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In February 2008, five patients were infected with the H1N1 subtype of influenza A virus in one hospital ward for immunocompromised patients at a hospital in North Rhine-Westphalia, Germany. All of these patients had an established haematologic disease and tested positive either for viral RNA or antigen shortly after the beginning of respiratory illness. In three of the patients, influenza virus was repeatedly detected, and four of the patients died in coincidence with the virus infection. Sequencing of the amplified (HA1) haemagglutinin yielded identical nucleotide sequences in isolates from three of the patients, whereas one nucleotide difference was found in the isolate of the fourth patient, resulting in an amino acid substitution (G153R). To investigate the source of infection, the medical staff ( n = 104) of the hospital unit was tested and found negative for influenza virus RNA and antigen in pharyngeal lavages. Testing for influenza virus antibodies by immunofluorescence assay revealed that 12 staff members were positive for influenza virus A IgA antibodies. These findings suggest that wild-type influenza virus infections occurred within the medical staff at the same time the patients were infected and that the staff might have contributed to the circulation of virus in the hospital ward. [ABSTRACT FROM AUTHOR]

Geriatric rehabilitation is a cornerstone of the German healthcare system to maintain the functional capacity of older patients and prevent the need for long-term care. Until recently, access to geriatric rehabilitation was largely limited to post-acute care. With the introduction of new legislation, patients aged 70 and over can be referred to geriatric rehabilitation by practitioners. However, in order to prescribe geriatric rehabilitation, physicians must document relevant diagnoses supported by the results of a series of functional or cognitive assessments. Alongside this information, the SINGER profile has been introduced. It is mandatory, although there is currently no manual to guide assessment with this tool. Diagnoses and test results must be consistent in documenting the need for geriatric rehabilitation. However, individual assessment of resources and motivation are prerequisites that need to be assessed by prescribing practitioners prior to prescription, considering the structure of the available formats. First analyses document improvement in access to geriatric rehabilitation but point to limited availability., Competing Interests: Die Autoren haben aufgrund ihrer Tätigkeiten in der geriatrischen Rehabilitation potenzielle Interessenkonflikte., (Thieme. All rights reserved.)

Since May 2020, several COVID-19 outbreaks have occurred in the German meat industry despite various protective measures, and temperature and ventilation conditions were considered as possible high-risk factors. This cross-sectional study examined meat and poultry plants to assess possible risk factors. Companies completed a self-administered questionnaire on the work environment and protective measures taken to prevent SARS-CoV-2 infection. Multivariable logistic regression analysis adjusted for the possibility to distance at least 1.5 meters, break rules, and employment status was performed to identify risk factors associated with COVID-19 cases. Twenty-two meat and poultry plants with 19,072 employees participated. The prevalence of COVID-19 in the seven plants with more than 10 cases was 12.1% and was highest in the deboning and meat cutting area with 16.1%. A subsample analysis where information on maximal ventilation rate per employee was available revealed an association with the ventilation rate (adjusted odds ratio (AOR) 0.996, 95% CI 0.993-0.999). When including temperature as an interaction term in the working area, the association with the ventilation rate did not change. When room temperatures increased, the chance of testing positive for COVID-19 (AOR 0.90 95% CI 0.82-0.99) decreased, and the chance for testing positive for COVID-19for the interaction term (AOR 1.001, 95% CI 1.000-1.003) increased. Employees who work where a minimum distance of less than 1.5 m between workers was the norm had a higher chance of testing positive (AOR 3.61; 95% CI 2.83-4.6). Our results further indicate that climate conditions and low outdoor air flow are factors that can promote the spread of SARS-CoV-2 aerosols. A possible requirement for pandemic mitigation strategies in industrial workplace settings is to increase the ventilation rate., Competing Interests: The authors have declared that no competing interests exist.

