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Objectives: To assess disparities in mortality by socioeconomic status in Germany., Design and Participants: We analyse a large administrative dataset of the German Pension Fund (DRV), including 27 million person-years of exposure and 42 000 deaths in 2013. The data cover the economically active population, stratified by sex and by East and West., Outcome Measures: Age-standardised mortality rates and Poisson regression mortality rate ratios (MRRs)., Results: The risk of dying increases with decreasing income: the MRRs of the lowest to the highest income quintile are 4.66 (95% CI 4.48 to 4.85) among men and 3.06 (95% CI 2.90 to 3.23) among women. The impact of income attenuates after controlling for education and other explanatory variables, especially for females. In the fully controlled model for females, individual income is a weaker predictor of mortality, but there is a clear educational mortality gradient. In the fully controlled model, the MRRs of the unemployed to the employed are 2.09 (95% CI 2.03 to 2.15) among men and 2.01 (95% CI 1.92 to 2.10) among women. The risk of dying is around half as high among foreigners as among German citizens. The socioeconomic disparities are greater among East than West German men., Conclusions: Low socioeconomic status is a major determinant of excess adult mortality in Germany. The persisting East-West differences in male adult mortality can be explained by the higher socioeconomic status of men living in the West, rather than by contextual differences between East and West. These differences can be further monitored using DRV data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted., Methods: Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature., Results: A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality., Conclusions: This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy., Systematic Review Registration: PROSPERO (International prospective register of systematic reviews): CRD42018086568.

Aim: The aim of this study was to develop new national standards for birth weight, length, head circumference, and weight for length for newborn twins based on the German perinatal survey of 2007-2011. We also assessed trends in anthropometric measurements by comparing these new percentile values with the percentile values of 1990-1994., Material and Methods: Perinatal survey data of 110,313 newborn twins from all the states of Germany collected in the years 2007-2011 were kindly provided by the AQUA Institute in Göttingen, Germany. Sex specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for 21-40 completed weeks of gestation. Percentile curves and tabulated values for the years 2007-2011 were compared with the published values of 1990-1994., Results and Discussion: The new percentile curves (2007-2011) closely resemble the previous ones (1990-1994). Small differences can nonetheless be found. For example, for birth weight the new values for the 10th percentile are a little higher., Conclusions: We recommend using the new percentile values instead of the old ones., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: The aim of this study was to derive percentile values for birth weight, length, head circumference, and weight for length for singleton neonates based on the German perinatal survey of 2007-2011 (using data from all 16 states of Germany). We also compared these new percentile values with the percentile values of 1995-2000 that so far have been considered standard values., Material and Methods: Data of 3 187 920 singleton neonates from the German perinatal survey of the years 2007-2011 were kindly provided to us by the AQUA Institute in Göttingen, Germany. Sex specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th), and 97(th) percentiles for 21-43 completed weeks of gestation. Percentile curves and tabulated values for the years 2007-2011 were compared with the published values of 1995-2000., Results and Discussion: Overall the new percentile curves closely resemble the previous ones. Minimal differences can be found for the 10(th) percentile and generally for early weeks of gestation. Values for the 10(th) percentile in the 2007-2011 dataset are somewhat higher than values of 1995-2000 for birth weight, length, and weight for length., Conclusions: We recommend the use of these new percentile values instead of the old ones., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Aim: We have previously analysed neonatal characteristics and duration of pregnancy in Germany based on data from the German Perinatal Survey of 1995-1997. Here we describe neonatal characteristics and duration of pregnancy based on the German Perinatal Survey of 2007-2011., Material and Methods: We had been provided with data from the German Perinatal Survey of 1995-1997 by the chambers of physicians of all the states of Germany except Baden-Württemberg (1 815 318 singleton neonates). We were also provided with access to the perinatal survey data of 2007-2011 by the AQUA Institute in Göttingen, Germany (3 187 920 singleton neonates). We investigated regional differences within Germany and also compared the 2 periods of time. We used the computer programme SPSS for data analysis and performed plausibility checks on the survey data., Results: Comparing the states of Germany, we found that birth weight was largest for neonates born in Schleswig-Holstein (3 407 g) and Mecklenburg-Western Pomerania (3 392 g); the lowest mean birth weight was observed in the Saarland (3 283 g). Preterm birth rate varied between 6.3% (Saxony) and 8.1% (Bremen, Saarland). Comparing 1995-1997 vs. 2007-2011, deliveries after 37 and 38 weeks of gestation were more common and deliveries after 39 and more weeks of gestation were less common in the later period of time., Conclusions: Regional differences in the anthropometric characteristics of neonates exist between the states of Germany. The proportion of deliveries after 39 and more weeks of gestation has decreased., (© Georg Thieme Verlag KG Stuttgart · New York.)

