Long-Term Results After Stapled Hemorrhoidopexy: A 15-Year Follow-Up.

BACKGROUND: The stapled hemorrhoidopexy is reported to have a low recurrence while treating the major hemorrhoidal symptoms of bleeding and prolapse. The aim of this study is to obtain long-term results on the outcome of the stapled hemorrhoidopexy. METHODS: All patients with a hemorrhoidal disease grade III, who underwent stapled hemorrhoidopexy from May 1999-December 2003, were included. Data collection was based on a standardized telephone interview. In the questionnaire, we recorded information regarding the postoperative recurrence and severity of hemorrhoidal symptoms (defined as bleeding, prolapse, burning, itching and moisture), further hemorrhoidal treatments and functional results (incontinence, fecal urgency and outlet obstruction) as well as patients' satisfaction. RESULTS: Of the 257 patients, who underwent stapled hemorrhoidopexy, follow-up data were available in 140 patients. In 47.4% of the patients, a recurrence of at least one hemorrhoidal symptom was registered, whereas this recurrence was observed in 47.3% of these patients more than 10 years postoperatively. A surgical re-intervention was necessary in 15.2%. We found a postoperative new incontinence in 15.5%, a fecal urgency in 28.0% and an outlet obstruction in 9.4%. Of all patients, 62.3% were "very satisfied" with the operation. CONCLUSIONS: The results of the study revealed a relatively high recurrence of hemorrhoidal symptoms after a mean follow-up of 15 years with a high recurrence rate more than 10 years postoperatively. In consideration of not negligible risk of incontinence, fecal urgency and outlet obstruction, the indication for a stapled hemorrhoidopexy should be made well considered. However, patients' satisfaction is very high.

SARS-CoV-2 mRNA vaccination-induced immunological memory in human nonlymphoid and lymphoid tissues.

Tissue-resident lymphocytes provide organ-adapted protection against invading pathogens. Whereas their biology has been examined in great detail in various infection models, their generation and functionality in response to vaccination have not been comprehensively analyzed in humans. We therefore studied SARS-CoV-2 mRNA vaccine-specific T cells in surgery specimens of kidney, liver, lung, bone marrow, and spleen compared with paired blood samples from largely virus-naive individuals. As opposed to lymphoid tissues, nonlymphoid organs harbored significantly elevated frequencies of spike-specific CD4+ T cells compared with blood showing hallmarks of tissue residency and an expanded memory pool. Organ-derived CD4+ T cells further exhibited increased polyfunctionality over those detected in blood. Single-cell RNA-Seq together with T cell receptor repertoire analysis indicated that the clonotype rather than organ origin is a major determinant of transcriptomic state in vaccine-specific CD4+ T cells. In summary, our data demonstrate that SARS-CoV-2 vaccination entails acquisition of tissue memory and residency features in organs distant from the inoculation site, thereby contributing to our understanding of how local tissue protection might be accomplished.

Obesity in the context of migration and socio-economic risk factors - a multivariate epidemiologic analysis.

PURPOSE: While the existence of a healthy migrant effect remains controversial, overweight and obesity are considered a global pandemic. Migrants seem to be affected more often, however most of the few existing studies did not differentiate a first-generation from a second-generation migration background and/or did not control common socio-demographic confounders. This study aims at examining the influence of first- and second-generation migration on body mass index (BMI) and obesity in Germany. SUBJECTS AND METHODS: We conducted a controlled observational study based on a survey of n = 64,089 participants of the German Socio-Economic-Panel. Missing values were multivariate imputed via chained equations (MICE). The influence of migration on BMI and obesity was assessed by comparing first-generation, second-generation and non-migrants to each other. Pairwise statistical testing was done by t tests and Fisher's exact tests. For the multivariate analysis, OLS and logistic regression models and its coefficients (beta, odds ratio) were used. Targeting multiple testing, Holm-correction was utilized. RESULTS: Within the bivariate analysis, all three group-specific mean BMI-values differ significantly from each other (P < .001). The pairwise differences regarding the obesity risk are also significant (P < .001). Within the multivariate analysis, only second-generation migration reveals an influence on BMI compared to first-generation migration (ß = 0.297; 97.5% CI: 0.127-0.467) and non-migrants (ß = 0.366; 98.33% CI: 0.103-0.628). This is equivalent to its influence on obesity versus first-generation (odds ratios = 1.220; 98.33% CI: 1.045-1.423) and non-migrants (odds ratios = 1.134; 97.5% CI: 1.018-1.262). CONCLUSIONS: After controlling socio-demographic confounders, a second-generation migration background but not a first-generation migration background is associated with a higher BMI and obesity.

