Acinar adipose tissue infiltration in salivary gland biopsy is associated with kynurenines-Interferon-γ pathway inflammation biomarkers.

OBJECTIVES: Assess if kynurenines metabolites are biomarkers of damage at labial salivary gland biopsy (LSGB). METHODS: This is a cross-sectional study including 99 patients with primary Sjögren's syndrome (AECG 2002 or ACR/EULAR 2017). Kynurenines were measured in plasma using liquid chromatography-tandem mass spectrometry. RESULTS: 95.9% were females, 51±12 years. Most had focal lymphocytic sialadenitis with focus score ≥1 (73.7%, n=73/99). The majority had mild to severe acinar atrophy (70.4%, n=57/81) and adipose infiltration (51.2%, n=39/80). Individuals with adipose infiltration were older (53.49±12.33 vs. 47.51±11.29 years, p=0.016), showed higher frequency of glandular dysfunction and higher kynurenines levels. Schirmer's test ≤ 5 mm/5min was found in 69.2% of individuals with adipose infiltration compared to 41% without (p=0.012) and unstimulated whole salivary flow (UWSF) was found in 87.2% compared to 70% without adipose infiltration (p=0.063). Additionally, individuals with adipose infiltration showed higher kynurenines metabolites compared with those without: quinolinic acid (503.35±193.30 vs. 427.35±285.76 nmol/L, p=0.029), kynurenine (1.99±0.6, 54 vs. 1.61±0.46 µmol/L, p=0.006), kynurenine/tryptophan ratio (KTR) (0.030±0.09 vs. 0.025±0.01, p=0.031) and anthranilic acid (03±4.96 vs. 16.46±5.24 nmol/L, p=0.022). CONCLUSIONS: Kynurenines are biomarkers of greater adipose infiltration in LSGB and glandular dysfunction suggesting that activation of interferon-γ pathway is involved in the salivary and lacrimal glands damage.

'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer.

BACKGROUND: Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks. OBJECTIVES: To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs. METHODS: Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS: Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest. CONCLUSIONS: Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.

Different outdoor professions have different risks - a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides.

BACKGROUND: One of the main risk factors for non-melanoma skin cancer (NMSC), the most common cancer worldwide, is solar ultraviolet radiation (UVR). This has led to the recognition of NMSC as occupational disease for outdoor workers in several countries. However, outdoor professions are a very heterogeneous group with diverse daily activities and associated UVR exposure. OBJECTIVE: To compare the prevalence of NMSC and associated risk behaviour in different outdoor professions. METHODS: Cross-sectional study among outdoor workers (farmers, gardeners, mountain guides) and indoor workers (office employees) as control group using a paper-based questionnaire on UVR exposure and protective behaviour followed by a skin examination by a dermatologist. RESULTS: A total of 563 participants (46.9% women, 46.9 ± 13.8 years) consisting of 348 outdoor workers (38.8% farmer, 35.3% gardener, 25.9% mountain guides) and 215 indoor workers were included in the study between March and September 2017. NMSC incl. actinic keratosis was diagnosed in 33.3% of mountain guides, 27.4% of farmers, 19.5% of gardeners and in 5.6% of indoor workers. Significant differences were seen between the outdoor professions with mountain guides at highest risk compared to farmers (OR = 2.6, 95% CI = 1.2-5.7). Substantial differences between the professions were also seen in skin cancer screening attendance rates (indoor worker 61.4%, mountain guides 57.8%, farmers 31.9%, gardeners 27.6%), daily UVR exposure during work and protective behaviour such as sunscreen use during work. CONCLUSION: Different outdoor professions have significant different risks for NMSC and show different risk behaviour. Tailoring prevention efforts to different professions based on their individual needs could be the key to lower the global burden of (occupational) NMSC.

Do outdoor workers know their risk of NMSC? Perceptions, beliefs and preventive behaviour among farmers, roofers and gardeners.

