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Background: Osteopathy and its practice in Germany is unregulated without nationally agreed competencies, frameworks or practice standards. The heterogeneity of practice makes it likely that there is a great variety in the nature and scope of practice. Educational programs vary greatly in length and content and no nationally agreed curriculum exists. The high number of osteopathic associations with varying political goals and perspectives suggests a fragmentation of the osteopathic community. Little formal research has been reported on standards and practice of osteopathic care in Germany. The lack of data contributes to uncertainty and makes it difficult to build a case for a more united regulated profession. Purpose: A series of connected studies aimed to develop an instrument to survey the osteopathic profession in Germany. The purpose was to obtain data about the characteristics of the osteopaths and osteopathic physicians and their practice in order to provide a coherent picture of the profession in Germany. Methods: A scoping review and appraisal of cross-sectional studies was conducted to create an overview of the literature from cross-sectional studies in the field and to identify possible survey tools usable in the German context. This phase led to the decision to develop a survey instrument specifically for the German environment which was informed by the results of the scoping review. Previous questionnaires informed the first draft of the questionnaire. Mixed methods enhanced the design of the questionnaire utilising a consensus group, cognitive interviews with stakeholders, expert rating and feedback methodologies with participants nominated by national associations. After a final online pilot test the survey was implemented in a national cross-sectional survey with the participants recruited from eight national associations. Invitations were disseminated by the associations with 2 follow-up reminders. Data were collected using the SmartSurvey® online questionnaire system. Results: The validated questionnaire consisted of 55 items subdivided into 8 sections and was used in a cross-sectional study with a sample group of 8,331 osteopaths and osteopathic physicians from November 2017 to February 2018. The response rate was 18.9% (n=1578), from which 1,175 were active practicing respondents who had complete data sets. Osteopaths and osteopathic physicians in Germany provide osteopathic care for a wide range of patient age groups presenting with various complaints and conditions using a variety on methods and techniques. Some differences were observed between German practice nationally and practice internationally. Conclusions: Cross-sectional studies of osteopathic practice are commonly poorly reported and many are weak methodologically. A newly validated questionnaire has provided data on the nature of practice in Germany. There is some variability in practice between and within stakeholder osteopathic groups in Germany. There is a need for unification of the osteopathic groups and regulation to improve professional identity and to support the implementation of nationally agreed standards of practice, education and safety.

Abstract: Inflammatory bowel diseases (IBD) are a group of chronic inflammatory conditions including ulcerative colitis (UC) and Crohn’s disease (CD) induced by an interaction between genetic susceptibility, environmental factors, dysbiosis of gut microbiota and an abnormal mucosal immune response. Alternative therapies, such as probiotics, prebiotics and dietary fibre supplements (PPF) are cost-effective, have fewer side effects and can alter the microbial composition of the gut to favour a decrease in gut inflammation. However, these products are relatively understudied with a lack of data on usage patterns. This study aimed to determine factors related to use and awareness of PPF in patients with IBD. A cross-sectional study was conducted in patients with a diagnosis of inflammatory bowel disease in the University of Alberta IBD clinic. Using a 20-item survey questionnaire, data on use and awareness of probiotics, prebiotics and dietary fibre supplements and demographic information of their users were collected. Clinical characteristics such as occurrence of flares, age at diagnosis, clinical scores of severity, presence of extra-intestinal disease and objective markers of disease, were collected from charts. Survey questionnaires were completed by 267 participants with IBD. Ninety-one percent of IBD patients had heard of PPF in their lifetime. Awareness of PPF was associated with female gender (p

Phenotypic characterization of patients with COPD may have potential prognostic and therapeutic implications. Available information on the relationship between emphysema and the clinical presentation in patients with COPD is limited to advanced stages of the disease. The objective of this study was to describe emphysema presence, severity, and distribution and its impact on clinical presentation of patients with mild to moderate COPD. METHODS: One hundred fifteen patients with COPD underwent clinical and chest CT scan evaluation for the presence, severity, and distribution of emphysema. Patients with and without emphysema and with different forms of emphysema distribution (upper/lower/core/peel) were compared. The impact of emphysema severity and distribution on clinical presentation was determined. RESULTS: Fifty percent of the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%). Upper and core zones had the more severe degree of emphysema. Patients with emphysema were older, more frequently men, and had lower FEV(1)%, higher total lung capacity percentage, and lower diffusing capacity of the lung for carbon monoxide. No differences were found between the clinical or physiologic parameters of the different emphysema distributions. CONCLUSIONS: In patients with mild to moderate COPD, although the presence of emphysema has an impact on physiologic presentation, its severity and distribution seem to have little impact on clinical presentation.