Does the Selection of the Procedure Impact the Return to Work in Unemployed Patients Undergoing Bariatric Surgery?

PURPOSE: Obesity and its comorbidities are risk factors for absenteeism and unemployment. Bariatric surgery might help to intervene in the vicious circle of unemployment, social disadvantage and increasing obesity. The most common bariatric procedures are sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). This survey analyzes the influence of the bariatric procedure on return to work. METHODS: The data of a German nationwide multicenter registry StuDoQ|MBE from 2015 to 2020 are evaluated. Patients are surveyed who underwent a primary SG or RYGB while being unemployed: 782 patients are included. Primary endpoint is any form of return to work within 1 year after treatment. The surgical procedure acts as the binary main treatment variable. A multivariate binary logistic regression model was performed with age, sex, vocational training and weight loss as third variables so that odds ratios (OR) and adjusted ORs were determined. RESULTS: Of the patients, 41.56% received a RYGB, 58.44% a SG. One year after bariatric surgery, 39.39% of the patients with SG and 33.85% with RYGB reached a return to work. The OR for return to work is 1.27 (p = 0.11) non-significant in favor of SG. The adjusted OR is 1.26 (p = 0.15), indicating that there is no significant influence of the difference between the two surgical procedures on the outcome of return to work. CONCLUSION: There is a positive effect regarding return to work in bariatric patients: More than a third of the previously unemployed patients were employed 1 year after surgery. Procedure-specific influences could not be determined.

Integration of Newly Arrived Refugee Children into the German School System.

Background: The assignment of newly arrived refugee children to the differentiated German school system represents a major challenge for the responsible municipalities. In this explorative research approach, the current assignment procedure, in addition to the necessary assessment of performance and the detection of learning, mental, or social disabilities of newly arrived refugee children in North Rhine-Westphalia (NRW), Germany, were investigated. Methods: Eight staff members of six relevant Communal Integration Centers (CICs) in NRW were interviewed and a qualitative content analysis was conducted. Results: The current assignment practices varied widely. The binding to guidelines differed; additionally, the school assignment or recommendation largely depended on personal engagement, connections, and attitudes of the relevant CIC staff. None of the CICs used standardized instruments. Instead, the staff assessed the performance with self-developed strategies such as free and playful approaches or self-developed worksheets, and counted on their 'gut feeling' and professional experience. Conclusion: The school career and education of newly arrived refugee children in NRW is largely inconsistent and dependent on the responsible CIC (e.g., the allocation of the family) and on the counseling staff member. Additionally, it must be assumed that relevant disabilities remain largely undetected.

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women.

This systematic literature review aims to point out sex-specific special features that are important in the bariatric treatment of women suffering from severe obesity. A systematic literature search was carried out according to Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. After the literature selection, the following categories were determined: sexuality and sexual function; contraception; fertility; sex hormones and polycystic ovary syndrome; menopause and osteoporosis; pregnancy and breastfeeding; pelvic floor disorders and urinary incontinence; female-specific cancer; and metabolism, outcome, and quality of life. For each category, the current status of research is illuminated and implications for bariatric treatment are determined. A summary that includes key messages is given for each subsection. An overall result of this paper is an understanding that sex-specific risks that follow or result from bariatric surgery should be considered more in aftercare. In order to increase the evidence, further research focusing on sex-specific differences in the outcome of bariatric surgery and promising treatment approaches to female-specific diseases is needed. Nevertheless, bariatric surgery shows good potential in the treatment of sex-specific aspects for severely obese women that goes far beyond mere weight loss and reduction of metabolic risks.

Stress and Health of Internally Displaced Female Yezidis in Northern Iraq.

