[Digital electroencephalography in brain death diagnostics : Technical requirements and results of a survey on the compatibility with medical guidelines of digital EEG systems from providers in Germany]. / Digitale Elektroenzephalographie in der Hirntoddiagnostik : Technische Anforderungen und Ergebnisse einer Umfrage zur Richtlinienkompatibilität digitaler EEG-Systeme bei Anbietern in Deutschland.

BACKGROUND: The guidelines of the German Medical Association and the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) require a high procedural and technical standard for electroencephalography (EEG) as an ancillary method for diagnosing the irreversible cessation of brain function (brain death). Nowadays, digital EEG systems are increasingly being applied in hospitals. So far it is unclear to what extent the digital EEG systems currently marketed in Germany meet the guidelines for diagnosing brain death. METHODS: In the present article, the technical und safety-related requirements for digital EEG systems and the EEG documentation for diagnosing brain death are described in detail. On behalf of the DGKN, the authors sent out a questionnaire to all identified distributors of digital EEG systems in Germany with respect to the following technical demands: repeated recording of the calibration signals during an ongoing EEG recording, repeated recording of all electrode impedances during an ongoing EEG recording, assessability of intrasystem noise and galvanic isolation of measurement earthing from earthing conductor (floating input). RESULTS: For 15 of the identified 20 different digital EEG systems the specifications were provided by the distributors (among them all distributors based in Germany). All of these EEG systems are provided with a galvanic isolation (floating input). The internal noise can be tested with all systems; however, some systems do not allow repeated recording of the calibration signals and/or the electrode impedances during an ongoing EEG recording. CONCLUSION: The majority but not all of the currently available digital EEG systems offered for clinical use are eligible for use in brain death diagnostics as per German guidelines.

The measuring of substantia nigra hyperechogenicity in an Italian cohort of Parkinson disease patients: a case/control study (NOBIS Study).

Transcranial sonography (TCS) shows an increased echogenic area of the substantia nigra (SN) in patients with Parkinson disease (PD). It has been increasingly used in the diagnosis of PD and its differentiation from atypical parkinsonian syndromes. Here, we studied the diagnostic accuracy of SN TCS in Italian patients. In this blinded cross-sectional study (NOBIS study), two expert neuro-sonologists performed TCS in 25 PD patients and 29 age- and sex-matched controls. The study participants were completely hidden to the TCS investigators using large drapery. One month later, the SN TCS recordings were re-read by the initial investigator, and cross-read by the second reader. Diagnostic accuracy was estimated on the first reading, intra-reader reliability on re-reading, and inter-reader reliability on cross-readings. The mean SN echogenic area was larger in the patients (0.24 cm2) than in the controls (0.15 cm2; Mann-Whitney test, p < 0.001). SN measures did not differ between right and left, or between ipsilateral and contralateral to the clinically more affected side. There was no correlation between SN echogenicity and PD severity or duration. High intra-reader (concordance correlation coefficient 0.93) and inter-reader (0.98) agreement of SN measurements was found. The diagnostic accuracy for the detection of PD was high (area under receiver-operating characteristic curve 0.91; 95% CI 0.83-1.00) with an optimum cut-off value for SN echogenic area of 0.18 cm2 with the device used here (specificity 0.83-0.90; sensitivity 0.72-0.92). This study supports the use of SN TCS in the diagnostic workup of PD if performed by trained readers.

[Municipal Health Promotion in Germany: Duties, Rights and Potential]. / Kommunale Prävention und Gesundheitsförderung in Deutschland: Pflichten, Rechte und Potenziale im Kontext der kommunalen Daseinsvorsorge.

Municipalities have an overarching structure in health promotion. Due to the right to self-government, municipalities are in charge of both voluntary and obligatory tasks. Some of the original and fundamental tasks can be summarized as "services to the public". Current common definitions do not include the term "health promotion". In the present study, a sub-target of a joint project, legal acts, requirements and recommendations were researched and analyzed. The results show substantive cornerstones of health promotion in various regulations of different disciplines. Based on these findings, health promotion can be interpreted as being part of services to the public. Currently the regulations for education, social tasks, environmental and consumer protection constitute the legal framework for community health promotion, but also include constitutions. They range from public international law to municipal resolutions. Quality management and also quality development are already an integral part in some communal departments. The management of structures, processes and results arises from commitments or measurable targets. In contrast, quality management for health promotion is not based on binding requirements. Specifications of other neighboring sectors (e. g. education, social sector) demonstrate the potential and effectiveness of legal policy guidelines, seen as a frame. A transparent communication about the current regulations is indispensable for formulating future guidelines. The German National Prevention Act opens opportunities for municipalities. However, its interpretation and local engagement will still guide the practice of communal health promotion.