BACKGROUND: Non-melanoma skin cancer (NMSC) was officially recognized in 2015 as an occupational disease for outdoor workers in Germany. Together with the enormous socioeconomic impact of NMSC, this has led to the continuous demand of evidence-based prevention. However, studies assessing the perceptions and beliefs along with risk behaviour of outdoor workers as an essential prerequisite for prevention are rare. OBJECTIVE: To assess perceptions, beliefs, barriers, risk and preventive behaviours towards non-melanoma skin cancer among different outdoor groups as a basis for the development of sustainable prevention programmes. PATIENTS AND METHODS: Cross-sectional study among outdoor workers of three different occupational groups (farmer, gardener, roofer) using a 20-question online survey on NMSC awareness, risk and preventive behaviours. RESULTS: Between March and April 2016, 353 outdoor workers participated in the study. Of these, 153 (43.4%) reported never to use sunscreen during work. Wearing headgear and long pants were the most common sun protection measures. Poor use of sunscreen was more likely in males and farmers. A low perceived skin cancer risk was significantly associated with poor use of sunscreen, long-sleeved shirts, sunglasses and headgear. CONCLUSIONS: Despite great evidence on NMSC risk in outdoor professions throughout the literature, high-risk groups in fact are not yet aware of the topic. Sustainable target group-oriented awareness prevention programmes are needed to lower the immense burden of NMSC.

[Networking, Coordination and Responsibilities based on Health Regionsplus: New Health Political Approaches and Developments in Bavaria]. / Vernetzung, Koordination und Verantwortung durch Gesundheitsregionenplus: Neue gesundheitspolitische Ansätze und Entwicklungen in Bayern.

For many health and health-care problems in the population, there is a need for professional management and coordination instruments as well as a competent local network. The new "Health Regionsplus" in Bavaria offer such a structure. This new concept is presented in the following article. The "Health Regionsplus" aim to improve the population's health, the health-related quality of life, equity in health, as well as to further develop the local health care. The Bavarian State Ministry of Health and Care will support up to 24 regions with a funding of up to 50 000 Euro yearly per "Health Regionplus" until the end of 2019. The structure of "Health Regionsplus" implies the establishment of a coordinating agency that works as a "motor", a health forum on the strategic level and relevant working groups. "Health Regionsplus" involve all relevant stakeholders of the regional health system and are chaired by the district administrator or mayor. They work primarily in the fields of health care and prevention/health promotion but can also pursue other region-specific fields. The Bavarian Health and Food Safety Authority supports and evaluates the "Health Regionsplus". There is also a coordinating office which organises the exchange of information and experience among the "Health Regionsplus". Although such a comprehensive regional approach does not change the statutory decision-making structures and responsibilities it does offer the communities an instrument to involve local needs in their decision-making processes.

Serum calprotectin is a biomarker of carotid atherosclerosis in patients with primary Sjögren's syndrome.

OBJECTIVES: We aimed to identify the association of carotid atherosclerosis with the traditional risk factors, disease features, cytokine profile, and calprotectin in patients with primary Sjögren's syndrome (pSS). METHODS: 63 primary pSS patients and 63 age- and sex-matched healthy controls underwent carotid ultrasound, clinical and laboratory examination. The presence of carotid plaques was taken as carotid atherosclerosis. The covariates of carotid atherosclerosis were identified in univariate and multivariate regressions. RESULTS: Patients with pSS had higher prevalence of carotid atherosclerosis (13% vs. 2%, p<0.05) and higher serum levels of calprotectin, tumour necrosis factor receptor 2 (TNF-R2), hepatocyte growth factor (HGF), and monocyte chemoattractant protein-1 (MCP-1) than controls. Sex, menopause, and the prevalence of traditional cardiovascular did not differ between groups (all p>0.05). In univariate analyses, serum calprotectin, most traditional cardiovascular (age, male sex, metabolic syndrome, hypertension, hypertriglyceridaemia, and serum creatinine), and some disease-associated risk factors (glucocorticoid or saliva substitute use, constitutional domain of Eular-Sjögren's syndrome disease activity index - EULAR) were associated with a higher risk for plaque. In a multivariate analysis, having pSS and higher serum calprotectin were associated with carotid atherosclerosis independent of traditional risk factors. CONCLUSIONS: pSS have a higher prevalence of carotid atherosclerosis, which is associated with higher serum calprotectin level independent of traditional cardiovascular risk factors. Our findings suggest calprotectin as a biomarker of subclinical atherosclerosis in pSS.

