[Health, Medical and Psychosocial Care Needs of Older Drug Addicts (40+): A Cross Sectional Study]. / Gesundheit und medizinscher und psychosozialer Versorgungsbedarf von akuten oder ehemaligen Drogenabhängigen im Alter (40+) ­ Eine Querschnittstudie.

BACKGROUND: We aimed 1) to assess health, health-related quality of life and social care needs of substance-abusing individuals aged 40+ and 2) to investigate associations between health and psychosocial care needs. METHODS: We estimated the size of the population by using capture-recapture methods. Based on this sample size estimation, we conducted a cross-sectional survey with socio-demographic data, using standardized instruments including the SF-36 (36 items), a measure of physical disorders (14 items), social support, and psychosocial and health care needs and substance abuse ("European Addiction Severity Index"). RESULTS: 37 persons participated in this study (30% women), 89% reported at least one disorder. The general health perceptions (p=0.011), vitality (p<0.001), social functioning (p<0.001), mental health (p<0.001) and physical health dimension (p=0.007) and mental health dimension (p<0.001) were significantly lower in this sample than in the German normal population (51-60 years). 54% reported having support needs. CONCLUSION: Health-related quality of life and social functioning are major problems for older substance-abusing individuals. There is a great need to have specific healthcare concepts to respond to the medical and psychosocial care needs of this group of individuals.

[Resilience trajectories-examples from longitudinal studies]. / Verläufe von Resilienz ­ Beispiele aus Längsschnittstudien.

BACKGROUND: According to current research concepts resilience can be defined as adaptation to past and ongoing exposure. Accordingly, adaptation to exposure is a dynamic process, which can be different in different population groups. Prospective longitudinal studies provide unique opportunities to investigate resilience processes. OBJECTIVES: The aim of this article is to define the concept of resilience, describe examples of longitudinal studies investigating resilience in children, adults and older individuals, exemplary describe four ongoing longitudinal resilience studies in which the authors of the article are participating and identify and analyze methodological challenges in empirical resilience research. MATERIAL AND METHODS: This study was based on a qualitative literature review of published prospective studies investigating resilience listed in PubMed and study protocols of the four longitudinal studies. RESULTS: The exemplarily described studies have shown that resilience processes are changeable in all age groups and subject to a variety of influencing factors. The specific and potentially age-associated types of alterations have so far been difficult to determine and need further clarification. DISCUSSION: In view of the dynamic course of resilience, prospective longitudinal studies are urgently needed. Prospective longitudinal studies have the potential to identify resilience mechanisms and predictors of the course of resilience in different population groups, such as children, adolescents, adults and older individuals. Furthermore, resilience research needs to develop an improved and precise assessment of exposure to stressors.

["Mental Health in Adults with Intellectual Disabilities. Protective and Risk Factors for Depression and Anxiety" - a Cross-sectional Study]. / "Psychische Gesundheit bei erwachsenen Menschen mit intellektueller Behinderung. Schutz- und Risikofaktoren in Bezug auf Depression und Angststörung" ­ eine Querschnittstudie.

Background: There are not many studies investigating mental health of individuals with intellectual disability. The aim of this study is to provide data on depression and anxiety in individuals with intellectual disability. Method: In a cross-sectional study, we assessed women and men with intellectual disability (18-65 years) with a standardized instrument with 2 divisions (division 1: variables "residence", "self-determination capabilities", "violence experiences", division 2: variables "depression" and "anxiety" with the Patient Health Questionaire-4). Univariate and bivariate analysis of the data was performed. Result: Out of a total of 59% men and 41% women, 44 participated in the study (response rate=45%). Overall, 20% (n=9) of the participants had an increased PHQ-2 score. This can be used as an indicator for depression. 18% (n=8) of the subject group indicated an increased GAD-2 score. This can be used as an indicator of anxiety. Risk factors for depressive disorders were "an increased level of disability" (RR=11,8), "living with parents" (RR=6, 7), "limited self-determination capabilities"(RR=6,2) and "fear of new situations" (RR=5:0). Violence experiences were a risk factor (RR=13,3) for anxiety. Conclusion: In view of the special methodological challenges of this study, the target group is very small. Nevertheless, this is one of the first studies in Germany that reveals factors with an impact on the mental health of individuals with intellectual disabilities. The association of experience of violence with anxiety in individuals with intellectual disability represents an important challenge for public health.

