The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study.

PURPOSE: Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. METHODS: Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. RESULTS: 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. CONCLUSION: This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.

Assessment of two e-learning methods teaching undergraduate students cephalometry in orthodontics.

AIM: Cephalometry is important for orthodontic diagnosis and treatment planning and is part of the core curriculum for training dentists. Training involves identifying anatomical landmarks. The aim of this investigation was to assess whether e-learning improves learning efficiency; a programme specifically designed for this purpose was compared to commercially available software. METHODS: Thirty undergraduate students underwent traditional training of cephalometry consisting of lectures and tutorials. Tracing skills were tested immediately afterwards (T0). The students were then randomly allocated to three groups: 10 students served as control (CF); they were asked to improve their skills using the material provided so far. Ten students were given a program specifically designed for this study that was based on a power point presentation (PPT). The last group was given a commercially available program that included teaching elements (SW). The groups were tested at the end the six week training (T1). The test consisted of tracing 30 points on two radiographs and a point score improvement was calculated. The students were interviewed after the second test. RESULTS: Both e-learning groups improved more than the traditional group. Improvement scores were four for CF; 8.6 for PPT and 2.8 for SW. For PPT all participants improved and the student feedback was the best compared to the other groups. For the other groups some candidates worsened. CONCLUSIONS: Blended learning produced better learning outcomes compared to using a traditional teaching method alone. The easy to use Power Point based custom software produced better results than the commercially available software.

[Rehabilitation results of Turkish immigrants - an analysis of routine data from the Rhineland and Westfalia Pension Insurance]. / Rehabilitationserfolg bei Menschen mit türkischem Migrationshintergrund - Eine Auswertung von Routinedaten der Deutschen Rentenversicherungen Rheinland und Westfalen.

AIMS OF THE STUDY: Approximately 3 million Turkish immigrants are living in Germany, in North Rhine-Westfalia their share amounts to 4.7%. They use the same rehabilitation services as Germans, but their treatment usually shows less positive results - as other studies have shown. The aims of the research project "Immigration and Health Inequalities in Rehabilitation" were (a) to quantify the use of medical rehabilitation by Turkish immigrants in different diagnosis groups, (b) to compare outcomes in different diagnosis groups and (c) to find out whether the results will be explained by immigrant status, or by socio-economic factors accompanying immigrant status. METHODS AND RESULTS: An analysis of routine data from Deutsche Rentenversicherung Rheinland and Deutsche Rentenversicherung Westfalen (Rhineland and Westfalia Pension Insurances) was carried out, pertaining to 363 855 persons who had participated in at least one rehabilitation procedure between 2000 and 2006. 4.8% of all rehabilitees were identified as being of Turkish origin. A modified name-based algorithm was used to help to identify Turkish rehabilitees. The outcome of rehabilitation was measured by comparing the medical discharge assessments. Turkish people were in need of rehabilitation more often because of mental disorders/behavioural disturbances (Turkish men=22.0% vs. non-Turkish men=18.4% [p<0.001]; Turkish women=30.8% vs. non-Turkish women=21.6% [p<0.001]) and less often because of neoplasms (Turkish men=4.7% vs. non-Turkish men =7.8% [p<0.001]; Turkish women=6.4% vs. non-Turkish women=13.9% [p<0.001]). Concerning treatment results in several diagnosis groups Turkish rehabilitees benefitted less from treatment than non-Turkish rehabilitees did (musculoskeletal disorders: OR=2.08 [95%-CI=1.97-2.20]; mental disorders/behavioural disturbances: OR=1.70 [95%-CI=1.57-1.84]; respiratory diseases: OR=1.41 [95%-CI=1.14-1.75]; digestive disorders/metabolic diseases: OR=1.36 [95%-CI=1.11-1.66]). Non-Turkish rehabilitees had higher chances of success, even adjusted by social and performance-related factors. The differences were non-significant only in cardio-vascular disease and neoplasm treatment. CONCLUSIONS: Rehabilitation outcomes are significantly less favourable for Turkish people. The differences found can partially be traced to factors related to their migration background and not only to other social differences or performance-related factors of the health services. Immigrant status, hence, affects rehabilitation outcome and must receive attention in both rehabilitation plans and rehabilitation facilities.