This study had 2 objectives. The first objective was to investigate motion patterns and the range of motion of the bovine proximal and distal interphalangeal joints on concrete during the stance phase. The second objective was to determine whether the range of motion and the locomotive stability of the interphalangeal joints differ on concrete and 3 different commercially available rubber mats (Karera, Kura, and Pedikura; Kraiburg Elastik GmbH & Co. KG, Tittmoning, Germany). Biplane high-speed fluoroscopic kinematography (72 ± 2.5 kV and 112.5 ± 12.5 mA, refresh rate 500 frames per second, shutter 0.5 ms) was applied to record 1 stance phase of the right forelimb of 2 Holstein Friesian heifers (15 mo old, 440 ± 10 kg; ± standard deviation) on each flooring. Three-dimensional digital animations were generated with a marker-supported manual animation technique based on the recordings and computer tomographic bone models. The mean maximum range of motion of each of the 4 interphalangeal joints in terms of flexion/extension, abduction/adduction, and internal/external rotation were calculated as well as the mean number of local extrema as a measure of stability during the stance phase. The main degree of freedom in all interphalangeal joints was flexion and extension with a range of motion of 17.7 to 25.9°. The second largest degree of freedom differed between abduction/adduction (7.7-10.0°) and internal/external rotation (6.5-9.6°) depending on the joint. Remarkably, although smaller, these extrasagittal directions still contribute to the overall motion to a considerable degree. In addition, the interphalangeal joints of the lateral digit showed a tendency to move less during the stance phase than their medial counterparts. Comparing concrete to the rubber mats, the interphalangeal joints tend to have to cover a larger range of motion on concrete with the exception of the distal interphalangeal joint in terms of flexion/extension. The unyielding surface of concrete seems to force the flexible parts of the animal-ground-interaction into extended motion. Furthermore, there tends to be more instability in all 3 degrees of freedom in all 4 joints on concrete, implying a greater effort of the soft tissues to achieve a balanced motion. Detailed biomechanical research contributes to the development of adequate flooring systems by evaluating the mechanical strain on claws and joints and working toward lameness prevention and thus animal welfare., (Copyright © 2019 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Background: In the course of demographic developments, an increase of vascular surgical procedures including major amputations in very elderly, multimorbid geriatric patients is expected. Due to the high vulnerability of these patients, geriatric rehabilitation directly following the acute inpatient treatment is likely to improve the abilities of these patients. This issue is not well analyzed in Germany up to now., Materials and Methods: This retrospective study includes all patients who were admitted to our clinic for geriatric rehabilitation after vascular surgery between 01 June 2012 and 31 December 2013. Geriatric assessments at the time of admission and discharge were considered. The group was divided into rehabilitation patients with major limb amputation and nonmajor limb amputation. Both groups were analyzed with respect to functional parameters and activities in daily life (ADL) during the course of rehabilitation as well as the discharge location (home versus nursing home)., Results: A total of 30 major-limb-amputee and 77 nonmajor-limb-amputee rehabilitants could be analyzed. Before surgical intervention, 100  % of patients lived in a home care situation. The median age was 78.3 years. During rehabilitation, both groups showed highly significant improvements in ADL (Barthel index), Timed Up and Go test, walking distance, and stair climbing; however the nonmajor amputees surpassed the major amputees in most mobility assessments especially in the five chair-rising test. The rehabilitation time (median) was 41.8 days for major and 23.9 days for nonmajor amputees. More than 90  % of the rehabilitants in both groups could be discharged home., Conclusion: The data from this retrospective study indicate that even advanced old age, multimorbid patients benefit from geriatric rehabilitation after vascular surgery intervention. Although less distinct than the group of minor amputee rehabilitants, highly significant improvements were also demonstrated in the group of major amputee rehabilitants as assessed in the discharge mobility and ADL results compared to the admission assessment results. These improvements were achieved in an adequate time period and led to discharge into home care for the majority of patients.

