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Introduction: : Amelogenesis imperfecta (AI) is a genetically determined, non-syndromic enamel dysplasia that may manifest as hypoplasia, hypomaturation, or hypocalcification and can commonly be classified into four primary groups. In this retrospective analysis, specific orofacial characteristics are described and associated with each of the AI types based on a patient cohort from Witten/Herdecke University, Germany. Methods: Data from 19 patients (ten male and nine female, mean age 12.27 ± 4.06 years) with AI who presented at the Department of Orthodontics between July 2011 and December 2023 were analyzed. Baseline skeletal and dental conditions were assessed, including the presence of hypodontia, displacements, and taurodontism. AI was classified into classes I–IV based on phenotype. Treatment needs were evaluated according to the main findings following the German KIG classification, while the radiological enamel situation was determined using panoramic radiographs. Results: An approximately equal distribution between classes II and III was found and a slight inclination toward a dolichofacial configuration (ΔML-NSL: 5.07 ± 9.23°, ΔML-NL: 4.24 ± 8.04°). Regarding orthodontic findings, disturbance in tooth eruption as well as open bite were the most prevalent issues (both 36.8%, n = 7). The most common AI classes were type I and II, which show an almost even distribution about the skeletal classes in sagittal dimension, while dolichofacial configuration was found most frequently in vertical dimension. Conclusion: Both clinical and radiological orthodontic findings in context with AI are subject to extensive distribution. It seems that no specific orofacial findings can be confirmed in association with AI with regard to the common simple classes I–IV. It may be more appropriate to differentiate the many subtypes according to their genetic aspects to identify possible associated orthodontic findings. [ABSTRACT FROM AUTHOR]

Background: The current literature lacks scientific research on child and adolescent psychiatrists' (CAPPS) perspectives on dental and oral health. This study aims to investigate the opinions and approaches of child and adolescent psychiatrists and their patients regarding oral and dental health. Methods: A questionnaire-based cross-sectional study was conducted among members of the Professional Association for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany. Results: Out of the association members, 10.9% (n = 109) participated, with 5.2% (n = 52; 38f/14m) completing the questionnaire. Dental and oral health topics were discussed with one-fifth of the patients (19.2%), while 11.5% reported that they were "never" a part of their therapy. Patient-related concerns about dental and oral health were primarily brought into the context of child and adolescent psychiatric work. Dental treatment anxieties were prominent. Only 3.8% of the participants regularly assigned diagnoses related to dental status. The CAPPS employ a bio-psycho-social model for the genesis of oral health-related conditions in Children and Adolescents with Special Needs. Conclusions: CAPPS have a foundation in relationship-based work for assessing oral and dental healthcare and providing recommendations for further dental care. Regional networking and science must be further developed. [ABSTRACT FROM AUTHOR]

Aims: In Germany, a curriculum in special care dentistry (SCD) is not mandatory. As a result, very little is known about dental students' attitudes toward interacting with people with disability (PwD). The study´s aim was to assess this among dental students at Witten/Herdecke University (UW/H). Material and Methods: In the academic years 2016–2017 to 2020–2021, dental students in the 7th semester (UW/H) were asked to complete a self‐assessment questionnaire. Prior to its start, the study had obtained a positive vote from the ethics committee of the UW/H (#174/2016). Results: Out of 199 students 166 persons on average 24.5 years old completed the questionnaire. Nearly all participants had already had previous experience with PwD in various domains of life prior to dental school (89.2%). Three‐quarters indicated not having reservations about interacting with PwD. The proportion of persons without previous experience in interacting with a PwD was almost twice as high in the group with reservation (16.2%) as it was in the group without reservation (8.7%). Almost all surveyed students (92.8%) affirmed that they would like to learn more on the topic of "Professional Interaction with PwD." Conclusion: Most of the respondents did not have reservations about interacting with PwD. Almost all the participants indicated a high level of interest in topics related to SCD. Also, the authors like to encourage the curriculum committees of dental schools at other universities to integrate courses on SCD, based on the iADH recommendations, into their dental curricula. [ABSTRACT FROM AUTHOR]

Theoretical models of the antecedents and outcomes of work-home interference (WHI) suggest that work characteristics (e.g., job stressors, working hours) increase the probability that an individual experiences work-home interference. Since work-home interference is considered as a role stressor, these experiences should be detrimental for long-term well-being. In this 2-wave panel study, the authors compared this suggested pathway with competing models that propose reverse causation and reciprocal effects in a sample of 365 employees (N at T2 = 130) from the German workforce using structural equation modeling. In particular, a model with two proposed antecedents (job stressors, working hours) of WHI and two proposed consequences (depression, turnover motivation) was analyzed in alternative configurations. The results support a cyclical model with a job stressors [right arrow] depression [right arrow] WHI [right arrow] job stressors pathway. Furthermore, working hours affected WHI, and turnover motivation emerged as an outcome of WHI. (Contains 1 figure and 3 tables.)

Introduction: The most common chromosomal anomaly is Down syndrome/Trisomy 21, which can be associated with varying degrees of intellectual disability and physical malformation. Specific orofacial characteristics regarding orthodontic treatment options and features are described on the basis of a patient collective from the Witten/Herdecke University, Germany. Methods: Data of 20 patients (14 boys and 6 girls, mean age: 11.69 ± 3.94 years) who underwent orthodontic treatment between July 2011 and May 2022 were analyzed. Baseline skeletal and dental conditions were assessed, as well as the presence of hypodontia, displacements, and treatment-related root resorptions. The treatment need was evaluated based on the main findings according to the German KIG classification. In addition, treatment success was determined in relation to patient compliance. Results: The patient group was characterized predominantly by a class III relationship (ΔANB: −2.07 ± 3.90°; ΔWITS: −3.91 ± 4.33 mm) and a brachyfacial cranial configuration (ΔML-NL: −4.38 ± 7.05°, ΔArGoMe: − 8.45 ± 10.06°). The transversal discrepancy of the dental arch width from maxilla to mandible was −0.91 ± 3.44 mm anteriorly and −4.4 ± 4.12 mm posteriorly. Considering the orthodontic indication groups, the most frequent initial finding and treatment indication represented hypodontia (85%), followed by frontal (75%) and unilateral lateral (35%) crossbite. In 55% of the cases, the teeth had a regular shape, but in 35% a generalized and in 15% an isolated hypoplasia. Only 25% of the patients could be treated with a fixed multiband appliance due to sufficient cooperation. In each of these patients, varying degrees of root resorptions were detected during treatment, and 45% of all treatments had to be terminated prematurely due to a lack of cooperation by patients or parents. Conclusion: The extent of dental and skeletal malformations and the high rate of findings requiring treatment in patients with Down syndrome represent a significant indication for orthodontic therapy, which can be well illustrated by the KIG classification. However, this is in contrast to the eventually increased risk of root resorption, with significantly reduced patient cooperation. A compromised treatment outcome and process must be expected. Consequently, the orthodontic treatment must be simple and realistic to achieve fast and therapeutically satisfactory treatment result. [ABSTRACT FROM AUTHOR]

