E-Health intervention for subthreshold depression: Reach and two-year effects of a randomized controlled trial.

BACKGROUND: There is evidence for e-Health interventions for full-blown depression. Little is known regarding commonly untreated subthreshold depression in primary care. This randomized controlled multi-centre trial assessed reach and two-year-effects of a proactive e-Health intervention (ActiLife) for patients with subthreshold depression. METHODS: Primary care and hospital patients were screened for subthreshold depression. Over 6 months, ActiLife participants received three individualized feedback letters and weekly messages promoting self-help strategies against depression, e.g., dealing with unhelpful thoughts or behavioural activation. The primary outcome depressive symptom severity (Patient Health Questionnaire;PHQ-8) and secondary outcomes were assessed 6, 12 and 24 months. RESULTS: Of those invited, n = 618(49.2 %) agreed to participate. Of them, 456 completed the baseline interview and were randomized to ActiLife (n = 227) or assessment only (n = 226). Generalised estimation equation analyses adjusting for site, setting and baseline depression revealed that depressive symptom severity declined over time, with no significant group differences at 6 (mean difference = 0.47 points; d = 0.12) and 24 months (mean difference = -0.05 points; d = -0.01). Potential adverse effects were observed at 12 months, with higher depressive symptom severity for ActiLife than control participants (mean difference = 1.33 points; d = 0.35). No significant differences in rates of reliable deterioration or reliable improvement of depressive symptoms were observed. ActiLife increased applied self-help strategies at 6 (mean difference = 0.32; d = 0.27) and 24 months (mean difference = 0.22; d = 0.19), but not at 12 months (mean difference = 0.18; d = 0.15). LIMITATIONS: Self-report measures and lack of information on patients' mental health treatment. DISCUSSION: ActiLife yielded satisfactory reach and increased the use of self-help strategies. Data were inconclusive in terms of depressive symptom changes.

Effects of an individualised nutritional intervention to tackle malnutrition in nursing homes: a pre-post study.

PURPOSE: Individualised interventions are recommended to tackle malnutrition in older adults, but approaches for nursing home (NH) residents are scarce. This study investigated the effects of an individualised nutritional intervention in NH residents with (risk of) malnutrition. METHODS: In a pre-post study, 6 weeks (w) of usual care were followed by 6w of intervention. The intervention consisted of up to three supplement modules (sweet and savoury protein creams and protein-energy drink, single or combined) and, if required, reshaped texture-modified meals (RTMM). RESULTS: Fifty residents completed the study (84 ± 8 years, 74% female). One-third (32%) received RTMM. Additional 258 ± 167 kcal/day and 23 ± 15 g protein/day were offered. Mean daily energy intake increased by 207 (95%CI 47-368, p = 0.005) kcal and protein intake by 14 (7-21, p < 0.001) g (w12 vs w1). Quality of life (QoL) increased in the subscale "care relationship" (+ 9 (3-15) points, p = 0.002, w12 vs w6). Body weight, handgrip strength, and other QoL subscales did not change. CONCLUSION: Our intervention improved dietary intake and one QoL subscale in NH residents with (risk of) malnutrition. As a next step, randomized controlled trials are needed to investigate the impact of individualised interventions more comprehensively.

Membrane mechanics govern spatiotemporal heterogeneity of endocytic clathrin coat dynamics.

Dynamics of endocytic clathrin-coated structures can be remarkably divergent across different cell types, cells within the same culture, or even distinct surfaces of the same cell. The origin of this astounding heterogeneity remains to be elucidated. Here we show that cellular processes associated with changes in effective plasma membrane tension induce significant spatiotemporal alterations in endocytic clathrin coat dynamics. Spatiotemporal heterogeneity of clathrin coat dynamics is also observed during morphological changes taking place within developing multicellular organisms. These findings suggest that tension gradients can lead to patterning and differentiation of tissues through mechanoregulation of clathrin-mediated endocytosis.

Mefenamic acid: A possible cause of drug-induced acute pancreatitis.