[Diagnostics of clinical and prodromal idiopathic Parkinson's disease : New criteria]. / Diagnostik des klinischen und prodromalen idiopathischen Parkinson-Syndroms : Neue Kriterien.

BACKGROUND: Recently, the Movement Disorder Society (MDS) published an adaptation of the previous United Kingdom Brain Bank Society (UKBBS) criteria for the diagnosis of idiopathic Parkinson's disease (iPD). OBJECTIVES: This article presents the changes in the current clinical diagnostic criteria for IPD. Furthermore, the new MDS criteria for prodromal iPD are discussed. RESULTS: The recently introduced MDS criteria for the clinical diagnosis of iPD include useful novel features (e.g. postural instability is no longer listed as a cardinal symptom, familiar history of iPD and intake of neuroleptics at the first visit no longer lead to exclusion of the diagnosis) and red flags do not lead to exclusion of the diagnosis; however, they must be counterbalanced by the presence of supportive criteria for iPD. The criteria for identification of persons in the prodromal stage are currently established only for scientific investigations. CONCLUSION: The new MDS criteria for the diagnostics of iPD should help to improve the sensitivity and specificity.

[Helpful instrumental examinations in idiopathic Parkinson's disease]. / Hilfreiche Zusatzuntersuchungen beim idiopathischen Parkinson-Syndrom.

BACKGROUND: The clinical diagnosis of idiopathic Parkinson's disease (iPD) can be challenging. In these cases, additional diagnostic methods are available that can help to improve diagnostic accuracy. OBJECTIVES, MATERIAL AND METHODS: This article provides an overview of currently available and promising novel ancillary methods for the early and differential diagnosis of iPD. RESULTS: Imaging tools, such as 1.5 Tesla magnetic resonance imaging (MRI) and computed tomography (CT) are mainly used for the differentiation between iPD and symptomatic parkinsonian syndromes (PS). High-resolution diffusion tensor imaging and iron and neuromelanin-sensitive high-field MRI sequences can become important in the future, particularly for earlier diagnosis. Transcranial B­mode sonography of the substantia nigra and basal ganglia is established for early and differential diagnostics, especially in the combination of diagnostic markers but necessitates an adequately trained investigator and the use of validated digital image analysis instruments. DATScan can discriminate iPD from essential tremor, medication-induced parkinsonism and psychogenic movement disorder but not iPD from atypical PS. For the latter differential diagnosis, fluorodeoxyglucose positron emission tomography and myocardial metaiodobenzylguanidine scintigraphy can be helpful. Olfactory testing should preferably be used in combination with other diagnostic tests. Genetic, biochemical and histopathological tests are currently not recommended for routine use. Novel sensor-based techniques have a high potential to support clinical diagnosis of iPD but have not yet reached a developmental stage that is sufficient for clinical use. Novel sensor-based techniques have high potential to support clinical diagnosis of iPD, but have not yet reached a development stage that is sufficient for clinical use. CONCLUSION: Ancillary diagnostic methods can support the early and differential diagnosis of iPD.

Accuracy of transcranial brain parenchyma sonography in the diagnosis of dementia with Lewy bodies.

BACKGROUND AND PURPOSE: Transcranial sonography (TCS) of the brain parenchyma is used to visualize alterations in the substantia nigra (SN) and it is applied for early diagnosis of Parkinson's disease. Our aim was to explore specific echogenic alterations of the SN in dementia with Lewy bodies (DLB) compared to Alzheimer's disease (AD). METHODS: Seventy-one subjects underwent TCS: 22 DLB, 28 AD and 21 healthy elderly controls. Cognitive impairment, extrapyramidal signs, visual hallucinations, fluctuations and rapid eye movement sleep behaviour symptoms were investigated. TCS assessed SN hyperechogenicity and symmetry. RESULTS: Transcranial sonography revealed SN hyperechogenicity in 100% of DLB compared to 50% of AD and 30% of controls. Mean SN echogenic area (cm(2) ) was 0.22 ± 0.03 in DLB, 0.15 ± 0.03 in AD and 0.14 ± 0.03 in controls (P < 0.0001). More than 50% of DLB presented a marked hyperechogenicity (cutoff value >0.22 cm(2) ) compared to only 10% of AD (P < 0.0003). DLB had symmetrical SN enlargement, whereas AD were mostly asymmetrical (P = 0.015). A combination of SN echogenic area and asymmetry index had a sensitivity of 88.9% and a specificity of 81.2% in discriminating DLB from AD (positive predictive value 85.7%, negative predictive value 85.7%). No association was found between SN hyperechogenicity and Unified Parkinson's Disease Rating Scale part III, Mini Mental State Examination or the presence of visual hallucinations. CONCLUSIONS: Transcranial sonography may be a valid supportive tool in the diagnostic workup of neurodegenerative dementia helping clinicians to distinguish DLB from AD even at the early stages.