Background: Pediatricians frequently feel uncertain about their ability to detect early symptoms of child abuse and how to respond in suspected cases. Aim: This study investigated the transactional stress model in German pediatricians who experienced imagination stories with a child protection scenario and another potentially stress-triggering scenario. Methods: A two-part survey was conducted online. Each part included a different imagination story and evaluation of the Stress Appraisal Measure (SAM), as well as questions on child protection, current problematics, and suggested remedies. In total, 96 pediatricians participated. The child abuse scenario was perceived as significantly more threatening and more stressful than a medical emergency. The pediatricians declared moderate familiarity with the Child Protection Guidelines and the Federal Child Protection Act and an average confidence in their application. The greatest perceived problems were communication difficulties with parents and youth welfare services. Suggested improvements were concrete procedural directives, more training programs, better interdisciplinary networks, and greater exchange among colleagues. Conclusions: To optimize their potential in the child protection system, pediatricians need to be better supported in coping with the identified stressors in child abuse scenarios. [ABSTRACT FROM AUTHOR]

Objectives: This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. Methods: An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. Results: Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r =.56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 =.48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. Conclusions: Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry. [ABSTRACT FROM AUTHOR]

Modern theories of authoritarianism have stressed the importance of threat to the expression of authoritarian attitudes and intolerance. Arguably, authoritarian tendencies may have increased during COVID-19 pandemic, a major threat to life and security. One issue arising when comparing mean scores is that of measurement invariance. Meaningful comparisons are only possible, if latent constructs are similar between groups and/or across time. This prerequisite is rarely ever tested in research on authoritarianism. In this study, we aim to analyze the short scale for authoritarianism KSA-3 by investigating its measurement invariance on two levels (three first-order and one second-order factors) and latent mean changes using two German representative samples (N = 4,905). Specifically, we look at differences before and during the pandemic (2017 vs. 2020). While measurement invariance holds across both levels in all conditions, we find a decrease in latent means in 2020, contrary to expectations and established theories. Moreover, latent means differ with regard to gender, education, and east-west Germany. We conclude that analyses of latent means and measurement invariance instead of mean comparisons with composites should become the standard. Future studies should focus on threat as a moderator between authoritarianism and intolerance, and on possible interactions with context variables. [ABSTRACT FROM AUTHOR]

Abstract: This paper empirically analyzes the effect of the inclusion of German corporations in the Dow Jones STOXX Sustainability Index (DJSI STOXX) and the Dow Jones Sustainability World Index (DJSI World) on stock performance. In order to receive robust estimation results, we apply an (short-term) event study approach that is based on both a modern asset pricing model, namely the three-factor model according to Fama and French [24], and additionally a t-GARCH(1,1) model. Our empirical results suggest that stock markets may penalize the inclusion of a firm in sustainability stock indexes. This finding is mainly driven by a strongly negative effect of the inclusion in the DJSI World. In contrast, we do not find significant average cumulative abnormal returns for the inclusion in the DJSI STOXX. This suggests that the inclusion in a more visible sustainability stock index may have larger negative impacts. [Copyright &y& Elsevier]

In the context of driving ability diagnostics in Germany, administrative cutoffs for various drugs and pharmaceuticals in urine have been established. Two liquid chromatography-tandem mass spectrometry methods for simultaneous detection and quantification of amphetamines, designer amphetamines, benzoylecgonine, benzodiazepines, opiates, and opioids in urine were developed and validated. A 500-μL aliquot of urine was diluted and fortified with an internal standard solution. After enzymatic cleavage, online extraction was performed by an ion-exchange/reversed-phase turbulent flow column. Separation was achieved by using a reversed-phase column and gradient elution. For detection, a Thermo Fisher TSQ Quantum Ultra Accurate Mass tandem mass spectrometer with positive electrospray ionization was used, and the analytes were measured in multiple-reaction monitoring mode detecting two transitions per precursor ion. The total run time for both methods was about 15 min. Validation was performed according to the guidelines of the Society of Toxicological and Forensic Chemistry. The results of matrix effect determination were between 78 % and 116 %. The limits of detection and quantification for all drugs, except zopiclone, were less than10 ng/mL and less than 25 ng/mL, respectively. Calibration curves ranged from 25 to 200 ng/mL for amphetamines, designer amphetamines, and benzoylecgonine, from 25 to 250 ng/mL for benzodiazepines, from 12.5 to 100 ng/mL for morphine, codeine, and dihydrocodeine, and from 5 to 50 ng/mL for buprenorphine and norbuprenorphine. Intraday and interday precision values were lower than 15 %, and bias values within ± 15 % were achieved. Turbulent flow chromatography needs no laborious sample preparation, so the workup is less time-consuming compared with gas chromatography-mass spectrometry methods. The methods are suitable for quantification of multiple analytes at the cutoff concentrations required for driving ability diagnostics in Germany. [ABSTRACT FROM AUTHOR]

A number of cross-sectional studies have demonstrated a significant co-variation of patriotism and nationalism with prejudice against immigrants. This study examines the causal relationship between the three variables among 551 adult German respondents without migration background. Employing a longitudinal cross-lagged design with two measurements 4 years apart, a positive and significant effect of nationalism on prejudice was found. Patriotism predicted ethnic prejudice negatively when nationalism was controlled for. However, in a separate cross-lagged model where the common variance between nationalism and patriotism was not controlled for, patriotism had no causal effect on prejudice. In the discussion, these contradictory effects of patriotism on prejudice against immigrants are interpreted as the result of different dimensions composing patriotism, namely national identification and adherence to democratic norms. Consequences and political implications of the results are discussed, referring to the negative effects of enforcing both nationalism and patriotism. [ABSTRACT FROM PUBLISHER]