INTRODUCTION: Drug-induced acute pancreatitis (AP) is rare, but as there are no systematic data on it, the true incidence is not known. CASE REPORT: This case report is a first description of two episodes of AP occurring after administration and subsequent re-administration of mefenamic acid to a young woman without comorbidities. Other common causes of AP could be ruled out. With both episodes, the latency of AP was less than 24 h after drug intake. CONCLUSION: Mefenamic acid should be considered as a possible cause of drug-induced AP.

[Intramedullary nailing vs. locking plate osteosynthesis in proximal humeral fractures: Long-term outcome]. / Marknagel- vs. winkelstabile Plattenosteosynthese bei proximalen Humerusfrakturen: Langzeitergebnisse.

BACKGROUND: For the treatment of proximal humeral fractures two major therapeutic principles can be employed: intramedullary nailing (PHN) or locking plate osteosynthesis. The aim of this study was to evaluate and compare clinical and radiological long-term outcome of proximal humeral fracture stabilization using PHN or angular stable plating. MATERIALS AND METHODS: In a retrospective study between March 2009 and March 2010, we analyzed 72 out of 118 patients with unified proximal humeral fracture who had been treated at least 3 years previously using PHN (44 patients) or angular stable plating (28 patients) in a level 1 trauma center. Functional and radiological outcomes were assessed at least 3 years after trauma using the Constant and Murley score and SF-36 score. RESULTS: According to the Neer classification, there were 31 3-part fractures (PHN: 23; plate: 8) and 41 4-part fractures (PHN: 21; plate: 20), respectively. No clinical symptoms after 3 years were observed in 42 patients, whereas in 30 patients clinical symptoms were evaluated related to pain and/or loss of function. Functional outcome using the Constant and Murley score demonstrated a total score of 73 points (ipsilateral side) vs. 88 points (contralateral side) in all evaluated patients, on average. CONCLUSION: Both PHN and angular stable plating are adequate treatment options for proximal humeral fractures. Both systems require precise preoperative planning and advanced surgical experience. No significant differences in long-term clinical and radiological outcome between implants regarding fracture classification, age of patient, and choice of implant were found.

[Data for epidemiological research on ageing in Germany. Opportunities and limitations of existing datasets: results of the second workshop of the working group Epidemiology of Ageing within the German Society for Epidemiology (DGEpi)]. / Daten für die epidemiologische Altersforschung. Möglichkeiten und Grenzen vorhandener Datensätze. Ergebnisse des 2. Workshops der Arbeitsgruppe Epidemiologie des Alterns der Deutschen Gesellschaft für Epidemiologie (DGEpi).

Due to the increasing proportion of older people in the general population epidemiologists are interested in identifying which factors determine healthy ageing. For this reason within the German Society for Epidemiology we founded the working group 'Epidemiology of Ageing' in 2011. The working group organised a workshop to present useful datasets on ageing in Germany for epidemiological research. Those presented included: Study of Health in Pomerania (SHIP) The German Ageing Survey (DEAS) Surveys from the Robert Koch Institute: German Health Interview and Examination Survey for Adults (DEGS) and the German Health Update (GEDA) The German Socio-Economic Panel Study (SOEP) Cooperative Health Research in the Region of Augsburg (KORA-Age) Survey of Health, Ageing and Retirement in Europe (SHARE) Germany Claims data from statutory health insurance agencies Presentations contained a brief description of the datasets, methodologies, age-related themes, their strengths and limitations as well as their availability for secondary analysis. All presented datasets can be used for longitudinal analyses and are available to the scientific community.

[Loneliness trends in the second half of life: results from the German Ageing Survey (DEAS)]. / Einsamkeittrends in der zweiten Lebenshälfte : Befunde aus dem Deutschen Alterssurvey (DEAS).

