Prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population.

The association of hidradenitis suppurativa with other skin diseases has not yet been investigated in larger studies based on dermatological exams. The objectives of this study are to determine the prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Between 2014 and 2017, 20,112 people in 343 German companies were examined for the presence of clinical features of hidradenitis suppurativa within the framework of a cross-sectional epidemiological study based on whole-body examinations. In addition, all cutaneous comorbidities were recorded. Point prevalence was calculated and the differences between individuals with and without hidradenitis suppurativa were determined by bivariate analysis. All statistical procedures were performed using SPSS 23.0 for Windows. Of 20,112 people examined, mean age was 43.6 ± 10.5 years; 52.3% were male. In total, n = 57 people (0.3%) with hidradenitis suppurativa were identified; 61.4% (n = 35) being male. In addition, non-inflammatory hidradenitis suppurativa-related lesions were found in 674 other individuals. In a bivariate comparison, patients with hidradenitis suppurativa showed significantly more frequently the following cutaneous comorbidities: acne vulgaris, psoriasis, seborrhoeic dermatitis, excoriations, and folliculitis. We determined a point prevalence of hidradenitis suppurativa of 0.3%. Since we have examined the working population, the healthy worker effect, which could have led to underestimation of prevalence, cannot be ruled out. The point prevalence of 0.3% for employed people in Germany and a prevalence of 3.0% for inflammatory and non-inflammatory hidradenitis suppurativa-related lesions show that hidradenitis suppurativa is an important disease for the whole health system.

[Access to statutory skin cancer screening : Organizational and regional factors in Germany]. / Zugang zum gesetzlichen Hautkrebsscreening : Organisatorische und regionale Faktoren in Deutschland.

BACKGROUND: In 2008, statutory skin cancer screening (gesetzliches Hautkrebsscreening, gHKS), conducted by dermatologists or general practitioners, was introduced in Germany. The aim was earlier detection of cancer and therefore improved health care delivery. To assess the success of the gHKS and to increase utilization, the opinion of the population on access to the gHKS is of great relevance. OBJECTIVES: The study examines administrative and regional factors of access to the gHKS in Germany. MATERIALS AND METHODS: In this cross-sectional study, a nationwide survey was conducted among statutory health insured persons aged 18 and over. They were interviewed by telephone about the gHKS with focus on the access to the gHKS. Descriptive statistics and subgroup analysis based on sociodemographic variables and physician specialties were performed. RESULTS: Overall, 1015 people were interviewed, of whom 359 (35.4%) had already utilized the gHKS. Most of them (38.3%) were informed about this service by their general practitioner. Most respondents (70%) preferred having the dermatologists conduct the screening and more participants consulted the dermatologist than the general practitioner for it (76% vs. 24%). At the dermatologist, the travel time to the gHKS was more often longer than 30 min (12% vs. 1%, p < 0.05) and the waiting times for appointments were more often longer than 2 weeks (67% vs. 18%, p < 0.05). Regional differences were identified for travel times and the choice of travel modalities. CONCLUSIONS: The participants of the study preferred having a dermatologist conduct the gHKS. The dermatologist was also consulted more frequently by the gHKS participants. However, access in terms of travel and waiting times for the gHKS was longer at the dermatologist than at the general practitioner.

Recycled Cellulose Polypropylene Composite Feedstocks for Material Extrusion Additive Manufacturing.