In research on antisemitism related to Germany generally four subdimensions of hatred towards Jews are differentiate: (a) the anti-Judaism related to the Christian religion, (b) the biologically argued racial antisemitism, (c) secondary Antisemitism, and (d) antisemitism presented as antizionism. The central question in relation to the shift in how antisemitic attitudes are articulated in the German population is the dispute over whether this shift consists merely in a change in how a continuing, fundamental antisemitic attitude is articulated, and whether antisemitic attitudes have merely found another avenue of communication. The overall object of the study is to explore the structures, contexts, and dynamics of antisemitism and to focus on aspects of political psychology, hence looking at mainly collective identification, defense, and projection patterns. In terms of methodology the intention is to study the project as part of a qualitative supplementary study, based on the integration concept described by Christian Seipel and Peter Rieker of a sequence of quantitative and qualitative empirical research. The supplementary study will have as its base a sub-sample extracted from the overall results of the GMF Survey 2005. An especially suitable method for this is the Structured Depth Interview since it makes possible revealing non-communicated motives-whether consciously kept quiet or unconsciously suppressed. The main goal here is to penetrate the surface structure of antisemitism, to decipher its political-psychological dynamics, and to elaborate its associative contexts. [ABSTRACT FROM AUTHOR]

Introduction: The cervical spine is prone to artefacts in T2 MR-imaging due to patient movements and cerebrospinal fluid flow. The periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER/BLADE) acquisition method was developed to reduce motion artefacts. We sought to determine if T2-BLADE is superior to T2-TSE with conventional k-space reading. Methods: Twenty-five patients were examined using a 1.5 T MR-scanner. T2-weighted imaging of the cervical spine in sagittal and axial orientation using conventional or BLADE k-space reading was performed. Spinal cord, subarachnoid space, vertebrae and discs were evaluated by two independent observers using a scale from 0 (non-diagnostic) to 3 (excellent). Interobserver correlation was assessed as Cohen's kappa. Results of Mann-Whitney U test with p < 0.05 were regarded as significant. Furthermore, the investigators were asked for subjective evaluation in consensus. Results: Overall interobserver accuracy of κ = 0.91 was obtained. Comparison of sagittal images showed better values for all investigated structures in T2-BLADE: spinal cord (TSE/BLADE: 1.52/2.04; p < 0.001), subarachnoid space (1.36/2.06; p < 0.001) and vertebrae/discs (1.66/2.86; p < 0.001). Comparison of axial images showed better values in T2-BLADE for spinal cord (1.68/1.86; p = 0.149) and vertebrae/discs (1.0/1.96: p < 0.001) while subarachnoid space was better to be evaluated in conventional T2-TSE (1.94/1.12; p < 0.001). In sagittal orientation, motion- and CSF-flow artefacts were reduced in T2-BLADE. In axial orientation, however, CSF-flow artefacts were pronounced in T2-BLADE. Conclusion: The image quality of the sagittal T2-BLADE sequences was significantly better than the T2-TSE and acquired in less time. In axial orientation, increased CSF-flow artefacts may reduce accuracy of structures in the subarachnoid space. [ABSTRACT FROM AUTHOR]

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This study compares two theoretical models that make different assumptions about the structure of subjective health constructs and about the effects of job stressors and working time variables on health. The first model, the sequence model, is based on sequential models of the development of ill-health and posits that chronic fatigue and sleep problems mediate the effects of job stressors and working time variables on depression and somatic complaints. The second model, the general strain factor model, posits that specific health constructs (e.g. fatigue, depression, and somatic complaints) are reflections of a common general strain factor (i.e. detrimental job conditions increase the individual's sensitization to strain). In this way the study expands traditional models of stress-related effects on health. The analyses were carried out in a sample of 365 individuals in Germany. Although both models fitted the data, the general strain factor model was found to be superior. Furthermore, the effects of job stressors and working time on the health constructs fatigue and sleep quality were mediated by the general strain factor. Also, a negative relationship emerged between working time duration and general strain. It is suggested that the general strain model could be useful in future health psychology research. [ABSTRACT FROM AUTHOR]

Despite the resurgence of interest in group threat theory for explaining negative interethnic relations, adequate empirical evidence on the causal ordering of perceived group threat and outgroup derogation is still missing. In the literature, three theoretical perspectives concerning this issue have been raised. The predominating view assumes that perceived group threat is a causal antecedent to outgroup derogation. Contrary to this perspective, a second theoretical model conceptualizes perceived group threat to be a consequence of prior levels of outgroup derogation. Alternatively, a third theoretical perspective suggests to consider the causal relations between perceived group threat and outgroup derogation to be reciprocal. In this article, we conduct a longitudinal test of these competing theoretical models drawing upon cross-national multiwave panel surveys from Germany and Russia. Using latent autoregressive cross-lagged models, we find that perceptions of threatened group interests are causally antecedent to German's dislike and negative behavioural intentions against foreigners as well as to Russian's ethnic distance towards minorities. The data provide no support for the two alternative models. Findings are discussed with regard to its meaning for group threat theory. [ABSTRACT FROM AUTHOR]

The article examines whether the level of anomia among the population in Germany has changed between 2002 and 2004 due to social change. It explores the role of education, age, sex, region, and political orientation for the explanation on the development of anomia. In addition, it presents the different sources of anomie in modern societies and introduces the different definition of anomia. Key information on some theoretical implications is further presented.

Different types of prejudice are usually treated as separate constructs. We propose that they constitute a syndrome of group-focused enmity (GFE), that is, they are related to each other and share a common core that is strongly predicted by a generalized ideology of inequality. Furthermore, GFE components are supposed to have similar predictors and outcomes. An empirical test is presented using structural equation modeling on the syndrome, its causes, consequences, and structural stability over time. The study relies on three German cross-sectional probability samples (each = 2,700) and a related panel study (2002, 2003, and 2004). The idea of a GFE syndrome is strongly supported. Future research is discussed, as well as alternative approaches of a common prejudice factor. [ABSTRACT FROM AUTHOR]

