The effects of sex, nation, ethnicity, age and self-reported pubertal development on participant-measured right-left 2D:4D (Dr-l) in the BBC internet study.

Digit ratio (2D:4D) - a proxy for prenatal sex steroids - shows sex, nationality and ethnic differences and is linked to pubertal onset. It is unclear whether right-left 2D:4D (Dr-l) also correlates with prenatal sex steroids, as evidence of these differences has been less conclusive. The present study examined the effects of sex, nation, ethnicity, age and self-reported pubertal development (i.e. the rate of physical development and age at menarche [females] or first shave [males]) on Dr-l in a large online study (the BBC internet study). Digit lengths were self-measured in 201,865 adults (110,955 males) and the sample of nations included 41 countries. Participants reported the self-perceived rate of physical pubertal development on a five-point scale (from very slow to very fast) and provided information on the age at menarche or first shave. Adult (>17 years) males had lower Dr-l than females with weak effect size across 41 nations (males-females; d = -.065, p < .0001). There were sex and ethnicity effects on Dr-l across seven ethnic groups with males < females and lower Dr-l in Whites and Middle/Near Eastern participants compared to Asian, Black and Chinese respondents. Considering age effects, the authors focused on participants >12 years; there were stable sex differences and a weak positive effect of age on Dr-l. Dr-l showed a positive relationship with the rate of physical development and a negative relationship with age at menarche or first shave. Relationships were present in males and females with stronger effects in the latter. It is concluded that Dr-l shows a weak sex difference (males < females) independent of nation, ethnicity and age, and suggest that Dr-l is a proxy for prenatal sex steroids.

Strong impact of MammaPrint and BluePrint on treatment decisions in luminal early breast cancer: results of the WSG-PRIMe study.

PURPOSE: The WSG-PRIMe Study prospectively evaluated the impact of the 70-gene signature MammaPrint® (MP) and the 80-gene molecular subtyping assay BluePrint® on clinical therapy decisions in luminal early breast cancer. METHODS: 452 hormone receptor (HR)-positive and HER2-negative patients were recruited (N0, N1). Physicians provided initial therapy recommendations based on clinicopathological factors. After prospective risk classification by MammaPrint/BluePrint was revealed, post-test treatment recommendations and actual treatment were recorded. Decisional Conflict and anxiety were measured by questionnaires. RESULTS: Post-test switch (in chemotherapy (CT) recommendation) occurred in 29.1% of cases. Overall, physician adherence to MP risk assessment was 92.3% for low-risk and 94.3% for high-risk MP scores. Adherence was remarkably high in "discordant" groups: 74.7% of physicians initially recommending CT switched to CT omission following low-risk MP scores; conversely, 88.9% of physicians initially recommending CT omission switched to CT recommendations following high-risk MP scores. Most patients (99.2%) recommended to forgo CT post-test and 21.3% of patients with post-test CT recommendations did not undergo CT; among MP low-risk patients with pre-test and post-test CT recommendations, 40% did not actually undergo CT. Luminal subtype assessment by BluePrint was discordant with IHC assessment in 34% of patients. Patients' State Anxiety scores improved significantly overall, particularly in MP low-risk patients. Trait Anxiety scores increased slightly in MP high risk and decreased slightly in MP low-risk patients. CONCLUSIONS: MammaPrint and BluePrint test results strongly impacted physicians' therapy decisions in luminal EBC with up to three involved lymph nodes. The high adherence to genetically determined risk assessment represents a key prerequisite for achieving a personalized cost-effective approach to disease management of early breast cancer.

Absorption of light by water in the region of high transparency: recommended values for photon-transport calculations.

Prompted by data requirements for photon-transport simulation, we have surveyed measurements of the absorption coefficient of light by water in the wavelength range 171-2000 nm, covering the whole region where the absorption length exceeds 1 mm. Absorption spectra were compiled for pure water, clean seawater, and seawater containing a moderate amount of organic matter. The intensive and detailed nature of the laboratory and at-sea observations leading to the pure-water and clean-seawater spectra lend confidence to these results. As to dissolved organic matter in seawater, this is so highly variable in composition and concentration that this spectrum can only be considered as indicative of its effects.