Exposure to secondhand tobacco smoke and child behaviour - results from a cross-sectional study among preschool children in Bavaria.

AIM: To evaluate the association of postnatal exposure to secondhand tobacco smoke on childhood behavioural problems after taking maternal smoking during pregnancy into account. METHODS: In a cross-sectional survey of preschool children in Bavaria, exposure to secondhand tobacco smoke in the child's home was assessed via a parent questionnaire. The Strength and Difficulties Questionnaire (SDQ) was applied to assess child's behaviour. The association with secondhand tobacco smoke exposure was assessed for 'probable' outcomes of the problem subscales and of prosocial behaviour. RESULTS: Among 5494 children (48% female), the SDQ indicated behavioural problems in up to 11%. After adjustment for socioeconomic factors, low birth weight and maternal smoking before and during pregnancy, a dose-response relationship with exposure to secondhand tobacco smoke was observed regarding hyperactivity/inattention (odds ratio compared to 'none' was 1.35 for 'low/medium' and 2.39 for 'high' exposure, 95% confidence intervals 1.02-1.78 and 1.62-3.53, respectively) as well as for conduct problems (OR 1.68 (1.37-2.06) and 1.93 (1.39-2.68)). CONCLUSION: Secondhand tobacco smoke exposure at home appears to be associated with an increased risk of behavioural problems among preschool children. Prevention of behavioural problems may be a further reason to target secondhand tobacco smoke exposure in children.

[Regional differences in health behaviour in bavaria - a multilevel analysis of a representative population questionnaire in combination with socioeconomic structural data]. / Regionale Unterschiede des Gesundheitsverhaltens in Bayern - Mehrebenenanalyse einer bevölkerungsrepräsentativen Befragung in Verbindung mit sozioökonomischen Strukturdaten.

OBJECTIVES: There are regional differences in mortality in Bavaria. Although these regional dif-ferences in mortality were associated with behavioural risk factors and socioeconomic factors in a study conducted for this reason, the quantitative effect of behavioural risk factors and socio-economic factors as well as the regional structure on the individual health as a predictor of mortality were not known. METHODS: Persons between the age of 18 and 80 were interviewed with the Behavioral Risk Factor Surveillance System (BRFSS) in two Bavarian regions with high mortality, two Bavarian regions with low mortality and in the capital of Bavaria, Munich. For regional structural data, the INKAR database was used. Data were analysed descriptively, with a multivariable-adjusted logistic regression and with a multilevel analysis. RESULTS: There were lower proportions of persons with a good or very good state of health as well as adverse results for overweight/adipositas, the behavioural risk factors for doing sports, smoking and consuming fruits and vegetables and the socioeconomic factors education and unemployment in the two regions with high mortality "Ostbayerische Grenzregion" and "Oberfranken". In a multivariable adjusted logistic regression, the body mass index, smoking, doing sports, climbing stairs, consuming alcohol, being satisfied with the job and the interaction between education and marital status were found to have an influence on the individual health. The small remaining regional component could be explained in the multilevel analysis by different variables which describe the economical situation of the regions. CONCLUSIONS: In accordance with the study hypotheses, a consistency between behavioural risk factors and regional differences in mortality could be observed. Socioeconomic influences and a small regional component are involved. In addition to specific prevention programmes for the target groups, structural support is also meaningful with regard to its potential health impact.