Many types of consumer-grade packaging can be used in material extrusion additive manufacturing processes, providing a high-value output for waste plastics. However, many of these plastics have reduced mechanical properties and increased warpage/shrinkage compared to those commonly used in three-dimensional (3D) printing. The addition of reinforcing materials can lead to stiffer parts with reduced distortion. This paper presents work in the reinforcement of recycled polypropylene using cellulose waste materials to generate a green composite feedstock for extrusion-based polymer additive manufacturing. Recycled polypropylene/waste paper, cardboard, and wood flour composites were made using a solid-state shear pulverization process. Fourier transform infrared and thermogravimetric analysis were utilized to qualitatively analyze the amount of filler incorporated into the 3D-printed materials. Recycled polymer composites had increased levels of filler incorporated in the printed parts compared to the virgin polymer composites based on the thermal gravimetric analysis. The dynamic mechanical analysis showed a ca. 20-30% increase in storage modulus with the addition of cellulose materials. Tensile strength was not significantly increased with the addition of 10 wt % cellulose, but the elastic modulus increased 38% in virgin polypropylene. The analysis of fracture surfaces revealed that failure initiates at the interface, suggesting that the interfacial strength is weaker than the filler strength.

Identifying Determinants for Traveled Distance and Bypassing in Outpatient Care: A Scoping Review.

The outpatient sector represents a growing share of health care. This review examines how patients choose their physician for continuous outpatient care and why they are willing to bypass the nearest physician. It was conducted according to the PRISMA extension for scoping reviews (PRISMA-ScR). Three databases (PubMed/Medline, ScienceDirect, and Ovid Medline) were searched, focusing on articles in which distance influenced the choice of physician. In all, 1,308 articles were accessed, and 17 selected for final review. First, we extracted methods for assessing distance traveled and bypassing. Second, we identified determinants that directly influence the traveled distance and transferred all into a conceptual framework. The center of this framework is the individual "willingness-to-go", which reflects the willingness of patients to accept additional distances. Our findings can support studies on patient mobility and physician choice, which are essential for examining both the distribution and use of medical services, as well as for adequate need related planning.

[Determinants of the Distance-Related Choice of Physician Using the Example of Patients with Psoriasis and Chronic Wounds]. / Einflussfaktoren auf die distanzbezogene Arztwahl am Beispiel von Patienten mit Psoriasis und chronischen Wunden.

STUDY AIM: There is only little knowledge about the influence of individual and sociodemographic characteristics determining patients' choice of their physicians. Furthermore, the role of patients' mobility is not clear. The primary aim of this study was the analysis of patients' decision patterns when choosing a physician. Patients' mobility as well as sociodemographic aspects were included in the analysis. METHODS: A multicenter cross-sectional study was conducted. Data were assessed at office-based dermatologists and at the University Medical Center Hamburg-Eppendorf. Patients with psoriasis and chronic wounds were interviewed about their behaviour when choosing a physician. Data analysis was performed using descriptive and multivariate methods. RESULTS: Data on 309 patients (50.5% male, mean age 58.3 years) were analysed. 211 patients were recruited at the outpatient unit of the university clinic, 98 at office-based physicians. The decision to visit a physician is primarily influenced by the physicians' competence, his range of service and the physician-patient relationship. The perspective of a better therapy as well as worsening of quality of life are responsible for a higher motivation to travel a longer distance to the physician. CONCLUSION: The results show a complex behaviour pattern of patients when choosing a physician. The physician's competence and his range of services are crucial for the patients' decision. The results also show that patients are willing to travel longer distances than necessary.

What is psoriasis? - Perception and assessment of psoriasis among the German population.

BACKGROUND: Delivery of health care to psoriasis patients plays an important role in the field of dermatology. Following the 2014 WHO resolution and the 2016 WHO global report, there has been an increase in the awareness of psoriasis among the general public. However, the perception of psoriasis by the general population remains unclear. The goal of the present study was to investigate the perception and assessment of psoriasis among the German population. PATIENTS AND METHODS: Representative telephone survey among 2,001 adults using a standardized questionnaire. Analyses with respect to place of residence, age, gender and level of education were conducted in a descriptive manner. RESULTS: Twenty-nine percent of participants were familiar with the term "Psoriasis"; 86 %, with the German designation "Schuppenflechte". Ninety-three percent considered the disease to be a significant burden for affected individuals; 59 % stated that there were effective drugs available for psoriasis; 9 % considered the disease to be communicable. Ten percent reported that they would not want to live in the same household as an affected individual; 23 % did not want to share the same swimming pool; and 27 % did not want to be in a personal relationship with someone affected. Twelve percent stated to be familiar with the WHO resolution on psoriasis; 6 % with the World Psoriasis Day; and 3 % with the "Bitte berühren" ("Please touch") campaign. CONCLUSIONS: Although a majority of the German population is familiar with the term "Schuppenflechte", there is a significant lack of knowledge about the disease as well as prejudice toward affected individuals. Further measures are required to improve the level of information and decrease stigmatization.