UNLABELLED: BACKGROUND AND RESEARCH QUESTIONS: In the current paper, it is analyzed whether the extent of loneliness of adults in the second half of their lives has changed between 1996 and 2008 in Germany. Because patterns of objective social integration have evolved differently in different birth cohorts (familial integration in earlier birth cohorts more fragile, more solid in later birth cohorts), we expected different trends in the extent of loneliness in different birth cohorts. DESIGN AND METHODS: The three waves of the German Ageing Survey (DEAS) constitute the database for the analysis: 1996 (n = 3,979), 2002 (n = 2,766) and 2008 (n = 4,392). Loneliness was measured with the de Jong Gierveld Loneliness Scale. The German Ageing Survey (DEAS) is a nationwide representative survey of the German population aged 40-85 years. RESULTS: Only a minority of people report being very lonely in the second part of life. Between 1996 and 2008, there is a positive trend in the extent of loneliness in the second half of life, i.e., the prevalence of loneliness decreased during this period of time. From 1996 to 2008, the youngest respondents (40-54 years of age) and the middle aged respondents (55-69 years) demonstrated a decline from 1996 to 2002 followed by an increase in loneliness between 2002 and 2008. The oldest respondents (70-85 years of age) experienced a steady decline in loneliness. Gender differences (men are somewhat lonelier than women) remain stable between 1996 and 2008. DISCUSSION AND CONCLUSION: While people who are currently old are socially well integrated and, hence, experience loneliness only to a small degree, there is a higher risk for persons who are currently in middle adulthood because their social networks have become increasingly more fragile. Further changes have to be observed.

[Severe polytrauma with an ISS ≥ 50]. / Das schwere Polytrauma mit einem ISS ≥ 50.

In Germany 427,500 persons per year are injured in traffic accidents. So we analysed in a retrospective study the post-traumatic quality of life of patients suffering from a severe trauma (ISS ≥ 50). Highlights of interest were: (i) pattern of injury, (ii) injured part of the body, (iii) days in ICU, (iv) outcome, (v) actual state of health, (vi) mental health. Between 1/2000 and 12/2005, 1,435 patients with multiple trauma were hospitalised in the Trauma Center Murnau. 88 suffered from a severe trauma with ISS ≥ 50. 23 % of these patients had a good outcome and 36 % died. Actually, more than half of the patients were physically handicapped or suffered from pain. 41 % showed characteristics typical for a post-traumatic stress disorder. In conclusion the patients with severe trauma had a good survival rate, but they showed a poor post-traumatic quality of life. Thus, in the time after trauma it is important to treat the "whole patient" and not only the physical lesions.

[Unusual skin alterations in a 72-year-old patient with multiple myeloma]. / Ungewöhnliche Hautveränderungen bei 72-jähriger Patientin mit multiplem Myelom.

We report on a 72-year-old female patient with multiple myeloma who presented with alopecia and eye-catching alterations of the skin and the nails. A biopsy of the skin could confirm the diagnosis of immunoglobulin light chain (AL) amyloidosis, which was also suspected of having affected other organs. After six cycles of a cytoreductive therapy with bortezomib and dexamethasone a very good partial response of the multiple myeloma was seen and an improvement in the skin and nail alterations could be achieved.

Type 2 diabetes and lipoprotein metabolism affect LPS-induced cytokine and chemokine release in primary human monocytes.

AIMS/HYPOTHESIS: Obesity and insulin resistance are characterized by a chronic and low grade state of inflammation and the pro-inflammatory response of monocytes is affected in type 2 diabetes mellitus (T2D). We aimed to investigate whether LPS-induced monocytic cytokine and chemokine release depends on serum lipoprotein parameters in T2D patients. METHODS: Primary human monocytes were isolated from 29 patients with known T2D and from 20 healthy volunteers. Anthropometric and disease-related parameters such as age, gender, BMI, WHR, diabetes duration, diabetes complications, and diabetes control (HbA1c) were documented. Monocytes were stimulated for 18 h with LPS (1 µg/ml). Unstimulated monocytes served as control. The supernatant concentrations of CCL2, CCL3, CCL4, CCL5, MIF and resistin were measured by ELISA. RESULTS: LPS-stimulation significantly (p<0.001) increased CCL chemokine and resistin concentrations in healthy controls and in patients with T2D, whereas MIF release was not affected in both groups. LPS-induced CCL2 and resistin concentrations were significantly higher in T2D patients when compared to healthy controls. In T2D patients, LPS-induced CCL3 concentration was higher in males when compared to females (p=0.039) and supernatant resistin concentration upon stimulation with LPS showed a significant and positive correlation with age (r=0.6; p=0.001). LPS-induced CCL2 concentration was significantly and positively correlated with serum triglyceride concentration (r=0.4; p=0.009) in T2D patients. Furthermore, LPS-induced CCL4 concentration was significantly and positively correlated with total (r=0.4; p=0.035) and LDL cholesterol (r=0.4; p=0.033) concentration. CONCLUSIONS: LPS responsiveness of monocytes is altered in T2D and is affected by the respective serum lipoprotein metabolism.