[Psychological Well-being of Highly-sensitive Persons in Transition to Parenthood - A Cross-sectional Study]. / Psychological Well-Being von hochsensiblen Personen im Übergang zur Elternschaft ­ eine Querschnittstudie.

BACKGROUND: Well-being of highly sensitive people in the transformation period to parenthood is of increasing concern. This study examines whether the transformation period to parenthood has a higher effect on the psychological well-being (PWB) of highly sensitive people than on not highly sensitive people. METHOD: A cross-sectional study was undertaken of parents (n=614), highly sensitive (n=440) and not highly sensitive (n=174), at the transition to parenthood. Instruments were the Ryff psychological well-being scale. Independent variables and well-being were examined by descriptive and bivariate methods. RESULT: Well-being of highly sensitive parents is associated with transition to parenthood (b=-10,129; p<0.05) compared to the control group (7.3% of highly sensitive <50% of PWB; 0.6% of not highly sensitive <50% of PWB). CONCLUSION: As one of the first studies, this examination looks into the data of highly sensitive parents. It can be stated that there is an urgent need for research in this area. Because with a prevalence of 10-20% highly sensitive people within the population, it can be assumed that highly sensitive mostly young parents, could be an important target group of health promotion.

Male and female physical intimate partner violence and socio-economic position: a cross-sectional international multicentre study in Europe.

OBJECTIVES: This work explores the association between socio-economic position (SEP) and intimate partner violence (IPV) considering the perspectives of men and women as victims, perpetrators and as both (bidirectional). STUDY DESIGN: Cross-sectional international multicentre study. METHODS: A sample of 3496 men and women, (aged 18-64 years), randomly selected from the general population of residents from six European cities was assessed: Athens; Budapest; London; Östersund; Porto; and Stuttgart. Their education (primary, secondary and university), occupation (upper white collar, lower white collar and blue collar) and unemployment duration (never, ≤12 months and >12 months) were considered as SEP indicators and physical IPV was measured with the Revised Conflict Tactics Scales. RESULTS: Past year physical IPV was declared by 17.7% of women (3.5% victims, 4.2% perpetrators and 10.0% bidirectional) and 19.8% of men (4.1% victims, 3.8% perpetrators and 11.9% bidirectional). Low educational level (primary vs university) was associated with female victimisation (adjusted odds ratio, 95% confidence interval: 3.2; 1.3-8.0) and with female bidirectional IPV (4.1, 2.4-7.1). Blue collar occupation (vs upper white) was associated with female victimisation (2.1, 1.1-4.0), female perpetration (3.0, 1.3-6.8) and female bidirectional IPV (4.0, 2.3-7.0). Unemployment duration was associated with male perpetration (>12 months of unemployment vs never unemployed: 3.8; 1.7-8.7) and with bidirectional IPV in both sex (women: 1.8, 1.2-2.7; men: 1.7, 1.0-2.8). CONCLUSIONS: In these European centres, physical IPV was associated with a disadvantaged SEP. A consistent socio-economic gradient was observed in female bidirectional involvement, but victims or perpetrators-only presented gender specificities according to levels of education, occupation differentiation and unemployment duration potentially useful for designing interventions.

[Combination of a universal antidote and temporary skin substitute for chemical burns: Extended case report]. / Kombination von universellem Antidot und temporärem Hautersatz bei Verätzungen: Erweiterter Fallbericht.

In this article we describe our experiences in the treatment of chemical burns with Diphoterine(®) solution and Suprathel(®) as a temporary skin substitute material, a treatment which in the past was not commonly used for this pattern of injuries. In the study period from October 2012 to December 2013 we treated five patients (four male and one female including two children and three adults) with chemical burns by decontamination with Diphoterine(®) and wound covering with Suprathel(®). The control group included five patients with similar injury patterns who were treated with Diphoterine(®) and occlusive wound dressings. No wound infections occurred in any of the five cases and no interactions were observed between Suprathel(®) and the chemical substance involved. In four cases the skin areas with IIa-IIb degree damage showed good wound healing and only slight scarring in the follow-up after 3 months and one of the five patients had to be treated surgically. Suprathel(®) can be used as a temporary skin substitute for the treatment of skin burns and is also available for the treatment of chemical burns.