In the present paper we compare public views regarding the equality of rights foreigners deserve in Germany and Israel using data from two national representative samples (ALLBUS in Germany, 1996 and Attitudes Towards Minorities Survey in Israel, 1999). The data reveal that anti-immigrant sentiments (as expressed by the denial to grant rights to foreign workers) are more pronounced in Israel than in Germany. These findings hold even after controlling for individual socio-economic and demographic characteristics and differential levels of threat. In both countries, support for foreigners' rights tend to increase with level of education and to decline with age. In Germany, support for rights is also affected by income (positively), right-wing orientation (negatively), and residence in East Germany (negatively). In both countries, the most important determinant of support for foreigners' rights is the perception of threat. The greater the threat the more likely citizens are to deny rights to labour migrants. It should be noted, however, that the impact of threat on attitudes towards foreigners' rights as well as the impact of political orientation (right-wing) is more pronounced in Germany than in Israel. While threat is the more important determinant of anti-foreigner sentiments in both societies, it only partially intervenes between individual characteristics and attitudes toward foreigners' rights. [ABSTRACT FROM AUTHOR]

Whereas variance in preferences is a central explanation for human behaviour in the social sciences, economists traditionally avoid using preferences to explain behaviour. Rather, change in behaviour or different kinds of behaviour are explained solely by differences in the economic restrictions imposed on an individual. Whereas restrictions have been analysed as monetary constraints in traditional economics, Gary Becker has broadened this term. In his work, he tried to integrate 'time'--the non-monetary restriction--into the economic constraints. In our paper we test empirically the effects of monetary and time restrictions on the travel-mode choice of a representative sample of the German population. We do this by means of testing some hypotheses from Becker's work on microcensus data from Germany. These data include the following variables: travel-mode choice, distance of travel, time of travel, as well as some additional socioeconomic characteristics. Results of introducing these additional socioeconomic variables will also raise the question whether it is really true that only monetary and time costs matter. [ABSTRACT FROM AUTHOR]

Background: In Germany, there is limited evidence on the oral health of adults with intellectual disabilities (AwID). Methods: In 2017/18, dental examinations of AwID and a questionnaire survey of their legal guardians were carried out. The mean D3MFT values were calculated to describe the caries experience. The prevalence of AwID with at least one fissure sealant (FS) was determined and associations between caries experience and various sociodemographic factors (e.g., age, gender, living arrangements) were investigated. Results: The data of 132 AwID (mean age 35.2 years; range 18–69 years) could be included. For all AwIDs the mean D3MFT value was 9.5 (95% CI 8.1–11.0). The mean D3MFT value for the 35–44-year-olds was 10.9 (95% CI 8.4–13.4). All caries-free persons (n = 14) were younger than 45 years. Furthermore, the mean D3MFT value for AwID living with their parents was lower at a statistically significant level than that of AwID in independent living arrangements. Moreover, younger AwIDs (18–34-year-olds) with at least one FS had a statistically significantly lower mean D3MFT value compared to those without any FS (D3MFT: 3.0 vs. 6.7). Conclusions: The dental health of AwID has improved in Germany in recent years, but, on average, AwIDs still have more missing teeth than their peers in the general population. Oral epidemiological studies on AwID should include information on their living arrangements to assess potential associations between sociodemographic factors and oral health. [ABSTRACT FROM AUTHOR]

An essay about a new order in Europe is presented. The author looks into the restructuring of Europe following the events such as the impending reunification of Germany and the removal of Soviet Union control over European states in the central and eastern part of the continent. Also addressed in this essay are the problems that might arise and the possible implications of the events mentioned and the emergence of Germany as a new superpower.

Successful campaigns to combat the COVID-19 pandemic depend, in part, on people's willingness to be vaccinated. It is therefore critical to understand the factors that determine people's vaccination intentions. We applied a reasoned action approach - the theory of planned behavior - to explore these factors. We used data from an online survey of adults (18–74 years; n = 5044) conducted in Germany between April 9 and April 28, 2021 and found that attitudes toward getting vaccinated predicted vaccination intentions, while normative and control beliefs did not. In turn, positive attitudes toward getting vaccinated were supported by trust in science and fear of COVID-19 whereas negative attitudes were associated with acceptance of conspiracy theories and skepticism regarding vaccines in general. We advise policymakers, physicians, and health care providers to address vaccination hesitancy by emphasizing factors that support positive attitudes toward getting vaccinated, such as prevention of serious illness, death, and long-term health detriments, as opposed to exerting social pressure or pointing to the ease of getting vaccinated. • Vaccination intentions are driven by peoples' attitudes toward vaccination. • Positive attitudes are related to trust in science, fear, age, and gender (male). • Negative attitudes are related to conspiracy beliefs and vaccine skepticism. • Vaccination hesitancy should be countered highlighting personal health benefits. [ABSTRACT FROM AUTHOR]

The major objective of the present research is to examine the long-standing theoretical proposition that hostility and discriminatory attitudes toward out-groups are likely to rise with relative size of the out-group population. Using data from The German General Social Survey (ALLBUS, 1996) we provide, for the first time, an examination of the impact of both actual and perceived size of the foreign population on discriminatory attitudes toward foreigners. Specifically, by using a multiple-indicators analytical model, we examine the theoretical proposition that perceived threat posed by an out-group population mediates the relations between size of the out-group and exclusionary attitudes toward the out-group. The analysis does not support the theoretical expectation that actual size of the foreign population in the locale is likely to increase either perception of threat or exclusionary attitudes. Perceived size, however, is found to be associated, as expected, with perceived threat, and perceived threat is found to mediate the relations between perceived size and support for exclusionary practices against foreigners—the higher the perceived size, the more pronounced are both the threat and anti-foreigner attitudes. The findings and their significance are discussed in the light of sociological theories on the relations between minority size and discrimination. [ABSTRACT FROM AUTHOR]

A widespread, severe outbreak of canine distemper encephalitis was observed in wildlife in Southern Bavaria in the spring and summer of 2008. The haemagglutinin (HA) genes of six representative canine distemper virus (CDV) samples originating from five red foxes and one badger during this outbreak had a Y549H amino acid substitution in the HA protein compared to sequences from two captive domesticated ferrets which succumbed to CDV in the same area 2 years earlier. As this specific substitution at the receptor-binding site has been hypothesised to contribute to the emergence of CDV and its spread to novel hosts, the outbreak in wildlife in Southern Bavaria might, directly or indirectly, be associated with a Y549H amino acid exchange. [ABSTRACT FROM AUTHOR]