Was ist Schuppenflechte? - Wahrnehmung und Bewertung der Psoriasis in der deutschen Bevölkerung.

HINTERGRUND: Die Versorgung der Psoriasis vulgaris nimmt in der Dermatologie einen wichtigen Stellenwert ein. Im Zuge der WHO-Resolution 2014 und des WHO Global Reports 2016 hat die öffentliche Aufmerksamkeit für die Psoriasis zugenommen. Unklar ist, wie Psoriasis in der Allgemeinbevölkerung wahrgenommen wird. Ziel ist die Erfassung der Wahrnehmung und Bewertung von Psoriasis in der Bevölkerung. PATIENTEN UND METHODEN: Repräsentative Telefonumfrage mit 2001 Erwachsenen mittels eines standardisierten Fragebogens. Die Auswertungen erfolgten deskriptiv nach Region, Alter, Geschlecht und Bildungsstatus. ERGEBNISSE: Die Begriffe Psoriasis bzw. Schuppenflechte waren 29 % bzw. 86 % der Befragten, bekannt. 93 % schätzten die Krankheit als sehr belastend für die Betroffenen ein, 59 % nahmen an, dass es wirksame Medikamente gegen Schuppenflechte gibt und 9 % hielten diese Erkrankung für ansteckend. 10 % würden nicht mit einer betroffenen Person im Haushalt leben wollen, 23 % nicht mit Betroffenen ins Schwimmbad gehen und 27 % nicht in einer Partnerschaft sein. 12 % gaben an, die WHO-Resolution zur Psoriasis zu kennen, 6 % den Weltpsoriasistag und 3 % die Kampagne "Bitte berühren". SCHLUSSFOLGERUNGEN: Wenngleich einer Mehrheit in der deutschen Bevölkerung die Schuppenflechte bekannt ist, bestehen deutliche Wissensdefizite und teilweise Vorurteile gegenüber dieser Erkrankung. Weitergehende Maßnahmen zur besseren Information und zur Minderung der Stigmatisierung sind notwendig.

Effects on Neurons and Hippocampal Slices by Single and Multiple Primary Blast Pressure Waves From Detonating Spherical Cyclotrimethylenetrinitramine (RDX) Explosive Charges.

Threshold shock-impulse levels required to induce cellular injury and cumulative effects upon single and/or multiple exposures are not well characterized. Currently, there are few in vitro experimental models with blast pressure waves generated by using real explosives in the laboratory for investigating the effects of primary blast-induced traumatic brain injury. An in vitro indoor experimental platform is developed using real military explosive charges to accurately represent battlefield blast exposure and to probe the effects of primary explosive blast on dissociated neurons and tissue slices. Preliminary results indicate that physical insults altered membrane permeability, impacted cellular viability, created axonal beadings, and led to synaptic protein loss in hippocampal slice cultures. Injuries from blast under the conditions that were examined did not appear to cause immediate or sustained damage to the cells. Three consecutive primary blasts failed to disrupt the overall cellular integrity in the hippocampal slice cultures and produced a unique type of pathology comprised with distinct reduction in synaptic proteins before cellular deterioration set in. These observed changes might add to the challenges in regard to enhancing our understanding of the complex biochemical and molecular mechanisms caused by primary blast-induced injury.

Development and validation of the Patient Benefit Index for peripheral arterial disease.

