The Mandatory German Breast Implant Registry Law: A Model for Sustainable Implant Registries.

BACKGROUND: Recurrent scandals involving breast implants have revealed that scientific evidence on the performance of these devices is lacking, and passive monitoring systems are not capable of detecting problems at an early stage. The German health authorities therefore decided to implement a prospective, mandatory registry. OBJECTIVES: The aim of this article was to provide information about the advantages of implementing a mandatory registry, the potential hurdles involved, and to establish structural requirements that future registries can use. METHODS: Since 2018, the authors have assisted the German Ministry of Health in refining the Implant Law and its implementation. They adapted an internationally consented dataset, promoted international data amplification and conducted monthly trial inputs for over 2 years. By identifying several key issues they were able to assist in developing solutions. RESULTS: The cooperation with the authorities was characterized by appreciation of the authors' expertise and previous international work. Challenges included data privacy issues, federal competence, longitudinal follow-up, and contact data; as well as associated costs and technical solutions for data inclusion and the use of information technology to communicate with stakeholders. Addressing these challenges required considerable interference with personal rights and complementary measures for all stakeholders. Extensive structural precautions were taken to safeguard personal data privacy as far as possible. CONCLUSIONS: The authors' experience and lessons learned can guide registries seeking to engage in high levels of evidence data. The authors describe their approach, the obstacles they encountered, and the strategies employed to overcome the setbacks of other registries.

Considerations on the Demography of BIA-ALCL in European Countries Based on an E(A)SAPS Survey.

BACKGROUND: A growing body of evidence indicates that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is associated with the use of certain breast implants. Regional variations have been reported, and a genetic susceptibility has also been suggested. However, large variations in the ability to correctly diagnose BIA-ALCL and to further report and register cases exist between countries and may in part explain variations in the demography. MATERIAL AND METHODS: A survey was conducted by The European Association of Societies of Aesthetic Plastic Surgery E(A)SAPS and sent to 48 European countries. The primary aim was to identify the total number of confirmed cases of and deaths from BIA-ALCL in each country during four consecutive measurements over a two-year period. RESULTS: An increase in BIA-ALCL cases during four repeated measurements from a total of 305 in April 2019 to 434 in November 2020 was reported by 23 of the 33 responding countries. A nearly 100-fold variation in the number of cases per million inhabitants was noted, where Netherlands had the highest rate (4.12) followed by Finland (1.99). Countries with the lowest reported rates were Austria (0.078), Romania (0.052) and Turkey (0.048). CONCLUSION: The current study displays a notable variation ßin the number of confirmed BIA-ALCL cases across Europe, even for countries with established breast implant registers. Variations in diagnosis and reporting systems may explain the differences, but the influence of genetic variations and the prevalence of high-risk implants cannot be excluded. Incomplete sales data along with medical tourism preclude an absolute risk assessment. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating full-thickness skin grafts in intraperitoneal onlay mesh position versus onlay position in mice.

BACKGROUND: Importance: Hernia surgery requires reinforcement material with few side effects when used in the intraperitoneal position. Autologous skin grafting may meet this requirement, but animal experiments are obligatory before being applied in humans. OBJECTIVE: To compare survival and effects of isogeneic full-thickness skin grafts in the intraperitoneal onlay mesh (IPOM) position in mice, with a control group using the onlay position. Primary end point was graft survival and secondary end point adhesion formation and inflammation through NF-κB activity. METHODS: Design: Intervention study with 8-week follow-up in accordance with ARRIVE criteria, performed between 2015 and 2016. SETTING: Animal laboratory. PARTICIPANTS: Transgenic C57BL/6 mice with isogeneic background were used. Recipients were female wild-type phenotype mice >3 mo (n = 24). Donors were male or female mice >7 mo, with phenotype-positive for the luciferase gene (n = 20) or positive for NF-κB-luciferase gene (n = 4). INTERVENTION: Full-thickness skin was grafted in the IPOM position and compared with grafts in the onlay position as controls. Survival was evaluated by regular longitudinal postoperative luminescence imaging over 8 wk. Adherence formation was evaluated macroscopically after sacrifice. Inflammation of full-thickness skin grafts in IPOM position of NF-κB mice was evaluated in four additional mice. Main outcome and measure: Survival of grafts, evaluated by luminescence. RESULTS: Ten animals received grafts in the IPOM position, and 10 in the onlay position as controls. Graft survival after 8 wk was 100% (20/20). Average luminescence at the end of the 8-week period was 999,597 flux (min 162,800, max 2,521,530) in the IPOM group (n = 10) and 769,708 flux (min 76,590, max 2,164,080) in the onlay control group (n = 10). No adhesions requiring sharp dissection (Jenkins' scale >2) were seen. Four animals with grafts in the IPOM position showed peak inflammation (NF-κB activity) 5 d after surgery subsiding toward the end of follow-up. CONCLUSIONS: Full-thickness skin survives as well in the IPOM position as in the onlay control position, and few adherences develop. Further studies are required to fully characterize the tissue remodeling and repair processes associated with IPOM skin grafting. The result is relevant in the search for alternative reinforcement materials to be used in complex hernia surgery in humans.