Objective: The concept of "Healing Architecture" addresses the relevance of design and architectural issues on the outcome of medical and therapeutic treatment in hospitals. The questionnaire ARCHI was developed to record data on the opinion of different groups of users on the architectural design of their therapeutic environment in departments of child and adolescent psychiatry., Method: A Questionnaire-based cross-sectional study was conducted in two phases between 2020 and 2022 using ARCHI to gather the perspectives of senior physicians and architects on the significance of architectural design in German child and adolescent psychiatric facilities., Results: In the survey of the senior physicians, 49 heads of child and adolescents psychiatric departments initiated the survey, and 73.5% (n = 36) of them completed the questionnaire in its entirety. During the survey for the architect-specific, 145 individuals commenced the survey, and 60.7% of them completed the questionnaire (n = 88). Significant differences between architects and senior physicians became visible for four of the 93 items, namely "environment of the hospital", "structure of building", "labelling of floors" and "visible cleanliness"., Conclusions: Although senior physicians and architects were characterized by the same opinions on the relevance of architectural design on therapeutic issues for the major part of issues, differences could be obtained for several aspects which are important for the architectural planning of new departments and hospitals. It remains open why both professional groups had different point of views on these four aspects of hospital design which should be clarified to improve the process of hospital development in the future., Competing Interests: Declarations Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The aim of this study was to investigate the experiences, barriers, and solutions in communication during the provision of care for people with intellectual developmental disabilities in Germany. As there are approximately 350,000 people living with intellectual or developmental disabilities in Germany, who rely on assistance when communicating with healthcare providers, this study was conducted to examine the communication challenges and potential solutions in this population. The analysis especially focused on the potentials of digital applications facilitating information transfer., Methods: Thirteen expert interviews were conducted using a structured interview guide with caregivers and medical providers to people with intellectual developmental disabilities. The interviews were analyzed using an inductive and deductive content analysis approach, according to Meuser and Nagel., Results: The results revealed that the provision of care for people with intellectual developmental disabilities was characterized by time constraints and uncertainty when caregivers lack experience in caring for this population. Additionally, information transfer increased in complexity due to an overload of individual information provided by caregivers verbally or paper-based as well due to the passive role of patients who were usually not actively involved in the communication process. With regard to the potential for integrating digital applications for information transfer, a controversy between opportunity and risk emerged., Conclusion: The findings demonstrate that there is a need to implement training programs for professionals to enable them to offer improved health care for people with intellectual developmental disabilities. It is essential that caregivers are given sufficient time to communicate with patients, and that digital applications are utilized to support information transfer. Moreover, other research shows that digital applications offer new possibilities to communicate with people with intellectual developmental disabilities, such as the use of simplified or pictorial language. By addressing these communication challenges, healthcare professionals may be able to provide more effective and efficient care to this population. However, this requires further research, which addresses the controversial results regarding digital applications outlined in this paper., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: Mental distress has become a major public health concern. Temporal trends in psychological distress are complex and depend on numerous factors. In this study, we examined age-period-cohort effects for mental distress including gender and German region over a 15 years' time span., Methods: Data on mental distress from ten cross-sectional surveys of the general German population, covering the years from 2006 to 2021, was used. Hierarchical age-period-cohort analyses including gender and German region as predictors were performed to disentangle age, period, and cohort effects. The Patient Health Questionnaire-4 was used as a brief screener for mental distress., Results: We found significant period and cohort effects, with peek values for mental distress in the years 2017 and 2020 and for the oldest birth cohort (born before 1946). Age did not affect mental distress when cohort- and period effects as well as gender and German region were considered. An interaction effect for gender and the German region was found. Women in West Germany reported significantly higher mental distress compared to women in East Germany. Compared to men, women reported the highest prevalence in both regions., Conclusion: Important political events as well as major crises can lead to an increase of mental distress in societies. Furthermore, an association between birth cohort and mental distress could be linked to socialization effects of that certain time, causing traumatic experiences or a specific coping style within this cohort group. Prevention and intervention strategies could benefit from acknowledging structural differences linked to period and cohort effects., (© 2023. The Author(s).)

Background: Impairments and disabilities can have a negative impact on oral health. However, studies on the oral health of people with impairments and disabilities are rare. This article examines the 12-month prevalence of dental utilization among adults with and without impairments and disabilities in Germany., Methods: Analyses are based on data from 23,372 persons aged 18 years and older with permanent residency in Germany from the GEDA 2014/2015-EHIS study. Participants were asked when they last visited a dentist or orthodontist on their own behalf - "less than 6 months ago," "6 to less than 12 months ago," "12 months ago or longer," or "never." For the analyses, the first two and the last two response options were combined, giving the 12-month prevalence of dental utilization., Results: Adults with impairments and disabilities were slightly more likely not to have visited a dental practice in the year prior to the survey than adults without impairments and disabilities (21.5% and 18.4%, respectively; p = 0.002). However, the association between the presence of impairments and disabilities and lower dental utilization did not persist after controlling for age, gender, partnership, and socioeconomic status., Discussion: There are hardly any differences in the dental utilization between persons with and without impairments and disabilities. However, due to their poorer oral health on average, it is necessary to consider how the dental care of this very heterogeneous group can be further improved. The analyses point to the need for care and prevention potentials., (© 2023. The Author(s).)

Aim: To analyse oral health-related diagnostic prevalences in children, adolescents (KiJu), young adults with mental/behavioural disorders (PEVS) and those of the general population in Germany based on claims data., Method: Anonymously provided ZI (Zentralinstitut)-data sets of GKV-insured persons (0-44 years) were i. e. stratified according to gender, age groups, ICD-K00-K14 diagnosis., Result: No reliable oral or dental health-related information was generated from the requested data set. Regardless of the F diagnosis, according to the data set, 1.8% of all 11,854,384 KiJu-GKV-insured persons and 0.2% of 18-44-year-olds (23,348,399 GKV-insured persons) had a diagnosis related to the dental hard tissue (ICD-10 K02/K03.2). Based on available literature on the prevalence of caries in KiJu with PEVS, a mean unweighted prevalence of 51% can be assumed. According to the available literature on the prevalence of caries in KiJu with PEVS a mean unweighted prevalence of 51% can be calculated. Following this and the diagnosis prevalence of PEVS in 0- to 17-year-olds from 2017, an estimated 957.952 children with PEVS should also have a caries., Conclusion: The nationwide data on the prevalence of oral health-related diagnoses made by physicians in the general population and in people of the same age with PEVS are very low. Apparently, dental diagnoses are only given very rarely by general practitioners and paediatricians, among others. The existing literature as well as the clinical experience of the authors indicate that this claim data is not suitable to realistically represent the dental and oral health of the examined group of people. Thus, for networking, the improvement of health care research and the care, e. g. of subgroups of the society, is an interprofessional dental/medical, data protection-compliant central database to be driven forward., Competing Interests: Die Autoren erklären keinen Interessenkonflikt., (Thieme. All rights reserved.)