Biological manganese-dependent sulfide oxidation impacts elemental gradients in redox-stratified systems: indications from the Black Sea water column.

The reduction of manganese oxide with sulfide in aquatic redox-stratified systems was previously considered to be mainly chemical, but recent isolation of the Black Sea isolate Candidatus Sulfurimonas marisnigri strain SoZ1 suggests an important role for biological catalyzation. Here we provide evidence from laboratory experiments, field data, and modeling that the latter process has a strong impact on redox zonation in the Black Sea. High relative abundances of Sulfurimonas spp. across the redoxcline in the central western gyre of the Black Sea coincided with the high-level expression of both the sulfide:quinone oxidoreductase gene (sqr, up to 93% expressed by Sulfurimonas spp.) and other sulfur oxidation genes. The cell-specific rate of manganese-coupled sulfide oxidation by Ca. S. marisnigri SoZ1 determined experimentally was combined with the in situ abundance of Sulfurimonas spp. in a one-dimensional numerical model to calculate the vertical sulfide distribution. Abiotic sulfide oxidation was too slow to counterbalance the sulfide flux from euxinic water. We conclude that microbially catalyzed Mn-dependent sulfide oxidation influences the element cycles of Mn, S, C, and N and therefore the prevalence of other functional groups of prokaryotes (e.g., anammox bacteria) in a sulfide-free, anoxic redox zone.

Phenological diversity in the interactions between winter moth (Operophtera brumata) larvae and parasitoid wasps in sub-arctic mountain birch forest.

Population cycles of the winter moth (Operophtera brumata) in sub-arctic coastal birch forests show high spatiotemporal variation in amplitude. Peak larval densities range from levels causing little foliage damage to outbreaks causing spatially extensive defoliation. Moreover, outbreaks typically occur at or near the altitudinal treeline. It has been hypothesized that spatiotemporal variation in O. brumata cycle amplitude results from climate-induced variation in the degree of phenological matching between trophic levels, possibly between moth larvae and parasitoids. The likelihood of mismatching phenologies between larvae and parasitoids is expected to depend on how specialized parasitoids are, both as individual species and as a guild, to attacking specific larval developmental stages (i.e. instars). To investigate the larval instar-specificity of parasitoids, we studied the timing of parasitoid attacks relative to larval phenology. We employed an observational study design, with sequential sampling over the larval period, along an altitudinal gradient harbouring a pronounced treeline outbreak of O. brumata. Within the larval parasitoid guild, containing seven species groups, the timing of attack by different groups followed a successional sequence throughout the moth's larval period and each group attacked 1-2 instars. Such phenological diversity within parasitoid guilds may lower the likelihood of climate-induced trophic mismatches between victim populations and many/all of their enemies. Parasitism rates declined with increasing altitude for most parasitoid groups and for the parasitoid guild as a whole. However, the observed spatiotemporal parasitism patterns provided no clear evidence for or against altitudinal mismatch between larval and parasitoid phenology.

Case Reports of Enamel Microabrasion Associated with At-home Dental Bleaching After Orthodontic Bracket Removal.

Adequate removal of residual bonded materials from the enamel surface after orthodontic bracket debonding is critical, since any remaining composite may compromise enamel surface morphology and esthetics. The following clinical case reports present the association of at-home dental bleaching using 10% carbamide peroxide and the removal of residual bonded material using a super fine, tapered diamond bur followed by the use of an enamel microabrasion product after orthodontic bracket debonding. The proposed treatment considerably improved the esthetics and successfully removed the grooves created during the removal of the bonding composite, resulting in a smooth enamel surface.

[Shaping the future of vocational rehabilitation of adults: eight fields of action as starting points for a cross-actor innovation process]. / Die Zukunft der beruflichen Rehabilitation Erwachsener gestalten: Acht Handlungsfelder als Ausgangspunkt für einen akteursübergreifenden Innovationsprozess.

Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons' right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons' self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual's resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.

Enamel Microabrasion and Dental Bleaching on Teeth Presenting Severe-pitted Enamel Fluorosis: A Case Report.

The present clinical case report describes the clinical steps of enamel microabrasion associated with dental bleaching to restore severely-pitted fluorosed teeth. The process of removing the fluorotic superficial stains started by using macroabrasion with a water-cooled fine tapered 3195 FF diamond bur. Rubber dam isolation of the operative field was used to remove the remaining enamel stains and superficial irregularities with the Opalustre microabrasive compound (6.6% hydrochloric acid associated with silicon carbide particles) followed by polishing using fluoridated paste and subsequent 2% neutral fluoride gel topical application. After one month, dental bleaching was performed using 10% carbamide peroxide in custom-formed acetate trays for two hours/day for 42 days. The association of enamel microabrasion with dental bleaching was effective for reestablishing the dental esthetics of a patient with severe dental fluorosis.

Home Dental Bleaching Monitored With Microelectronic Sensors to Record the Wearing Times of an Acetate Tray/Bleaching Product.

The present case study quantifies the clinical wearing time of an acetate tray/bleaching product during home dental bleaching. The patient was instructed to use a 10% carbamide peroxide gel for 6-8 hours each day for 20 days. The wearing time of the tray was measured by a microsensor from TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) completely embedded in the tray so that the clinician would be informed as to the precise time the tray was placed in the mouth. Evaluation of the daily printout during dental bleaching demonstrated that the patient did not correctly follow the clinician's instructions as to the wearing time of the tray. Recording the wearing time of dental bleaching agents can be beneficial for both dental professional and patient to obtain a more effective treatment according to the patient's needs and expectations.

Marriage and the psychological consequences of a heart attack: a longitudinal study of adaptation to chronic illness after 3 years.

As part of a larger study on recovery from myocardial infarction in a national sample of male cardiac patients, data was collected on slightly under 400 men and their wives over a 5-year period. This longitudinal data set was used to investigate the role of patient health cognitions and marital factors on long-term psychological response to the illness. Negative appraisals of threat and loss due to cardiac impairment/disability were found to be the best predictor of anxiety and depression at 3-4 years after hospitalisation. Patient cognitions appeared to be a chief mediator of medically-defined illness. Supportive marital environments were defined by scales measuring intimate attachment and spouse conflict. The latter was found associated with negative health cognitions and elevated anxiety. High intimacy marriages appeared to provide adequate social support, and the level of intimacy between the spouses was inversely related to the level of depressed mood. These findings were suggestive of a buffering effect of the patient's social support system. Other predictors, including the type A pattern, 'vital exhaustion', and social class were investigated as components of a multifactorial model for clinical screening purposes.

Organizational characteristics associated with agency position in community care networks.

This study examines how organizational characteristics affect agency participation and centrality in community service networks. We find that the network structure of agency relations varies for administrative and client-related activities among the 69 agencies studied, which include all but the most isolated agencies serving people with physical disabilities in a single community. In identifying structurally equivalent groups using network analysis, we find that all types of agencies except HMOs are found throughout community service networks. Analyses show that among the five types of relations, minimal intergroup activity occurs within funding and planning networks and that organizational size and ownership are the best organizational predictors of network location and centrality. Non-profits are the most central for planning and client referrals, and large agencies are the most central for funding. We explore the implications of these findings, particularly for sustaining cooperation within the service networks and for the role of non-profits and medical providers in the community.

Pemphigus vulgaris.

Pemphigus vulgaris is a rare, potentially fatal skin disease with lesions usually first appearing in the mouth. Histologic examination is the only reliable mechanism with which to establish an accurate diagnosis. An elderly patient with multiple oral and skin lesions was diagnosed, referred to the dermatology service, and successfully treated with corticosteroid therapy.

Flattened papillary mass on the posterior hard palate.

An unusually large, asymptomatic, exophytic mass of the palate with a papillary surface architecture--characteristic of an oral squamous papilloma--has been presented. The cause of the squamous papilloma is unknown. Surgical excision, with microscopic examination of removed tissue, is the preferred treatment. Recurrence or malignant change, or both, are unusual.