Long-term evaluation of community health promotion: using capacity building as an intermediate outcome measure.

OBJECTIVES: Between 2001 and 2012, the health authority of Hamburg-Eimsbüttel carried out a health promotion programme for children and their parents in a disadvantaged neighbourhood called Lenzsiedlung. The programme consisted of different action fields aiming at sustainable establishment of community capacities. STUDY DESIGN: The research goal was the long-term assessment of community capacities with a newly developed instrument 'KEQ' (KEQ = Kapazitätsentwicklung im Quartier/capacity building in small areas/neighbourhoods). Practitioners and researchers wanted to know whether community capacities could be increased, which changes occurred during the programme and whether processes of capacity building could be maintained. Research results were also used for the continuous adjustment of the programme to community needs. METHODS: Three surveys on community capacities were conducted (t1: June 2006 [including a retrospective measurement of t0: 2001]; t2: June 2008; and t3: November 2011), each directed to 40-60 stakeholders of the Lenzsiedlung. The instrument consists of five domains (participation, local leadership, available resources, networking and cooperation and health care) with a total of 51 items. RESULTS: For the community capacities, we found a positive trend from 2001 to 2006 supported by data from a documentary analysis over the same period of time. Then, 2006-2011 was a phase of consolidation with only slight improvements (e.g. in the particularly important domain 'health care'). CONCLUSIONS: The results show the feasibility of a community health promotion programme and its maintenance over a period of 10 years. However, Lenzgesund was not the sole programme in the neighbourhood during the period of observation, so that not all improvements in capacities are directly assignable to the interventions. The instrument mainly reflects the possibly one-sided perspective of the interviewed experts from the community.

[Urban Health (StadtGesundheit): The Wider Perspective Exemplified by the City State of Hamburg]. / StadtGesundheit (Urban Health) - eine Blickfelderweiterung am Beispiel Hamburgs.

Public health and city planning have common roots, and in many places they are now reuniting under the heading of urban health. To organize this field adequately requires a broad, integrative view of medical care, health promotion, and health in all urban policies. Given current crises and developments including climate change and globalization, such a wider perspective should also be useful for Germany. Using the City State of Hamburg as an example and combining historic and systematic approaches, we explore the preconditions for in-depth analyses. Our results show that health is a significant topic of Hamburg urban policy, featuring a broad range of structures, processes and actors, both within the health sector and far beyond. Health promotion over the last 30 years evolved notably from a niche topic into an established field with remarkable cooperative structures. The tradition of comprehensive reporting on urban health in Hamburg that was initiated more than 200 years ago is no longer alive today. However, local health reporting keeps integrating a wide range of diverse topics. Communication among the Hamburg health actors - beyond straightforward medical quality assurance - does not seem to focus on critical evaluations, e. g. concerning social and ecologic sustainability. A prerequisite for in-depth analyses including external comparisons is to secure permanent access to relevant sources. Robust approaches to this end, however, seem to be lacking.

[Capacity Building for Prevention and Health Promotion for Children and Parents in a Deprived Urban Quarter: Lenzgesund]. / Strukturbildung für Prävention und Gesundheitsförderung bei Kindern und Eltern in einem benachteiligten Quartier: Lenzgesund.

In 2005 the local health authority Hamburg-Eimsbüttel developed a prevention programme for the disadvantaged quarter "Lenzsiedlung" which has been implemented by the stakeholders committee "Round Table Lenzgesund" and other partners led by the health authority. The Department of Medical Sociology and Health Economics of the University Medical Centre had taken on the accompanying analysis and long-term evaluation with a mixture of qualitative and quantitative methods for health reporting and evaluation and a new instrument for measuring capacity building in the quarter (KEQ).

[Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level]. / Memorandum--Prävention und Gesundheitsförderung nachhaltig stärken: Herausforderungen auf Bundes-, Landes- und kommunaler Ebene.

Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard prevention and health promotion. The memorandum is intended to stimulate a discourse resulting in structure-building and stabilizing measures designed to ensure the sustainability of prevention and health promotion.

Risk factors of striae gravidarum.

BACKGROUND: Stretch marks are a common skin disorder. Pregnancy-related lesions are defined as striae gravidarum. The root cause of striae formation remains unknown. OBJECTIVE: The aim of this paper was to identify the risk factors associated with striae gravidarum (SG) development. PATIENTS AND METHODS: The study was conducted at Plastic, Reconstructive and Aesthetic Surgery Clinic and Obstetrics Outpatient Department among 299 Caucasian women maximum 6 months after the delivery, regardless of whether they were primiparas or multiparas. RESULTS: Among the women participating in the study, 71.2% (213 of 299) developed striae gravidarum at least in one site. Logistic regression analysis showed that four of the analysed factors were independent predictors of striae gravidarum occurrence: family history of SG, BMI before pregnancy, the lack of chronic diseases and birthweight (P < 0.0001). It has been found that the presence of striae distensae on the breasts increases the risk of SG development (71.4% vs. 28.6%, P = 0.0008), whereas the presence of these lesions on the thighs decreases the risk (23% vs. 77%, P = 0.0076). CONCLUSION: In this study, we presented a model that can help to predict the risk of SG formation, including family history of SG, BMI before pregnancy, birthweight and chronic diseases. Moreover, women with stretch marks on their breasts should know that the risk of SG development is significantly higher, whereas lesions on the thighs do not increase such a risk.

[Self-help friendliness as an element of patient-centered rehabilitation--results of a model project]. / "Selbsthilfefreundlichkeit" als Element patientenorientierter Rehabilitation--Ergebnisse eines Modellversuchs.

BACKGROUND: The concept of self-help friendliness describes a systematic approach in health care institutions to strengthen patient-centeredness through closer collaboration with self-help groups. Self-help groups enable patients to better coping with their diseases. METHOD: Organised as a participatory process 5 quality criteria for best practice in the cooperation between professionals in rehabilitation facilities and patient organizations were developed and tested. The process of standards development of ISQUA--International Society for Quality in Health Care guided the model project. RESULTS: Implementing the criteria is feasible and in line with institution-specific requirements. The process documentation is accessible via the network "Selbsthilfefreundlichkeit und Patientenorientierung im Gesundheitswesen" (www.selbsthilfefreundlichkeit.de). The discussion deals with problems of realization and perspectives concerning the transfer of results.

Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy--findings from clinical practice.

PURPOSE: Clinical practice adherence to current guidelines that recommend primary prophylaxis (PP) with granulocyte colony-stimulating factors (G-CSFs) for patients at high (≥20 %) overall risk of febrile neutropenia (FN) was evaluated. METHODS: Adult patients with breast cancer, non-small cell lung cancer (NSCLC), small-cell lung cancer (SCLC), or ovarian cancer were enrolled if myelotoxic chemotherapy was planned, and they had an investigator-assessed overall FN risk ≥20 %. The primary outcome was FN incidence. RESULTS: In total, 1,347 patients were analysed (breast cancer, n = 829; NSCLC, n = 224; SCLC, n = 137; ovarian cancer, n = 157). Patients with breast cancer exhibited fewer individual FN risk factors than patients with other cancers and were far more likely to have received a high-FN-risk chemotherapy regimen. However, a substantial proportion of all patients (45-80 % across tumour types) did not receive G-CSF PP in alignment with investigator risk assessment and guideline recommendations. FN occurred in 127 patients overall (9 %, 95% confidence interval (CI) 8-11 %), and incidence was higher in SCLC (15 %) than other tumour types (8 % in ovarian and NSCLC, 9 % in breast cancer). A post hoc analysis of G-CSF use indicated that G-CSF prophylaxis was not given within the recommended timeframe after chemotherapy (within 1-3 days) or was not continued across all cycles in 39 % of patients. CONCLUSIONS: FN risk assessment was predominantly based on clinical judgement and individual risk factors, and guidelines regarding G-CSF PP for patients at high FN risk were not consistently followed. Improved education of physicians may enable more fully informed neutropenia management in patients with solid tumours.