Correlation between abdominal rectus diastasis width and abdominal muscle strength.

BACKGROUND: Surgery for Abdominal Rectus Diastasis (ARD) is a controversial topic and some argue that it is solely an aesthetic problem. Many symptoms in these patients are indefinite, and no objective criteria have been established, indicating which patients are likely to benefit from surgery. This study investigated the correlation between preoperative assessment and intraoperative measurement of ARD width, and objective measurements of muscle strength. METHODS: 57 patients undergoing surgery for ARD underwent preoperative assessment of ARD width by clinical measurement and CT scan, and thereafter intraoperative measurement. Abdominal muscle strength was investigated using the Biodex System 4 including flexion, extension and isometric measurements. Correlations were calculated by the Spearman test. RESULTS: Intraoperative ARD width between the umbilicus and the symphysis correlated strongly with Biodex measurements during flexion (p = 0.007, R = -0.35) and isometric work load (p = 0.01, R = -0.34). The following measurements showed no correlation: between muscle strength and BMI; muscle strength and waistline; or between muscle strength and ARD width above the umbilicus, assessed preoperatively at the outpatient clinic, by CT scan, or measured intraoperatively. CONCLUSION: There is a strong correlation between intraoperatively measured ARD width below the umbilicus and flexion and isometric abdominal muscle strength measured with the Biodex System 4.

Lower extremity soft tissue reconstruction and amputation rates in patients with open tibial fractures in Sweden during 1998-2010.

BACKGROUND: The rates of soft tissue reconstruction and amputation after open tibial fractures have not been studied on a national perspective. We aimed to determine the frequency of soft tissue coverage after open tibial fracture as well as primary and secondary amputation rates. METHODS: Data on all patients (> = 15 years) admitted to hospital with open tibial fractures were extracted from the Swedish National Patient Register (1998-2010). All surgical procedures, re-admissions, and mechanisms of injury were analysed accordingly. The risk of amputation was calculated using logistic regression (adjusted for age, sex, mechanism of injury, reconstructive surgery and fixation method). The mean follow-up time was 6 (SD 3.8) years. RESULTS: Of 3,777 patients, 342 patients underwent soft tissue reconstructive surgery. In total, there were 125 amputations. Among patients with no reconstructive surgery, 2% (n = 68 patients) underwent amputation. In an adjusted analysis, patients older than 70 years (OR = 2.7, 95%, CI = 1.1-6) and those who underwent reconstructive surgery (OR = 3.1, 95% CI = 1.6-5.8) showed higher risk for amputation. Fixations other than intramedullary nailing (plate, external fixation, closed reduction and combination) as the only method were associated with a significant higher risk for amputation (OR 5.1-14.4). Reconstruction within 72 hours (3 days) showed better results than reconstruction between 4-90 days (p = 0.04). CONCLUSIONS: The rate of amputations after open tibial fractures is low (3.6%). There is a higher risk for amputations with age above 70 (in contrast: male sex and tissue reconstruction are rather indicators for more severe soft tissue injuries). Only a small proportion of open tibial fractures need soft tissue reconstructive surgery. Reconstruction with free or pedicled flap should be performed within 72 hours whenever possible.

Sequelae Treatment Needs Following Peripheral Facial Palsy: Retrospective Analysis of 525 Patients.