[Anxiety and depressive symptoms and exposition towards violence in the general older population (between 60 and 84 years) in Germany - results from a cross-sectional study]. / Angst- und depressive Symptome und Gewaltexposition in der Wohnbevölkerung (60-84 Jahre) in Deutschland - Ergebnisse einer Querschnittstudie.

BACKGROUND: Depression and anxiety are important public health challenges in the general older population in Germany. Exposition towards violence/abuse in old age has been widely neglected as a risk factor for anxiety and depression among the older population. METHODS: The ABUEL study ("Abuse of the Elderly in Europe") is a cross-sectional study of people between 60 and 84 years living in Stuttgart. Anxiety and depression are assessed with the "Hospital Anxiety and Depression Scale" (HADS). We assessed 1) socio-demographic variables and 2) exposition towards violence in the past 12 months as independent variables. RESULTS: The results indicate that violence exposition in the past 12 months is a risk factor for anxiety (OR: 2.25, 95% CI: 1.32­3.84) and depression (OR: 2.27, 95% CI: 1.27­4.04) among the elderly population in Germany. Anxiety is associated with female gender (OR: 3.18, 95% CI: 1.62­6.25). Anxiety and depression are associated with times of unemployment in the life course. CONCLUSION: Our data suggest that exposure to violence in old age should be assessed to allow targeted prevention and intervention programmes.

[Care of infectious diseases in underage refugees exemplified by Ukraine]. / Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine: Vorgehen in Deutschland gemäß der S1-Leitlinine (AWMF-Register Nr. 048-017).

Background: By early June 2022, around 300,000 children and adolescents from Ukraine were registered in the German central registry for foreigners.The updated recommendations for action should provide the foundations for an evidence-based and targeted care for the diagnosis and prevention of infectious diseases in underage refugees and asylum seekers, exemplified by Ukraine. Objective: The recommendations for action are intended to support medical personnel in the care of minor refugees in order to1) ensure early recognition and completion of an incomplete vaccination status,2) diagnose and treat common infectious diseases,3) ensure early recognition and treatment of infectious diseases that are rare in the German healthcare system. Material and methods: The recommendations for action were drafted as level 1 (S1) guidelines coordinated by the Association of the Scientific Medical Societies in Germany (AWMF) and were adapted to the situation of refugees from Ukraine.The recommendations were compiled by a representative expert panel appointed by the participating professional societies in an informal consensus and finally officially adopted by the board of directors of all societies concerned. Results: Recommendations are given for the extent of the medical evaluation of minor refugees, including the medical history and physical examination, adapted to the situation of refugees from Ukraine. A blood count and screening for tuberculosis, hepatitis B and C as well as human immunodeficiency virus (HIV) infections are recommended for all minor refugees.For a rapid completion of the vaccination status, an age-related and indications-related prioritization of individual vaccinations will be undertaken. Conclusion: In view of the continuing high numbers of refugees not only from Ukraine, a further professionalization of medical health care is necessary. For this purpose, the necessary structural and personnel framework conditions need to be accomplished.

Association between the spread of COVID-19 and weather-climatic parameters.

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites. CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.

[Planning and controlling care services for elderly migrants--an analysis of health-care reporting in nursing homes and at home]. / Planung und Steuerung der Pflegeversorgung auch für Migranten und Migrantinnen?--Eine Analyse der Pflege- und Gesundheitsberichterstattung in der ambulanten und stationären Altenpflege.

Elderly migrants are a rapidly growing group in Germany. Well-grounded health and nursing care reports which deal with the situation of migrants are therefore necessary to secure an appropriate local and national planning of care for elderly migrants. Also quality control and development need substantiated data in order to ensure proper nursing care services for this segment of the population. This contribution explores whether and to what extent data sources provide information about access, quality and use of care services by migrants. The result: the major data sources for regional and national care planning and quality control render no specific information about migrants. This is problematic since several studies indicate severe deficits in nursing care services for this group.

Mental health, health care utilisation of migrants in Europe.