[Memorandum prevention research - research areas and methods]. / Memorandum zur Präventionsforschung - Themenfelder und Methoden (Langfassung).

From 2004 to 2012, the German Ministry of Education and Research (BMBF) established its first funding programme for the promotion of prevention research. 60 projects on primary prevention and health promotion and the meta-project entitled "Cooperation for Sustainable Prevention Research" (KNP) received BMBF grants under this programme during this period. The experience and knowledge gained and recommendations arising from the research funded under this programme are compiled in memorandum format. The "Memorandum on Prevention Research - Research Areas and Methods" highlights 5 research areas that are considered to be especially relevant from the perspective of the involved scientists and practice partners.The promotion of structural development and sustainability enhancement in disease prevention and health promotion are central areas that should branch out from existing nuclei of crystallization. Improving the health competence of the population and of specific subpopulations is another major area. Research in these areas should contribute to the development of theoretical concepts and to the empirical testing of these concepts. The transfer of knowledge for effective use of developed disease prevention and health promotion programmes and measures is still a scarcely researched area. Among other things, studies of the transfer of programmes from one context to another, analyses of the coop-eration between politics and science, and the continued theoretical and conceptual development of transfer research are needed. Long-term data on the effects of intervention studies are also needed for proper evaluation of sustainability. The latter dem-onstrates the importance of method development in disease prevention and health promotion research as an area that should receive separate funding and support. This research should include, in particular, studies of the efficacy of complex interventions, health economic analyses, and participative health research.

[Customer and patient satisfaction. An appropriate management tool in hospitals?]. / Kunden- beziehungsweise Patientenzufriedenheit. Ein geeignetes Steuerungsinstrument im Krankenhaus?

Recently, the concept of patient satisfaction has been established as an essential part of the quality management of hospitals. Despite the concept's lack of theoretical and methodological foundations, patient surveys on subjective hospital experiences contribute immensely to the improvement of hospitals. What needs to be considered critically in this context is the concept of customer satisfaction for patients, the theoretical integration of empirical results, the reduction of false satisfaction indications and the application of risk-adjusted versus naïve benchmarking of data. This paper aims to contribute to the theoretical discussion of the topic and to build a basis for planning methodologically sound patient surveys.

Digit ratios and their asymmetries as risk factors of developmental instability and hospitalization for COVID-19.

COVID-19 presents with mild symptoms in the majority of patients but in a minority it progresses to acute illness and hospitalization. Here we consider whether markers for prenatal sex hormones and postnatal stressors on developmental instability, i.e. digit ratios and their directional and unsigned asymmetries, are predictive of hospitalization. We focus on six ratios: 2D:3D; 2D:4D; 2D:5D; 3D:4D; 3D:5D; 4D:5D and compare hospitalized patient and control means for right, and left ratios, directional asymmetries (right-left) and unsigned asymmetries [|(right-left)|]. There were 54 patients and 100 controls. We found (i) patients differed in their digit ratios from controls (patients > controls) in all three ratios that included 5D (2D:5D, 3D:5D and 4D:5D) with small to medium effect sizes (d = 0.3 to 0.64), (ii) they did not differ in their directional asymmetries, and (iii) patients had greater |(right-left)| asymmetry than controls for 2D:4D (d = .74) , and all ratios that included 5D; 2D:5D (d = 0.66), 3D:5D (d = .79), 4D:5D (d = 0.47). The Composite Asymmetry of the two largest effects (2D:4D + 3D:5D) gave a patient and control difference with effect size d = 1.04. All patient versus control differences were independent of sex. We conclude that digit ratio patterns differ between patients and controls and this was most evident in ratios that included 5D. Large |(right-left)| asymmetries in the patients are likely to be a marker for postnatal stressors resulting in developmental perturbations and for potential severity of COVID-19.