Doppler and Duplex Sonography for the Diagnosis of the Irreversible Cessation of Brain Function ("Brain Death"): Current Guidelines in Germany and Neighboring Countries.

Extra- and transcranial sonography of brain-supplying arteries is accepted worldwide in brain death protocols as a valid "ancillary" method of proving brain circulatory arrest. Color-coded duplex sonography and CT angiography have been newly incorporated in the fourth update of the German Medical Association's guidelines for the determination of the irreversible cessation of brain function ("brain death"), effective July 2015. The updated guidelines address in more detail the diagnostic procedures and the required qualifications of the examiners. The present article summarizes the guidelines and the recommendations regarding the application and documentation of ultrasound findings for the diagnosis of brain circulatory arrest in children and adults, as valid in Germany. The method, limitations, and procedure in the case of inconclusive findings are described. Age-related minimum values of mean arterial pressure for the diagnosis of cerebral circulatory arrest in children are presented. A concise overview of the respective regulations for the use of sonography for diagnosing brain death in other countries, especially in the countries neighboring Germany, is given.

Transcranial Sonography of the Insula: Digitized Image Analysis of Fusion Images with Magnetic Resonance.

Purpose: Transcranial B-mode sonography (TCS) of brain parenchyma is increasingly used as a diagnostic tool for movement disorders. Accordingly, experimental B-Mode Assist software was developed to enable digitized analysis of the echogenicity of predefined brain regions. The aim of the study was to assess the reproducibility of digitized TCS image analysis of the insula. Materials and Methods: A total of 130 patients with an indication for neurosonological examination were screened for participation in the study. The insula was imaged from the right temporal bone window using Virtual Navigator and TCS-MRI (magnetic resonance imaging) fusion imaging. All subjects were examined three times by two experienced sonographers. Corresponding images of the insula in the axial thalamic plane were encoded and digitally analyzed. Interclass correlation coefficient (ICC) and Spearman's rank correlation coefficient were used for the assessment of intra- and inter-reader as well as intra- and inter-investigator reliabilities. Results: TCS images of 114 patients were evaluated (21 patients with TIA, 53 patients with headache, 18 patients with essential tremor, 22 patients with neurodegerative disease). 16 patients were excluded from analysis due to insufficient bone window. The intra-reader, inter-reader, intra-investigator and inter-investigator ICCs/Spearman's rank correlation coefficients were 0.995/0.993, 0.937/0.921, 0.969/0.961 and 0.875/0.858, resp. Conclusion: The present study demonstrates a high reliability to reproduce echogenicity values of the insula using digitized image analysis and TCS-MRI fusion images with almost perfect intra-reader, inter-reader, intra-investigator and inter-investigator agreement.

Asexual expansion of Toxoplasma gondii merozoites is distinct from tachyzoites and entails expression of non-overlapping gene families to attach, invade, and replicate within feline enterocytes.