Background: There are only limited data on the extent to which children and adolescents with the need of integrative assistance (KiJu-PflEh) are considered for outreach dental care service. Aim The aim of this study was to evaluate accounting data from the Kassenzahnärztliche Bundesvereinigung (KZBV) on the use of dental care by KiJU-PflEh. Material and Methods Based on six specific BEMA items (accounting year 2019), the KZBV performed a filtering of GKV-insured persons (0-17 years). The generated data sets of the study group (KiJu-PflEh) and the control group (all KiJu) were made the UW/H available in anonymized form for further analyses., Results: The study group comprised 1602 KiJu-PflEh (mean age: 11.6 years). The gender ratio from ♂ to ♀ was 2:1. 56.0% of the KiJu-PflEh underwent diagnostic dental examination. The use of individual prophylactic (IP) measures was as follows: oral hygiene status assessment - IP1 (47.5%), oral health promotion - IP2 (46.1%), fluoridation of the teeth - IP4 (63.1%), fissure sealing per tooth - IP5 (30.1%). Compared to KiJu, statistically significantly fewer IP-measures were taken and carried out in the study group KiJu-PflEh. (KiJu: 85.7%; KiJu-PflEh: 46.7%)., Conclusion: For the first time, it was shown that KiJu-PflEh is inadequately cared for and provided with dental care in comparison to peers in the general population. Increased dental care is urgently recommended as the KiJu-PflEh group has a high risk of caries. Medical information is also necessary to implement targeted prevention measures for all KiJu-PflEh. For this purpose, the introduction of a central database, which enables dental and general medical networking, should be driven forward. Furthermore, there is a need for more research to obtain primary data on the epidemiology of caries in KiJu-PflEh to verify the findings of the present pilot study., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme. All rights reserved.)

Background: Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic., Methods: An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017)., Results: The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% ( n = 82) had been younger than three years. Although 78.3% ( n = 162) tooth brushed twice daily, only 30.9% ( n = 64) brushed for 2-3 min; 84.0% ( n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% ( n = 12) of PDS < 18 years ( n = 39) independently performed dental self-care; this was 67.3% ( n = 113) for PDS ≥ 18 years ( n = 168). A statistically significant ( p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste., Conclusions: Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Background: Nationally there is a lack of data on the prevalence and experience of caries among 10- to 14-year-old schoolchildren with increased caries risk, and in the second period of mixed dentition/early period of permanent dentition., Aim: To compare caries prevalence and experience and prevalence of fissure sealant (FV) among schoolchildren with disability attending special needs schools (FS) with children with lower level of educational attainment attending secondary general schools (HS)., Methods: Dental health of schoolchildren aged 10 to 14 years attending FS or HS was determined according to WHO standards in two study periods (UP1=school year 2010/2011; UP2=school year 2015/2016). Data were anonymized and analyzed with MS Excel 2019 and IBM SPSS Version 26. The study was approved by the ethics committee of the University of Witten/Herdecke (#119/2016)., Results: Data on 2539 schoolchildren were available for analysis. Prevalence of caries in schoolchildren attending HS (UP1=36.5%; UP2=32.7%) and FS (UP1=31.4%; UP2=33.3%) was very similar as also the corresponding mean DMFT values. There was a significant difference in caries prevalence between the 2 groups in UP1 and a significant decrease between UP1 and UP2 among schoolchildren attending HS. With respect to FV, 50.7% (UP1) and 50.9% (UP2) of schoolchildren attending HS and 36.3% (UP1) and 52.1% (UP2) of schoolchildren attending FS had at least one FV. Furthermore, caries experience and caries prevalence of schoolchildren with at least one FV of both school types was significantly lower compared to schoolchildren without FV. Mean DMFT values for schoolchildren attending HS were 0.53 (UP1, FV>0), 1.16 (UP1, FV=0), and 0.49 (UP2, FV>0), 0.99 (UP2, FV=0) with p<0.001 in each case. Mean DMFT values for schoolchildren attending FS were 0.56 (UP1, FV>0), 0.9 (UP1, FV=0) (p=0.01), and 0.51 (UP2, FV>0), 1.02 (UP2, FV=0) (p=0.003)., Conclusions: Dental health of schoolchildren attending HS and FS in the REK is significantly poorer compared to the general population. This suggests that both these groups belong to population-subgroups with an increased risk of developing caries. In order to improve this situation, caries prevention measures should be implemented beyond primary school age in children attending these 2 types of school., Competing Interests: Die Autoren erklären, dass die Studie vom Lehrstuhl für Behindertenorientierte Zahnmedizin der Universität Witten/Herdecke finanziert wurde. Peter Schmidt erklärt und dankt für das Reisestipendium der Deutschen Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), welches es ihm ermöglichte, auf dem Kongress der Europäischen Organisation für Kariesforschung (ORCA) 2017 in Oslo ein Poster mit einem Teil der Ergebnisse dieser Studie zu präsentieren. Weitere Teilergebnisse wurden auf der wissenschaftlichen Tagung der Deutschen Gesellschaft für Kinderzahnheilkunde (Leipzig 2017) und dem Kongress des Öffentlichen Gesundheitsdienstes (München 2017) präsentiert., (Thieme. All rights reserved.)

The last systematic review regarding oral health of persons with disability in Germany was published in 2012. For that review, only three field studies on caries prevalence of children, adolescents, or adults with disability published between 2000 and 2012 were identified. The aim of the present overview is to present the results of new studies and the evolving consequences. In this regard, all studies and abstracts that had been published or accepted for publication between 1 January 2000 and 31 January 2021 were included.In this time interval, six regional studies and one supra-regional study were conducted in Germany in children and adolescents with disability. In addition, three regional studies and one supra-regional study were conducted in adults with disability. The studies had taken place in four of the 16 German federal states. Caries experience of the study participants was determined with the aid of a specific index. On average, children with disability and aged between 6 and 10 years had a higher caries experience than children without disability. In adolescents this difference is only true for those with intellectual disability. In adults with intellectual disability the higher caries experience yielded in a higher mean number of missing teeth compared to the general population.In conclusion, preventive and dental care for persons with disability still has to be intensified. This goal may be achieved by adding dental care for persons with disability to the national dental curriculum and by integrating this discipline in the education of dental students in all universities where dentistry is taught.

