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Hintergrund: Circa ein Drittel der Patientinnen und Patienten mit fortgeschrittenen Krebserkrankungen ist von psychischen Komorbiditäten betroffen und circa die Hälfte weist eine psychische Belastung im klinisch signifikanten Bereich auf. Zur psychotherapeutischen Behandlung dieser Patientengruppe stehen unterschiedliche psychotherapeutische Interventionen zur Verfügung. Die CALM-Therapie, eine manualisierte Kurzintervention im Einzelsetting, ist eine dieser Interventionen. Hier bilden vier Module, welche auf den wichtigsten Anliegen und Belastungsfaktoren von Patientinnen und Patienten mit fortgeschrittenen Krebserkrankungen basieren, den inhaltlichen Rahmen.
Ziel: Die Treatment Integrity beschreibt das Maß, inwieweit eine psychotherapeutische Intervention wie vorgesehen umgesetzt wurde. Für eine fundierte Interpretation psychotherapeutischer Interventionseffekte sind Kenntnisse über die Treatment Integrity entscheidend. Die vorliegende Arbeit untersuchte Teilaspekte der Treatment Integrity durchgeführter CALM-Therapien im Vergleich zu durchgeführten konventionellen psychoonkologischen Therapien, um einen Beitrag zu einer fundierten Interpretation von Interventionseffekten der CALM-Therapie zu leisten.
Methoden: Transkriptionen von zwei CALM-Therapien und zwei Therapien einer konventionellen psychoonkologischen Intervention wurden anhand einer qualitativen Inhaltsanalyse nach P. Mayring untersucht. Im Zentrum stand hierbei ein selbst entwickeltes Kategoriensystem zur Analyse des gesamten Textmaterials. Zusätzlich wurden Auffälligkeiten bezüglich Ansprachen von Themenbereichen der CALM-Module unsystematisch beobachtet.
Ergebnisse: Die Inhalte der untersuchten CALM-Therapien bezogen sich durchschnittlich zu 99,54% und die der konventionellen psychoonkologischen Therapien durchschnittlich zu 98,71% auf die Themenbereiche der CALM-Module. Die ermittelten Werte für einzelne Therapiesitzungen lagen für CALM-Sitzungen zwischen 98,12% und 100% und für Sitzungen der konventionellen psychoonkologischen Therapie zwischen 96,20% und 100%. Unsystematisch beobachtete Auffälligkeiten zeigten, dass die Themenbereiche der CALM-Module zum Teil sehr spezifisch durch die CALM-Therapeutinnen und -Therapeuten angesprochen und vernetzt wurden.
Schlussfolgerung: Unter Berücksichtigung von methodischen Grenzen zeigte sich bezüglich des Anteils von Themenbereichen der CALM-Module innerhalb der beiden untersuchten Therapiegruppen kein maßgeblicher Unterschied. Zusätzlich liefert die vorliegende Arbeit Hinweise für einen spezifischen therapeutischen Umgang mit den Themenbereichen der CALM-Module innerhalb der untersuchten CALM-Therapien. Um ermittelte Interventionseffekte der CALM-Therapie fundiert interpretieren zu können, sollten zukünftige Untersuchungen unterschiedliche Umgangsweisen von Therapeutinnen und Therapeuten der beiden Therapiegruppen mit den Themenbereichen der CALM-Module genauer in den Blick nehmen.
Es wurde anhand von 500 OPGs aus der kieferorthopädischen Abteilung des Universitätsklinikums Würzburg eine dentale Altersbestimmung mit Hilfe des London Atlas of Dental Development, der Methode nach Demirjian sowie ihrer Modifikation nach Willems durchgeführt. Ziel war es herauszufinden, ob zuverlässig vom dentalen auf das chronologische Alter geschlossen werden kann.
Die Methode nach Willems (M= -0,33J, SD=1,06J) ist der Methode nach Demirjian (M=-0,08J SD= 1,27J) und dem London Atlas (M=0,34J SD=1,09J) überlegen und kann auf die deutsche Population angewendet werden.