BACKGROUND: The apicomplexan parasite Toxoplasma gondii is cosmopolitan in nature, largely as a result of its highly flexible life cycle. Felids are its only definitive hosts and a wide range of mammals and birds serve as intermediate hosts. The latent bradyzoite stage is orally infectious in all warm-blooded vertebrates and establishes chronic, transmissible infections. When bradyzoites are ingested by felids, they transform into merozoites in enterocytes and expand asexually as part of their coccidian life cycle. In all other intermediate hosts, however, bradyzoites differentiate exclusively to tachyzoites, and disseminate extraintestinally to many cell types. Both merozoites and tachyzoites undergo rapid asexual population expansion, yet possess different effector fates with respect to the cells and tissues they develop in and the subsequent stages they differentiate into. RESULTS: To determine whether merozoites utilize distinct suites of genes to attach, invade, and replicate within feline enterocytes, we performed comparative transcriptional profiling on purified tachyzoites and merozoites. We used high-throughput RNA-Seq to compare the merozoite and tachyzoite transcriptomes. 8323 genes were annotated with sequence reads across the two asexually replicating stages of the parasite life cycle. Metabolism was similar between the two replicating stages. However, significant stage-specific expression differences were measured, with 312 transcripts exclusive to merozoites versus 453 exclusive to tachyzoites. Genes coding for 177 predicted secreted proteins and 64 membrane- associated proteins were annotated as merozoite-specific. The vast majority of known dense-granule (GRA), microneme (MIC), and rhoptry (ROP) genes were not expressed in merozoites. In contrast, a large set of surface proteins (SRS) was expressed exclusively in merozoites. CONCLUSIONS: The distinct expression profiles of merozoites and tachyzoites reveal significant additional complexity within the T. gondii life cycle, demonstrating that merozoites are distinct asexual dividing stages which are uniquely adapted to their niche and biological purpose.

[Reaching Target Groups--Shaping Accessibility]. / Zielgruppen erreichen--Zugangswege gestalten.

This paper describes the public health discourse on the accessibility and access paths, theoretical approaches as well as factors influencing the utilisation of prevention and health promotion interventions, and requirements for their evaluation. Various projects funded by the German Federal Ministry of Education and Research address many aspects of accessibility and describe extensive experiences with access paths, approaches to information transfer, target group-driven supply chain design, etc. Recommendations for practice and research are given at the end of the article.

[Transfer of Preventive Interventions into Health Care Provision]. / Präventive Maßnahmen transferieren--In Versorgungspraxis überführen.

Successful transfer of evidence based prevention programs and interventions in health care is a precondition for improvement of public health. The BMBF research focus on prevention contained substantial transfer experiences that have been analysed. As a result, a set up of a new research focus including specific methodology was recommended. The paper summarizes the KNP transfer results.

[Health and Prevention Behaviour of Persons with and without Migration Background]. / Gesundheits- und Präventionsverhalten von Personen mit und ohne Migrationshintergrund.

Based on a sample of the Hannover registration office this project analyses the health and prevention behaviour of Russian- and Turkish-language migrants compared to natives. The project analysis revealed considerable differences, particularly concerning addiction behaviour and physical activities.

[Importance and Implementation of Prevention in Germany--A Nationwide Survey of Decision-makers in the GKV-Spitzenverband and Political Decision-makers]. / Stellenwert und Umsetzung der Prävention in Deutschland--Eine bundesweite Befragung von Entscheidungsträgern in GKV-Spitzenverband, Bund, Ländern und Kommunen.

Representatives of the statutory health insurance (n=46) and policy makers at the local, federal and state level (n=136) were interviewed in 2 nationwide online surveys about the significance and degree of implementation of prevention. The group comparison between the decision-makers shows significant differences in terms of attitudes towards health prevention. The political leaders are demanding an improvement of the GKV-benefit package and the obstacles require the cooperation of urgent attention.

[Reaching Target Groups--Shaping Accessibility. Results of a Survey Among Experts on Recommendations for Science and Practice]. / Zielgruppen erreichen--Zugangswege gestalten. Ergebnisse einer Befragung von Expertinnen und Experten zu Empfehlungen für Wissenschaft und Praxis.

In an online survey, in which 18 experts participated, recommendations for research and practice to improve access to target groups were discussed. The recommendations were developed within the context of the KNP project. For the implementation of the recommendations, not only is an increased cooperation between science and practice particularly important, but also materials and training as well as standardization of methods. Furthermore, financial resources, especially for conducting evaluation studies are needed.

[Changing structures--Integrating health]. / Strukturen ändern--Gesundheit integrieren.

Changes in (municipal) structures for the improvement of health are often required but, in contrast to behavioural measures, less frequently implemented and scientifically evaluated. Results on this subject for Germany are scarce. In recent years, municipal prevention and health promotion programmes received new impetus from the expansion of the German "Early Assistance" initiative. Early assistance programmes to help children grow up healthy initiated municipal processes such as the establishment of networks between health services and youth welfare services, prevention chains and nationwide initiatives. This has moved issues such as equal opportunities for health into the centre of politically driven structural development efforts. Neighbourhood management groups and municipal round tables on prevention-specific topics etc. have been established throughout Germany. Regarding this structural development, 6 projects from the field of prevention research give a good indication as to how the structure of municipal concepts can be effectively implemented.