[Health and old age: taking stock from the perspective of health reporting]. / Alter und Gesundheit: Eine Bestandsaufnahme aus Sicht der Gesundheitsberichterstattung.

With advancing age, there is a significant increase in the number of health problems; at the same time, the complexity of the existing impairments increases. In addition to the diagnosed somatic and psychological illnesses, functional disorders and disabilities as well as the self-assessed health of the individual play an important role. Health in old age is an important individual and societal topic today and in the future. In order to plan health politics, mapping of morbidity and prognosis are important. They require representative, valid, current, and comparable data over time. Databases of the health reporting in the area of senior citizens have improved in recent years. However, data are still missing, for example, in the area of not being able to fully take part in daily life. Research is needed, because of the specificity of health problems in the elderly, including the survey methodology and the selection of suitable indicators.

[Theories on aging and health: what do aging and old age mean and what constitutes a good life in old age?]. / Theorien zu Alter(n) und Gesundheit: Was bedeuten Alterwerden und Altsein und was macht ein gutes Leben im Alter aus?

The present paper starts by introducing different perspectives of the aging process and includes biological, psychological, and sociological theories in its scope. The article addresses the issue of when "old age" begins and why a distinction is made between the third and fourth age. With increasing age, it becomes more and more difficult to differentiate between health-related losses due to illnesses or to aging. However, this can be important with respect to health behavior and health care. Having the best possible health in old age is an important factor for a good life in old age. Over their whole lives, from childhood to old age, people can actively contribute to their health in old age. But health is not the sole criterion for a good life in old age. Having interests and aims are just as important as being integrated in a social network. In old age, people often differ greatly and this is why there is such variety in what people consider to constitute a good life for themselves in old age.

[Living conditions of aging and old people in Germany]. / Lebenssituationen älter werdender und alter Menschen in Deutschland.

This contribution aims to convey a general overview of the living conditions of aging and old people in Germany. It introduces a series of contributions devoted to the topic "health in old age" and focuses on older people as a very heterogeneous group in society. Who exactly are these older people? We start by discussing the definition of "old age" as a stage of life and the distinction between a "third" and "fourth" age. This is followed by a presentation of some facts describing demographic change at the population level. The main body of the contribution looks at households and housing, family relations and social integration, income, life satisfaction and the health of older people. The two waves of the German Aging Survey, a representative study of persons in the second half of life undertaken in 1996 and 2000, provide the empirical base for the paper.

[Technology in residences for support of a self-determined life style for the elderly. The research project "sentha" and initial results of a social science project]. / Technik im Haushalt zur Unterstützung einer selbstbestimmten Lebensführung im Alter. Das Forschungsprojekt "sentha" und erste Ergebnisse des Sozialwissenschaftlichen Teilprojekts.

Sentha is an interdisciplinary research team involving the Technical University Berlin, the Berlin Institute for Social Research GmbH (BIS), the German Centre for Research on Ageing at the University of Heidelberg (DZFA), the School of Fine Arts Berlin (HdK), and the Brandenburg Technical University Cottbus (BTU). Building on empirical investigations of the role of everyday household products in the everyday life of older people, product-independent design and assessment guidelines and new products are being developed in an intensive interdisciplinary process in order to better meet the needs of older people and to enhance their autonomous living. The following paper describes the contributions from the participating disciplines and presents initial results of the social sciences subproject, describing the problems arising in living independently in old age and detecting the demands on new technological solutions. Data are based on a representative survey conducted in 1999 and including a stratified sample of 1417 men and women aged 55 and older.