OBJECTIVE: This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention. STUDY DESIGN: Retrospective case review. SETTING: Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions. PATIENTS: All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022. INTERVENTIONS: Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae. MAIN OUTCOME MEASURES: Types of initial and late treatments were noted. Sunnybrook and/or House-Brackmann scales were used for palsy grading. RESULTS: Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients ( p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House-Brackmann 3 to 6. CONCLUSIONS: Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.

ESPRAS Survey: National and European Societies for Plastic Surgeons.

BACKGROUND: The European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) comprises 40 national societies across Europe. In addition to ESPRAS, there are 8 different European Plastic Surgery societies representing Plastic Surgeons in Europe. The 4th European Leadership Forum (ELF) of ESPRAS, held under the motto "Stronger together in Europe" in Munich in 2023, aimed to collect and disseminate information regarding the national member societies of ESPRAS and European societies for Plastic Surgeons. The purpose was to identify synergies and redundancies and promote improved cooperation and exchange to enhance coordinated decision-making at the European level. MATERIAL AND METHODS: An online survey was conducted regarding the organisational structures, objectives and challenges of national and European societies for Plastic Surgeons in Europe. This survey was distributed to official representatives (Presidents, Vice Presidents and General Secretaries) and delegates of national and European societies at the ELF meeting. Missing information was completed using data obtained from the official websites of the respective European societies. Preliminary results were discussed during the 4th ELF meeting in Munich in March 2023. RESULTS: The ESPRAS survey included 22 national and 9 European Plastic Surgery societies representing more than 7000 Plastic Surgeons in Europe. Most national societies consist of less than 500 full members (median 182 members (interquartile range (IQR) 54-400); n=22). European societies, which covered the full spectrum or subspecialities, differed in membership types and congress cycles, with some requiring applications by individuals and others including national societies. The main purposes of the societies include research, representation against other disciplines, specialisation and education as well as more individual goals like patient care and policy regulation. CONCLUSION: This ESPRAS survey offers key insights into the structures, requirements and challenges of national and European societies for Plastic Surgeons, highlighting the relevance of ongoing close exchange between the societies to foster professional advancement and reduce redundancies. Future efforts of the ELF will continue to further explore strategies for enhancing collaboration and harmonisation within the European Plastic Surgery landscape.

Secondary Breast Reconstruction in Irradiated Patients: Prospective Trial Comparing DIEP to Brava Expansion and Fat Transplantation.

BACKGROUND: Autologous tissue reconstruction of the breast is preferable after irradiation. Fat transplantation is a possible alternative. The aim of this prospective trial was to compare outcomes of deep inferior epigastric perforator (DIEP) flaps to Brava expansion and fat grafting, after mastectomy and irradiation. METHODS: Patients were recruited among the candidates for delayed breast reconstruction after mastectomy and irradiation and were given the same information on both methods. Twenty-six patients underwent DIEP reconstruction, and 31 patients had multiple fat grafting sessions after Brava external tissue expansion. Outcomes were evaluated using the BREAST-Q questionnaire and the Telemark Breast Score. RESULTS: Twenty-four of 31 patients in the fat graft group completed the study. Six to nine operative sessions were required to gain a mean volume of about 490 mL. The mean total operative time was 11.5 hours. Four patients in this group developed a new primary or metastatic cancer disease during the study. Twenty-four of 26 patients in the DIEP group completed the study. The mean total operative time was 8 hours. The mean volume of the reconstructed breast was 523 mL. Telemark Breast Score values showed similar improvements in both groups at short terms of 3 months in the Brava group and 6 months in the DIEP group. CONCLUSIONS: Supplementary surgical procedures are often needed in breast reconstruction after mastectomy with irradiation using Brava external expansion and fat grafting. Even though the aesthetic results evaluated by surgeons were comparable, patients were more satisfied with outcomes after DIEP reconstruction compared with Brava expansion and fat grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Comparing 200,000 Breast Implants and 85,000 Patients over Four National Breast Implant Registries.

