpassen. So werden beispielsweise nach der Aktivierung des „Hypoxia inducible-factors-1α“ Modifikationen am Glukosestoffwechsel, der intrazellulären pH-Regulation oder der Angiogenese initiiert. In dieser immunhistochemischen Pilotstudie analysierten wir primär kutane Melanome mit positivem und negativem Schildwächterlymphknotenstatus im Hinblick auf mögliche Unterschiede ihrer metabolischen Signatur. Hierbei konnten wir unter anderem zeigen, dass die Expression von Glukosetransporter‑1 (GLUT-1) sowohl in allen Melanomen ohne Subgruppenanalyse, als auch in der Subgruppe mit negativem Schildwächterlymphknoten positiv mit der Tumordicke sowie dem Vorliegen einer Ulzeration korrelierte. Zudem korrelierte bei Melanomen mit positivem Schildwächterlymphknoten die Expression von vaskulärem endothelialem Wachstumsfaktor (VEGF) positiv mit dem Vorliegen einer Ulzeration.

BDJ Open 8(1), 9 (2022). doi:10.1038/s41405-022-00101-z, Published by Nature Publishing Group, London

With modern intensive care medicine, even older patients and those with pre-existing conditions can survive critical illnesses and major operations; however, unreflected application of intensive care treatment might lead to a state called chronic critical illness. Today, withholding treatment and/or treatment withdrawal precede many deaths in the intensice care unit (ICU). We looked at changes in measures at the end of life and withholding or withdrawal of treatment in the ICU of a German tertiary hospital in 2017/2018 compared to 2011/2012.In this retrospective explorative study, we analyzed end of life practices in adult patients who died in an intermediate care unit (IMC)/ICU of Klinikum Hanau in 2017/2018. We compared these data with data from the same hospital in 2011/2012 RESULTS: Of the 1246 adult patients who died in Klinikum Hanau in 2017/2018, 433 (35%) died in an ICU or IMC unit. Deceased ICU patients were 74.0 ± 12.5 years and 86.6% were older than 60 years. At least one life-sustaining measure was withheld in 278 (76.2%) and withdrawn in 159 (46.3%) of patients. More than three quarters of patients (n = 276, 75.6%) had a do not resuscitate (DNR) order and in about half of the patients invasive ventilation (n = 175, 49.9%) or renal replacement therapy (n = 191, 52.3%) was limited. In 113 patients (31.0%) catecholamine treatment was withdrawn, in 72 (19.7%) patients invasive ventilation and in 49 (13.4%) patients renal replacement therapy. Compared to 2011/2012, we saw an increase by ~15% (absolute increase) in withholding and withdrawal of treatment and observed an effect of documents like advance directive or healthcare proxy.In 76.2% of deceased ICU patients withholding treatment and in 43.6% treatment withdrawal preceded death. Compared to 2011/2012 treatment was withheld or withdrawn more often. Compared to 2011/2012, we saw an increase (~15% absolute) in withholding and withdrawal of treatment. After withholding or withdrawal of treatment, most patients died within 3 and 2 days, respectively.HINTERGRUND: Mittels moderner intensivmedizinischer Methoden können auch ältere Menschen und Menschen mit erheblichen Vorerkrankungen größere Operationen und kritische Erkrankungen überleben. Die unkritische Anwendung intensivmedizinischer Maßnahmen kann jedoch auch zu einem Zustand führen, der als chronische kritische Erkrankung bezeichnet wird. Da wahrscheinlich vielen Todesfällen auf der Intensivstation Therapiebegrenzungen oder -abbrüche vorangehen, haben wir Akten von Todesfällen der Jahre 2017/2018 angesehen und mit Daten aus den Jahren 2011/2012 verglichen.In dieser retrospektiven explorativen Arbeit haben wir Todesfälle auf den Intensiv‑/Intermediate-Care-Stationen (chirurgisch/interdisziplinär und konservativ) des Klinikum Hanau in den Jahren 2017/2018 bzgl. Therapiebegrenzungen und Therapieabbrüchen untersucht und diese den Daten aus 2011/2012 gegenübergestellt.In den Jahren 2017/2018 sind 1246 Patienten im Klinikum Hanau verstorben. Davon starben 433 (35 %) auf einer Intensiv‑/Intermediate-Care-Station. Die verstorbenen Intensivpatienten waren im Mittel 74,0 ± 12,5 Jahre alt und 86,6 % waren älter als 60 Jahre. Bei 278 Patienten (76,2 %) wurde mindestens eine Maßnahme begrenzt, bei 159 (46,3 %) mindestens eine Maßnahme abgebrochen. Mehr als drei Viertel aller Patienten (276, 75,6 %) hatte eine „Do-not-resuscitate“(DNR)-Anordnung, und bei über der Hälfte der Verstorbenen wurde die invasive Beatmung (n = 175, 49,9 %) oder eine Nierenersatztherapie (n = 191, 52,3 %) begrenzt. Bei 113 Patienten (31,0 %) wurde die Katecholamintherapie, bei 72 (19,7 %) Patienten die invasive Beatmung und bei 49 (13,4 %) Patienten eine Nierenersatztherapie abgebrochen. Sowohl bei den Therapiebegrenzungen wie auch den -abbrüchen sind die Zahlen im Vergleich zu 2011/2012 um ca. absolute 15 % (absolute Zunahme) gestiegen wobei ein Effekt von Vorsorgedokumenten zu erkennen war.Bei 76,2 % der verstorbenen Intensivpatienten wurde eine Therapie begrenzt und bei 43,6 % abgebrochen. Im Vergleich zu 2011/2012 sind mehr Therapien begrenzt und abgebrochen worden. Nach Begrenzung oder Abbruch einer Therapie sind die meisten Patienten innerhalb von 3 bzw. 2 Tagen verstorben.