Objective: To compare the diagnostic efficacy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) vs. multidetector computed tomography (MDCT) for the detection and classification of focal liver lesions, differentiated also for lesion entity and size; a separate analysis of pre- and postcontrast images as well as T2-weighted MRI sequences of focal and exclusively solid lesions was integrated., Methods: Twenty-nine patients with 130 focal liver lesions underwent MDCT (64-detector-row; contrast medium iopromide; native, arterial, portalvenous, venous phase) and MRI (1.5-T; dynamic and tissue-specific phase 20 min after application of Gd-EOB-DTPA). Hepatic lesions were verified against a standard of reference (SOR). CT and MR images were independently analysed by four blinded radiologists on an ordinal 6-point-scale, determining lesion classification and diagnostic confidence., Results: Among 130 lesions, 68 were classified as malignant and 62 as benign by SOR. The detection of malignant and benign lesions differed significantly between combined and postcontrast MRI vs. MDCT; overall detection rate was 91.5% for combined MRI and 80.4% for combined MDCT (p<0.05). Considering all four readers together, combined MDCT achieved sensitivity of 66.2%, specificity of 79.0%, and diagnostic accuracy of 72.3%; combined MRI reached superior diagnostic efficacy: sensitivity 86.8%, specificity 94.4%, accuracy 90.4% (p<0.05). Differentiated for lesion size, in particular lesions <20mm revealed diagnostic benefit by MRI. Postcontrast MRI also achieved higher overall sensitivity, specificity, and accuracy compared to postcontrast MDCT for focal and exclusively solid liver lesions (p<0.05)., Conclusion: Combined and postcontrast Gd-EOB-DTPA-enhanced MRI provided significantly higher overall detection rate and diagnostic accuracy, including low inter-observer variability, compared to MDCT in a single centre study., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: Updated and regional data about the circumstances of death and the psychosocial backgrounds of suicides can be helpful for improving suicide-preventive strategies in childhood and adolescence., Method: All known cases of completed suicide in the period from 1996 to 2008 in persons ≤ 21 years of age from the Institute of Forensic Medicine, Frankfurt/Main were analysed in a retrospective study. We included 78 cases and matched them with a comparative sample of 1,797 adult suicides of persons > 21 years of age., Results: Within the chosen period there was a 44 % decrease in incidence of suicide in the group of ≤ 21-year-olds. The fraction of incarcerated persons in this group was 8.0 % compared to 2.56 % in the adult group. Differences from suicide in adulthood were also demonstrated in terms of suicide-related substance abuse (less detection of alcohol, more frequent detection of illicit drugs) and choice of methods (more deaths by being hit by a train)., Conclusions: Incarcerated adolescents are an important risk group for suicidal tendency and need increased, well-directed preventive measures. Clinical adolescent psychiatry should pay special attention to the indications in this study of an age-dependent association of drug use in suicide.

In cases of post-mortem dismemberment, the main medicolegal task apart from the identification and assignment of body parts to one or several individuals is the determination of the cause of death and the course of events. Notably in cases of offensive postmortem dismemberment, the medicolegal findings on the victim may be of special importance also for the psychiatric evaluation of the suspect. In a case of offensive post-mortem dismemberment, parts of the body were found in a stone quarry and in the apartment where the victim and the suspect had lived together. Since the suspect refused to make a statement, the medicolegal findings were of great relevance for the psychiatric evaluation. In the first trial, in which the psychiatric expert was not present when the forensic pathologist gave his opinion, the Regional Court acquitted the suspect of murder and committed him to a psychiatric hospital. The accused successfully appealed on points of law, as the form and content of the psychiatric expert opinion did not comply with the requirements of procedural law and the forensic psychiatric state of the art. In a second trial, additional psychiatric experts were summoned. In that hearing, the task of the medicolegal expert was to reconstruct the course of events as far as possible to create a reliable basis for the psychiatric evaluation, as the suspect refused to make a statement both with regard to his personal circumstances and the facts of the case and did not agree to a psychiatric exploration either. The motivational and morphological criteria of the medicolegal classification as offensive post-mortem dismemberment with a cannibalistic background are discussed. In addition, some issues to be answered such as the detection of bloodstains on nonporous surfaces by means of leucocrystalviolet and the time of heat exposure of burned body parts are dealt with.

Objective: The incidence of second primary malignancies seems to be increasing. The aim of this study was to investigate the incidence, treatment and outcome for patients with second primary lung cancer (SPLC)., Methods: Between January 1996 and December 2005, 163 patients with SPLC, occurring after an extrapulmonary malignancy, were recruited by the Tumor Center of Halle (Saale), which represents a region of nearly 1.0 million inhabitants in Germany. The SPLCs were treated under curative aim (n=59), with palliative intend (n=76) or best supportive care (n=28)., Results: The incidence of SPLC was 1.6 per 100,000 inhabitants. The localization of the first tumor differed depending on the sex of the patients. The actuarial 5-year survival rate of all patients was 12.7% (median survival time 11.4 months). Univariate analysis revealed treatment strategy as a prognostic factor (p=0.0001). Patients with SPLC having undergone curative treatment turned out to have the best prognosis (median survival: 31.0 months). The Cox proportional hazards model demonstrated that only TNM-staging system was a multivariate and significant independent prognostic predictor for overall survival. The method of surgery, standard lung resection (e.g. lobectomy) versus limited resection had no considerable influence on overall survival (p=0.22), respectively recurrence-free survival (p=0.55)., Conclusions: In cases of operability, standard resection must be the method of choice, because of its best survival rates. The results support the demand of an exact and short-term oncological care system to detect early stages of SPLC for patients operated upon for tumors at different sites.

Structural equation modeling (SEM) has been widely used in psychology and sociology for testing validity of measurement instruments. However, this statistical technique has so far played minor role in quality-of-life research. The main objective of this paper is to demonstrate the potential of SEM for constructing and testing the validity of a Subjective Well-being under Neuroleptics (SWN) index for patients with schizophrenia. For these purposes, data from the GEO study (Gesundheitsökonomische Evaluation von Olanzapin in Deutschland; Health economics study of olanzapine in the treatment of schizophrenia in Germany) were used. The GEO is a prospective, comparative, noninterventional, observational study. A total of 646 participants treated with either olanzapine (n = 416) or haloperidol (n = 230) were enrolled in the study; 360 patients were available for factor analyses. The short (20-item) form of the SWN scale was administered to assess patients' perspectives on their quality of life. The structural equation models (SEMs) were then applied to construct 5- and 10-item indexes based on SWN. The data indicate that the 5-item index is the most time-saving approach for evaluating perceptions of well-being (and thus, quality of life) among patients with schizophrenia. The application of SEM showed no appreciable loss of validity of this index.