BACKGROUND: Migration during the 1990s has been high and has been characterised by new migrations. Migration has been a key force in the demographic changes of the European population. Due to the different condition of migration in Europe, variables related to mental health of migrants are: motivation for migration, living conditions in the home and in the host country. AIMS: To give an overview on (i) prevalence of mental disorders; suicide; alcohol and drug abuse; (ii) access to mental health and psychosocial care facilities of migrants in the European region, and (iii) utilisation of health and psychosocial institution of these migrants. METHODS: Non-system review of the literature concerning mental health disorders of migrants and their access to and their consumption of health care and psychosocial services in Europe. RESULTS: It is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. The literature showed (i) mental health differs between migrant groups, (ii) access to psychosocial care facilities is influenced by the legal frame of the host country; (iii) mental health and consumption of care facilities is shaped by migrants used patterns of help-seeking and by the legal frame of the host country. CONCLUSION: Data on migrant's mental health is scarce. Longitudinal studies are needed to describe mental health adjusting for life conditions in Europe to identify those factors which imply an increased risk of psychiatric disorders and influence help seeking for psychosocial care. In many European countries migrants fall outside the existing health and social services, particularly asylum seekers and undocumented immigrants.

Mental health of patients from different cultures in Germany.

BACKGROUND: Empirical studies on migration and mental health of migrants are still rare. In Germany they are often characterised by low sample sizes and are limited to certain diseases and geographical areas (old federal states). The comparability of their results is limited. Nonetheless, the assessment of migrants' health is necessary for adequate medical and psychosocial care for this target group. AIM: To provide data on mental health of migrants from Poland and from Vietnam in Germany. METHODS: We have assessed a random sample of migrants from Poland (n=140) and from Vietnam (n=88) using the Giessen Subjective Complaints List - 24 (GSCL-24) and the Hospital Anxiety and Depression Scale (HADS). Additionally we asked migrants about their knowledge of health care institutions in case of psychosocial problems, their demands and the existing barriers to health care utilisation. RESULTS: Migrants from Poland and Vietnam have a higher general score of complaints of physical ill-health and higher anxiety and depression values than Germans. Psychosocial and medical institutions are visited less. CONCLUSION: Further analytical studies are needed to clarify health differences between these groups. Migrants are a heterogeneous group and only group-specific investigations will clarify associations between countries of origin, health status and use of health care institutions.

Precise predictions for V + jets dark matter backgrounds.

High-energy jets recoiling against missing transverse energy (MET) are powerful probes of dark matter at the LHC. Searches based on large MET signatures require a precise control of the Z ( ν ν ¯ ) +  jet background in the signal region. This can be achieved by taking accurate data in control regions dominated by Z ( ℓ + ℓ - ) +  jet, W ( ℓ ν ) +  jet and γ +  jet production, and extrapolating to the Z ( ν ν ¯ ) +  jet background by means of precise theoretical predictions. In this context, recent advances in perturbative calculations open the door to significant sensitivity improvements in dark matter searches. In this spirit, we present a combination of state-of-the-art calculations for all relevant V +  jets processes, including throughout NNLO QCD corrections and NLO electroweak corrections supplemented by Sudakov logarithms at two loops. Predictions at parton level are provided together with detailed recommendations for their usage in experimental analyses based on the reweighting of Monte Carlo samples. Particular attention is devoted to the estimate of theoretical uncertainties in the framework of dark matter searches, where subtle aspects such as correlations across different V +  jet processes play a key role. The anticipated theoretical uncertainty in the Z ( ν ν ¯ ) +  jet background is at the few percent level up to the TeV range.

Perineal ultrasound offers useful information in girls with congenital adrenal hyperplasia.