There are few, but controversial data on the prognostic role of upfront primary tumour resection and mesenteric lymph node dissection (PTR) in patients with diffuse metastatic small intestinal neuroendocrine neoplasia (SI-NEN). Therefore, the prognostic role of PTR and other factors was determined in this setting. This retrospective cohort study included patients with stage IV SI-NETs with unresectable distant metastases without clinical and radiological signs of acute bowel obstruction or ischaemia. Patients diagnosed from January 2002 to May 2020 were retrieved from a prospective SI-NEN database. Disease specific overall survival (OS) was analysed with regard to upfront PTR and a variety of other clinical (e.g., gender, age, Hedinger disease, carcinoid syndrome, diarrhoea, laboratory parameters, metastatic liver burden, extrahepatic and extra-abdominal metastasis) and pathological (e.g., grading, mesenteric gathering) parameters by uni- and multivariate analysis. A total of 138 patients (60 females, 43.5%) with a median age of 60 years, of whom 101 (73%) underwent PTR and 37 (27%) did not, were included in the analysis. Median OS was 106 (95% CI: 72.52-139.48) months in the PTR group and 52 (95% CI: 30.55-73.46) in the non-PTR group (p = 0.024), but the non-PTR group had more advanced metastatic disease (metastatic liver burden ≥50% 32.4% vs. 13.9%). There was no significant difference between groups regarding the rate of surgery for bowel complications during a median follow-up of 51 months (PTR group 10.9% and non-PTR group 16.2%, p = 0.403). Multivariate analysis revealed age 60 years, normal C-reactive protein (CRP) at baseline, absence of diarrhoea, less than 50% of metastatic liver burden, and treatment with PRRT as independent positive prognostic factors, whereas PTR showed a strong tendency towards better OS, but level of significance was missed (p = 0.067). However, patients who underwent both, PTR and peptide radioreceptor therapy (PRRT) had the best survival compared to the rest (137 vs. 73 months, p = 0.013). PTR in combination with PRRT significantly prolongs survival in patients with stage IV SI-NEN. Prophylactic PTR does also not result in a lower reoperation rate compared to the non-PTR approach regarding bowel complications.

Aims/Methods At present, there is no information about the course of psychological adjustment in young subjects with Mobius sequence (MS) and their parents' strain and life satisfaction. To fill this gap, we performed a four-year follow-up study. Parents were anonymously asked to fill out the Child Behavior Checklist 4-18 [CBCL/ 4-18] or the Young Adult Behavior Checklist 18-30 [YABCL/ 18-30] and the Freiburger Personality Inventory-Revised [FPI-R], subscales strain and life satisfaction. Results 12 males and 14 females (mean: 15.20 years, standard deviation: 3.48 years) could be included in the follow-up (response rate: 83.9%).Compared to the general population, subjects with MS showed significantly higher scores on almost all CBCL scales (exception: externalizing problems) at T1 and T2. At both study times, parental strain and life satisfaction were not significantly different from findings in the general population. No significant longitudinal changes could be found for CBLC scales, parental strain and life satisfaction. Conclusions Problems with psychological adjustment seem to be frequent among younger subjects with MS. Therefore, careful monitoring as well as early and adequate interventions, if indicated, are crucial for subjects with MS, not only with regard to somatic complaints but also to aspects of adjustment.