Über die Bedeutung der Halswirbelmethode zur skelettalen Reifebestimmung ist man sich in Fachkreisen uneins. Bislang veröffentlichte Arbeiten setzen sich zumeist mit dem im prä-und peripuberalen Wachstumsabschnitt auseinander. Ziel dieser Studie wares, die Anwendbarkeit der CVM-Methode im Erwachsenenalter zu untersuchen. Dazu wurden insgesamt 420 Fernröntgenseitenaufnahmen des Universitätsklinikums Würzburg herangezogen und digitalisiert. Darunter befanden sich 320 Probanden, die das 20. Lebensjahr bereits überschritten haben, sowie 100 Kinder im Alter von 8-10 Jahren als Vergleichsgruppe. Anschließend wurden die Röntgenbilder durch das Programm Onyx-Ceph 3 TMdigital analysiert. Es wurden relevante Strukturen der Halswirbelkörper durch den Beobachter markiert und die benötigten Strecken und Winkel berechnet. Zur Überprüfung des Intrabeobachterfehlers bei der Punktierung wurden 50 zufällig ausgewählte Aufnahmenim Abstand von zwei Wochen erneut punktiert.Alle Aufnahmen wurden zudem durch einen Beobachter nach den CVM-Klassifizierungen von Hassel und Farman sowie Baccetti et al.bewertet. Nach zwei Wochen wurde dieser Vorgang erneut wiederholt. Die Ergebnisse dieser Studie zeigen, dass ausgereifte Halswirbelkörper deutlich von der vorgegebenen Form nach den finalen Reifestadien nach Baccetti et al.sowie Hassel und Farman abweichen. Die Konkavitäten der basalen Wirbelbegrenzung fallen flacher aus als in der bisherigen Literatur angenommen (149° -156°). Dieses Merkmal ist bei Frauen tendenziell stärker ausgeprägt. Darüber hinaus konnte festgestellt werden, dass ausgereifte Halswirbelkörper zumeist quadratischer Form sind (Höhen-Breiten-Verhältnis von 0,93 -0,99). Die Messungen ergaben ebenfalls, dass beide superioren Winkel durchschnittlichnicht das Kriterium des rechten Winkels erfüllen und somit keine eindeutig rechteckige Form gebildet wird.
80Die Auswertung der Vergleichsgruppe von 8-10Jährigen zeigte deutliche Überschneidungen einzelner Merkmale. Vor allem am anterior-superior und posterior-superioren Winkel konnte eine große Übereinstimmung der Werte der Adulten mit den der Kinder festgestellt werden. Auch die inferioren Konkavitäten an C2 und C3 sowie das anterior-posteriore Höhenverhältnis zeigten maßgebliche Überschneidungen der Werte beider Gruppen. Es kann also geschlussfolgert werden, dass die Form der Wirbelkörper kein verlässlicher Parameter bei der Bestimmung der skelettalen Reife ist. Diese Ergebnisse konnten bereits in der internationalen Fachzeitschrift „Journal of Forensic Odonto-Stomatology“ publiziert werden [49].Die visuelle Analyse wird zusätzlich dadurch erschwert, dass die Stadien oftmals nicht deutlich voneinander abgrenzbar sind, sondern regelrecht ineinander übergehen. Diese Grenzfälle führten zu einer nicht ausreichenden Intrabeobachterreliabilität, was auf eine unzureichende Verlässlichkeit der oben genannten Klassifikationen schließen lässt.Im Vergleich zu bisherigen Methoden kann die Bestimmung der skelettalen Reife nach der Halswirbelmethode durch die hohe Varianz in der Anatomie nicht eindeutigerfolgen.Somit sollte die CVM-Methode nicht als alleiniges Mittel bei der Bestimmung der skelettalen Reife genutzt werden, sondern eher zur Stützung bereits bewährter Methoden. Es sollte über eine zukünftige Klassifizierung diskutiert werden, die diese anatomischen Varianzen vor allem in den Endstadien berücksichtigt.
Background and objectives:
Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population‐based studies worldwide.
Methods:
We performed a systematic search in PUBMED and EMBASE for population‐based studies of cross‐sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta‐analysis, we used a random effects model.
Results:
Eighteen studies were included in the systematic evaluation and 11 in the meta‐analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I\(^{2}\)) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4%, 95%‐CI 0.5‐2.9) than those from Europe (0.5%, 0.2‐1.0) and Northern American (0.1%, 0.1‐0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex‐specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time.