The clinical relevance of osteoporosis as a frequent systemic skeletal disease is to be found in fractures and their consequences. For prevention of these disease manifestations great importance must be attached to a safest possible diagnosis even before the occurrence of the first fracture and osteodensitometry is a well established technique for this purpose. Among the different measurement procedures DXA (dual-energy X-ray absorptiometry) has become the gold standard worldwide. This method is seen as very reliable and adequately precise. Prerequisites for these characteristics are the correct interpretation of the measurement data obtained by taking into consideration all potential influencing factors which can either false positively or false negatively influence a single value as well as the calculated mean value and the T and Z scores. Thus, exact knowledge of potential sources of error is of crucial importance. The present study shows important sources of error and difficulties in interpretation as well as a discussion of the options for their prevention. For the clinical practice osteodensitometry is to be seen as an important diagnostic component, which can only been interpreted meaningfully with respect to the clinical data.

Background: Socioeconomic differences in old-age mortality have not been studied in Germany. This study fills in the gap, evaluating mortality and life expectancy differentials among retired German men aged 65+ in 2003., Methods: Mortality rates are calculated from the administrative database on all public pensions and deaths of pensioners in 2003. Relative mortality rates and life expectancies are estimated for population subgroups according to the quintiles of lifetime earnings, type of medical insurance, broad occupational group, and residence in eastern or western Germany., Results: Among pension income quintiles, mortality varies by 60% and life expectancy at age 65 ranges from 14.9 to 18.5 years. Quintile-specific mortality and life-expectancy values are only slightly more favorable in western compared to eastern Germany. The mortality of manual workers is by 35% greater than that of salaried employees, while the mortality of those with mandatory public health insurance is 44% greater than the mortality of those with private or voluntary public health insurance. When all four characteristics are taken into account, relative mortality in the group with the highest mortality is three times higher than at the opposite end of the distribution, and corresponding life expectancies are 12.5 and 20 years. Half of all male deaths at ages 65+ are attributable to this variation. The mortality differentials remain significant at ages 80+., Conclusions: Socioeconomic mortality differentials persist into old age. They are similar in both regions and their magnitude is much greater than the diminishing mortality gap between the two parts of the country.

Using data from Germany, we examine if month of birth influences survival up to age 105. Since age reporting at the highest ages is notoriously unreliable we draw on age-validated information from a huge age validation project of 1487 alleged German semi-supercentenarians aged 105+. We use month of birth as an exogenous indicator for seasonal changes in the environment around the time of birth. We find that the seasonal distribution of birth dates changes with age. For 925 age-validated semi-supercentenarians the seasonality is more pronounced than at the time of their birth (1880-1900). Among the December-born the relative risk of survival from birth to age 105+is 16% higher than the average, among the June-born, 23% lower. The month-of-birth pattern in the survival risk of the German semi-supercentenarians resembles closely the month-of-birth pattern in remaining life expectancy at age 50 in Denmark.

Background: In order to promote the quality of asthma management in Germany, a national asthma guidelines clearing project was initiated in 2000 by the German Guidelines Clearinghouse (Sponsors: German Medical Association (GMA), National Association of the Statutory Health Insurance Physicians (NASHIP), German Hospital Federation, Federal Association of the Statutory Sickness Funds. This Part shows the key topics which should be dealt with in a German guideline on bronchial asthma., Summary Points: For quality promotion of bronchial asthma management in Germany, the development of a national evidence-based guideline, using the internationally accepted quality criteria for clinical practice guidelines, was recommended by an expert group of the German Guideline Clearinghouse. The experts identified and peer-reviewed 16 out of 54 guidelines, which might be useful as benchmarks and examples for a German asthma guideline. From the peer review results, the expert group identified 18 key topics for a national asthma guideline.

The blood groups were analysed of staff and patients (N=45) infected during two nosocomial outbreaks of norovirus gastroenteritis at a German University hospital. Persons with O phenotype were significantly less affected than was expected from the normal distribution of blood group types in Southwest Germany (OR 2.45; 95% CI 1.22-4.95; P=0.01).