Background: The aim of this study was to develop and validate a specific Patient Benefit Index (PBI) version for the treatment of peripheral arterial disease (PAD). Patients and methods: A non-interventional longitudinal development study was conducted. The first phase comprised a qualitative pre-study with n = 50 patients, in which the PBI was adapted for peripheral arterial disease. The resulting Patient Benefit Index for peripheral arterial disease (PBI-PAD) was validated in the second phase at two points of measurement. The total PBI-PAD score was calculated by weighting item-wise the achievement of treatment goals with the initially assessed needs. Feasibility, internal consistency, and construct validity were analysed and the generic three level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L) and the disease-specific instrument Vascular Quality of Life Questionnaire (VascuQoL) were used for convergent validation. Results: In the pre-study, the PBI-PAD, consisting of 12 items, was developed. N = 103 patients participated in the main study. At T2, data were available for n = 57 patients. Mean age was 71.0 years ± 9.1 and 66.7 % of the participants were male. The amount of missing values of the PBI-PAD score was low (< 4.0 %) and no relevant floor effects were observed. Both parts of the PBI (needs at T1 and benefits at T2) were internally consistent with Cronbach's alpha > 0.7. PBI-PAD total score correlated significantly with the T2-T1-differences of the EuroQol-visual analogue scale (EQ VAS) (r = 0.4, p = 0.007) and the Vascular Quality of Life Questionnaire (r = 0.5, p < 0.001). Conclusions: The PBI-PAD is a feasible, internally consistent, and valid instrument to assess patient-relevant benefits in PAD patients receiving minimally invasive treatment or surgical procedures. It can be recommended for use in routine care as well as in clinical studies.

Synthesis and Characterization of Segmented Polyurethanes Containing Trisaminocyclopropenium Carbocations.

Diol-functionalized trisaminocyclopropenium (TACP) carbocations were used as chain extenders in a two-step synthesis of a segmented polyurethane. Differential scanning calorimetry demonstrated significant differences in the crystallization behavior of the poly(tetramethylene oxide) soft segment when minor changes were made to the TACP structure and when compared to a control that was chain extended with butane diol. Fourier transform infrared spectroscopy was used to characterize the different level of hydrogen bonding in the polymers and showed that the bulky, charged TACP chain extender limited hydrogen bonding interactions when compared to the control. Dynamic mechanical analysis was used to probe the thermomechanical behavior of polymers that showed that the TACP-containing polymers were much more resistant to flow at high temperatures when compared to the control. Small-angle X-ray scattering showed a phase separated morphology for all the polymers tested. Tensile testing of the TACP polyurethanes demonstrated an elastic response over a wide range of strain, followed by a significant strain hardening. These results suggest a morphology of ionic aggregates rather than hard segment physical cross-links.

Validity and feasibility of the wound-QoL questionnaire on health-related quality of life in chronic wounds.

Chronic wounds have a major socioeconomic impact due to their frequency, chronicity, and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires for a continuous assessment of QoL and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline-based wound care. The aim of this study was to investigate the validity of the Wound-QoL questionnaire. Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound-QoL and two other QoL questionnaires (European Quality of Life-5 Dimensions, EQ-5D, and Freiburg Life Quality Assessment for wounds, FLQA-wk) at baseline and at two more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question. Two hundred and twenty-seven patients (48.5% women) participated in the study. Mean age was 66.9 years (range 17-96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischemic foot ulcers (5.3%), pressure ulcers (2.6%), and other etiologies (30.0%). The Wound-QoL showed good internal consistency, with high Cronbach's alpha in all the subscales and in the global scale in all time points (>0.8). Convergent validity was satisfactory since there were significantly (p ≤ 0.001) good correlations with the EQ-5D (range = 0.5-0.7) and FLQA-wk global score (r > 0.8) at every time point. Responsiveness was high, too. The Wound-QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and clinical routine.

