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Purpose: We studied a cohort of adult patients with chronic hepatitis B (CHB) infection, followed at a tertiary referral liver center in Germany over 12.5 years to analyze the clinical features and impact of management on disease progression and survival of CHB patients in general and of those with CHB and HCC in particular. Methods: We retrospectively evaluated the medical records of 242 adult (age ≥ 18 years) patients. CHB was defined as positive hepatitis B surface antigen (HBsAg) and/or HBV-DNA levels >10 IU/mL for at least 6 months. Patient demographics, HBV markers, antiviral treatment, laboratory parameters, liver imaging and histology were recorded for each visit. HCC patients were divided into two groups and separately analyzed (group 1: n = 24, HCC at first visit and group 2: n = 11, HCC during surveillance). Results: The mean age was 44 years in CHB patients without HCC (63 % male) and about 59 years in patients with HCC (77 % male). Antiviral therapy was given to 59 % of patients without HCC compared to only 25 % in group 1 and 18 % in group 2 with comparable median HBV DNA levels of approximately 36,000 IU/mL. There was no statistically significant difference concerning the HCC stages (Milan, UCSF, BCLC) at first diagnosis. Five-year survival was 19 % in group 1 vs. 64 % in group 2 ( p = 0.019), with LTx performed in 12 vs. 45 %, respectively. Conclusion: Surveillance of CHB patients did not result in early stage detection of HCC but in a higher likelihood to receive potentially curative treatments. [ABSTRACT FROM AUTHOR]

Objectives: In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy. Design: Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation. Setting: Geriatric clinic at an academic teaching hospital in Hamburg, Germany. Participants: 4,735 hospitalised patients ≥65 years. Measurements: Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated. Results: There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items 'transfer' + 'walking' score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3. Conclusions: Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients. [ABSTRACT FROM AUTHOR]

This investigation was carried out within the scope of EU-FP5 project MAGPROX. In parallel with the work of Kalinski et al. (2004, submitted), in which the magnetic signatures of the same soil profiles were analysed in more detail. The ‘hot spot’ under investigation was situated in the Lausitz area, Eastern Germany, between two major power plants, Schwarze Pumpe and Boxberg. This heavily industrialized region is known as the Black Triangle, named after the large lignite deposits and the old-technology power plants, among other petrochemical plants, refineries, textile manufacturing and glasswork industries. The relationship between magnetic parameters and heavy metal concentrations (Fe, Mn, Zn, Pb, Cu, Cr, Cd, Co and Ni) in soil profiles was determined statistically using linear regression analysis. Strong positive correlation was observed between heavy metal concentrations as viewed preliminarily from the heavy metal and magnetic susceptibility distributions with depth (soil profiles), and from the correlation coefficients obtained. [ABSTRACT FROM AUTHOR]

Objectives: Many studies examining early bilingualism in migrant populations focus on the development of the first language. As language acquisition is closely related to the hearing development, there is a critical need to investigate language development in hearing-impaired children being raised bilingually who were fitted with cochlear implants and/or hearing aids. Therefore, this research project aimed to study the linguistic development of hearing-impaired children being raised with German as a second language who were provided with hearing aids or cochlear implants. Further, the language development of these children is compared with that of hearing-impaired children being raised in a monolingual environment and with normal-hearing children being raised bilingually., Methods: In this prospective study, we analyzed data from 95 typically developing children with hearing loss (43 bilingual and 52 monolingual) aged 3;0 to 10;11 (years; months) on four language measures in German: receptive vocabulary, productive vocabulary, receptive grammar, productive grammar (sentence repetition). Additionally, 30 bilingual children with normal hearing were included in this study., Results: 44 children were provided with hearing aids in both ears; 34 used cochlear implants bilaterally and 17 were fitted bimodally. Statistical analysis showed that bilingual hearing-impaired children scored significantly poorer than monolingual hearing-impaired children., Conclusion: Hearing-impaired children being raised bilingually should have speech and language examinations on a regular basis. An examination of both languages would be desirable in order to be able to fully assess speech and language acquisition., (Copyright © 2019. Published by Elsevier B.V.)