Background: Although the number of elderly patients with fractures is increasing, there have been only a few studies to date of the efficacy of collaborative treatment by trauma surgeons and geriatricians., Methods: Data on patients over age 75 with femoral neck, trochanteric, proximal humeral, and pelvic ring fractures were evaluated from the eras before and after the establishment of a certified center for geriatric traumatology (CGT) (retrospective analysis, n = 169; prospective analysis, n = 216). Moreover, data were also analyzed from younger patients (aged 65-74) with the same types of fracture who were not treated in the CGT. The main outcome parameter was in-hospital mortality. Other ones were the frequency and length of stays in the intensive care unit, the overall length of hospital stay, and the use of inpatient rehabilitation after acute hospitalization., Results: Before the CGT was established, 20.7% of all patients over age 75 (95% confidence interval [CI], 14.8-27%) were treated in an intensive care unit; the corresponding figure after the establishment of the CGT was 13.4% (95% CI, 9.3-18.5%, p = 0.057). The mean length of stay in the intensive care unit before and after establishment of the CGT was 48 hours (95% CI, 32-64 hours) and 53 hours (95% CI, 29-77 hours), respectively (p = 0.973). The in-hospital mortality declined from 9.5% (95% CI, 5.3-13.8%) to 6.5% (95% CI, 3.7-9.5%, p = 0.278), while the overall length of hospital stay increased from 13.7 days (95% CI, 12.6-14.8 days) to 16.9 days (95% CI, 16.1-17.7 days, p<0.001). The percentage of patients transferred to an inpatient rehabilitation facility upon discharge decreased slightly, from 53.8% to 49.1%. Among the younger patients who were not treated in the CGT, no comparable trends were seen toward lower in-hospital mortality or toward less treatment in an intensive care unit. In fact, the developments over time in the younger age group tended to be in the opposite direction.0.001). The percentage of patients transferred to an inpatient rehabilitation facility upon discharge decreased slightly, from 53.8% to 49.1%. Among the younger patients who were not treated in the CGT, no comparable trends were seen toward lower in-hospital mortality or toward less treatment in an intensive care unit. In fact, the developments over time in the younger age group tended to be in the opposite direction., Conclusion: The collaborative treatment of elderly patients with fractures by trauma surgeons and geriatric physicians can markedly improve their acute care.

Introduction: The question whether educational programmes improve dentists' knowledge of oral cancer is still an unexplored subject. The aim of this study was to assess dentists' opinions and practices concerning oral cancer using a standardised survey after educational intervention over one year., Material and Methods: Following a baseline survey which was mailed to every dentist in Schleswig-Holstein, Germany (n = 2280), the results were analysed to produce a multifaceted educational programme. After educational intervention, the same survey was redistributed and the results before and after intervention were compared., Results: The results are based on 394 surveys. Following intervention, 62% of responders, compared to 49% at baseline, described their overall knowledge as current. The percentage of dentists routinely investigating older patients at the recall appointment increased from 28% at baseline to 37% if the responders had attended a continuing education course during the period of intervention. Similar improvements were observed at initial appointment for older patients, with results improving from 33% to 38% for responders who attended a further educational course., Conclusions: Our results showed that a 1-year educational intervention with a multifaceted approach was successful. They underline that continuing education programmes improve the competence of dentists performing examination of the oral cavity. Therefore, regular participation in continuing educational courses is recommended., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The objective of this study was to assess the knowledge about oral cancer, in particular about diagnostic items and risk factors, after educational intervention by means of a standardized survey. On the basis of the evaluation at baseline, an educational programme consisting of different approaches (for instance, oral presentations, poster, DVD and a brochure) was designed. In May 2009, the questionnaire 'Practices and opinions about oral cancer' focusing on the knowledge about diagnostic factors and risk factors for oral cancer was mailed to every dentist in Schleswig-Holstein, Germany (n = 2280). The results were based on 394 of 2280 questionnaires. After a 1-year educational intervention, the dentists' overall knowledge about diagnostic procedures and risk factors for oral cancer had improved. The low baseline results for diagnostic procedures and risk factors showed the highest improvement rate immediately after the intervention. Within the reevaluation subgroups, responders who had attended a continuing education course during the intervention period showed better results compared with the whole sample of the reevaluation. The results showed that a structured educational programme with different approaches increases dentists' knowledge about diagnostic procedures and risk factors. This intervention may not only give useful recommendations for further educational courses, but emphasizes the necessity of attending continuous further educational courses.

