Search

Aim: To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first‐line therapy and the factors associated with this. Methods: This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti‐hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first‐line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first‐line therapy. Results: A total of 7.1% of participants received insulin as a first‐line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81–4.06], age > 80 years (OR 2.35, 95% CI 1.20–4.61) compared with age ≤ 40 years, HbA1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81–4.95) compared with HbA1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29–2.81), peripheral artery disease (OR 1.94, 95% CI 1.30–2.81), neurological complications (OR 1.45, 95% CI 1.00–2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08–1.25) and higher number of different drugs prescribed within 12 months prior–the index date (OR 1.09, 95% CI 1.05–1.12) were significantly associated with the probability of receiving insulin as a first‐line therapy. Conclusion: Insulin is rarely used as a first‐line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first‐line therapy is significantly influenced by diabetologist practice, age, HbA1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy. What's new?: In this study, we used a nationwide real‐world database, allowing unbiased estimation of prescription prevalence in German primary care practices.Some 7.1% of participants with type 2 diabetes received insulin as a first‐line therapy.Factors that significantly impact the probability of receiving insulin as a first‐line therapy include diabetologist practice, age > 80 years, HbA1c ≥ 85.8 mmol/mol (10%), as well as renal, neurological and vascular complications, a higher Charlson Comorbidity Index, and polypharmacy. [ABSTRACT FROM AUTHOR]

Purpose: Children and adolescents spend up to 50% of their time at school. The purpose of this study was to assess injury patterns of school accidents (along with their treatment) in the trauma center of a German university hospital, and to compare these data to those in the literature. Methods: All school accidents treated in a level 1 pediatric trauma center over a five-year period were statistically analyzed in a retrospective manner by chart review. Results: There were 1,399 school accidents that were treated in our department. Average age of the injured person was 11.8 years, with a boy:girl ratio of 3:2. Almost 40% of the injuries occurred during school sports. The most frequently injured region was the upper extremity, including the hand (36.8%). Distortion and contusion was the most frequent diagnosis among all injuries. Sixteen percent of the cases had to be treated surgically and/or under general anesthesia, and 16% of the patients had to be admitted to the hospital. Conclusion: It can be concluded that special attention must be paid during school sporting activities and breaks because they account for most of the accidents. Traffic education may reduce severe injuries. Specific knowledge of the growing long bones of the upper extremity and the hand is important for the diagnosis and treatment of school accidents. [ABSTRACT FROM AUTHOR]

Land use and mineral characteristics affect the ability of surface as well as subsurface soils to sequester organic carbon and their contribution to mitigation of the greenhouse effect. There is less information about the effects of land use and soil properties on the amount and composition of organic matter (OM) for subsurface soils as compared with surface soils. Here we aimed to analyse the long-term (≥ 100 years) impact of arable and forest land use and soil mineral characteristics on subsurface soil organic carbon (SOC) contents, as well as on amount and composition of OM sequentially separated by Na pyrophosphate solution (OM(PY)) from subsurface soil samples. Seven soils with different mineral characteristics (Albic and Haplic Luvisol, Colluvic and Haplic Regosol, Haplic and Vertic Cambisol, Haplic Stagnosol) were selected from within Germany. Soil samples were taken from subsurface horizons of forest and adjacent arable sites continuously used for >100 years. The OM(PY) fractions were analysed for their OC content (OC) and characterized by Fourier transform infrared spectroscopy. Multiple regression analyses for the arable subsurface soils indicated significant positive relationships between the SOC contents and combined effects of the (i) exchangeable Ca (Ca) and oxalate-soluble Fe (Fe) and (ii) the Ca and Al contents. For these soils the increase in OC (OC multiplied by the relative C=O content of OM(PY)) and increasing contents of Ca indicated that OM(PY) mainly interacts with Ca. For the forest subsurface soils (pH < 5), the OC contents were related to the contents of Na-pyrophosphate-soluble Fe and Al. The long-term arable and forest land use seems to result in different OM(PY)-mineral interactions in subsurface soils. On the basis of this, we hypothesize that a long-term land-use change from arable to forest may lead to a shift from mainly OM(PY)-Ca to mainly OM(PY)-Fe and -Al interactions if the pH of subsurface soils significantly decreases to <5. [ABSTRACT FROM AUTHOR]