Composite Fibers from Recycled Plastics Using Melt Centrifugal Spinning.

New methods are being developed to enable the production of value-added materials from high-volume, low-cost feedstocks arising from domestic recycling streams. In this work, recycled bottle-grade polyethylene terephthalate, polystyrene, and polypropylene were spun into fibers from the melt using a centrifugal spinning technique. Mono-component fibers and 50/50 blends of each polymer and a 33/33/33 blend of all three polymers were evaluated. Fiber morphology, chemistry, thermal, and mechanical properties were probed. Fiber diameters ranged from ca. 1 to over 12 µm, with polypropylene fibers having the smallest fiber diameters. Mono-component fibers were generally defect-free, while composite fibers containing polypropylene were beady. Fibers made from polyethylene terephthalate had the highest tensile strength, and the addition of polyethylene terephthalate to the other polymers improved the mechanical properties of the blends. Nano- and micro-fibers from both pure and mixed waste streams are expected to have applications in myriad areas such as ultra/micro-filtration, composites, and insulation.

"Living" dynamics of filamentous bacteria on an adherent surface under hydrodynamic exposure.

The potential advantages of cell-based biohybrid devices over conventional nonliving systems drive the interest to control the behavior of the underlying biological cells in microdevices. Here, the authors studied how shear influenced the geometry and elongation of fimbriated filaments on affinity substrates. The cells were engineered to express FimH, which binds to mannose with a high affinity. A microfluidic channel was functionalized with RNAse B, which is rich in mannose residues, and the device was used to control the hydrodynamic force on live Escherichia coli under filamentous growth. It was discovered that filamentous E. coli cells adopt buckled geometry when the shear rate is low, but assume an extended geometry at high shear and align with the flow direction. The extension moves from bidirectional to preferentially downstream as the shear rate increases. Furthermore, living filaments slide easily on the substrate, and detach from the substrates at a rate nearly ten times greater than unfilamented live E. coli at high shear conditions (1000-4000 s-1). The hydrodynamic force and binding force experienced by the cells are further analyzed by COMSOL simulation and atomic force microscopy measurements, respectively, to explore the mechanism behind the living cell dynamics. Knowledge from this work helps guide design of interfacial properties and shear environments to control the geometry of living filamentous bacteria.

Analysis of patients' willingness to be mobile, taking into account individual characteristics and two exemplary indications.

BACKGROUND: With respect to health care planning, it is commonly assumed that patients consult the nearest physician. In reality, however, patients frequently accept great-er efforts/expenses than necessary to see a physician. The objective of the present study was to determine under which circumstances patients were willing to accept additional efforts/expenses, and which role sociodemographic and clinical characteristics play in this regard. METHODS: Data collection was carried out in the context of a multicenter cross-sectional study among office-based and hospital-affiliated (University Medical Center Hamburg-Eppendorf) dermatologists. Patients (n = 309) with psoriasis and chronic wounds were surveyed about their mobility patterns and disease severity. Data analysis was performed using descriptive and multivariate methods. RESULTS: The willingness to accept additional efforts/expenses is primarily determined by a physician's expertise and service portfolio. Comparing both diagnoses showed that psoriasis patients usually traveled longer distances than wound patients. Among psoriasis patients, one significant predictor for accepting additional efforts/expenses was the level of education. With regard to wound patients, key factors included wound size (severity). CONCLUSION: The present study revealed complex mobility patterns among patients, which are affected by numerous personal as well as clinical factors. Depending on the diagnosis and individual preferences, additional efforts/expenses can - among other things - be explained by disease severity. Further studies are required to obtain more conclusive data.

Explosive Blast Loading on Human 3D Aggregate Minibrains.

The effects of primary explosive blast on brain tissue still remain mostly unknown. There are few in vitro models that use real explosives to probe the mechanisms of injury at the cellular level. In this work, 3D aggregates of human brain cells or brain microphysiological system were exposed to military explosives at two different pressures (50 and 100 psi). Results indicate that membrane damage and oxidative stress increased with blast pressure, but cell death remained minimal.