Aktives Ruckentraining kann Ruckenbeschwerden wirksam reduzieren, es ist jedoch unklar, welche Wirkmechanismen fur diesen Ruckgang verantwortlich sind. Welche Bedeutung haben Trainingsumfang, muskulare Leistungssteigerung, Alter und Geschlecht fur die Wirksamkeit eines multimodalen Ruckentrainings? Im Rahmen einer Multicenterstudie (39 Standorte) uber 24 Monate durchliefen 1395 Menschen (Durchschnittsalter 46,9 [standard deviation (SD) ± 12,3] Jahre, 65 % Frauen) mit Ruckenbeschwerden ein multimodales Ruckentrainingsprogramm. Zu Beginn des Programms sowie nach 6, 12, 18 und 24 Monaten wurden Ruckenbeschwerden und physische Leistungsfahigkeit in Kraft, Mobilitat und bilateralen Kraftverhaltnissen der wirbelsaulenstabilisierenden Muskulatur gemessen. Die Teilnehmer trainierten im Durchschnitt 41,0 (SD ± 17,8) Trainingseinheiten a 60 min und steigerten sich im Vergleich zu den alters- und geschlechtsspezifischen Referenzwerten von Menschen ohne Ruckenbeschwerden in der Kraft um 28,1 %-Punkte, in der Mobilitat um 14,7 %-Punkte und im Kraftverhaltnis um 6,5 %-Punkte. Die Ruckenbeschwerden reduzierten sich um 37,5 %. Der Ruckgang der Ruckenbeschwerden wurde zu 70 % durch den Trainingsumfang und zu 30 % durch die physischen Leistungssteigerungen erklart. Das Geschlecht hatte keine und das Alter nur eine marginale Auswirkung auf den Trainingseffekt. Physische Leistungssteigerungen wirken sich positiv auf die Reduzierung der Ruckenbeschwerden aus. Die Anzahl der Trainingseinheiten ist fur den Ruckgang der Ruckenbeschwerden jedoch von deutlich hoherer Relevanz.

This study aimed to investigate factors affecting (1) women’s media use regarding health-related behaviors during pregnancy and lactation, (2) women’s preferences for media format, and (3) the content of media-based interventions on lifestyle-related risk factors during pregnancy and lactation. A cross-sectional observational multi-center study of pregnant and lactating women and women of childbearing age was carried out in 14 randomly selected obstetric and gynecologic care settings in the 12 most populated cities in Baden-Wuerttemberg, South-West Germany. Data from 219 surveyed women showed that older women, pregnant women, and lactating women have a higher probability of using media during pregnancy and lactation, respectively. The majority of women preferred a combination of analog and digital media-based interventions in gynecological (46.9%) and obstetric (47.1%) care settings and at home (73.0%). Women would like to see information brochures and flyers on health-related behaviors during pregnancy and lactation for use in gynecological and obstetric care settings, and for media use at home, they would like to have books. The probability of preferring the favored media formats in gynecological and obstetric care settings and at home were associated with pregnancy status, relationship status, socioeconomic status (SES), ethnicity, and health insurance status. About 80% of the surveyed women preferred media content regarding recommendations for a healthy lifestyle and healthy behavior during pregnancy and lactation. All of the independent variables were associated with the probability of preferring a specific media content. The SES was found to play a major role in the probability of preferring a specific media content, followed by pregnancy status, ethnicity, and health insurance status. The results from our study provide a basis for tailored preventive interventions in gynecological and obstetric care settings and for use at home. The results imply that a woman can be reached before conception, during pregnancy, or during lactation with preventive measures tailored to their requirements, however, acceptance may vary across personal attributes, such as SES, ethnicity, and others.

Dental caries constitutes a public health challenge. As preventive strategies are desirable, this retrospective cohort study aimed to assess the caries experience and increment in children attending kindergartens with an early childhood caries (ECC) preventive program (intervention group, IG) compared to basic prophylaxis measures (control group, CG) located in areas of different socioeconomic status (SES) within Marburg (Germany). The long-term caries experience (2009–2019) of these 3–5-year-old kindergarten children was evaluated. For the caries increment, dental records of 2019 were screened for the availability of a minimum of two dental examinations at least 8 months apart. Caries was scored according to the WHO criteria (dmf–t). The data were split by observation period (300–550 and >550 days). Overall, 135 children (Ø 3.7 years) attended IG, and 132 children (Ø 3.6 years) attended CG. After 300–550 days, no significant differences were found between both groups regarding mean caries increment and experience (p > 0.05). After >550 days, IG with low SES exhibited a high caries experience. Fluoride varnish applications could not reduce the caries increment compared to CG in the short-term but slightly decreased the long-term caries experience. Comprehensive ECC prevention measures actively involving parents are needed to overcome the caries burden.