Multiple, painful vesiculoulcerative lesions in the oral mucosa.

An example of pemphigus vulgaris with initial clinical manifestations confined to the mouth has been presented. Clinicians must recognize this serious disease and understand that probably more than half of the patients with pemphigus vulgaris will first experience oral lesions, and almost all will, at some time, have oral vesiculoulcerative lesions.

Well-defined radiolucent area involving the anterior maxilla.

An example of a large and symptomatic nasopalatine duct cyst is presented. This cyst is the most common type of developmental or fissural cyst occurring in the maxilla. Treatment for most patients is conservative surgical excision. The excised tissue should be submitted for histopathologic examination to establish a definitive diagnosis and to rule out the possibility of a more serious lesion.

A solitary cauliflower-like nodule on the mucosal surface of the lower lip.

The incidence of oral condylomata acuminata and simultaneous genital condylomata is not known. A review of the literature implies that the disease is rare, but it is more likely that it is only rarely reported. As the virus is autoinoculable and transmissible, the etiologic factor in this case of oral condylomata acuminatum is most likely orogenital contact. This case report serves as a reminder also that oroanogenital contact expands the anatomic range of sexually transmitted diseases.

Large nonpainful swelling of the lower lip.

The lipomas are slow-growing benign neoplasms. They are characterized by a smooth-surfaced, sessile or pedunculated, yellow-to-pink submucosal mass that is usually asymptomatic. Superficially situated lesions show a telangiectatic vascular network. Deeper lesions may only be noticed as a subtle swelling, making them difficult to detect and treat. Despite its relative infrequency in the mouth, clinicians should be aware of the possibility of lipoma when diagnosing nonulcerated, soft-tissue masses of the mouth. Proper treatment consists of surgical excision, histologic examination, and patient follow-up.

Well-defined radiolucent lesion in the maxillary anterior region.

A case of nasopalatine duct cyst is described. Such cysts often remain asymptomatic for lengthy periods and may be discovered during routine radiography. The quiescent nature of this cyst underscores the importance of thorough clinical and radiographic examination before the fabrication of a prosthesis, as such cysts may give rise to acute infection, enlargement, and penetration through the overlying mucosa if not removed before denture insertion.

[Long-term anxiety and depression following myocardial infarct]. / Langfristige angst und Depressivität nach Myokardinfarkt.

Data from the 5-year Oldenburg Longitudinal Study were used for investigating the causes of differences in psychological well-being in a national sample of 1000 cardiac patients. In a subsample of 400 married patients, for whom data from the spouse were available, exogenous influences, cognitive mediators, and two measures of psychological distress were linked up in models explaining/predicting the level of anxiety and depression. A major hypothesis was the salience of the illness-related cognitions of the patient as a determinant of long-term behavior and mood state. Early patient subjective health perceptions, the 'primary appraisal' of threat/harm/loss, were found to be the most important predictors of subsequent psychological well-being at the fourth wave of the study several years later. As an instrument for patient screening and psychosocial intervention, Type A's and other groups of subjects seemed to constitute high-risk patient groups.

Recurrent pleomorphic adenomas of the parotid gland: clinical evaluation and long-term follow-up.

We report 94 patients with recurrent pleomorphic adenomas of the parotid gland who were referred to our clinics after operations elsewhere. In 78 patients (83%) enucleation was the surgical technique used to remove the tumour. Patients with more than one recurrence were significantly younger than patients who had only one. Many recurrent adenomas (44%) were multifocal. In 20 (21%) further recurrences became obvious after we had operated on them. The mean time interval before recurrence ranged from 7.3 to 10.1 years. Twenty patients (14%) had persistent motor disorders of the facial nerve after operation for recurrence (n = 143). Twenty eight of the 84 patients from whom follow-up data could be obtained developed Frey's syndrome (33%). Our data support the importance of an adequate initial operation to avoid recurrences of pleomorphic adenomas in the parotid gland.