Effects of repetitive low-pressure explosive blast on primary neurons and mixed cultures.

Repetitive mild traumatic brain injury represents a considerable health concern, particularly for athletes and military personnel. For blast-induced brain injury, threshold shock-impulse levels required to induce such injuries and cumulative effects with single and/or multiple exposures are not well characterized. Currently, there is no established in vitro experimental model with blast pressure waves generated by live explosives. This study presents results of primary neurons and mixed cultures subjected to our unique in vitro indoor experimental platform that uses real military explosive charges to probe the effects of primary explosive blast at the cellular level. The effects of the blast on membrane permeability, generation of reactive oxygen species (ROS), uptake of sodium ions, intracellular calcium, and release of glutamate were probed 2 and 24 hr postblast. Significant changes in membrane permeability and sodium uptake among the sham, single-blast-injured, and triple-blast-injured samples were observed. A significant increase in ROS and glutamate release was observed for the triple-blast-injured samples compared with the sham. Changes in intracellular calcium were not significant. These results suggest that blast exposure disrupts the integrity of the plasma membrane, leading to the upset of ion homeostasis, formation of ROS, and glutamate release. Published 2016. †This article is a U.S. Government work and is in the public domain in the USA.

The effect of explosive blast loading on human neuroblastoma cells.

Diagnosis of mild to moderate traumatic brain injury is challenging because brain tissue damage progresses slowly and is not readily detectable by conventional imaging techniques. We have developed a novel in vitro model to study primary blast loading on dissociated neurons using nitroamine explosives such as those used on the battlefield. Human neuroblastoma cells were exposed to single and triple 50-psi explosive blasts and single 100-psi blasts. Changes in membrane permeability and oxidative stress showed a significant increase for the single and triple 100-psi blast conditions compared with single 50-psi blast and controls.

Recycled PET Nanofibers for Water Filtration Applications.

Water shortage is an immediate and serious threat to our world population. Inexpensive and scalable methods to clean freshwater and wastewater are in high demand. Nanofiber filtration membranes represent a next generation nonwoven filter media due to their unique properties. Polyethlyene terephthalate (PET) is often used in the packaging of water and other commonly used materials, leading to a large amount of plastic waste often with limited incentive for recycling (few value-added uses). Here, we present work in the generation of nanofiber liquid filtration membranes from PET plastic bottles and demonstrate their use in microfiltration. PET nanofiber membranes were formed via solution electrospinning with fiber diameters as low as ca. 100 nm. Filtration efficiency was tested with latex beads with sizes ranging from 30 to 2000 nm. Greater than 99% of the beads as small as 500 nm were removed using gravity filtration. To reduce biofouling, the mats were functionalized with quaternary ammonium and biguanide biocides. The biguanide functionalized mats achieved 6 log reduction for both gram negative and gram positive bacteria.

In vitro studies of primary explosive blast loading on neurons.

In a military setting, traumatic brain injury (TBI) is frequently caused by blast waves that can trigger a series of neuronal biochemical changes. Although many animal models have been used to study the effects of primary blast waves, elucidating the mechanisms of damage in a whole-animal model is extremely complex. In vitro models of primary blast, which allow for the deconvolution of mechanisms, are relatively scarce. It is largely unknown how structural damage at the cellular level impacts the functional activity at variable time scales after the TBI event. A novel in vitro system was developed to probe the effects of explosive blast (ranging from ∼25 to 40 psi) on dissociated neurons. PC12 neurons were cultured on laminin-coated substrates, submerged underwater, and subjected to single and multiple blasts in a controlled environment. Changes in cell membrane permeability, viability, and cell morphology were evaluated. Significant increases in axonal beading were observed in the injured cells. In addition, although cell death was minimal after a single insult, cell viability decreased significantly following repeated blast exposure.