Background Exercise is considered an effective intervention to relieve chronic back pain. However, it is still unknown whether specific exercise patterns vary in terms of their efficiency and effectiveness. Aim To investigate the differential health and economic effects of intensity, specificity and degree of subjective perceived physical exertion across five exercise patterns (endurance, gymnastics, fitness, back gymnastics, multimodal back exercise) in adults with back pain. Design Longitudinal observational cohort study over a period of 24 months. Setting Various non-therapeutic exercise facilities (e.g. outdoor, fitness centers, health insurance programs, sports clubs) across one federal state of Germany (Baden-Wuerttemberg). Population Adults with back pain (N.=2,542, Mean =46.9 years, 66% females, graded chronic back pain [GCPS] 1=40.5%, GCPS 2=27.3%, GCPS 3=20.7%, GCPS 4=11.5%). Methods Self-reported back pain (functional restrictions and pain = back pain function score, [BPFS]) and characteristics of exercising behavior (frequency, duration, type, physical exertion) were assessed at baseline and at 6, 12, 18 and 24 months. Direct medical costs for back disorders (international classification of diseases, dorsopathies: M40-M54) were compiled from health insurance records. Results Moderate- to high-intensity exercise patterns were effective in reducing back pain, particularly at lower levels of subjective perceived physical exertion. At these intensity levels, multimodal back exercise (i.e. exercising the spine-stabilizing muscles specifically, ergonomic training) was 14.5 times more effective than non-back specific fitness exercise in reducing BPFS. The beneficial effects of both exercise types increased with the initial severity of back pain. However, only multimodal back exercise (moderate- to high-intensity/high back specificity) was associated with a significant decrease in direct medical costs for back pain. Conclusions Targeted exercise of the spine-stabilizing musculature at moderate to high intensities without maximum perceived exertion is effective and efficient in reducing back pain. Clinical rehabilitation impact The combination of high-intensity and high-specificity exercises yielded a significant reduction in medical costs. However, the intensities in terms of muscular load in endurance training and gymnastics may not be sufficient to reduce back pain effectively.

The creation of control groups in the evaluation of statutory health insurances is a key issue. Randomization represents both an ethical and a legal problem with legally guaranteed services. Matching procedures are relevant alternatives in the construction of control groups. Matchings are mostly based on secondary data from statutory health insurances (for example age, gender, cost of illness, days of incapacity to work). In this study, we examined whether matching based on secondary data alone can cause selection bias.We used data from three large prevention studies and applied sensitivity analyses to compare the results of propensity score matchings used to create control groups on the basis of secondary data, with those obtained on the basis of both primary and secondary data. Analysis of covariance was used to investigate the impact of potential selection bias on cost effects.Matchings based on secondary data alone lead to control groups with similar characteristics captured by secondary data. However, the control group participants are significantly healthier (they have, for example, lower levels of pain, lower levels of psychological stress, a higher degree of quality of life) than the patients in intervention groups. This selection bias would lead to a systematic underestimation of the cost reduction produced by preventive interventions.Prevention course participants seem to have characteristics that differ from the average population (higher health orientation level, preference for prevention over medical treatment services, etc.) and cannot be captured by secondary data; therefore, matchings based on secondary data alone cause selection bias.Including both primary and secondary data reduces the risk of selection bias in matching procedures for prevention studies. The E-value can be used to evaluate the robustness of results with regard to selection bias.

To compare the cost-effectiveness of a multimodal back exercise programme for non-specific back pain with that of standard treatment. Medical costs were measured in euros (EUR) and effectiveness was measured using Graded Chronic Pain Status (GCPS). A controlled multicentre study (39 sites) with a 6-month intervention phase and follow-up at 6, 12 and 18 months. The study included 1,829 participants in an intervention group and 495 individuals in a control group. The multimodal back exercise programme comprises 36 exercise sessions for optimizing the spine stabilizing muscles and everyday motor func-tions. The patients were given a home training programme at the end of the intervention programme. The back exercise programme resulted in a significant reduction, of 0.4, in back pain grade on the GCPS after 2 years, compared with standard treat-ment, and reduced medical costs by 763 EUR. The exercise programme was therapeutically effective for GCPS back pain grades 1–4 and produced cost savings in the case of grade 4 GCPS. The multimodal back exercise programme was therapeutically effective for back pain (grades 1–2) and pain-related functional impairment (grades 3–4). It resulted in reduced costs for chronic back pain causing high pain-induced functional impairment (grade 4). The therapeutic and economic effects of the programme increase with the grade of back pain.

Objectives: The aim of this study was to test the relationship between a newly developed sugar index and caries experience in 4th- and 6th-graders. Materials and Methods: A total of 1,019 fourth-graders and 925 sixth-graders from 2 regions in Northern Germany participated in the study. Caries experience was recorded by applying the ICDAS criteria. Tooth-brushing habits and other independent variables were examined psychometrically. Structured questions were formulated that were related to specific everyday eating situations, especially between main meals, which proved to be relevant for a higher caries risk. To compare mean caries scores, nonparametric tests were applied. The Pearson coefficient was calculated in order to verify the correlation between the sugar index and the caries experience. The influence of various independent variables on caries experience was assessed by stepwise backward logistic regression analysis. Results: With regard to the primary teeth of the 4th-graders, significant correlations with values > 0.1 were found for all ICDAS outcome variables. With regard to the permanent teeth of the 6th-graders, the only significant correlations with the sugar index were for the ICDAS outcome variables D3–6MFT and D3–6FS. Conclusion: The results of our study show that not only the correlation between the sugar index and caries experience was stronger for 4th-graders than for 6th-graders, but also more distinctly visible differences were observed when comparing extreme groups. This indicates that protective factors, such as fluoridation and the preventive sealing of fissures, help level out the differences in caries occurrence in older children when compared to younger children.