[School Development by Using Health Management: Indicator Toolbox as Quality Assurance Instrument for Self-Evaluation in Schools]. / Schulentwicklung durch Gesundheitsmanagement: Kennzahlentoolbox als Qualitätssicherungsinstrument für Selbstevaluation an Schulen.

Organisational development is crucial to health promotion in schools. The intervention "Learning to Live Healthy" is a new school health promotion strategy designed to develop schools into healthy environments for all those who work and study there. The aim of the study "School Development by using Health Management" is to introduce the management instrument balanced scorecard and to develop an indicator toolbox. This allows schools to evaluate the achievement of objectives, the implementation level of the measures and the changes in their organisation regarding health management.

[Implementing daily physical education in primary school - potentials and barriers from the involved actor's point of view]. / Täglichen Schulsport in der Grundschule implementieren - Potenziale und Barrieren aus Sicht der beteiligten Akteure.

OBJECTIVE: The objective was to determine to what extent daily physical education can be implemented in primary schools, what barriers exist and how to overcome the mentioned barriers. Moreover, it was analysed to what extent daily physical education is accepted by teachers, external trainers, parents and students. METHODS: Semi-structured interviews with parents (n=7), teachers (n=5) and external trainers (n=6) of the intervention schools. The intervention students (n=44) were surveyed within focus groups. RESULTS: All surveyed groups appraised the implementation of daily school sports as successful. The cooperation between the schools and the sports club should be maintained during a comprehensive implementation of daily physical education. Besides an improved lessons quality teachers and external trainers reported an improved social behaviour of the children. Parents perceived positive effects on the child development. All groups believe that daily physical education increases the enjoyment of children in sports. As a certain barrier a lack of resources (e. g., facilities, equipment, financial resources) in the schools were mentioned. CONCLUSIONS: The cooperation between the schools and the sports club proved to be an applicable model to implement daily physical education. The combination of teachers and external trainers can contribute to a higher lesson quality. Considering the perceived potentials of daily physical education by all surveyed groups, a comprehensive implementation of systematic daily physical activity promotion in the primary school setting should be tapped more strongly in future.

[Strengthen the prevention and health promotion in a science-based way--Results and experience of the German National Prevention Research Initiative]. / Prävention und Gesundheitsförderung wissenschaftsbasiert stärken--Ergebnisse und Erfahrungen des BMBF-Förderschwerpunkts Präventionsforschung.

From 2004 to 2013, the German Ministry of Education and Research (BMBF) established its first funding programme for the promotion of prevention research. Objectives of this programme were the prevention of widespread health risks and diseases and to reinforce health promotion. Within this programme, 4 phases concentrated on socially disadvantaged target groups and on methodical and structural challenges relating to prevention/ health promotion. The projects covered evaluating the effectiveness of existing or newly-designed measures, developing and testing new concepts, programmes and access routes. Furthermore, the projects should contribute to the development of methods. The umbrella project "Kooperation für nachhaltige Präventionsforschung" (KNP-Cooperation for sustainable prevention research) was set up in 2009 to support the meaningful processing and application of key knowledge from this BMBF funding focus on prevention research and to promote networking between science, practice, and politics.

[Effectiveness and Cost-Effectiveness of Daily School Sport in the Primary School--Project: "fit for pisa"]. / Effektivität und Kosteneffektivität täglichen Schulsports in der Grundschule--das Projekt "fit für pisa".

The "fit for pisa" intervention implemented daily physical education at five primary schools in Göttingen. The results of the evaluation show an increase in physical activity among the students participating in the programme. At the same time sedentary behaviour, like watching television, decreased remarkably. In the long run the promotion of an active lifestyle had improved the body mass index. The study emphasises the need for government funding to implement the programme across the country.

[The Preventive Home Visit as a Preventive Intervention to Reach the Elderly--Effectiveness and Cost-Effectiveness of Different Ways of Approach]. / Der präventive Hausbesuch als zugehende Präventionsmaßnahme im Alter--Effektivität und Kosteneffektivität von Zugangswegen.

The aim of the study was a systematical further development of targeted approaches. Research questions were how elderly women and men could be motivated to participate in a preventive intervention and by which approaches elderly with different health risks could be reached. In several stages a specific motivational material was developed. Afterwards two different approaches to the elderly (general practice, health insurance) were tested and evaluated considering its (cost) effectiveness.