Immunoglobulin framework-derived peptides function as cytotoxic T-cell epitopes commonly expressed in B-cell malignancies.

Although the idiotypic structures of immunoglobulin from malignant B cells were the first tumor-specific determinants recognized, and clinical vaccination trials have demonstrated induction of tumor-specific immunity, the function of immunoglobulin-specific CD8+ cytotoxic T lymphocytes in tumor rejection remains elusive. Here, we combined bioinformatics and a T cell-expansion system to identify human immunoglobulin-derived peptides capable of inducing cytotoxic T-lymphocyte responses. Immunogenic peptides were derived from framework regions of the variable regions of the immunoglobulin that were shared among patients. Human-leukocyte-antigen-matched and autologous cytotoxic T lymphocytes specific for these peptides killed primary malignant B cells, demonstrating that malignant B cells are capable of processing and presenting such peptides. Targeting shared peptides to induce T-cell responses might further improve current vaccination strategies in B-cell malignancies.

[Integration of self-help associations into the health services system--developments and perspectives]. / Integration von Selbsthilfefreundlichkeit in das Gesundheitswesen--Entwicklungen und Perspektiven.

The concept of a special label for "self-help-friendly" institutions was first developed for hospitals. A demonstration project (funded by the BKK BV, the German Federal Association of Company Health Insurance Funds) was launched in Hamburg. Between 2004 and 2007 quality criteria were developed and put into practice. Shortly thereafter, a group of experienced self-help supporters started to integrate self-help friendliness into quality management systems for ambulatory care. Recently similar developments have been initiated in the Public Health Services. After an introduction on the origins and political context of these new developments we present in this article the efforts and experiences in the 3 mentioned areas of the health-care system. It can be shown that user-based quality standards are becoming more and more common in quality development processes of the health-care services. In the last part we introduce the national "Network Self-Help-Friendliness in the Health Services--Together for Self-Help and Patient Orientation" as the new structure for further implementation, and give hints that the organised self-help is facing completely new challenges.

[Promoting instead of controlling health--lessons learned, lessons to learn]. / Gesundheit fördern statt kontrollieren - lessons learned, lessons to learn.

Health promotion, as laid down in the Ottawa Charta by the World Health Organisation, embraces the call for self-responsibility. Self-responsibility, however, is not merely directed towards apparently personal risk factors. The Ottawa Charta clearly puts health in a wider societal context and follows the line of early social medicine, which, as Virchow put it, understood politics as medicine on a large scale. With the increasing dominance of neoliberal thinking during the 1990s, this view of health in its societal context was pushed aside to make way for an individualistic understanding of self-responsibility. At the same time a resurgence of expert-led prevention strategies could be observed. Recently, however, the discussion on self-responsibility appears to be regaining societal aspects. The task on hand is, to support this societal approach to health whilst at the same time to ensure the field of health promotion does not overstretch itself.

[Recruitment and activation of members in self-help organisations. Results of a survey of self-help organisations at the national level]. / Mitgliedergewinnung und -aktivierung in Selbsthilfeorganisationen. Ergebnisse einer Befragung von Selbsthilfeorganisationen auf Bundesebene.