A variable spectrum of urogenital malformations exists in girls with congenital adrenal hyperplasia (CAH). The vagina may enter the urethra at a variable level, and relations to the sphincter complex vary accordingly. Furthermore, an enlarged clitoris and variations in the bladder sphincter anatomy can be found. Endoscopy, genitography or magnetic resonance imaging (MRI) are commonly used for the assessment of these anomalies, and to provide information for counselling and treatment. When surgery is planned, introitoplasty cosmetical reduction of the clitoris and labioplasty are discussed with the families; introitoplasty is the most demanding aspect. In order to plan the most appropriate surgical approach, the entrance level of the vagina into the urethra and its relation to the bladder sphincter must be known. Thus, imaging has an important role in CAH. The imaging techniques mentioned above require sedation, anaesthesia or involve ionizing radiation of the gonads and, thus, are relatively invasive. It would therefore be highly desirable to have a minimally invasive and accurate technique that provides images of the individual anatomic situation. The present paper describes experience with perineal ultrasound in the initial imaging evaluation of girls with CAH. Ultrasound findings were compared to the results of endoscopy that was performed before surgery. From 2006 to 2012, 11 girls had perineal ultrasound and endoscopy. Measurements of clinical relevance for introitoplasty were: the length of the urogenital sinus, the distance to the vaginal opening into the urogenital sinus, and the length of the bladder neck. This retrospective analysis showed that the entrance point of the vagina into the urogenital sinus could be identified in 10 of 11 girls. In some cases, the correlation of endoscopic and ultrasound data showed a correlation between endoscopic and sonographic findings. The length of the bladder neck and the length of the urogenital sinus could be measured by ultrasound in 10 of 11 girls, and were subsequently confirmed by endoscopy. This showed, for the first time, that perineal ultrasound could provide the information required for surgical correction of the urogenital sinus anomaly in CAH. Advantages of these techniques are the minimal invasiveness and wide availability. Because long-term problems are not uncommon, perineal ultrasound may also be of value during follow-up. Widespread use of this technique has the potential to reduce costs and morbidity associated with endoscopy and genitography.

[Migration-sensitive data collection for public health surveillance]. / Migrationssensible Datenerhebung für die Gesundheitsberichterstattung. Arbeitsgruppe Gesundheitsberichterstattung des Arbeitskreises "Migration und öffentliche Gesundheit".

Despite the many potential sources of stress and strain that accompany a migration situation, there are very few data in official statistics with regard to the health and social situation of migrants in Germany. The fact that this information is not available for public health reporting could lead to problems of improper, lacking or excessive health care. A working group within the Arbeitskreis Migration und Offentliche Gesundheit has been addressing this problem since 2003. In this article, a systematic overview of the most important data sources for public health reporting and of the indicators for migration background and social status that each one contains will be given. After that we will present examples of good practice in migration-sensitive data collection at the local and national level. Finally suggestions for improving the data situation with regard to the health of migrants based on the recommendation for recording the migration status in epidemiological studies will be made.

[Postgraduate qualifications in epidemiology in Germany. Experiences in Berlin, the current situation and future prospects]. / Epidemiologische Masterstudiengänge in Deutschland. Erfahrungen aus Berlin-aktueller Stand und Perspektiven.

The postgraduate Masters Program in Epidemiology (MSc) was established in 2001 in Germany in Bielefeld, Munich and Berlin. The study program is conducted with a common curriculum. Its aim is the qualification of new scientists for jobs in the field of epidemiological research, as well as the training of scientists working in this area. This article reports the experiences of 3 years of classes at the Berlin center. It shows the structure of the program and gives a vision for the future of epidemiological education in Europe.

OPS imaging of human microcirculation: a short technical report.

Despite the pivotal role of microcirculation in numerous diseases, techniques for the direct assessment of human microcirculation are limited. A new approach based on orthogonal polarization spectral (OPS) imaging (Cytoscan microscope) allows noninvasive observation of human microcirculation in all accessible tissue surfaces. Limitations remain: application of pressure with the instrument affects blood flow, lateral movement of tissue precludes continuous investigation of a given microvascular region, and blood flow velocities above 1 mm/s cannot be measured. We addressed these problems by (a) constructing an attachment to the probe, preventing direct contact of the instrument with the observed tissue area and allowing fixation of the tissue, and (b) implementing a double-flash spatial correlation technique extending the measuring range for blood flow velocities up to approximately 40 mm/s. The modified approach was tested in vitro and in vivo. Velocity readings correlated well with velocities of an external standard (r(2) = 0.99, range 1.9-33.8 mm/s). Pulsatile flow patterns synchronous with heart rate with maximal velocities of about 10 mm/s could be detected in arterioles of the human sublingual mucosa. The modified instrument may prove useful to investigate the microcirculation in the context of research, diagnosis and therapy control.