BACKGROUND: Growing awareness about breast implant-related adverse events has stimulated the demand for large, independent data resources. For this, data from breast implant registries could be combined. However, that has never been achieved yet. METHODS: Real-world data from four currently active national breast implant registries were used. All permanent breast implants from the Australian, Dutch, Swedish, and American registries were included. A subpopulation present across all registries between 2015 and 2018 was subsequently selected, including only permanent breast implants inserted during primary surgery for breast reconstruction or augmentation in patients without previous breast device surgery. Nationwide coverage, patient and implant characteristics, infection control measures, and revision incidences were analyzed. RESULTS: A total of 207,189 breast implants were registered. Nationwide coverage varied between 3% and 98%. The subpopulation included 111,590 implants (7% reconstruction, 93% augmentation). Across the registries, mean patient age varied between 41 and 49 years ( P < 0.001) for reconstruction and 31 and 36 years ( P < 0.001) for augmentation. Variation was observed in implant preferences across the countries and over the years. Infection control measures were most frequently registered in Australia. Cumulative revision incidence at 2 years ranged from 6% to 16% after reconstruction and from 1% to 4% after augmentation. CONCLUSIONS: For the first time, independent, national, registry-based data from four breast implant registries were combined. This is a powerful step forward in optimizing international breast implant monitoring, evidence-based decision-making, and patient safety.

Mental health state and its determinants in German university students across the COVID-19 pandemic: findings from three repeated cross-sectional surveys between 2019 and 2021.

Background: Students were at an increased risk for elevated mental symptoms during the first year of the COVID-19 pandemic compared to pre-pandemic levels. As universities remained closed much longer than anticipated, the mental burden was expected to persist through the second year of the pandemic. The current study aimed to investigate the prevalence of mental distress from 2019 through 2021 and identify risk factors for elevated mental burden, focusing on gender. Methods: We analyzed three cross-sectional online surveys among students at the University of Mainz, conducted in 2019 (n = 4,351), 2020 (n = 3,066), and 2021 (n = 1,438). Changes in the prevalence of depressive symptoms, anxiety, suicidal ideation, and loneliness were calculated using Pearson's chi-square tests and analyses of variance. Multiple linear regressions yielded associated risk factors. Results: The proportion of students with clinically relevant depressive symptoms was significantly higher during the pandemic (38.9% in 2020, and 40.7% in 2021), compared to pre-pandemic (29.0% in 2019). Similarly, more students reported suicidal ideation and generalized anxiety during the pandemic with a peak in the second pandemic year (2021). The level of loneliness was significantly higher in 2020, compared to 2019, and remained at a high level in 2021 (p < 0.001, ηp2 = 0.142). Female and diverse/open gender, being single, living alone, and being a first-year student were identified as risk factors associated with mental burden during the pandemic. Discussion: Mental burdens remained elevated among students through the second year of the pandemic and were associated with socio-demographic risk factors and pandemic-related concerns. Future research should monitor recovery and evaluate the need for psychosocial support.

Focal signs in infantile spasms.

BACKGROUND: Infantile spasms belong to the group of epileptic encephalopathies that typically occur in early infancy and are often associated with severe developmental delay. Little is known about whether focal features are part of the syndrome and thus occur independently of etiology, or whether focal features always indicate a cerebral lesion. METHODS: In our study we included all patients with infantile spasms documented by prolonged video-electroencephalogram (EEG) monitoring between 7/2003 and 11/2020 and analysed symptoms such as tonic posturing, clonic movements, deviation of the eyes and unilateral deviation of the mouth. These symptoms were classified as lateralizing or non-lateralizing and the correlation to the presence of a lesion was investigated. RESULTS: Eighteen patients (9 w/9 m) were included in the study. Lateralizing tonic posturing was found in 66.6% of the patients. Deviation of the eyes to one side and unilateral deviation of the mouth were detected in 61.1% and 11.1% of patients, respectively. Taking into account all symptoms (tonic posturing, clonic movements, deviation of the eyes, unilateral deviation of the mouth), focal signs were observed in a total of 94.4%, with only half of the total patient population having a cerebral lesion. CONCLUSION: In our study, lateralizing symptoms in infantile spasms occurred independently of the presence of a lesion. In contrast, focal symptoms in older children or adults usually correlate with the presence and localization of a lesion. A possible hypothesis could be that the brain is still maturing in infancy.

Internet-Related Disorders and Their Effects on Personality Development in Adolescents from Germany-Results from a Prospective Study.