Introduction: The present study was part of a comprehensive weight-of-evidence approach with the goal of identifying potential causes for the declines in fish populations, which have been observed during the past decades in the Upper Danube River., Methods: The specific goal was the investigation of the endocrine disrupting potential of sediment extracts from different sites along the Danube River. Parallel to the identification and quantification of target estrogens, two in vitro bioassays were employed to assess the estrogenic potential (yeast estrogen screen, YES) of the sediment samples and to evaluate their effects on the production of testosterone (T) and E2 (H295R Steroidogenesis Assay). Using a potency balance approach, the contribution of the measured compounds (Chem-EEQs) to the total endocrine activity measured by the YES (YES-EEQs) was calculated., Results and Discussion: Of the nine sediment extracts tested five extracts exhibited significant estrogenic activities in the YES, which suggested the presence of ER agonists in these samples. The xenoestrogens nonylphenol (NP) and bisphenol A (BPA) and the natural estrogen estrone (E1) were detected while concentrations of 17β-estradiol (E2) and ethinylestradiol (EE2) were less than their respective limits of quantification in all sediment extracts. A comparison of the measured YES-EEQs and the calculated Chem-EEQs revealed that as much as 6% of estrogenic activity in extracts of most sediments could be explained by two xeno- and one natural estrogen. Exposure of H295R cells to sediment extracts from four different locations in the Danube River resulted in significantly increased concentrations of E2, but only slight inhibition of T synthesis. Furthermore, application of the H295R Steroidogenesis Assay provided evidence for endocrine disrupting potencies in sediment samples from the Upper Danube River, some of which were not detectable with the YES. In conclusion, differential endocrine activities were associated with several sediments from the Upper Danube River. Further investigations will have to show whether the observed activities are of biological relevance with regard to declines in fish populations in the Upper Danube River.

Genotoxicity can be correlated with adverse reproductive effects or may even result in elevated extinction risk for particular species of an ecosystem. It may thus be a valuable tool for screening of pollution and potential environmental harm. Since many genotoxicants tend to adsorb onto particulate matter, sediments and suspended materials are of particular interest for genotoxicity screening under field conditions. In order to correlate the genotoxic potential of sediments with genetic damage in fish, rainbow-trout liver (RTL-W1) cells were exposed in vitro to acetone extracts of sediments collected at 10 selected sites along the upper Danube River and analyzed in the comet and micronucleus assays. These in vitro results were compared with micronucleus formation in erythrocytes of the European barbel (Barbus barbus) caught in the field. The two in vitro bioassays showed excellent correlation, indicating comparability of genotoxic potentials in vitro. Sampling sites could be clearly differentiated with respect to severity of effects, with Rottenacker as the most heavily contaminated site, Ehingen and Schwarzach as moderately genotoxic, and with the weakest effects in the tributary Lauchert. All other sediment extracts showed intermediate genotoxic or clastogenic effects. In situ, micronucleus formation in barbel erythrocytes indicated severe genotoxicity at Rottenacker, moderate effects at Ehingen, but minor contamination at Riedlingen and Sigmaringen. In situ observations thus showed excellent correlation with corresponding in vitro tests and document the ecological relevance of in vitro studies with sediment extracts. With respect to the ecological status of the Danube River, the results overall indicate a moderate to severe genotoxic potential with a highly differential localization., (Copyright 2010 Elsevier B.V. All rights reserved.)