Background: In order to promote quality of asthma management in Germany, a national asthma guidelines clearing project was initiated in 2000 by the German Guidelines Clearinghouse (Sponsors: German Medical Association (GMA), National Association of the Statutory Health Insurance Physicians (NASHIP), German Hospital Federation, Federal Association of the Statutory Sickness Funds. Part 1 of this article shows the methodology and the results of the appraisal, part 2 (to be published) shows the key topics which should be dealt with in a german guideline on bronchial asthma., Objectives: To identify and compare evidence-based, high-quality German- and English language asthma guidelines as benchmarks for ongoing guideline development and implementation programmes. To disseminate information about asthma guidelines developed in accordance with current methodological know-how. To identify and consent key topics for a national evidence-based guideline for Germany., Methods: Search procedure, formal appraisal: Systematic search using literature databases (XMED, incl. Medline and Embase) and English-/German-language guideline databases (via www. leitlinien.de), published between January 1990 and March 2000. Abstract screening of the search results according to the inclusion criteria (n = 54 of a total of 502 hits). Methodological guideline evaluation of 16 guidelines using the German checklist for methodological guideline appraisal. Appraisal of guidelines' contents: Peer review of guidelines with the following inclusion criteria: Bronchial Asthma-general, German and English language, based in references published later than 1994, new guideline or actual update. Peer review was performed by a multidisciplinary focus group of EBM experts (clinical and ambulatory settings). No expert was involved in guideline production during the review period., Results: Methodological appraisal: 16 out of guidelines were in accordance with the formal minimal standard with a wide range within the following domains: "description of the development process", "declaration of authors' independence", "explicit link between recommendations and the supporting evidence", "management options", "tools for implementation". The focus group recommended for future national asthma guidelines to rely on the following procedures: (1) to formulate the recommendations using standardized, clearly described consensus methods basing on evidence retrieved and selected in a systematic way (2) to prove links between recommendations and supporting evidence (3) to develop guideline versions for health care professionals as well as for consumer/patients (4) to develop guideline-based education tools (5) to ensure periodical updates of the asthma guideline (6) to consider the methodological recommendations and to give reasons for deviations from the methodological recommendations. APPRAISAL OF GUIDELINES CONTENT: None of the guidelines identified comprised information about all of the following key topics considered to be relevant for a German national guideline by the focus group: (1) intended guideline users/goals, (2) definition (3) cause of disease, (4) form of disease, (5) severity, (6) diagnosis, (7) therapeutic goals, (8) prevention, (9) pharmacotherapy, (10) non-pharmacotherapy, (11) therapy control and compliance, (12) emergency treatment, (13) rehabilitation, (14) comorbidity, (15) special aspects, (16) coordination of care, (17) quality assurance/quality management, (18) implementation., Summary Points: For quality promotion of bronchial asthma management in Germany, the development of a national evidence-based guideline, using the internationally accepted quality criteria for clinical practice guidelines, was recommended by an expert group of the German Guideline Clearinghouse. The experts identified and peer-reviewed 16 out of 54 guidelines, which might be useful as benchmarks and examples for a German asthma guideline. From the peer review results, the expert group identified 18 key topics for a national asthma guideline.

This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e(0-75)] for the periods 1980/1983-1988 and 1991/1992-1996/1997. Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial east-west gap by the late 1980s and early 1990s. In the 1980s, in east Germany, 50-60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30-40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality.In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35+ in Poland and 55+ in Germany. A persisting east-west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997. The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of "unnecessary untimely deaths" appear to contribute to a persisting east-west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west.

Rendering a medical expert opinion on the musculoskeletal system is an extraordinary responsibility. Nearly all physicians are confronted with this medical task in their daily clinical practice. Difficulties encountered and misjudgments made in formulating an expert opinion are certainly primarily a result of insufficient knowledge of the sociomedical basis. Proper organization and compliance with a standardized structure are especially important for an expert opinion. Intensified teaching of the principles and importance of the medical expert opinion during medical training will not only result in optimization and acceleration of the sociomedical procedures, it will also awaken pleasure in this many-sided activity.

Simian virus 40 (SV40) is a dsDNA polyomavirus that induces osteosarcomas and mesotheliomas in hamsters and transforms many types of cells in tissue culture, including human cells. Osteosarcoma is a bone malignancy with multiple molecular lesions underlining progression from normal bone to osteosarcoma. Recent investigations have identified SV40 DNA sequences in osteosarcomas, suggesting that SV40 may contribute to tumor development. However, these studies also demonstrated that geographical differences exist between SV40 and tumor association. Our study analyzed 46 frozen German tumor specimens (42 osteosarcomas and 4 sarcomas initially suspected to be osteosarcomas) for the presence of SV40 DNA sequences by using PCR. Two different primer sets amplifying a 573 bp region of SV40 Tag gene with the complete intron sequence (SV.for 2/SV.rev) and a 172 bp region with no intron sequence (SV.5/SV.6) were used. DNA sequencing analysis verified the results. No SV40 sequences could be detected using the primer set SV.for 2/SV.rev, while 2 out of 42 osteosarcoma specimens and 1 out of 4 poorly-differentiated tumor specimens contained SV40 sequences, using the primer set SV.5/SV.6. From one of these two positive osteosarcomas, multiple tumor biopsies taken at different times during the dissection, including metastasis, tested positive for SV40. These results indicated that in Germany, only rare osteosarcomas can be linked to SV40. These results support previous findings involving geographical differences in the presence of SV40. Finally, the specific detection of SV40 sequences with multiple specimens from one of the two patients and the absence of SV40 sequences in all other samples underscores the specificity and reproducibility of this investigation and ruled out PCR contamination.