Internet-related disorders (IRD) are increasingly becoming a major health issue. IRD are defined as the predominant use of online content, related to a loss of control and continued use despite negative consequences. Despite findings from cross-sectional studies, the causality of pathways accelerating the development of IRD are unclear. While etiological models emphasize the role of personality as risk factor, mutual influences between IRD and personality have not been examined. A prospective study with two assessments was conducted with n = 941 adolescents (mean age of 13.1 years; 10-17 years). Our aim was to validate etiological assumptions and to examine the effects of IRD-symptoms on the maturation of personality. IRD were measured with the Scale of the Assessment of Internet and Computer game Addiction (AICA-S). Personality traits were assessed using the Brief Five Factor Inventory (BFI). Conscientiousness and neuroticism were predictive for IRD symptoms one year later, and were likewise prone to changes depending on incidence or remission of IRD. Conscientiousness and openness moderated the course of IRD symptoms. Our findings point to complex trait-pathology associations. Personality influences the risk of development and maintenance of IRD symptoms and pre-existing IRD-symptoms affect the development of personality. Adaptations to etiological models are discussed and perspectives for novel intervention strategies are suggested.

Potential risk groups and psychological, psychosocial, and health behavioral predictors of pharmacological neuroenhancement among university students in Germany.

Aiming to develop and implement intervention strategies targeting pharmacological neuroenhancement (PN) among university students more specifically, we (1) assessed the prevalence of PN among German university students, (2) identified potential sociodemographic and study-related risk groups, and (3) investigated sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior related factors predicting the 12-month prevalence of PN. Therefore, a cross-sectional online survey was administered to students of the University of Mainz, Germany. A binary logistic regression with stepwise inclusion of the five variable groups was performed to predict PN. A total number of 4351 students out of 31,213 registered students (13.9%) participated in the survey, of which N = 3984 answered the question concerning PN. Of these, 10.4% had used one substance for PN at least once in the past 12 months. The regression analysis revealed 13 variables that were significantly related to the 12-month prevalence of PN. Specifically, the group of health behavior related variables showed the strongest relationship with PN. Therefore, an approach to the prevention of PN should be multifactorial so that it addresses social conditions, as well as education on substance use and healthy behaviors in terms of non-pharmacological strategies as alternatives of PN.

Distinct Patterns of University Students Study Crafting and the Relationships to Exhaustion, Well-Being, and Engagement.

Job crafting has been established as a bottom-up work design instrument for promoting health and well-being in the workplace. In recent years, the concepts of job crafting have been applied to the university student context, proving to be positively related to student well-being. Building on person-centered analyses from the employment context, we assessed approach study crafting strategy combinations and the relationships to students' exhaustion, study engagement, and general well-being. Data from 2,882 German university students were examined, collected online during the summer term in 2020. Using latent profile analysis, we found five distinct crafting groups, which showed discriminate validity with regard to emotional exhaustion, engagement, and well-being. The results underscore the positive role of study crafting for students' health and well-being. They further indicate a less important role of increasing social resources for emotional exhaustion when combined with a moderate increase in structural resources and a moderate increase in challenging demands. Our findings imply that interventions to promote study crafting should be considered to promote student health and well-being.

Determinants of university students' COVID-19 vaccination intentions and behavior.

Vaccination hesitancy has been a major challenge for health authorities and societies during the COVID-19 pandemic. The general determinants of vaccination intentions and behavior include sociodemographic and health-related, psychological, and communication-related factors, with varying relevance for different types of vaccinations, countries, and target groups. The predictors of university students' COVID-19 vaccination behavior have not been sufficiently studied. Using a German university as an example and based on an online survey of 1398 university students, we investigated factors related to (a) the likelihood of vaccination against COVID-19 and (b) vaccination intention among those who had not been vaccinated by summer of 2021. Psychological factors showed high relevance. Field of study, trust in, and use of certain media and information channels were found to be important determinants of students' vaccination decision. Our findings can help better understand university students' vaccination behavior to develop and implement tailored strategies and campaigns.

Long-term follow-up after surgical repair of abdominal rectus diastasis: A Prospective Randomized Study.