Background Although Europe is supposed to be non-endemic for hepatitis E virus (HEV), locally acquired human cases are registered, and a relatively high prevalence for anti-HEV was found in blood donors in some European countries. Transfusion–transmitted infections by contaminated blood products were reported in Japan and sporadically in Europe. Materials and Methods Several samples from a plasma donor were screened with a highly sensitive quantitative HEV real-time polymerase chain reaction and the full-length genome was generated. Serology was performed with two different commercially available ELISA kits. Results The full-length genome sequence of human HEV was identified using samples from a plasma donor with acute self-limiting hepatitis. Plasma donated 2 weeks before onset of elevated liver enzyme levels was already positive for HEV RNA (104 copies/ml). High viraemia (106 copies/ml) correlated with the detection of anti-HEV IgM in the first blood sample with increased alanine transaminase levels. Phylogenetic analyses grouped the isolate within genotype 3, subtype 3f. Conclusion The sequence analyses and the epidemiological data revealed that the plasma donor was most probably infected with a swine HEV. This case supports the ongoing discussion of an obligatory HEV nucleic acid testing of blood products for special recipient risk groups. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the real-time usage of krankheitserfahrungen.de, a website providing scientifically collected and analyzed experiences of persons with various chronic illnesses., Methods: Web analytics of website use of www.krankheitserfahrungen.de in 2016. Qualitative content analysis of the 150 most and least opened video/audio clip titles in 2018-19., Results: In 2016, krankheitserfahrungen.de had 19,703 unique visits, of which 3925 were returning visits. Between new and returning visits, the latter were characterized by more actions and more time spent on the website. Thematic pages were clicked more often during new visits and person pages were more frequented during returning visits. In 2018-19, video/audio clip titles related to topics around uncertainties and/or decision making were most often clicked, whereas the least clicked clips dealt with topics like illness management, problem-solving, giving advice to others and emotionally difficult topics such as suffering, death and burden for the family., Conclusion: A website with balanced, scientifically collected and analyzed patient experiences attracts a sufficient number of users and is used for further explorations., Practice Implications: Using multiple formats, broad topics and diverse personal experiences being accessible through themes or persons is necessary when a scientifically based website on patients' experiences is designed., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: To ensure successful medical education despite the COVID-19 pandemic, the demand for online instruction has substantially increased. Fast and efficient teaching in a digital format poses a great challenge for medical students and lecturers as well as the universities., Objective: The aim of this study is to capture the readiness of medical students and faculty members to participate in rapidly- evolving online education., Methods: This cross-sectional study is based on two questionnaires distributed among medical students and associate deans for education in Germany, Austria and Switzerland. Questions included decision- making questions, categorical questions, and open-ended questions, all addressing the frequency and format of the digital education offered, the perceived quality of digital education, and medical student satisfaction with digital education. Questions about missing content and areas for improvement from the perspectives of medical students were included. The associate deans were asked for their opinions about the impact of the pandemic on teaching, the organizational setup and implementation of digital education by universities, and plans for future initiatives., Results: Three thousand and thirty medical students (m = 752 and f = 2245) from 53 universities participated in the study. The study showed that 92% of students were affected by the pandemic, and 19% of the students viewed the changes as entirely negative. 97% of the medical students were able to participate in digital courses, but only 4% were able to learn exclusively online. For 77% of the medical students, digital offerings accounted for over 80% of the education offered. In terms of content, medical students complained about a lack of practical teaching, such as contact with patients, lecturers, fellow medical students, and a poor perceived quality of teaching due to dubbing, frequent changeover of seminars, problem-oriented learning groups and in-person teaching, a lack of interaction possibilities and a lack of technical equipment, such as lecturers' knowledge and server capacities, at the universities. Overall, almost half of the medical students (42%) rated the implementation of digital teaching at their universities as good or very good. Forty-one of the 53 associate deans responded to the questionnaire, and 35 felt medical education was influenced by the pandemic. The associate deans (80%; 33/41) felt that the digitalization of medical education was negatively influenced by the pandemic. Only 44% (18/41) felt that their universities were well or very well positioned for digital teaching. All the associate deans believe that digital teaching in medicine will continue after the pandemic., Conclusions: In the German-speaking world, the rapid conversion of medical teaching to a digital format has been well implemented in many cases. The perceived quality of the implementation of digital education still lacks practical relevance and the use of new digital media, such as learning games, VR, and online question time. The digital format of medical education will likely continue beyond the COVID-19 pandemic., (© 2022. The Author(s).)

Background and Objectives: One-third of childhood cancer long-term survivors suffer from severe late effects (e.g., secondary cancer and cardiovascular diseases). The German Childhood Cancer Registry (GCCR) holds approximately 70,000 registered cancer cases, of which more than 41,000 are long-term survivors, with recent follow-up and contact information that can be used for scientific studies on late effects. The characteristics of this cohort are presented, previous late effects studies with the support of the GCCR are described, and the respective participation rates are reported., Methods: For all patients who developed cancer between 1980 and 2019 and were in long-term observation at the GCCR, the distribution of diagnoses, current age, observation time, and number of secondary cancers as of 16 July 2021 was determined. The rates of patients who responded to history queries were computed. The influence of determinants on the participation rate were calculated using generalized estimating equations., Results: The cohort comprises 41,466 long-term survivors. Of these, 10% are older than 40 years and 40% had their cancer diagnosis more than 20 years ago. The participation rates range between 30 and 60% and depend on age at diagnosis, the complexity of the study, and the number of previously conducted surveys. A time interval of at least four years between two consecutive contacts seems optimal., Conclusions: Our unique cohort enables population-based research on late effects after childhood cancer. To define a sensible time interval for contacting survivors is essential. In order to ensure that survivors are not contacted too frequently, the number of survivors included in research projects should be as small as possible., (© 2022. The Author(s).)