Mobile emergency care units provide immediate benefit for patients with acute cardiovascular disease, but the subsequent prognosis of this patient population is unclear. We, therefore, aimed to determine whether the long-term survival of patients with acute cardiovascular syndromes requiring emergency medical care differs from controls of the general population. The long-term survival was analysed in all consecutive patients who were treated for acute cardiovascular events (coronary syndromes/cardiac arrest, pulmonary oedema, stroke, vascular disorientation/unconsciousness) by a mobile emergency care unit or rescue helicopter in Berlin from 1987 to 1988 and were admitted to hospital. Subsequent mortality follow-up information was obtained throughout 1994 from medical records and official vital statistics. The survival of the patient population was compared with standardized mortality data of controls matched for gender, age, and residential location. A total of 1206 patients (48% men, 67 +/- 14 years, 52% women, 72 +/- 17 years) were included in the analysis. The 1-year survival of the patient population was significantly lower compared with controls (76% vs. 88%, p < 0.001), but during subsequent years this difference was continuously reduced. Seven years after the initial event, survival rates of patients and controls were similar (43% vs. 41%). The results were similar in both gender groups. Patients > 65 years of age had a markedly higher mortality compared with patients < or = 65 years, as would be expected. Older patients had a similar long-term survival compared with controls (27% vs. 28%), whereas younger patients sustained a relatively lower long-term survival compared with controls (75% vs. 86%, p < 0.05). It is concluded that a novel population-based approach demonstrates similar long-term prognosis of cardiovascular patients following mobile emergency care compared with matched controls. The present results may contribute to the assessment of long-term effectiveness and the appropriate design of emergency care systems.

Objective: To investigate the contamination of a vitrectomy apparatus with Serratia marcescens., Design: Descriptive microbiological and molecular environmental study., Setting: An 1,800-bed university hospital., Results: S. marcescens was found inside the vitrectomy apparatus at the pressure transducer. Molecular typing by randomly amplified polymorphic DNA-automated laser fluorescence analysis and pulsed-field gel electrophoresis identified a single pattern for all strains isolated from the apparatus. Surprisingly, the contaminating strain was identical to two strains of S. marcescens isolated nearly 2 years earlier from two patients who were involved in a small outbreak of acute postoperative endophthalmitis following cataract surgery at another hospital. The emergency vitrectomies in these patients were performed at our hospital with the same apparatus that was found to be contaminated 2 years later., Conclusion: Performing a systematic environmental search for the assumed bacterial reservoir within the system of the vitrectomy apparatus finally made it possible to find and eliminate the nidus for the gram-negative rod. Molecular typing demonstrated that all isolates belonged to a single genotype, and revealed unexpectedly a link to two vitrectomies performed 2 years earlier. The data support the hypothesis that the source of the contamination was one of these patients, and thus contamination of the apparatus was present for almost 2 years.

Visual acuity was tested in 1861 members of the German armed forces who possessed military or civilian driving licences, first by means of a screening test (Roden-stock R12) and second by an ophthalmologist observing German Industrial Standard 58220, part 3. The tests were done with the patients wearing any corrective spectacles in use before the appointment. In 27.6% of all subjects the monocular or binocular visual acuity was less than 1.0. Binocular visual acuity less than 1.0 was found in 17.0%, less than 0.8 in 7.3% and less than 0.5 in 0.9%. After adjustment of the corrective lenses by the ophthalmologist these figures were reduced to visual acuity less than 1.0 in 1.6%, less than 0.8 in 0.4% and less than 0.5 in 0.1%. The frequency of suboptimal visual acuity showed no difference in driving licence classes. We found fewer cases of suboptimal visual acuity in our patients than Kratz and Häseker found in the civilian community in the study published in 1986. The age distribution was also different. In contrast to former publications, which showed an age-related progression, our population had the lowest number of subjects with subnormal visual acuity in the age group 35-45 years. The screening test for visual acuity and the test by the ophthalmologist showed the same results in 76.8% of cases.

The dynamics of the life expectancy is quantified using the example of some European industrial countries. It is possible to determinate the part of the mortality of infants and children at the life expectancy by performed prototype calculations. Further increase of years of ane's life is especially possible by decreasing mortality in the middle and higher age.