Burden and vulnerability factors after the genocide by ISIS accumulate to a high risk of health for displaced Yezidi women having survived or escaped the "ISIS" persecutions and massacres 2014. In May 2017, standardized interviews, including tests for the acquisition of healthrelated quality of life (SF12), stress (PSS10) and experienced trauma were performed with 29 and a medical anamnesis with 10 displaced female Yezidi in camps for internally displaced people (IDP) and unofficial settlements in Northern Iraq. 58, 62% stated their general health as "poor", 17.24% each as "fair" or "good" and 3.45% each as "very good" or "excellent". In the assessment of health-related quality of life, physical as well as mental health showed significantly reduced values, while simultaneously a high level of stress was recorded. 79.3% reported about having experienced at least one traumatic event. Chronic stress due to living conditions and traumatization is most likely responsible for the recorded poor health.

Narrative Review: The (Mental) Health Consequences of the Northern Iraq Offensive of ISIS in 2014 for Female Yezidis.

The Yezidis who represent a religious minority living in Northern Iraq were particularly affected by the persecution by ISIS (Islamic state of Iraq and Syria, syn.: ISIL-Islamic state of Iraq and the Levant) that gained power after 2013. This paper gives an overview of the events and the mental health consequences on the Yezidi community as well as associated influences on affected female Yezidis. Based on a systematic literature search, the aspects of "Persecution by ISIS and actual situation of the Yezidi community", "Gender-specific aspects of the persecution and its consequences", "Mental health of the affected women", and "Cultural-historical and religious context" are worked out. Research indicates a high burden of health strain and mental health problems in the surviving Yezidi women, especially post-traumatic stress disorders (PTSD) and depression. Concerning transgenerational trauma, the recent genocide has revived past experiences in the history of the community. Like the narrow cultural and religious rules of the community, this can be both a resource and a burden. The actual extent of the attacks is neither predictable for the affected individuals nor for the community, consequences could also be passed onto descendants. Long-term care and support of the affected persons, their descendants, and the Yezidi community seems indispensable.

Does the Electronic Health Card for Asylum Seekers Lead to an Excessive Use of the Health System? Results of a Survey in Two Municipalities of the German Ruhr Area.

BACKGROUND: The initial and intermediate-term access of refugees to healthcare in Germany is limited. A previous study showed that the obligation to request healthcare vouchers at the social security offices decreases the asylum seekers' consultation rate of ambulant physicians. The introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers is considered skeptically by some municipalities and federal states, among other reasons due to the fear of an overuse of health care services by asylum seekers. The aim of this study is to further evaluate the data of the authors' initial study with a new focus on inpatient care as well as a differentiation of the ambulant consultation rate into general practitioners and outpatient specialists. METHODS: The now-differentiated consultation rate of the initial study as well as the asylum seekers' use of inpatient care are compared to the values of the sex- and age-corrected autochthonous population as given by the German Health Interview and Examination Survey for Adults (DEGS1). A mean difference test (student's t-test) is used for comparison and significance testing. RESULTS: Asylum seekers who were in possession of the EHIC were significantly less likely to visit their ambulant general practitioners and specialists than the German autochthonous population. Simultaneously, this difference is partly compensated for by their more frequent use of impatient care. CONCLUSIONS: There is no indication that the EHIC leads to an overuse of healthcare services.

Impact of the Introduction of the Electronic Health Insurance Card on the Use of Medical Services by Asylum Seekers in Germany.

Objectives: Asylum seekers in Germany represent a highly vulnerable group from a health perspective. Furthermore, their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, there is hardly any empirical evidence regarding its actual impact on the use of medical services. The aim of the study is to examine this impact on the use of medical services by asylum seekers as measured by their consultation rate of ambulant physicians (CR). Study Design: For this purpose, a standardized survey was conducted with 260 asylum seekers in different municipalities, some of which have introduced the EHIC for asylum seekers, while others have not. Methods: The period prevalence was compared between the groups “with EHIC” and “without EHIC” using a two-sided t-test. Multivariate analysis was done using a linear OLS regression model. Results: Asylum seekers in possession of the EHIC are significantly more likely to seek ambulant medical care than those receiving healthcare-vouchers. Conclusions: The results of this study suggest that having to ask for healthcare-vouchers at the social security office could be a relevant barrier for asylum seekers.