Aim: The aim of this cross-sectional retrospective study was to estimate the prevalence of different physical and psychiatric disorders as well as multimorbidity in outpatients with type 1 diabetes (T1D) in Germany., Methods: A total of 6967 adult patients with T1D from 958 general or diabetologist practices in Germany between January 2015 and December 2019 from the Disease Analyzer database (IQVIA) were included. The main outcome of the study was the prevalence of different diabetes-related and nondiabetes-related disorders within 12 months prior to the last outpatient visit. Multivariate logistic regression models were fitted with multimorbidity differently defined as >2, >3, >4, and >5 different disorders as a dependent variable and age, sex, glycated hemoglobin (HbA1c) values, and insulin pump therapy as impact variables., Results: Mean age (standard deviation [SD]) was 45.3 (16.7) years; 42.9% were women, the mean HbA1c was 7.9% (SD: 1.4%). The most frequent disorder was arterial hypertension (31.2%), followed by dyslipidemia (26.4%), dorsalgia (20.4%), diabetic neuropathy (17.3%), and depression (14.6%). The proportion of thyroid gland disorders, retinopathy, urethritis, iron deficiency anemia, and psychiatric disorders was higher in women than in men. Hypertension and mental and behavioral disorders due to the use of tobacco were higher in men. On average, each patient was diagnosed with 3.1 different disorders. Age had the strongest association with multimorbidity, followed by HbA1c value and female sex., Conclusion: In summary, patients with T1D are often multimorbid, and the multimorbidity is associated with higher gender, female sex, and high HbA1c values. Understanding all of these factors can help practitioners create a risk profile for every patient.

Purpose: Fanconi anemia (FA) and ataxia-telangiectasia (AT) are rare inherited syndromes characterized by abnormal DNA damage response and caused by pathogenic variants in key DNA repair proteins that are also relevant in the pathogenesis of breast cancer and other cancer types. The risk of cancer in children with these diseases is poorly understood and has never been assessed in a population-based cohort before., Methods: We identified 421 patients with FA and 160 patients with AT diagnosed between 1973 and 2020 through German DNA repair disorder reference laboratories. We linked patients' laboratory data with childhood cancer data from the German Childhood Cancer Registry., Results: Among 421 patients with FA, we observed 33 cases of childhood cancer (15 cases of myelodysplastic syndrome; seven cases of acute myeloid leukemia; two cases of lymphoma, carcinoma, medulloblastoma, and nephroblastoma, respectively; and one case of rhabdomyosarcoma, acute lymphoblastic leukemia, and glioma, respectively) versus 0.74 expected (on the basis of population-based incidence rates in Germany). This corresponds to a 39-fold increased risk (standardized incidence ratio [SIR] = 39; 95% CI, 26 to 56). For all FA subgroups combined, the cancer-specific SIR for myeloid neoplasms was 445 (95% CI, 272 to 687). Among the 160 patients with AT, we observed 19 cases of childhood cancer (15 cases of lymphoma, three cases of leukemia, and one case of medulloblastoma) versus 0.32 expected. This corresponds to a 56-fold increased risk (SIR = 56; 95% CI, 33 to 88). The cancer-specific SIR for Hodgkin lymphoma was 215 (95% CI, 58 to 549) and for non-Hodgkin lymphoma 470 (95% CI, 225 to 865)., Conclusion: Approximately 11% of patients with FA and 14% of patients with AT develop cancer by age 18 years.