The multiple causal pathways model on the etiology of attention-deficit/hyperactivity disorder (ADHD) is well established. However, developmental implications of the model are not yet sufficiently analyzed. The model implies that critical neural and neuropsychological deviations from normative development precede secondarily developing ADHD symptoms. Cognitive, "cool" inhibitory control (CIC) and reward-related, "hot" functions (RRF) are regarded as neuropsychological basic deficits that indicate independent causal pathways. Both functions involve top-down control networks that undergo major normative developmental changes in the preschool period. We formalized the following assumptions in a path model: (a) CIC and RRF predict change in ADHD symptoms in the preschool period, (b) the reverse is not true, and (c) CIC and RRF independently contribute to this prediction. A community-based sample of 125 (71 boys) preschoolers was assessed at at age 4 and 5 years. At each assessment wave, CIC and RRF were measured by a battery of age-appropriate valid tasks. ADHD symptoms were measured by a clinical parent interview. Evaluation of model fit using manifest maximum likelihood parameter estimation clearly supported the hypothesized path model while controlling for gender of child and maternal education level. Thus, regarding the basic deficits of CIC and RRF, the results add evidence on the developmental implications of the multiple causal pathways model. Our findings point to the potential significance of these early emerging characteristics as indicators of risk and as targets for preventive interventions.

Non-invasive caries treatment is a major focus in modern dentistry. The present study was designed to evaluate the effectiveness of monomeric self-assembling peptide P11-4 (SAP P11-4) in combination with fluoride varnish or polymeric self-assembling peptide matrix (SAPM) in treatment of non-cavitated occlusal caries. Ninety children and adolescents were included in this randomized, gold-standard-controlled clinical trial. Test Group 1 received SAP P11-4 and twice fluoride varnish at baseline and Day 180, Test Group 2 received SAP P11-4 on baseline and twice weekly SAPM (home-application), and Control Group received fluoride varnish on baseline and Day 180. Caries progression was measured by laser fluorescence, Nyvad Caries Activity, ICDAS-II-codes, and investigator assessments. Laser fluorescence changes demonstrated superior results for Test Group 1 and 2, as values decreased compared to an increase for the Control Group (p

For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking.To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES.The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner Sozialindex I (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication.There was no significant functional association between SES and healthcare costs for any of the analysed cost types.In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have a significant influence on healthcare utilisation in Germany.

Standard dosing and intermittent bolus application (IB) are important risk factors for pharmacokinetic (PK) target non-attainment during empirical treatment with β-lactams in critically ill patients, particularly in those with sepsis and septic shock. We assessed the effect of therapeutic drug monitoring-guided (TDM), continuous infusion (CI) and individual dosing of piperacillin/tazobactam (PIP) on PK-target attainment in critically ill patients. This is a retrospective, single-center analysis of a database including 484 patients [933 serum concentrations (SC)] with severe infections, sepsis and septic shock who received TDM-guided CI of PIP in the intensive care unit (ICU) of an academic teaching hospital. The PK-target was defined as a PIP SC between 33 and 64 mg/L [fT > 2–4 times the epidemiological cutoff value (ECOFF) of Pseudomonas aeruginosa (PSA)]. PK-target attainment with standard dosing (initial dose) was observed in 166 patients (34.3%), whereas only 49 patients (10.1%) demonstrated target non-attainment. The minimum PK-target of ≥ 33 mg/L was overall realized in 89.9% (n = 435/484) of patients after the first PIP dose including 146 patients (30.2%) with potentially harmful SCs ≥ 100 mg/L. Subsequent TDM-guided dose adjustments significantly enhanced PK-target attainment to 280 patients (62.4%) and significantly reduced the fraction of potentially overdosed (≥ 100 mg/L) patients to 4.5% (n = 20/449). Renal replacement therapy (RRT) resulted in a relevant reduction of PIP clearance (CLPIP): no RRT CLPIP 6.8/6.3 L/h (median/IQR) [SCs n = 752, patients n = 405], continuous veno-venous hemodialysis (CVVHD) CLPIP 4.3/2.6 L/h [SCs n = 160, n = 71 patients], intermittent hemodialysis (iHD) CLPIP 2.6/2.3 L/h [SCs n = 21, n = 8 patients]). A body mass index (BMI) of > 40 kg/m2 significantly increased CLPIP 9.6/7.7 L/h [SC n = 43, n = 18 patients] in these patients. Age was significantly associated with supratherapeutic PIP concentrations (p