Objective: To revise the German guidelines and recommendations for ensuring Good Epidemiological Practice (GEP) that were developed in 1999 by the German Society for Epidemiology (DGEpi), evaluated and revised in 2004, supplemented in 2008, and updated in 2014., Methods: The executive board of the DGEpi tasked the third revision of the GEP. The revision was arrived as a result of a consensus-building process by a working group of the DGEpi in collaboration with other working groups of the DGEpi and with the German Association for Medical Informatics, Biometry and Epidemiology, the German Society of Social Medicine and Prevention (DGSMP), the German Region of the International Biometric Society (IBS-DR), the German Technology, Methods and Infrastructure for Networked Medical Research (TMF), and the German Network for Health Services Research (DNVF). The GEP also refers to related German Good Practice documents (e.g. Health Reporting, Cartographical Practice in the Healthcare System, Secondary Data Analysis)., Results: The working group modified the 11 guidelines (after revision: 1 ethics, 2 research question, 3 study protocol and manual of operations, 4 data protection, 5 sample banks, 6 quality assurance, 7 data storage and documentation, 8 analysis of epidemiological data, 9 contractual framework, 10 interpretation and scientific publication, 11 communication and public health) and modified and supplemented the related recommendations. All participating scientific professional associations adopted the revised GEP., Conclusions: The revised GEP are addressed to everyone involved in the planning, preparation, execution, analysis, and evaluation of epidemiological research, as well as research institutes and funding bodies.

Introduction: The introduction of neonatal hearing screening and the increasingly early age at which children can receive a cochlear implant has intensified the need for a validated questionnaire to assess the speech production of children aged 0‒18. Such a questionnaire has been created, the LittlEARS ® Early Speech Production Questionnaire (LEESPQ). This study aimed to validate a second, revised edition of the LEESPQ., Methods and Materials: Questionnaires were returned for 362 children with normal hearing. Completed questionnaires were analysed to determine if the LEESPQ is reliable, prognostically accurate, internally consistent, and if gender or multilingualism affects total scores., Results: Total scores correlated positively with age. The LEESPQ is reliable, accurate, and consistent, and independent of gender or lingual status. A norm curve was created., Discussion: This second version of the LEESPQ is a valid tool to assess the speech production development of children with normal hearing, aged 0‒18, regardless of their gender. As such, the LEESPQ may be a useful tool to monitor the development of paediatric hearing device users., Conclusion: The second version of the LEESPQ is a valid instrument for assessing early speech production of children aged 0‒18 months.

Background: Patients with permanent end ileostomy are at high risk for detrimental stomal effects on their quality of life. However, little is known about the long-term quality of life of these patients., Objective: The purpose of this study was to assess long-term quality of life in patients with permanent end ileostomy., Data Sources: Registration at the German self-help organization ILCO was used for this study., Study Selection: Selection included a cross-sectional survey of 1434 patients with permanent end ileostomy., Main Outcome Measures: Quality of life was assessed using the Medical Outcomes Study Short Form 36, including physical and mental component summary scores, the Gastrointestinal Quality of Life Index, and the Cleveland Global Quality of Life Index. Multivariate risk factor analysis was performed., Results: A total of 783 responders were included. Indications for ileostomy included ulcerative colitis (44%), Crohn's disease (38%), and colorectal cancer (7%). Adverse effects on daily life because of stoma were reported by 72% of participants. Quality of life was significantly impaired compared with the general population on all of the summary scores and several subscales (physical component summary: 44.6 ± 10.4 (mean ± SD) vs 50.2 ± 10.2, p < 0.001; mental component summary: 47.5 ± 10.7 vs 51.5 ± 10.2, p < 0.001; Gastrointestinal Quality of Life Index: 94.4 ± 16.4 vs 126.0, p < 0.001). Stoma care problems affecting quality of life were reported by 63% of respondents. These included parastomal hernia (p < 0.001), stenosis (p = 0.003), and prolapse (p = 0.008). Vitamin B12, iron, and zinc deficiencies were also associated with diminished quality of life; in particular, vitamin B12 deficiency was associated with reduced mental and emotional quality of life., Limitations: Not all patients undergoing ileostomy in Germany are registered at ILCO, and there were many nonresponders. In addition, the inherent limitations of cross-sectional studies should be considered, including the response-shift phenomenon., Conclusions: Quality of life was markedly impaired in patients with permanent end ileostomy as compared with the general population. The main reasons were stoma-associated morbidity and nutritional deficiency syndromes. These findings highlight the importance of prevention, screening, and adequate treatment.