Objectives: Since 2000/2001, no large-scale prospective studies addressing traumatic brain injury (TBI) epidemiology in Germany have been published. Our aim was to look for a possible shift in TBI epidemiology described in other European countries, to look for possible changes in TBI management and to identify predictors of 1-year outcome especially in patients with mild TBI., Design: Observational cohort study., Setting: All patients suffering from a TBI of any degree between 1 October 2014 and 30 September 2015, and who arrived in one of the seven participating BG hospitals within 24 hours after trauma, were included., Participants: In total, 3514 patients were included., Outcome Measures: Initial care, acute hospital care and rehabilitation were documented using standardised documentation forms. A standardised telephone interview was conducted 3 and 12 months after TBI in order to obtain information on outcome., Results: Peaks were identified in males in the early 20s and mid-50s, and in both sexes in the late 70s, with 25% of all patients aged 75 or older. A fall was the most frequent cause of TBI, followed by traffic accidents (especially bicyclists). The number of head CT scans increased, and the number of conventional X-rays of the skull decreased compared with 2000/2001. Besides, more patients were offered rehabilitation than before. Though most TBI were classified as mild, one-third of the patients participating in the telephone interview after 12 months still reported troubles attributed to TBI. Negative predictors in mild TBI were female gender, intracranial bleeding and Glasgow Coma Scale (GCS) 13/14., Conclusion: The observed epidemiologic shift in TBI (ie, elderly patients, more falls, more bicyclists) calls for targeted preventive measures. The heterogeneity behind the diagnosis 'mild TBI' emphasises the need for defining subgroups not only based on GCS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this article is to understand how, when and why the topics of information and information needs arise when people diagnosed with colorectal cancer (CRC) narrate their illness experiences., Methods: Guided by principles of grounded theory, a qualitative interview study was conducted that collected a wide variety of illness experiences with CRC in Germany using maximum variation sampling. Sampling criteria included place of residence, age at interview, age at diagnosis, treatment, disease course and sociodemographic factors such as varying family backgrounds and professions., Setting and Participants: Men and women diagnosed with CRC in different parts of Germany were sought via physicians, social workers and psychologists in hospital settings, organisations offering psychosocial support for patients with cancer, self-help groups, rehabilitation centres, newspapers and personal contacts. The interviewees in the final sample (n=41) had been diagnosed with CRC between 4 weeks and 36 years prior to the interview., Results: Three inter-related categories of information needs emerged from the analysis: the need for non-medical information for daily life; the challenge of integrating the bodily changes that accompany CRC in everyday life; and sources of non-medical information concerning handling daily life. Learning to live with the bodily changes of CRC in everyday life was described as a long process of learning-by-doing. While sources for medical information were clear, finding practical information was often a challenge. The best source of such information was often seen to be other people living with the disease, who shared their experiential knowledge, as well as stoma and nutritional therapists., Conclusion: Information needs are part of the process and struggle to normalise everyday life after a disruptive diagnosis and treatment. Providing access to practical knowledge and information from others with CRC experience may be an important resource for patient support., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first-line therapy and the factors associated with this., Methods: This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti-hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first-line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first-line therapy., Results: A total of 7.1% of participants received insulin as a first-line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81-4.06], age > 80 years (OR 2.35, 95% CI 1.20-4.61) compared with age ≤ 40 years, HbA 1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81-4.95) compared with HbA 1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29-2.81), peripheral artery disease (OR 1.94, 95% CI 1.30-2.81), neurological complications (OR 1.45, 95% CI 1.00-2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08-1.25) and higher number of different drugs prescribed within 12 months prior-the index date (OR 1.09, 95% CI 1.05-1.12) were significantly associated with the probability of receiving insulin as a first-line therapy., Conclusion: Insulin is rarely used as a first-line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first-line therapy is significantly influenced by diabetologist practice, age, HbA 1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy., (© 2020 Diabetes UK.)

Background: Beckwith-Wiedemann syndrome (BWS) is a cancer predisposition syndrome caused by defects on chromosome 11p15.5. The quantitative cancer risks in BWS patients depend on the underlying (epi)genotype but have not yet been assessed in a population-based manner., Methods: We identified a group of 321 individuals with a molecularly confirmed diagnosis of BWS and analysed the cancer incidence up to age 15 years and cancer spectrum by matching their data with the German Childhood Cancer Registry., Results: We observed 13 cases of cancer in the entire BWS cohort vs 0.4 expected. This corresponds to a 33-fold increased risk (standardised incidence ratio (SIR) = 32.6; 95% confidence interval = 17.3-55.7). The specific cancers included hepatoblastoma (n = 6); nephroblastoma (n = 4); astrocytoma (n = 1); neuroblastoma (n = 1) and adrenocortical carcinoma (n = 1). The cancer SIR was highest in patients with a paternal uniparental disomy of 11p15.5 (UPDpat). A high cancer risk remained when cases of cancer diagnosed prior to the BWS diagnosis were excluded., Conclusions: This study confirms an increased cancer risk in children with BWS. Our findings suggest that the highest cancer risk is associated with UPDpat. We were unable to confirm an excessive cancer risk in patients with IC1 gain of methylation (IC1-GOM) and this finding requires further investigation.

In Europe, cowpox virus (CPXV) infection in South American camelids occurs as a so-called spill-over infection. Although infected animals generally have a mild form of the disease and survive, cases of fatal generalised CPXV infection have also been described. Prevention by prophylactic vaccination is the only way to protect animals from disease. In the present study, modified vaccinia virus Ankara (MVA) vaccine, which has been successfully used in many animal species, was used in a prime-boost vaccination regimen in two alpaca herds with a history of CPXV infection. The focus of the study was the prevention of further clinical cases, and to determine the safety and immunogenicity of the MVA vaccine in alpacas. The MVA vaccine was well tolerated and safe in the 94 animals vaccinated. An indirect immunofluorescence assay (IFA) using MVA as an antigen showed that the seroprevalence of antibody after booster vaccination was 81.3% in herd I and 91.7% in herd II. Detectable antibody titres declined to 15.6% in herd I and 45.8% in herd II over a 12-month period after booster vaccination. Animals could be divided into four groups based on individual antibody titres determined over one year: Group 1 consisted of 19.3% of animals that were seropositive until the end of the trial period; Group 2 consisted of 58.0% of animals that were seropositive after booster vaccination, but seronegative one year later; Group 3 consisted of 14.7% of animals that were not seropositive at any time point; and Group 4 consisted of 7.9% of animals that were seropositive after initial immunisation, seronegative six months later, but seropositive or intermediate in IFA one year after immunisation, likely because of natural exposure. In new-born crias born to MVA-vaccinated mares, specific maternal antibodies were detected in 50.0% of animals up to 14 weeks of age. Our results confirm that MVA vaccination is a feasible tool for the prevention of CPXV disease in alpacas. Long-term studies are needed to verify future vaccination regimen in CPXV affected herds.