Pain is a common symptom in patients with depressive disorders, which, if present, worsens the prognosis. However, there is little empirical knowledge of the therapeutic effects of antidepressants on painful physical symptoms of patients with depressive disorders. Furthermore, tricyclic/tetracyclic antidepressants (TCAs) have not yet been included in existing meta-analyses.A broad, systematic search of PubMed literature on antidepressant drug treatment of patients with depressive disorders with comorbid pain symptoms was carried out. A random-effects meta-analysis has been performed among 3 different groups of drugs for the 2 end points: pain and depression.Fourteen placebo-controlled studies with selective serotonin-noradrenaline reuptake inhibitors (SSNRIs) could be included, with 3 of them also investigating selective serotonin reuptake inhibitors (SSRIs). Three further placebo-controlled SSRI studies were identified, but only 2 placebo-controlled TCA studies.Both SSNRIs and SSRIs, but not TCAs, were significantly superior to placebo as regards their analgesic effects. However, all effects were small. For SSNRIs, there was a strong positive correlation between their effectiveness for pain relief and their positive effect on the mood of the patients.The analgesic effects of SSNRIs and SSRIs in patients with primary depressive disorders can be interpreted as largely equivalent. Because of a lack of placebo-controlled TCA studies, the results for TCAs would be comparable only to those of SSRIs and SSNRIs, if non-placebo-controlled TCA studies were included. The positive correlation found indicates a close relationship of pain relief and antidepressant treatment effects. These results refer merely to patients with primary depressive disorders, not to patients with primary pain disorders. Further studies comparing the effects of different types of antidepressant drugs on pain in depressive patients are warranted.

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

Background This study investigated the effects of three different risk displays used in a cardiovascular risk calculator on patients’ motivation for shared decision-making (SDM). We compared a newly developed time-to-event (TTE) display with two established absolute risk displays (i.e. emoticons and bar charts). The accessibility, that is, how understandable, helpful, and trustworthy patients found each display, was also investigated. Methods We analysed a sample of 353 patients recruited in general practices. After giving consent, patients were introduced to one of three fictional vignettes with low, medium or high cardiovascular risk. All three risk displays were shown in a randomized order. Patients were asked to rate each display with regard to motivation for SDM and accessibility. Two-factorial repeated measures analyses of variance were conducted to compare the displays and investigate possible interactions with age. Results Regarding motivation for SDM, the TTE elicited the highest motivation, followed by the emoticons and bar chart (p

Background For children and adolescents with mental health problems, there is a lack of data as to whether the type of residential area (urban vs. rural) influences healthcare costs for affected individuals. The aim of this study was therefore to explore potential urban vs. rural healthcare cost differences in children and adolescents with conduct disorder (CD), one of the most frequent and cost-intensive child and adolescent psychiatric disorders. Additionally, we aimed to compare healthcare costs of youths with CD, and of youths without this diagnosis. Methods We analysed data from a German health insurance company, extracting all youths with a CD diagnosis in 2011 (CD group; N = 6337), and an age- and sex-matched group without this diagnosis (control group). For both groups, annual costs per person for outpatient and inpatient healthcare were aggregated, stratified by area of residence (urban vs. rural). Results While mean annual overall costs in the CD group did not differ significantly between urban and rural areas of residence (2785 EUR vs. 3557 EUR, p = 0.253), inpatient treatment costs were significantly higher in rural areas (2166 EUR (60.9% of overall costs) vs. 1199 EUR (43.1% of overall costs), p

Background In order to investigate correlations between specific parameters and dental caries, it is useful to record incipient and dentine lesions. Aim The aim of this study was to evaluate the effect of a selective intensified preventive program (SIP) on oral health of fourth graders using ICDAS. Design A cohort study was performed. ICDAS and DMFT index were recorded. Prevention and social factors were collected with psychometric questionnaires. The test group and the control group were parallelized using sociodemographic variables. Results The participants in the fluoride varnish program in the test region showed a significantly lower caries experience than pupils in the control region. The bivariate analysis revealed that a migrant background had a negative impact on oral health whereas fissure sealants, use of fluoridated table salt, use of fluoride tablets, early start of toothbrushing and high social status exerted a positive influence on dental health. Stepwise backward logistic regression analysis confirmed that fissure sealants, a high social status and an early start of toothbrushing had a significant positive impact on dental health. Conclusion The results of our study suggest that a SIP impedes the primary occurrence of incipient lesions and the transition from incipient to advanced lesions.