[Injury prevention as the physician's challenge]. / Prävention von Verletzungen als ärztliche Aufgabe.

In Germany, more than 9 million individuals yearly sustain injuries and more than 30,000 fatal injuries. Based on estimations, preventive measures could avoid more than one half of all accidents and could influence the other half of the accidents such that the injuries caused are minor. The aim of an initiative of the Study Group on Injury Prevention of the German Trauma Society (DGU) is a complete inventory of all prevention programs from different expert groups in Germany. A synopsis of the gathered knowledge should serve as a basis for further interdisciplinary preventive measures. The consistent interdisciplinary orientation of this program is a special characteristic including trauma surgery, orthopedics, pediatric surgery, pediatrics, sociology, legal medicine, psychology, sports medicine, geriatrics, anesthesiology, and others. Special attention was also directed to the age groups of children/adolescents and the elderly.

[Health monitoring units in Bavaria. Concept, aims and thematic focus of the first survey on children's environment and health]. / Gesundheits-Monitoring-Einheiten (GME) in Bayern. Konzept, Ziele und thematische Schwerpunkte des 1. Surveys zu Umwelt und Gesundheit von Kindern.

Starting in 2004, health monitoring units (GME) were established in three rural and three urban regions of the federal state Bavaria, Germany. The GME s aim is to gain current and relevant health data especially of children in Bavaria and to evaluate health promotion and prevention strategies. The first survey 2004/2005 was a cross-sectional study of the environmental health of children aged 5 to 7 years. There are data available from 3030 girls and 3319 boys (response rate 78%). This paper describes the study regions and the sociodemographic characteristics of the study population which differed substantially between urban and rural regions. The thematic focus of the survey was: (1) Social disparities in housing conditions, related environmental exposures, and children's health, (2) accidents and injuries, (3) environmental tobacco smoke exposure of children and precautionary measures of their parents, (4) nutrition, physical activity and obesity, and (5) temporal trends of the prevalence of asthma and allergies. The insights gained within the health monitoring units will contribute to the identification and quantification of health risks as well as to the establishment of intervention strategies with special focus on the needs of the public health service.

[Incidence of severe injuries. Results of a population-based analysis]. / Inzidenz schwerer Verletzungen. Ergebnisse einer populationsbezogenen Untersuchung.

It is still unknown exactly how many persons sustain a severe injury (ISS > or =16) in Germany each year. Considering the growing restrictions and the introduction of DRGs, it was necessary to acquire data about this rather resource-intensive aspect of trauma care. The aim of this study was therefore to assess the incidence of severe trauma within a defined population. In a retrospective study all surgical emergencies within a 5-year period (1996-2000) were reviewed. Data on type, pattern, severity of injury, and mortality were extracted from the patients' records. During the study period 454 persons sustained a severe injury (ISS > or =16), 112 individuals died at the scene of the accident, and 64 during the hospital stay. The average ISS of the surviving patients was 27 (ISS 16-75). The calculated incidence of severe trauma was 25/100,000 inhabitants per year. Extrapolated, up to 40,000 persons sustain a severe injury each year in Germany. For the first time, this study has provided data on the incidence of major trauma in Germany. Based on the acquired data and a previous cost analysis, hospital treatment costs for severely injured patients amount to up to 2 billion Euros per year in Germany.

[New challenges to the Screening Center in the Bavarian State office for Health Care and Safe Quality of Foods]. / Neue Herausforderungen für das Screeningzentrum im Bayerischen Landesamt für Gesundheit und Lebensmittelsicherheit.