Background: The aim of the current study was to determine whether the time to insulin therapy initiation in patients with type 2 diabetes in primary care in Germany has changed in recent years., Methods: Longitudinal data from general practices in Germany (Disease Analyzer) were analyzed. These data included information of 7128 patients (age: 68.5 [SD: 11.5] years; 54.4% male) receiving incident insulin therapy in 2010/2011 and 8216 patients (age: 69.1 [SD: 11.9] years; 54.9% male) receiving incident insulin therapy in 2016/2017. Changes in time to insulin initiation in the practices and the last HbA1c value before the start of insulin therapy were analyzed, stratified by index date. To analyze the impact of covariables on the time to insulin initiation, a multivariate regression analysis was performed, adjusted for age, sex, diabetologist care, and HbA1c as independent variables., Results: Median time from T2D diagnosis to insulin therapy in the Disease Analyzer database increased from 1717 days in 2010/2011 to 1917 days in 2016/2017 ( P < .001). The proportion of patients with a HbA1c value ≥9% before insulin initiation was high in both groups (2010/2011: 33.0%, 2016/2017: 34.2%, P = .347). The time to insulin initiation in DPP-4i patients was 112 days longer, and in SGLT2 patients 346 days longer than in patients treated with sulfonylurea., Conclusions: The present analysis confirms an increasing delay of the insulin therapy initiation as a consequence of the more frequent use of newer oral antidiabetics. However, the rather moderate increase of time to insulin might display insufficient long-term glycemic control using these agents. Still, more than one-third of patients receive insulin only when HbA1c levels exceed 9%.

Various organic amendments are scrutinized as potential agricultural management strategies to ensure soil productivity while mitigating climate change due to the accumulation of soil organic matter (OM). The objectives of this experiment were to study the effects of biochar and biogas digestate versus mineral fertilizer on crop aboveground biomass as well as fractions and mineralization of soil organic carbon (SOC). Samples of a sandy Cambisol were taken 14 months after establishment of a field experiment in Germany. Treatments included application of equal nitrogen in the form of mineral fertilizer or liquid biogas digestate without biochar (B 0 ), with 1 Mg biochar ha -1 season -1 for two growing seasons (B 2 ), or with 40 Mg biochar ha -1 application (B 40 ). Soil fractionation in water separated water-extractable and free particulate (fPOM) OM, followed by sonification and sieving to isolate occluded particulate (oPOM) and < 20 μm aggregate-occluded and mineral-associated OM. CO 2 emissions were measured during 92-day laboratory incubations at 10 and 20 °C. Analysis of variance found digestate lowered (p < 0.05) rye aboveground biomass compared to mineral fertilizer (9.3 vs. 10.6 Mg ha -1 ), while biochar had no effect. B 40 treatments increased C mineralization during incubation by 16% and contained 3.8 times more SOC than B 0 treatments. This additional SOC was allocated to fPOM (52%), oPOM (22%), and the <20 μm fraction (26%). Digestate application increased SOC content of oPOM by 11% compared to mineral fertilizer. Furthermore, combined application of 40 Mg biochar ha -1 with digestate resulted in 20% more SOC in the <20 μm fraction than biochar with mineral fertilizer. The lack of a significant fertilizer or biochar-fertilizer interaction effect on C mineralization during incubation demonstrates the stability of SOC from digestate alone or in combination with biochar. The absence of significant differences in SOC content between B 0 and B 2 treatments demonstrates the difficulty of documenting SOC sequestration in the field at low biochar application rates., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The concentrations of difluoroacetic acid (DFA) and trifluoroacetic acid (TFA) in rainwater and surface water from Berlin, Germany resembled those reported for similar urban areas, and the TFA/DFA ratio in rainwater of 10:1 was in accordance with the literature. In contrast, nearby ground water historically contaminated with 1,1,2-trichloro-1,2,2-trifluoroethane (R113) displayed a TFA/DFA ratio of 1:3. This observation is discussed versus the inventory of microbial degradation products present in this ground water along with the parent R113 itself. A microbial transformation of chlorotrifluoroethylene (R1113) to DFA so far has not been reported for environmental media, and is suggested based on well-established mammalian metabolic pathways., Competing Interests: The authors declare no conflict of interest.