Conclusions:
On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex‐specific population‐based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors.
Background
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region.
Methods
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals.
Results
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period.
Conclusion
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
Background
The prevalence of food allergy (FA) among European school children is poorly defined. Estimates have commonly been based on parent‐reported symptoms. We aimed to estimate the frequency of FA and sensitization against food allergens in primary school children in eight European countries.
Methods
A follow‐up assessment at age 6‐10 years of a multicentre European birth cohort based was undertaken using an online parental questionnaire, clinical visits including structured interviews and skin prick tests (SPT). Children with suspected FA were scheduled for double‐blind, placebo‐controlled oral food challenges (DBPCFC).
Results
A total of 6105 children participated in this school‐age follow‐up (57.8% of 10 563 recruited at birth). For 982 of 6069 children (16.2%), parents reported adverse reactions after food consumption in the online questionnaire. Of 2288 children with parental face‐to‐face interviews and/or skin prick testing, 238 (10.4%) were eligible for a DBPCFC. Sixty‐three foods were challenge‐tested in 46 children. Twenty food challenges were positive in 17 children, including seven to hazelnut and three to peanut. Another seventy‐one children were estimated to suffer FA among those who were eligible but refused DBPCFC. This yielded prevalence estimates for FA in school age between 1.4% (88 related to all 6105 participants of this follow‐up) and 3.8% (88 related to 2289 with completed eligibility assessment).
Interpretation
In primary school children in eight European countries, the prevalence of FA was lower than expected even though parents of this cohort have become especially aware of allergic reactions to food. There was moderate variation between centres hampering valid regional comparisons.
Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS).
Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included.
Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay.
Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients.
Objective
The admission interview in oncological inpatient rehabilitation might be a good opportunity to identify cancer patients' needs present after acute treatment. However, a relevant number of patients may not express their needs. In this study, we examined (a) the proportion of cancer patients with unexpressed needs, (b) topics of unexpressed needs and reasons for not expressing needs, (c) correlations of not expressing needs with several patient characteristics, and (d) predictors of not expressing needs.
Methods
We enrolled 449 patients with breast, prostate, and colon cancer at beginning and end of inpatient rehabilitation. We obtained self‐reports about unexpressed needs and health‐related variables (quality of life, depression, anxiety, adjustment disorder, and health literacy). We estimated frequencies and conducted correlation and ordinal logistic regression analyses.
Results
A quarter of patients stated they had “rather not” or “not at all” expressed all relevant needs. Patients mostly omitted fear of cancer recurrence. Most frequent reasons for not expressing needs were being focused on physical consequences of cancer, concerns emerging only later, and not knowing about the possibility of talking about distress. Not expressing needs was associated with several health‐related outcomes, for example, emotional functioning, adjustment disorder, fear of progression, and health literacy. Depression measured at the beginning of rehabilitation showed only small correlations and is therefore not sufficient to identify patients with unexpressed needs.
Conclusions
A relevant proportion of cancer patients reported unexpressed needs in the admission interview. This was associated with decreased mental health. Therefore, it seems necessary to support patients in expressing needs.
(1) Background: We aimed to evaluate the effect of proposed “microbiome-stabilising interventions”, i.e., breastfeeding for ≥3 months and prophylactic use of Lactobacillus acidophilus/ Bifidobacterium infantis probiotics on neurocognitive and behavioral outcomes of very-low-birthweight (VLBW) children aged 5–6 years. (2) Methods: We performed a 5-year-follow-up assessment including a strength and difficulties questionnaire (SDQ) and an intelligence quotient (IQ) assessment using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI)-III test in preterm children previously enrolled in the German Neonatal Network (GNN). The analysis was restricted to children exposed to antenatal corticosteroids and postnatal antibiotics. (3) Results: 2467 primary school-aged children fulfilled the inclusion criteria. In multivariable linear regression models breastfeeding ≥3 months was associated with lower conduct disorders (B (95% confidence intervals (CI)): −0.25 (−0.47 to −0.03)) and inattention/hyperactivity (−0.46 (−0.81 to −0.10)) as measured by SDQ. Probiotic treatment during the neonatal period had no effect on SDQ scores or intelligence. (4) Conclusions: Prolonged breastfeeding of highly vulnerable infants may promote their mental health later in childhood, particularly by reducing risk for inattention/hyperactivity and conduct disorders. Future studies need to disentangle the underlying mechanisms during a critical time frame of development.