Fragestellung: Zum Screening von Autismus-Spektrum-Störungen (ASS) stehen verschiedene Fragebogenverfahren zur Verfügung. Leider zeigen neuere Studien, dass diese Verfahren zwar tatsächlich in der Lage sind, betroffene Personen mit ASS zu identifizieren, aber bezüglich der differentialdiagnostischen Abgrenzung zu anderen komplexen Störungsbildern (z. B. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung [ADHS], emotionale Störungen, Persönlichkeitsstörungen), insbesondere bei Personen ohne deutliche kognitive Beeinträchtigung, Probleme aufweisen (niedrige Spezifität). Methodik: In der vorliegenden Studie wurde an einer großen Inanspruchnahme-Stichprobe aus 309 Patienten (153 mit ASS, 156 mit sonstigen psychischen Störungen, IQ > 70) geprüft, inwiefern ausgewählte Items des ADI-R im Screening-Prozess von hochfunktionalen ASS eingesetzt werden können. Ergebnisse: Bei einem Cut-off von 5 zeigte sich eine hohe Sensitivität (0.93), bei einem Cut-off von 6 eine gute Spezifität (0.74). Dieses Ergebnis blieb für verschiedene Untergruppen (Einteilung nach Diagnose/Alter/IQ/Geschlecht) stabil. Schlussfolgerung: Insgesamt hat sich gezeigt, dass acht Interviewfragen des ADI-R dazu dienen können, Kinder und Jugendliche mit hochfunktionaler ASS von solchen mit anderen psychischen Störungen zu unterscheiden. Die Kombination aus früh beginnenden, ausgeprägten Auffälligkeiten im sozialen Kontakt mit stereotypen oder zwanghaft-ritualisierten Verhalten oder Interessen kann anhand weniger Fragen zu Screening-Zwecken ermittelt werden. Jedoch ist im weiteren Verlauf eine ausführliche und spezifische weitere kinder- und jugendpsychiatrische Diagnostik notwendig.

The aim of the present study was to evaluate the influence of various risk factors on dental caries increment in deciduous teeth of preschool children over 2.5 years. A longitudinal study was carried out in kindergartens in two German counties in Northern Hesse. At baseline examination in 2006–2007, the mean age of the children was 3.5 years. Caries experience was recorded according to WHO standards. Information about feeding practices during early childhood and preventive measures were collected by a structured questionnaire for each child. Three hundred ninety-five (69.8 %) of the 566 children showed no caries increment. A caries increase of 1 to 10 dmf-teeth was exhibited by 171 children (30.2 %). The mean dmf-t increment amounted to 0.75. The bivariate analysis revealed that the consumption of sugary food and beverages had a negative impact on oral health. Early start of toothbrushing, use of fluoridated children’s toothpaste, and frequent toothbrushing exerted a positive influence on dental health. Stepwise backward logistic regression analysis confirmed that a high social status has a significant positive impact on dental health (p = 0.028), whereas the consumption of sugary food and beverages was significantly associated with a higher dental caries increment (p = 0.004). Obviously, it is not possible to limit the caries increment in children of low socioeconomic status as successfully as in children of high socioeconomic status. There must be a stronger focus on families of low socioeconomic status when preventive measures are performed on groups or individuals.

Objective We aimed to validate the rapid eye movement (REM) sleep behavior disorder (RBD) screening questionnaire (RBDSQ) in 2 independent samples of patients with Parkinson's disease (PD) using different settings when performing the investigations. Methods The RBDSQ was administered to two independent samples of 52 and 75 consecutive PD patients investigated with video-polysomnography (vPSG). Results In sample A, the RBDSQ identified 46/52 (88.5%) patients correctly. In sample B, 50/75 (66.7%) patients were identified correctly. Considering a cut-off score of ≥ 5 as a positive test result, sample A showed a sensitivity of 0.90 and a specificity of 0.87, sample B showed a sensitivity of 0.68 and a specificity of 0.63. Main differences between both groups were that patients of sample A underwent a sleep history including RBD assessment prior to administration of the RBDSQ, whereas in sample B the RBDSQ was administered during routine work-up. Conclusions The diagnostic value of the RBDSQ strongly depends on the clinical setting and may be influenced by the individual's awareness on RBD. This finding is a critical issue which deserves clarification before use of this and other questionnaires can be recommended in epidemiological studies.

Die Effektivität des Elterntrainings „Stepping Stones/Triple P” als ergänzende Behandlung von Kindern mit einer Autismus-Spektrum-Störung (ASS) wurde untersucht. Die Eltern von 13 Kindern mit ASS (neun Jungen, vier Mädchen) zwischen vier und zwölf Jahren (M=6.7 Jahre, SD=2.61) nahmen an der Studie teil. Das Training fand über einen Zeitraum von 14 Wochen mit acht Gruppensitzungen à zwei Stunden statt. Die Eltern wurden zum Prä- und Postzeitpunkt, sowie sechs Monate später bezüglich komorbider Verhaltensauffälligkeiten und dem Erziehungsverhalten befragt. Außerdem wurden die autistische Kernsymptomatik sowie die elterliche Belastung zum Prä- und Postzeitpunkt erhoben. Ein Teil der Eltern wurde zusätzlich als Eigenwarteliste-Kontrollgruppe erfasst. Durch das Elterntraining konnten die komorbiden Verhaltensauffälligkeiten der Kinder reduziert werden (d=.65), außerdem verbesserten sich die Erziehungsfertigkeiten (d=.97). Keine Veränderungen ergaben sich hinsichtlich der elterlichen Belastung und der autistischen Kernsymptomatik. Insgesamt zeigt sich das Elterntraining nach „Stepping Stones/Triple P” als sinnvolle begleitende Intervention in der Behandlung von Kindern mit einer ASS.