In this paper, we use data from the German Socio-Economic Panel to investigate the effect of macro-economic conditions (in the form of local unemployment rates) on smoking behavior. The results from our panel data models, several of which control for selection bias, indicate that the propensity to become a smoker increases significantly during an economic downturn, with an approximately 0.7 percentage point increase for each percentage point rise in the unemployment rate. Conversely, conditional on the individual being a smoker, cigarette consumption decreases with rising unemployment rates, with a one percentage point increase in the regional unemployment rate leading to a decrease in consumption up to 0.8 percent., (Copyright © 2018. Published by Elsevier B.V.)

At the end of World War II and during the first decade after the war, roughly 200,000 children were fathered in intimate contacts between German women and foreign soldiers. The experiences of these German occupation children (GOC) have been so far described in case reports and from historical perspective only. Research on psychosocial consequences of growing up as a GOC has been missing so far. This study examined traumatic experiences, posttraumatic stress disorder, somatization, and depression in GOC (N = 146) using self-report instruments: Posttraumatic Diagnostic Scale and Patient Health Questionnaire. Findings have then been compared with a representative birth cohort-matched sample from the German general population (N = 977). German occupation children showed significantly higher prevalence rates of most traumatic experiences, higher point prevalence rates of full and partial posttraumatic stress disorder, depression, and somatization than the control group. In summary, GOC often grew up under difficult conditions (e.g., poverty, single mothers, and stigmatization). Even decades later, they showed higher rates of different mental disorders and higher comorbidity. These findings underline the complex and long-term impact of their burdened social, financial, and familial conditions. The results underpin the importance of conceptualizing occupation children as a vulnerable group in postconflict settings.

Objectives: To date the experiences of German occupation children (GOC) have been described solely in historical studies; empirical research on the psychosocial consequences growing up as German occupation children was missing. This paper provides an introduction to the background, methodological approaches and descriptive information on a sample for the first German-based empirical study on this topic. It also touches on methodical challenges and solution processes., Methods: Children born of war resemble a target group that is difficult to reach (hidden population). Therefore, an investigation needs consultation of both people from the target group and scientific experts (participatory approach) as well as specific methodological approaches. The questionnaire utilized contains adaptations of established and psychometrically validated instruments as well as adapted self-developed items. N = 146 occupation children were surveyed (mean age 63.4, 63.0% women) via press release and contact to platforms of children born of war., Summary: Despite methodological challenges an instrument to assess the target group was developed through participatory methods. The instrument shows high relevance for the target group and is highly accepted. High rates of American and French participants show the influence of networking in platforms on successful recruitment.

Quality assurance is required for all relevant instruments and procedures in epidemiological studies just like for clinical trials. The structure and complexity of the monitoring was developed based on the monitoring in clinical trials and applied to an epidemiological cohort study on early detection of cervical cancer (MARZY Study). Analyses of the on-site monitoring in participating gynaecological practices during the baseline investigation of the MARZY cohort were presented. The baseline investigation of the MARZY study was conducted between 2005 and 2007 in the city of Mainz, the rural district of Mainz-Bingen and surrounding areas. Women, who were randomly selected via population registries, were invited to attend cervical cancer screening at a gynaecologist's office of their choice. All study participants received a study swab in addition to their routine Pap smear. The on-site monitoring included equipment and support of all participating gynaecological practices during study recruitment. Each participant and physician signed an informed consent form. In addition, the participant completed an epidemiological questionnaire. The gynaecologist took the study swab and completed the study documentation form. Prior to recruitment, standardised processes and documentation forms were developed for the monitoring process. The monitoring visits were carried out every six to eight weeks. During the baseline investigation, participants were included in the study among 121 gynaecological practices. In total, 2,892 monitoring documentation forms from 390 on-site monitoring visits in 96 gynaecological practices from the study region and surrounding areas were analysed. On-site monitoring visits were more frequently conducted during the first year of the study. The average time needed for an on-site visit was 107 minutes (minimum 73 minutes, maximum 200 minutes). Problems such as incomplete study documentation forms or erroneous inclusion into the study occurred among 975 study participants (33.7%). 664 study participants (68.1%) did not fully complete the study forms, and 89 (9.1%) were included in the study despite the fact that they met the exclusion criteria such as hysterectomy or pregnancy. Most of these problems could be sufficiently corrected during the on-site monitoring. Monitoring in epidemiological studies performed at physicians' offices should be carried out in accordance with the monitoring in clinical trials. On-site monitoring helped to avoid missing data and to ensure adherence to exclusion criteria. On-site monitoring considerably contributed to the correct and complete study inclusion of all eligible participants and a high quality of study data., (Copyright © 2014. Published by Elsevier GmbH.)

Background: The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting., Aim: The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting., Method: MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months., Results: Among 200 residents (mean age 85.5 ± 7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of 'malnutrition' according to the MNA was 15.4%. The prevalence of 'risk of malnutrition' (NRS) and 'high risk of malnutrition' (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in 'malnourished', respectively 'high risk of malnutrition' or 'nutritional risk', was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents., Conclusion: The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.