Background
Pain is an early symptom of Fabry disease (FD) and is characterized by a unique phenotype with mainly episodic acral and triggerable burning pain. Recently, we designed and validated the first pain questionnaire for adult FD patients in an interview and a self-administered version in German: the Wurzburg Fabry Pain Questionnaire (FPQ). We now report the validation of the English version of the self-administered FPQ (enFPQ).
Methods
After two forward-backward translations of the FPQ by native German and native English speakers, the enFPQ was applied at The Mark Holland Metabolic Unit, Manchester, UK for validation. Consecutive patients with genetically ascertained FD and current or previous FD pain underwent a face-to-face interview using the enFPQ. Two weeks later, patients filled in the self-administered enFPQ at home. The agreement between entries collected by supervised administration and self-administration of the enFPQ was assessed via Gwet's AC1-statistics (AC1) for nominal-scaled scores and intraclass correlation coefficient (ICC) for interval-scaled elements.
Results
Eighty-three FD patients underwent the face-to-face interview and 54 patients sent back a completed self-administered version of the enFPQ 2 weeks later. We found high agreement with a mean AC1-statistics of 0.725 for 55 items, and very high agreement with a mean ICC of 0.811 for 9 items.
Conclusions
We provide the validated English version of the FPQ for self-administration in adult FD patients. The enFPQ collects detailed information on the individual FD pain phenotype and thus builds a solid basis for better pain classification and treatment in patients with FD.
For machine manufacturing companies, besides the production of high quality and reliable machines, requirements have emerged to maintain machine-related aspects through digital services. The development of such services in the field of the Industrial Internet of Things (IIoT) is dealing with solutions such as effective condition monitoring and predictive maintenance. However, appropriate data sources are needed on which digital services can be technically based. As many powerful and cheap sensors have been introduced over the last years, their integration into complex machines is promising for developing digital services for various scenarios. It is apparent that for components handling recorded data of these sensors they must usually deal with large amounts of data. In particular, the labeling of raw sensor data must be furthered by a technical solution. To deal with these data handling challenges in a generic way, a sensor processing pipeline (SPP) was developed, which provides effective methods to capture, process, store, and visualize raw sensor data based on a processing chain. Based on the example of a machine manufacturing company, the SPP approach is presented in this work. For the company involved, the approach has revealed promising results.
Smart sensors and smartphones are becoming increasingly prevalent. Both can be used to gather environmental data (e.g., noise). Importantly, these devices can be connected to each other as well as to the Internet to collect large amounts of sensor data, which leads to many new opportunities. In particular, mobile crowdsensing techniques can be used to capture phenomena of common interest. Especially valuable insights can be gained if the collected data are additionally related to the time and place of the measurements. However, many technical solutions still use monolithic backends that are not capable of processing crowdsensing data in a flexible, efficient, and scalable manner. In this work, an architectural design was conceived with the goal to manage geospatial data in challenging crowdsensing healthcare scenarios. It will be shown how the proposed approach can be used to provide users with an interactive map of environmental noise, allowing tinnitus patients and other health-conscious people to avoid locations with harmful sound levels. Technically, the shown approach combines cloud-native applications with Big Data and stream processing concepts. In general, the presented architectural design shall serve as a foundation to implement practical and scalable crowdsensing platforms for various healthcare scenarios beyond the addressed use case.