[Pathologic-anatomic investigations in laying hens in various housing systems]. / Pathologisch-anatomische Untersuchungen bei Legehennen aus verschiedenen Haltungssystemen.

Gross pathologic and histologic changes were investigated in a total of 1000 end-of-lay hens. Thirty animals were drawn from free range stocks, 270 from deep litter stocks, and 700 from caging systems. The following changes were evaluated with regards to housing systems: Pododermatitis, deformation of the keel bone and amputated beaks occurred primarily in free range hens. Deep litter hens also suffered from pododermatitis, keel bone deformation and amputated beaks in addition to pecking wounds. In caged hens severe fatty liver syndromes, injuries of the claws and inflammation of the feather follicles were mainly found. Furthermore, injuries and fractures due to handling and transport were almost exclusively found in caged hens. It has to be concluded that all of the investigated housing systems can predisposed hens to certain lesions. The documented changes--e.g. chronic inflammation, skelettal deformities and injuries--are painful and may lead to permanent alterations. Therefore, these changes should be condemned as conflicting with animal protection regulations.

Loss of invasiveness in squamous cell carcinoma cells overexpressing desmosomal cadherins.

The molecular and structural characteristics of intercellular adhesion were investigated in a squamous cell carcinoma (SCCA) cell line, originally derived from an oral tumor with an invasive growth pattern. The expression of adherens junction and desmosomal components were compared with that of cultured normal oral keratinocytes. Lack of membrane association in interdesmosomal areas, the disorganization of the actin cytoskeleton and the faster cell disassembly upon E-cadherin antibody binding in SCCA cells indicated decreased functional adherens junctions. These observations were supported by a significant reduction in E-, N-, and P-cadherin protein expression. In contrast, the level of desmosomal cadherin proteins, desmoglein 1/2 and desmocollin 2, were substantially upregulated and accompanied, ultrastructurally, by increased number and size of desmosomes. Since tumor invasion suppressor capacity has been proposed for desmosomal cadherins, we investigated the in vivo invasion potential of these SCCA cells by introducing them into SCID mice. Tumors developed, but with a benign phenotype. Based on these results, we hypothesize that the benign behavior of this SCCA cell line is a consequence of overexpressed desmosomal cadherins. This SCCA cell line, therefore, represents an excellent model system to further investigate the regulation and tumor invasion suppressor potential of desmosomal adhesion molecules.

[Results of pathological-anatomical studies of limbs and spinal column]. / Ergebnisse der pathologisch-anatomischen Befunderhebung an Gliedmassen und Wirbelsäule.

The pathomorphological study was carried out on a total of 360 broiler chicken which had been random-sampled on days 22 and 35 of the mast period, respectively, from those flocks that were to be compared. Furthermore, 161 animals with evidence of movement disturbance that were slaughtered in the last two mast weeks, were also evaluated. With regard to incidence, severity of movement disturbance and the spectrum of pathomorphological changes of the skeleton there were no differences between the different groups. When histological and morphometrical methods were applied, no differences in the skeleton structure were noted between flocks with conventional housing and flocks with reduced population density. Equally, no differences were ascertained with regard to dry substance and ash content of the bones including the minerals calcium and phosphorus. Furthermore, there were no group differences in serum calcium, phosphorus and alkaline phosphatase. In numerous chicken from all groups a plantar pododermatitis with differing incidence and strongly varying intensity was observed. The lesions were characterized by a papillomatous proliferation of the basal epithelial layers. There was widespread inflammation with loss of the epithelial layer and deep necroses of the sole. A latent infection with papilloma viruses is discussed. About 90% of the random-sampled chicken of all groups showed bending of the vertebral column by 20 degrees at the height of the 6th thoracic vertebra. In numerous chicken the 6th thoracic vertebra was dislocated and slightly rotated which caused encroachment of the vertebral canal. Whether this alteration may be responsible for the frequently observed movement disturbance of broilers in the last third of the mast period can not be decided on the basis of the pathomorphological study. In any case it must be assumed that both the pododermatitis and the bending and encroachment of the vertebral column cause pain. Thus, both lesions should be evaluated from the viewpoint of animal protection.