UNLABELLED: AIM of the newborn screening model programme implemented in Bavaria, Germany, in 1999 was earliest possible and complete detection of all children with treatable severe inborn errors of metabolism. This was to be achieved by the introduction of new laboratory methods (expanded disease coverage, earlier blood take) and of a tracking system to ensure complete access for all newborns and complete requested repeat testing. Long-term prognosis of the newly screened disorders is to be investigated. The model programme "newborn hearing screening in Bavaria" started in 2003 in the administrative district Oberpfalz aims at testing, whether tracking is also suitable to achieve early detection of all children with inborn severe hearing defects. METHODS: To attain these goals a central state screening centre was established. Demographic tracking coordinated by this centre is achieved by matching screening notifications with all birth notifications on name on a regional basis and individual contacts with parents of children with missing screening notification. In addition, all pending recalls are consequently tracked by case-specific contacts. This system was initially introduced for metabolism screening and is currently being implemented also for hearing screening of newborns. Both screening programmes are being scientifically evaluated. Children with disorders detected by screening are followed up in a long-term study by the screening centre. Written consent by the parents is requested yearly at the childs birthday regarding medical care, knowledge of the disease und health development of the child. RESULTS: 470,247 newborns were tested for treatable inborn errors of metabolism from 1999 to 2002. With the introduction of tracking, the documented participation rate increased from previously < 80 to 98.5 %. Due to tracking 99.2 % of requested recalls could be achieved. In 14 cases diagnosis was made, respectively therapy was initiated first after intervention by the screening centre. Altogether 368 children affected by the target disorders of the programme were detected. 332 children could be included in the long-term follow up study. Besides encouraging results, this study reveals deficits in parental information, provision with emergency cards, expert medical consultation, and sometimes treatment not according to the guidelines. Corresponding data from the hearing screening programme are not yet available. CONCLUSION: The establishment of an independent state screening centre has proved very valuable. It enables comprehensive state-wide demographic tracking despite several laboratories engaged in screening for inborn errors of metabolism. A long-term follow-up study has proved to be effective in this setting.

[DRGs of musculoskeletal diseases: consequences for orthopaedics and accident surgery]. / DRGs der muskuloskelettalen Erkrankungen: Konsequenzen für die Orthopädie und Unfallchirurgie.

The introduction of the new prospective payment system for inpatient care entails considerable changes for hospitals in Germany. The Australian Refined Diagnosis Related Groups (AR-DRGs), which form the basis for the German system, give the chance to estimate the consequences and implications for the specialty of orthopaedic surgery in Germany. Our study aims at highlighting the most important musculoskeletal diagnoses and to provide an initial economic forecast for them. The comparison with Australian data gives hints for operative and conservative-rehabilitative orthopaedic departments in respect to potentials and focal points for the development of novel patient management tools. The success of orthopaedic departments will depend in the future much more than now on organisational and management issues.

[Incidence of operations in Germany via telephone survey in 4 selected cities]. / Untersuchung zu Operationshäufigkeiten in Deutschland durch Telefonbefragung in vier ausgewählten Städten.

Considerable regional variation of surgical procedure rates has been reported for a number of countries. Influential variables that have been discussed are patient-related, physician-related and health care system-specific factors. A representative computer-assisted telephone survey was conducted in four selected regions for a study sponsored by the German Federal Ministry of Health. These regions were the townships of Aachen and Hamm in North Rhine-Westphalia and Chemnitz and Görlitz in Saxony. During the telephone survey 1897 persons were contacted and 1041 interviews completed. Multiple logistic regression showed a surgical procedure frequency which was by 40% higher in Aachen than in Hamm. During further analysis the regional localisation was replaced by region-specific structural health care information variables. During this analysis the regional frequency of medical specialists was significant at a 5% level (odds ratio: 1.07; 95% confidence interval: 1.02-1.12). This result can be interpreted as an increase in surgical procedures by 7% for each additional specialist per 10,000 persons. However, no definite conclusion can be reached based on the available data. Intensifying the presented survey-based health services research has the potential to identify regional over- or undersupply of medical services, to objectify and accompany informational, administrative or political action and thereby to support equity in access and health care in the sense of an optimized allocation of resources.