The increasing prevalence of smart mobile devices (e.g., smartphones) enables the combined use of mobile crowdsensing (MCS) and ecological momentary assessments (EMA) in the healthcare domain. By correlating qualitative longitudinal and ecologically valid EMA assessment data sets with sensor measurements in mobile apps, new valuable insights about patients (e.g., humans who suffer from chronic diseases) can be gained. However, there are numerous conceptual, architectural and technical, as well as legal challenges when implementing a respective software solution. Therefore, the work at hand (1) identifies these challenges, (2) derives respective recommendations, and (3) proposes a reference architecture for a MCS-EMA-platform addressing the defined recommendations. The required insights to propose the reference architecture were gained in several large-scale mHealth crowdsensing studies running for many years and different healthcare questions. To mention only two examples, we are running crowdsensing studies on questions for the tinnitus chronic disorder or psychological stress. We consider the proposed reference architecture and the identified challenges and recommendations as a contribution in two respects. First, they enable other researchers to align our practical studies with a baseline setting that can satisfy the variously revealed insights. Second, they are a proper basis to better compare data that was gathered using MCS and EMA. In addition, the combined use of MCS and EMA increasingly requires suitable architectures and associated digital solutions for the healthcare domain.
Physical activity trajectories among persons of Turkish descent living in Germany — a cohort study
(2020)
Physical activity (PA) behavior is increasingly described as trajectories taking changes over a longer period into account. Little is known, however, about predictors of those trajectories among migrant populations. Therefore, the aim of the present cohort study was to describe changes of PA over six years and to explore migration-related and other predictors for different PA trajectories in adults of Turkish descent living in Berlin. At baseline (2011/2012) and after six years, sociodemographics, health behavior, and medical information were assessed. Four PA trajectories were defined using data of weekly PA from baseline and follow-up: “inactive”, “decreasing”, “increasing”, and “stable active”. Multivariable regression analyses were performed in order to determine predictors for the “stable active” trajectory, and results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). In this analysis, 197 people (60.9% women, mean age ± standard deviation 49.9 ± 12.8 years) were included. A total of 77.7% were first-generation migrants, and 50.5% had Turkish citizenship. The four PA trajectories differed regarding citizenship, preferred questionnaire language, and marital status. “Stable active” trajectory membership was predicted by educational level (high vs. low: aOR 4.20, 95%CI [1.10; 16.00]), citizenship (German or dual vs. Turkish only: 3.60 [1.20; 10.86]), preferred questionnaire language (German vs. Turkish: 3.35 [1.05; 10.66]), and BMI (overweight vs. normal weight: 0.28 [0.08; 0.99]). In our study, migration-related factors only partially predicted trajectory membership, however, persons with citizenship of their country of origin and/or with poor language skills should be particularly considered when planning PA prevention programs.
Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there has not been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for identification of studies on major scientific literature sources and delineate the outcomes of identified studies.
During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi‐structured interviews were conducted with 468 Burundian soldiers before and after a 1‐year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.
Background: Tinnitus is often described as the phantom perception of a sound and is experienced by 5.1% to 42.7% of the population worldwide, at least once during their lifetime. The symptoms often reduce the patient's quality of life. The TrackYourTinnitus (TYT) mobile health (mHealth) crowdsensing platform was developed for two operating systems (OS)-Android and iOS-to help patients demystify the daily moment-to-moment variations of their tinnitus symptoms. In all platforms developed for more than one OS, it is important to investigate whether the crowdsensed data predicts the OS that was used in order to understand the degree to which the OS is a confounder that is necessary to consider.
Diese Studie sollte die Überlebensrate parodontal schwer vorgeschädigter parodontaler Taschen prüfen. Untersucht wurde anhand von Patienten aus dem Studentenkurs der Parodontologie in Würzburg, die eine nicht-chirurgische Parodontitistherapie nach dem Würzburger Behandlungskonzept erhielten.
Ausgewählt wurden alle Patienten, die zum Zeitpunkt ihrer Initialtherapie parodontale Taschen mit einer Sondierungstiefe von 8 mm oder mehr aufwiesen. Nach diesem Kriterium ergab die Ermittlung ganzer Behandlungsjahrgänge 179 Patienten mit dem durchschnittlichen Alter von ca. 57 Jahren, die sich in den Jahren 2008, 2009, 2011 und 2012 erstmals aufgrund von Parodontitis behandeln ließen. Alle untersuchten Patienten durchliefen das Standardprocedere der Initialtherapie und einer Reevaluation. Die meisten Patienten nahmen an dem für gewöhnlich bis zu zwei Mal jährlich stattfindenden Recallterminen mehr oder weniger regelmäßig teil, was die Alltagsrealität in den deutschen Zahnarztpraxen wiederspiegelt.