The majority of the German population can envisage a membership in self-help groups or organisations when this should become relevant. As a matter of fact, only relatively few people are attending joint self-help activities. However, a significant number of members is important for self-help organisations (SHO) for self-organisation, lobbyism and (political) influence. Many SHOs in Germany are dissatisfied with their membership development and are therefore looking for better recruitment and activation strategies. The project "Activating Potentials for Joint Self-help Activities" (funded by the statutory health insurance fund BKK BV 10/2006-04/2009) is a participative collaboration between scientists, practitioners and SHO representatives to develop strategies and methods to promote access to joint self-help activities. In co-operation with the BAG SELBSTHILFE (a National HCPO Alliance) and the NAKOS (the National Clearing House for the Encouragement and Support of Self-Help Groups) 322 boards of national level SHOs were contacted in late 2007 and asked to complete a questionnaire on membership development, recruitment strategies and measures to activate members for voluntary commitment. 50% returned the questionnaire. The results were fed back in a transfer workshop in August 2008 and discussed with 60 representatives of SHOs. Their views are integrated in this paper. Despite all claimed stagnation or decline in membership development, the results show stability or increases over the last two years. Furthermore, the majority of SHOs was founded from the 1990 s until today, specifically in the areas of rare and chronic diseases. This development is based on a better socio-political recognition and promotion of self-help activities, self-help groups and SHOs as well as in better communication technologies. The views on the co-operation between SHOs and social service and health care providers are controversial: Positive and negative experience is more or less balanced. Then the openness and self-reflection of the workshop and survey participants is remarkable. In the context of a growing patient orientation in the health-care system participative co-operation in research and development will become more meaningful.

[Self-help friendliness as quality target in the SHI health care]. / Selbsthilfefreundlichkeit als Qualitätsziel in der vertragsärztlichen Versorgung1.

OBJECTIVES: The article discusses different possibilities to integrate a sustainable co-operation with self-help groups within the framework of the obligatory quality management in SHI-physicians' establishments. The results of a pilot study, which was conducted to develop a model project "self-help friendly doctor's offices", are presented and discussed. METHODS: Until now the subject has been being rarely discussed in the scientific literature. Therefore, we carried out an extensive internet research and document analysis of available quality management systems (QMS). Furthermore, the representatives of the QMS were asked to assess both the current status of integration and prospective chances of including "self-help friendliness" as a core element of quality. RESULTS: We could identify 2 generic and 5 specific QMS concerning ambulatory medical care which all offer the chance to integrate "self-help Friendliness" as a quality criterion. The concept of "self-help friendly doctor's offices" also found great acceptance with the representatives of the QMS. As a side effect of the QMS-expert-interviews, 3 of them announced that they would include this aspect in the current development of the quality objectives and criteria of their QMS. CONCLUSION: The criterion "self-help friendliness" is principally capable of being integrated in several QMS. However, the further development of the approach needs answers to different questions (e.g., hierarchy of quality criteria), and a test period with all parties involved. Parallel processes in the health-care system as well as the political regulation of quality management in health-care are of great importance for a successful implementation of "self-help friendliness".

[Performance of self-help groups and their economic evaluation]. / Leistungen von Selbsthilfegruppen und deren ökonomische Bewertung.

Hoffmann von Fallersleben is quoted with the sentence "Self-help is worthwhile, because it does not demand anything from others". This sounds catchy; it is, however, wrong: Self-help groups ask for support, particularly for financial resources for the work of either individual, highly organized self-help associations or for general support of self-help groups via local contact and information centers ("contact points for self-help groups"). With this request for economic "investments" in self-help, the question arises whether this is profitable for the country, the local authority or the social health insurance. In principle, the initial answer to this is: yes, the work of self-help groups is worthwhile for a single person, but also for the larger community, as various kinds of services are provided by self-help groups and organizations. Despite many surveys of members or co-operation partners which show positive effects of self-help groups, the question remains whether services of self-help groups can be measured and economically evaluated. The socio- political question regarding funding is closely connected to the idea of an economic evaluation of self-help groups. The aim of this article is to summarize and discuss which empiric approaches and findings are available on this subject. The monetary value for the work done per member of self-help groups and year lies between approximately 700 and 900 EUR.