Objective: This study investigates the association between MNA results and frailty status in community-dwelling older adults. In addition the relevance of singular MNA items and subscores in this regard was tested., Design: Cross-sectional study., Setting: Community-dwelling older adults were recruited in the region of Nürnberg, Germany., Participants: 206 volunteers aged 75 years or older without cognitive impairment (Mini Mental State Examination >24 points), 66.0% female., Measurements: Frailty was defined according to Fried et al. as presence of three, pre-frailty as presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Malnutrition (<17 points) and the risk of malnutrition (17-23.5 points) were determined by MNA®., Results: 15.1% of the participants were at risk of malnutrition, no participant was malnourished. 15.5 % were frail, 39.8% pre-frail and 44.7% non-frail. 46.9% of the frail, 12.2% of the pre-frail and 2.2% of the non-frail participants were at risk of malnutrition (p<0.001). Hence, 90% of those at risk of malnutrition were either pre-frail or frail. For the anthropometric, dietary, subjective and functional, but not for the general MNA subscore, frail participants scored significantly lower than pre-frail (p<0.01), and non-frail participants (p<0.01). Twelve of the 18 MNA items were also significantly associated with frailty (p<0.05)., Conclusions: These results underline the close association between frailty syndrome and nutritional status in older persons. A profound understanding of the interdependency of these two geriatric concepts will represent the basis for successful treatment strategies.

Objectives: Even 60 years after World War II, the German elderly population is significantly more often affected by posttraumatic symptomatology compared to the younger cohorts. This study is addressing prevalence rates of posttraumatic symptomatology and its comorbidity with depression and somatisation., Methods: This study examines posttraumatic stress disorder (PTSD) according to DSM-IV, partial PTSD, depression and somatisation in a randomly selected sample of the German general population aged 60-85 years (N = 1.659) using self-rating instruments (Patient Health Questionnaire, PHQ; Post Traumatic Diagnostic Scale, PTDS)., Results: One-month prevalence rate was 4.0% for DSM-IV PTSD; another 12.2% fulfilled the criteria of partial PTSD. A significant increase across the age groups was found for partial PTSD. 11.5% of the persons affected by posttraumatic symptomatology fulfil the criteria of a somatoform syndrome, 8.6% fulfil the criteria of major depression and 10.4% fulfil the criteria of other depressive syndromes according to the PHQ. A current posttraumatic symptomatology is associated with increased prevalence rates of somatoform and depressive disorders. Moreover, traumatic experiences without a current PTSD are associated with increased rates of somatoform disorders., Conclusion: Posttraumatic symptomatology is a common phenomenon in the German elderly population. Especially, subsyndromal disorders are very common and increasing across the age groups. Posttraumatic symptomatology is associated with an increased risk of depressive and somatoform disorders. As posttraumatic symptoms are often neglected in geriatric health care, future effort should address the recognition and treatment of posttraumatic symptoms in elderly patients.

Living in the vicinity of nuclear power plants (NPP) is discussed here in terms of adverse health effects. A prospective population-based cohort study was conducted to evaluate whether the prevalence of birth defects in the vicinity of NPPs is elevated and scrutinize a possible distance correlation. A birth cohort born to mothers living within 10 km of two selected NPPs (study region) was compared to a region without NPP (comparison region), and an active surveillance of all live births, stillbirths, and induced abortions in the defined regions was performed. Between 01/2007 and 02/2008, all newborns were examined by specially trained study paediatricians according to the protocols of the Birth Registry Mainz Model. The cohort consisted of 5,273 infants (90% completeness). The outcome measure was an infant with birth defect(s). The prevalence of infants with birth defects was 4.5% in the study region and 4.7% in the comparison region, which corresponds to a relative risk (RR) of 0.94 (lower 95% confidence level (CL): 0.76). Thus, the prevalence of birth defects in the regions surrounding NPPs was not increased compared to those of the comparison region. Adjustment for potential confounders did not substantially change the result (RR 0.90, lower 95% CL 0.73). The adjusted and unadjusted distance approach (1/distance in km) did not show any correlation to vicinity to a NPP (p = 0.38). Specifically, within the study region, the prevalence of birth defects showed no upward trend with decreasing distance. Birth defect prevalence and most descriptive parameters in the comparison region were identical to those in the Birth Registry Mainz Model.

Malnutrition, which occurs in 27.4% of all elderly persons, is a great burden to those affected and for the health services. There are multiple causes for malnutrition, such as loss of appetite, poorly balanced diet, dementia, dysphagia chewing problems, as well as gastrointestinal disorders. Presence of weight loss and/or anorexia point towards malnutrition. A prerequisite for properly targeted nutritional intervention is to distinguish between sarcopenia and kachexia. In addition the "Mini Nutritional Assessment" (MNA (®)) questionnaire can be used quickly and reliably for diagnose malnutrition as recommended by the European Society for Clinical Nutrition and Metabolism. Treatment should be based on an individually designed nutritional regime, which incorporates eating habits and functional impairment of the patient., (© Georg Thieme Verlag KG Stuttgart · New York.)