Background Integrated Management of Childhood Illness (IMCI) is regarded as a standard public health approach to lowering child mortality in developing countries. However, little is known about how health workers adhere to the guidelines at the national level in sub-Saharan African countries. Methods Data from the Service Provision Assessment surveys of Namibia (NA) (survey year: 2009), Kenya (KE) (2010), Tanzania (TZ) (2006) and Uganda (UG) (2007) were analysed for adherence to the IMCI guidelines by health workers. Potential influencing factors included the survey country, patient’s age, the different levels of the national health system, the training level of the health care provider (physician, non-physician clinician, nurse-midwife, auxiliary staff), and the status of re-training in IMCI. Results In total, 6856 children (NA: 1495; KE: 1890; TZ: 2469; UG: 1002 / male 51.2–53.5%) aged 2–73 months (2–24 months, 65.3%; median NA: 19 months; KE: 18 months; TZ: 16 months; UG: 15 months) were clinically assessed by 2006 health workers during the surveys. Less than 33% of the workers carried out assessment of all three IMCI danger signs, namely inability to eat/drink, vomiting everything, and febrile convulsions (NA: 11%; KE: 11%; TZ: 14%; UG: 31%) while the rate for assessing all three of the IMCI main symptoms of cough/difficult breathing, diarrhoea, and fever was < 60% (NA: 48%; KE: 34%; TZ: 50%; UG: 57%). Physical examination rates for fever (temperature) (NA: 97%; KE: 87%; TZ: 73%; UG: 90%), pneumonia (respiration rate/auscultation) (NA: 43%; KE: 24%; TZ: 25%; UG: 20%) and diarrhoea (dehydration status) (NA: 29%; KE: 19%; TZ: 20%; UG: 39%) varied widely and were highest when assessing children with the actual diagnosis of pneumonia and diarrhoea. Adherence rates tended to be higher in children ≤ 24 months, at hospitals, among higher-qualified staff (physician/non-physician clinician) and among those with recent IMCI re-training. Conclusion Despite nationwide training in IMCI the adherence rates for assessment and physical examination remained low in all four countries. IMCI training should continue to be provided to all health staff, particularly nurses, midwives, and auxiliary staff, with periodic re-training and an emphasis to equally target children of all age groups.

Zusammenfassung Fragestellung: Berichtet wird über eine Verlaufsuntersuchung an jugendlichen und heranwachsenden Gewalt- und Tötungsdelinquenten (n=114), deren legale Entwicklung über einen Zeitraum von 12,8 Jahren verfolgt werden konnte. Ergebnisse: Unter den psychiatrischen Diagnosen nach ICD-10 (nur in 18 Fällen war keine solche zu stellen) standen in der Delinquentenstichprobe an erster Stelle Persönlichkeits- und Verhaltensstörungen (41,2%), gefolgt von Störungen des Sozialverhaltens (27,2%), Schizophrenien und wahnhaften Störungen (7%) und Störungen durch psychotrope Substanzen (5,3%). 2 Probanden (1,8%) litten an einem hyperkinetischen Syndrom und je einer an einer affektiven bzw. neurotischen Störung. Im Vergleich mit einer parallelisierten Patientenstichprobe wiesen die Straftäter im Marburger Symptom Rating (MSR) signifikant höhere Werte auf in den Symptomen Dissoziales Verhalten, Aggressivität, Drogen- und Alkoholmissbrauch, jedoch signifikant niedrigere Angstwerte. 44 der Probanden (38,5%) entwickelten sich zu chronischen Straftätern, die auch nach der Indextat weitere Delikte verübten. Als Untergruppe der chronischen Straftäter konnten 13 (11,4% der Gesamtstichprobe) als Mehrfachintensivtäter identifiziert werden, die in jeder Hinsicht am auffälligsten waren.

The aim of this study was to evaluate the in-vivo performance of the VistaProof fluorescence-based camera (VP) on occlusal surfaces. The study was approved by the ethics committee and informed consent was given by the participants. The study included 306 unrestored permanent teeth of 26 patients. The occlusal surfaces of the teeth were examined visually using International Caries Detection and Assessment System (ICDAS) criteria. Then, digital images of the surfaces were made using the VP. The actual depth of the lesions was assessed using radiographs and/or clinically by opening the lesion when appropriate. Correlation between all methods was assessed using Spearman's rank correlation coefficient (r s ). Sensitivity (SE) and specificity (SP) were calculated at D1-(enamel lesions) and D3-(dentine caries) diagnostic threshold and area under the ROC curve (AUC) were assessed. Significant positive correlation was found between ICDAS, VP measurements and the reference standard (r s 0.46–0.71, p