Despite low rates of obesity, many university students perceive themselves as overweight, especially women. This is of concern, because inappropriate weight perceptions can lead to unhealthy behaviours including eating disorders. METHODS: We used the database from the Cross National Student Health Survey (CNSHS), consisting of 5,900 records of university students from Bulgaria, Denmark, Germany, Lithuania, Poland, Spain and Turkey to analyse differences in perceived weight status based on the question: "Do you consider yourself much too thin, a little too thin, just right, a little too fat or much too fat?". The association between perceived weight and body mass index (BMI) calculated from self-reported weight and height was assessed with generalized non-parametric regression in R library gam. RESULTS: Although the majority of students reported a normal BMI (72-84% of males, 65-83% of females), only 32% to 68% of students considered their weight "just right". Around 20% of females with BMI of 20 kg/m2 considered themselves "a little too fat" or "too fat", and the percentages increased to 60% for a BMI of 22.5 kg/m2. Male students rarely felt "a little too fat" or "too fat" below BMI of 22.5 kg/m2, but most felt too thin with a BMI of 20 kg/m2. CONCLUSIONS: Weight ideals are rather uniform across the European countries, with female students being more likely to perceive themselves as "too fat" at a normal BMI, while male students being more likely to perceive themselves as "too thin". Programs to prevent unhealthy behaviours to achieve ill-advised weight ideals may benefit students.

Osteoporosis is a frequent health problem in adults. Optimization of bone mass acquisition during childhood and adolescence may play a major role in the prevention of this disease. Osteosonography is a recent technique for measuring bone mineralization without exposing the patient to radiation. OBJECTIVES: To measure bone mineral density using osteosonography in healthy Spanish Caucasian children and adolescents in order to determine normal values. METHODS: We performed a cross sectional study of 829 healthy child and adolescent volunteers (360 girls and 469 boys) randomly selected from the urban area of Pamplona in Navarre (Spain). Ages ranged from 6 to 18 years. ADBM Sonic 1200 ultrasound densitometer from IGEA was used. Daily calcium dietary intake and amount of physical activity were recorded. RESULTS: Cross sectional standards for Ad-SOS are presented. Ad-SOS did not significantly change between the ages of 6 and 9 years in girls or until the age of 10 years in boys. From the ages of 10 to 14 years, Ad-SOS values were higher in girls than in boys. After the age of 14 years, no significant differences were found. No correlation was found between calcium dietary intake, amount of physical exercise or bone mineralization values. CONCLUSIONS: Measurement of Ad-SOS by osteosonography is an easy, fast and inexpensive method for measuring bone mineral density in children and adolescents without exposing them to radiation. It can be used in the pediatric population to detect early alterations in bone mineralization.

Antineoplastic treatment has a deleterious effect on intellectual functions, which is mainly attributable to radiotherapy. With the object of determining the neuropsychological disturbances associated with brain irradiation in the child, and to try to differentiate them from the effects caused by the other types of treatment (surgical and chemotherapy) as well as from the effects of the tumor itself, a cross-sectional study was carried out in 25 survivors of medial edge intracranial tumors. In order to monitor the effect of systemic chemotherapy on the cognitive functions, and the effect of prolonged absence from school, two control groups were formed, one made up of subjects treated with chemotherapy for extracranial tumors, and the other of patients with non-malignant chronic disease. Neuropsychological functions were measured using the Spanish version of the Wechsler scale, as well as the following tests: Spreen-Benton, ITPA and TALE scales, Yuste Memory Test, Thurstone Attention Test, and the Rey Complex Figure. In addition to a progressive decline found in the full scale intelligence quotient in children irradiated for intracranial tumors, variance analysis showed that these patients deteriorate mainly in visual attention and memory, but also significantly in verbal fluency and in the Performance Intelligence Quotient and all its subtests, when compared to the control groups. Visual attention and the Wechsler Picture Arrangement and Block Designs, were the tests whose decline correlated with the total radiation administered. The article relates this specific neuropsychological injury with the total brain irradiation dose but also with the structures located in the cone-down fields of irradiation to boost regions in the middle edge intracranial content.