The medicolegal and subsequent criminologic interpretation of forensic and pathological findings in cases of homicide makes up an important tool of case profiling. In a retrospective study of 26 cases of "multiple homicides" involving 31 perpetrators (30 males, 1 female, mean age 33.5 years) and 73 victims (33 males, 40 females, mean age 36 years, 68 fatalities, 5 survivors), autopsy reports and prosecution authorities' files were investigated with regard to individual characteristics of victims and offenders, circumstances as well as mode of commitment. The major aim of this study was to comprehensively elucidate and characterise relevant forensic and criminologic features, which may gain importance for forensic case profiling. Forty-six victims were found in the close social environment of the perpetrator and 45 homicides were committed either in the victim's, the perpetrator's or the shared domicile. The main motives included concealment of a crime (n=13), personal conflicts/domestic arguments (n=7) and greed (n=12). The relevant injuries with regard to the cause of death were attributable to sharp force (n=13), blunt force (n=7), gunshot wounds (n=24), ligature strangulation (n=3), smothering (n=5), fire/carbon monoxide (n=4) and combined impacts (n=11). In 15 cases, so called defence injuries were found. In 5 victims a post-mortem blood alcohol concentration >1.5 g/l was determined. In six perpetrators, a severe psychiatric impairment of juridical responsibility was ascertained (Section 20 German criminal code, n=2, psychosis; Section 21 German criminal code, n=4, acute alcohol intoxication). As far as conviction data were available, 27 crimes were juridically assessed as murder, 12 as manslaughter and one as bodily harm with fatal consequences.

The second part of the paper on suicides by gunshots to the head in the presence of witnesses focuses on relevant morphological autopsy findings such as entrance site, signs of close range or contact shots, bullet path etc. and also discusses selected aspects of ascertaining gunshot residues. For the identification of the shooter an integral medicolegal assessment of all the facts including the investigation results and the autopsy findings is essential. However, the morphological findings alone do not allow safe diagnosis, as for example in a homicide the temporal region, which was affected in all our cases, may have been deliberately chosen by the perpetrator as a localization typical of suicide. Thus methods to ascertain gunshot residues on the firing hand (by means of adhesive films and the polyvinyl-alcohol collection method--PVAL) are of great practical importance. In seven cases adhesive films and/or the polyvinyl-alcohol collection method were used. In one case the gunshot residues (GSR) were analysed by means of tape lifts and subsequent scanning electron microscopy (SEM). It was found that especially the combined application of topographical (adhesive tape/PVAL) and cumulative (SEM) methods allowed for the doubtless identification of the shooter, thus usually confirming the suicide. By the example of one case it is demonstrated that without the immediate collection of evidence at the scene objective reconstruction of the event becomes impossible. On the basis of the reported cases recommendations are finally given for a differentiated approach in the medicolegal evaluation of alleged witnessed suicide by gunshot (to the head).

In the USA the frequency of witnessed suicide, i.e. suicide committed in the presence of at least one further individual, is reported to range between 5 and 15%. As up to now no detailed analysis of this special issue has been given in the medicolegal literature, this article presents and discusses a number of cases including 8 males and 1 female (age 19-58 years, mean 41.2 years) who had all committed suicide by inflicting a gunshot to the head. In 3 cases post-mortem blood alcohol concentrations of 1.73, 1.88 and 2.23 g/kg respectively were observed. Toxicological tests produced negative results. 5 cases had a medical history of psychiatric disorder with endogenous depression in 3, chronic alcohol abuse and drug abuse with concomitant psychosis in one case each. As far as the motives were known, domestic arguments were of prevailing importance. With one exception the suicides were committed at home. In 6 cases one witness was present, in 2 cases 2 individuals and in one case 22 persons witnessed the suicide. The reported cases are discussed in comparison with the psychiatric-psychological classification according to McDowell et al. with the aim to provide a solid and comprehensive medicolegal method to distinguish between homicide and suicide. Furthermore aspects of psychiatric sequelae and psychological support of the witnesses, which are also of importance for the forensic pathologist called to the scene, are discussed.

The interpretation of medicolegal findings in homicide is an important tool of case profiling (so-called "operative case analysis"). In 17 cases of "multiple homicides" involving 22 offenders (21 males, 1 female; mean age 33 years) and 45 victims (21 males, 24 females; mean age 35 years; 41 fatalities, 4 survivors), the autopsy reports and the prosecution authorities' files were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterise relevant forensic and criminologic aspects. 31 victims were found to belong to the close social environment of the perpetrator, and 32 killings were committed in the victim's, perpetrator's or the joint flat. The main motives included greed (n = 7), personal conflicts (n = 5) and concealing of a crime (n = 9). The relevant injuries were attributable to gunshot wounds (n = 13), sharp force (n = 11), blunt force (n = 3), ligature strangulation (n = 3), smothering (n = 6), fire/carbon monoxide (n = 2) and combined impacts (n = 7). In 12 victims, defense injuries were found. The blood alcohol concentration exceeded 1.5 g/l in 5 victims. In 5 offenders, a psychiatric impairment of juridical responsibility was assessed (and 20 German criminal code, n = 1, psychosis; and 21 German criminal code, n = 4; acute alcohol intoxication). As far as data were available, 16 crimes were judged as murder, 12 as manslaughter and one as physical injury with fatal outcome.

195 cases of homicide, grouped according to juridical assessment, were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment. The involvement of underage victims and perpetrators as well as differences between the urban and rural areas studied were taken into special consideration. To summarise, the majority of the offences studied was carried out by a male perpetrator with a mean age of 35 years driven by personal motives or greed in his immediate vicinity and affected family members or close acquaintances. The fatal injuries were mainly attributable to sharp or blunt force. With regard to killings of children, a higher prevalence of female victims and male assailants, emotional motives and an even higher importance of the social vicinity were found. Particularly in victims younger 12 years of age, manual modes of commitment without application of any tools were predominantly encountered. The comparison of urban and rural areas revealed a higher homicide rate in municipal areas especially of offences with a loose relationship between victims and assailants (greed, sexual assault). In contrast, rural areas exhibited higher rates of bodily harm with fatal consequences as well as offences by highly intoxicated assailants.

The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.