This paper examines the development of employment-oriented family policy in Germany and Japan, two countries united by conservative welfare legacies and very low birthrates, through a close analysis of discourse. Why have recent reforms in Germany moved well beyond those in Japan despite remarkably similar “human capital” discourses? The relative strength of interpretative patterns—in this case, discursive patterns that successfully frame family policy reform as an economic imperative—and the role of employers are identified as critical explanatory factors. Further comparative attention is called to the role of the state as a guarantor of new family policy entitlements.

Porcine Hokovirus (PHoV) was recently discovered in Hong Kong. This new Parvovirus of pigs is closely related to the human Parvoviruses 4 and 5 (PARV4/5) and bovine Hokovirus (BHoV). So far, nothing is known about the presence and prevalence of PHoV in regions of the world other than Hong Kong. A study was initiated to investigate PHoV in German wild boars from five different geographical regions, using a newly established quantitative real-time PCR assay. Analysis of collected liver and serum samples revealed high overall prevalence (32.7%; 51/156) of PHoV in wild boars. The prevalence differed between the regions and increased with age. Two near full-length genomes and a large fragment for three additional isolates from different regions were sequenced and used for phylogenetic analysis. The German PHoV sequences from wild boars showed a close relationship with sequences of isolates from Hong Kong.

In a screen of 880 extracts from plants and fungi for antiplasmodial, antitrypanosomal, and leishmanicidal activity, an ethyl acetate extract of the mushroom Ganoderma lucidum showed antiplasmodial activity with 79% inhibition at 4.9 microg/mL. HPLC-based activity profiling and subsequent isolation of the antiplasmodial compounds yielded seven lanostanes (1-7), of which three (2, 3, and 7) were new. A new benzofuran derivative (8) of the farnesyl hydroquinone ganomycin B was also identified. The structures and relative configurations of the new compounds were elucidated by comprehensive spectroscopic analysis and by comparison of their NMR data with those of related compounds. The lanostanes exhibited in vitro antiplasmodial activity with IC(50) values from 6 to greater than 20 microM.

Swine Hepatitis E virus (HEV) can be transmitted from pigs to humans causing hepatitis. A high prevalence of HEV in wild boar populations is reported for several European countries, but actual data for Germany are missing. During the hunting season from October to December 2007 liver, bile and blood samples were collected from wild boars in four different German regions. The samples were tested for HEV RNA by quantitative PCR (qPCR) and anti-HEV IgG antibodies by two different ELISAs and a Line immunoassay. A seroprevalence of 29.9% using ELISA and 26.2% in the Line immunoassay was determined. The seroprevalence rate varied greatly within the analyzed regions. However, qPCR analysis revealed a higher prevalence of 68.2% positive animals with regional differences. Surprisingly, also adult wild sows and wild boars were highly HEV positive by qPCR. Compared to liver and serum samples, bile samples showed a higher rate of positive qPCR results. Sequencing and phylogenetic analysis of a 969nt fragment within ORF 2 revealed that all isolates clustered within genotype 3 but differed in the subtype depending on the hunting spot. Isolates clustered within genotypes 3i, 3h, 3f and 3e. Within one population HEV isolates were closely related, but social groups of animals in close proximity might be infected with different subtypes. Two full-length genomes of subtypes 3i and 3e from two different geographic regions were generated. The wild boar is discussed as one of the main sources of human autochthonous infections in Germany.

A molecular approach, based on the detection of ribulose-1,5-bisphosphate carboxylase/oxygenase (RubisCO) large subunit genes, was applied to investigate the distribution and diversity of autotrophic bacteria in groundwater systems. DNA extracts from 48 sampling stations, including a variety of pristine and polluted, shallow and deep-subsurface groundwater samples obtained from Germany and Austria, served as a template for the PCR amplification of form I (cbbL) and form II (cbbM) large subunit RubisCO genes. The majority of the samples (>80%) contained two different forms of RubisCO. In 17 samples, all three forms of RubisCO were identified. PCR products from four selected groundwater habitats containing all three forms of RubisCO were used to construct clone libraries. Based on restriction fragment length polymorphism (RFLP) analysis, 109 RubisCO-clone-inserts were subjected to sequencing and phylogenetic analysis. With the exception of a form IA RubisCO sequence cluster obtained from deep subsurface samples, which was identical to the RubisCO genes described for Ralstonia metallidurans CH34, most sequences were distantly related to a variety of RubisCO species in chemolithoautotrophic Proteobacteria. Several sequences occurred in isolated lineages. These findings suggest that autotrophic bacteria with the capability to assimilate CO2 via the Calvin Cycle pathway are widespread inhabitants of groundwater systems.

The research activities of the Forschungszentrum Karlsruhe on minimally-invasive surgery (MIS) have for several years improved techniques and instrumentation for different types of MIS. Many types of instruments and robotic devices have been developed and new techniques implemented. In this paper we present the most recent results from our different projects, such as endoscopic heart surgery, tracking systems, a camera guidance device, telemanipulator systems, minimally-invasive breast biopsy in closed-bore MRI, endoscopic training simulators and developments using smart materials (e.g. Nitinol).