Die Untersuchung beinhaltet insgesamt 627 Zähne mit 1331 parodontalen Taschen. Ihre Auswertung erfolgte durch die Kaplan-Meier-Schätzung. Diese ist eine Überlebenszeitanalyse, die die Wahrscheinlichkeit für das Eintreffen eines oder mehrerer vorausgewählter Ereignisse berechnet. Diese Ereignisse wurden in dieser Untersuchung durch die für die parodontale Stabilität wichtigen Sondierungstiefen (5 mm und weniger, 5-8 mm und 8mm und größer) definiert. Der Vorteil dieser Auswertungsmethode besteht darin, dass alle Patienten bis zum Zeitpunkt ihrer letzten Behandlung in die Untersuchung einbezogen werden und dass die Zielereignisse variabel definiert werden können.
In der Hauptanalyse der 179 Patienten beschrieb die Überlebenskurve der Kaplan-Meier-Schätzung den positiven Effekt des Behandlungskonzeptes. Nach drei Jahren lag die Wahrscheinlichkeit bei 65,7 % für das Erreichen von Sondierungstiefen 5 mm oder weniger, was den Bereich der parodontalen Stabilität darstellt. Selbst unter der am meisten pessimistischen Annahme erreichten nach drei Jahren knapp ein Drittel aller Patienten den Bereich der parodontalen Stabilität.
Background
Though risk for recurrent vascular events is high following ischemic stroke, little knowledge about risk factors for secondary events post‐stroke exists.
Objectives
Coagulation factors XII, XI, and VIII (FXII, FXI, and FVIII) have been implicated in first thrombotic events, and our aim was to estimate their effects on vascular outcomes within 3 years after first stroke.
Patients/Methods
In the Prospective Cohort with Incident Stroke Berlin (PROSCIS‐B) study, we followed participants aged 18 and older for 3 years after first mild to moderate ischemic stroke event or until occurrence of recurrent stroke, myocardial infarction, or all‐cause mortality. We compared high coagulation factor activity levels to normal and low levels and also analyzed activities as continuous variables. We used Cox proportional hazards models adjusted for age, sex, and cardiovascular risk factors to estimate hazard ratios (HRs) for the combined endpoint.
Results
In total, 94 events occurred in 576 included participants, resulting in an absolute rate of 6.6 events per 100 person‐years. After confounding adjustment, high FVIII activity showed the strongest relationship with the combined endpoint (HR = 2.05, 95% confidence interval [CI] 1.28–3.29). High FXI activity was also associated with a higher hazard (HR = 1.80, 95% CI 1.09–2.98), though high FXII activity was not (HR = 0.86, 95% CI 0.49–1.51). Continuous analyses yielded similar results.
Conclusions
In our study of mild to moderate ischemic stroke patients, high activity levels of FXI and FVIII but not FXII were associated with worse vascular outcomes in the 3‐year period after first ischemic stroke.
Background
The allergy preventive effects of gut immune modulation by bacterial compounds are still not fully understood.
Objective
We sought to evaluate the effect of bacterial lysate applied orally from the second until seventh months of life on the prevalence of allergic diseases at school age.
Methods
In a randomized, placebo‐controlled trial, 606 newborns with at least one allergic parent received orally a bacterial lysate consisting of heat‐killed Gram‐negative Escherichia coli Symbio and Gram‐positive Enterococcus faecalis Symbio or placebo from week 5 until the end of month 7. A total of 402 children were followed until school age (6‐11 years) for the assessment of current atopic dermatitis (AD), allergic rhinitis (AR), asthma and sensitization against aeroallergens.
Results
AD was diagnosed in 11.0% (22/200) of children in the active and in 10.4% (21/202) of children in the placebo group. AR was diagnosed in 35% (70/200) of children in the active and in 38.1% (77/202) children in the placebo group. Asthma was diagnosed in 9% (18/199) of children in the active and in 6.6% (13/197) of children in the placebo group. Sensitization occurred in 46.5% (66/142) of participants in the active and 51.7% (76/147) in the placebo group.
Conclusion
An oral bacterial lysate of heat‐killed Gram‐negative Escherichia coli and Gram‐positive Enterococcus faecalis applied during the first 7 months of life did not influence the development of AD, asthma and AR at school age.