BACKGROUND: Abdominal rectus diastasis can lead to functional disability. There is no consensus regarding treatment. This was a prospective study on patients randomized to surgery using either Quill self-retaining sutures or retromuscular mesh for abdominal rectus diastasis repair. The primary aim of the study was to compare long-term recurrence after surgery. Secondary aims were abdominal muscle strength, pain, and quality of life. METHODS: A total of 57 patients were eligible and 52 were investigated. A routine 1-year follow-up ruled out any patient with recurrence and this was followed up by clinical examination for recurrence and assessment of the secondary outcomes a median of 5 years (3.8-6.5 years) after surgery. Quality of life was assessed using the Short Form-36 questionnaire. Pain related to activity was evaluated using the Ventral Hernia Pain Questionnaire. RESULTS: No recurrence of abdominal rectus diastasis was found. Significant improvements were seen between index surgery and long-term follow-up in all domains of Short Form-36. There were no significant differences in quality of life or self-reported muscle strength between the two surgical groups. Long-term pain remained unchanged compared to that at the 1-year follow-up. "Pain this week" had decreased significantly at long-term follow-up compared to prior to surgery (mesh p = 0.009, Quill p = 0.003). CONCLUSIONS: No recurrence of abdominal rectus diastasis appeared. There was no difference in quality of life or long-term pain between the two surgical groups. Implantation of retromuscular mesh entails more extensive surgery implying potentially higher risk for complications. This leads us to recommend reconstruction with double-row self-retaining sutures for the repair of abdominal rectus diastasis in patients with functional disability.

Challenge Accepted! a Critical Reflection on How to Perform a Health Survey Among University Students-An Example of the Healthy Campus Mainz Project.

Background: Universities represent an important setting of everyday life for health promotion. The Healthy Campus Mainz project aims to develop an evidence-based and comprehensive student health management program covering physical, mental, and social health promotion. Hence, an initial health survey was performed in order to identify the students' health concerns and resources. Up until now, it remains unclear which topics to choose in a health survey among university students and which strategies can be recommended to receive an acceptable response rate or representative student sample within a university setting. The present paper contributes to the call for the present research topic "Public Health Promotion in University Students" by describing methods for health assessment. Therefore, the current paper aims to give an empirical example on how to perform a health survey among university students, focusing on (1) choosing topics for the survey and (2) methodological considerations of how to reach the target population. Methods: An online questionnaire including around 270 items was developed covering a comprehensive set of health topics. Participants were recruited via the university email. Mixed channels for survey promotion, such as lecture visits and social media, were used, accompanied by different monetary and non-monetary incentives. Descriptive analyses were performed to describe the sample. Results: A total of 5,006 participants (out of 31,213 registered students) viewed the first page of the questionnaire; of whom, 4,714 continued further. After a manual data cleaning according to the predefined criteria, the final sample was 4,351, demonstrating a response rate of 13.9%. Students from different study disciplines participated. However, some study disciplines showed a low participation rate, hence, making the results not free from some bias. Discussion: This survey is exceptional as it integrates a great variety of health aspects. The incentive strategy demonstrated promising results. Future research should try to improve target-group-specific recruitment strategies for the traditionally underrepresented groups, such as males and specific study disciplines. This would not only include advancing marketing strategies, but also refining the incentive strategy.

Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines.

BACKGROUND: Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike. METHODS: The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience. RESULTS: The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient's symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior. DISCUSSION: The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.

Health Information Seeking Among University Students Before and During the Corona Crisis-Findings From Germany.

Health information-seeking behavior is the process of gathering information about health and disease and can be influential for health-related perception and behavior. University students are an important target group for prevention and health promotion and largely belong to an age group that is considered to play a leading role in propagating the SARS-CoV-2 epidemic in Germany. The paper deals with students' health information-seeking behavior before and during the corona crisis, aiming to give insights into its determinants and implications. Using the example of a large German comprehensive university and based on two cross-sectional surveys in the summer of 2019 (n = 4,351) and 2020 (n = 3,066), we investigate which information channels students use for health information, how information seeking changes during the course of the pandemic, and to what extent information seeking is associated with risk perception and risk behavior. For a subsample of participants that participated in both surveys (n = 443), we also trace developments at the individual level through a longitudinal analysis. The results show that students' health information seeking takes place primarily online and changed markedly during the corona crisis. The comparatively high relevance of sources that are largely based on unchecked user-generated content raises the concern whether students' health information-seeking behavior guarantees the necessary quality and reliability of health information. Significant correlations between the intensity of corona-related information seeking, risk perception, and actual risk behavior were found.