Diagnostic delay in children with inflammatory bowel disease in the German-Austrian patient registry CEDATA-GPGE 2014-2018.

The incidence and prevalence of pediatric-onset inflammatory bowel disease (PIBD) are on the rise worldwide. Initial symptoms are often recognized with a delay, which reduces the quality of life and may lead to an increased rate of complications. The aim of this study was to determine the diagnostic delay in PIBD and to identify potential influencing factors. Therefore, data from the German-Austrian patient registry CEDATA-GPGE for children and adolescents with PIBD were analyzed for the period January 2014 to December 2018. There were 456 children identified in the data, thereof 258 children (57%) with Crohn's disease (CD) and 198 children (43%) with Ulcerative colitis (UC). The median age was 13.3 years (interquartile range (IQR) = 10.9-15.0), and 44% were females. The median diagnostic delay was 4.1 months (IQR = 2.1-7.0) in CD and 2.4 months (IQR = 1.2-5.1) in UC (p = 0.01). UC was associated with earlier diagnosis than CD (p < 0.001). Only a few factors influencing the diagnostic delay have been verified, e.g., abdominal pain at night and if video capsule endoscopy was performed. Diagnostic delay improved over the years in participating centers, but the level of awareness needs to be high even in common symptoms like abdominal pain.

[Geriatric care in rural areas: Results from two standardized surveys of care providers]. / Geriatrische Versorgung in ländlichen Regionen: Ergebnisse aus zwei standardisierten Befragungen von Leistungserbringern und Akteuren.

BACKGROUND: Due to a growing elderly population the number of age-related diseases increases and thus the need for geriatric care. In rural areas with low population density and few healthcare providers there is a risk of inadequate care. AIM OF THE STUDY: The aim of our investigation was to identify gaps in care and preferred improvement approaches in rural areas from the perspective of local care providers. METHODS: 1,545 healthcare providers from two rural regions were surveyed on the care situation (assessment according to the German school grading system), improvement approaches and problems (simple frequencies). The participants' answers were categorized and analyzed by their work location according to the central-place concept of high-order, middle-order and lower-order (basic) centers. RESULTS: 348 healthcare providers participated (response rate: 22.5 %). The outpatient and inpatient care situation in geriatrics was rated "satisfactory" on average. Geriatric care is most often jeopardized by long waiting times for specialist treatment (71.0 %). Significant differences in the rating were found in the coverage of geriatric care by inpatient care (p=0.0018) and the accessibility of medical facilities by public transport (p=<0.001). These were better rated in the higher-order centers. The preferred approach to improve care was intersectoral networking (62.3 %) among care providers. CONCLUSIONS: In rural areas, supply problems in geriatrics exist, in particular accessibility and waiting times in middle-order and basic centers. Solutions of regional, intersectoral and interprofessional care were approved by a majority of the participants.

Digital detection and analysis of branching and cell contacts in neural cell cultures.

Changes in human/animal behaviour and the involved neural functions are characterized by structural alterations in the brain circuitry. These changes comprise the formation of new synapses and the elimination of existing synapses aside from the modulation of connecting properties within other ones. The mechanisms of neuronal branching and cell contacting regulate and prepare for the processes of synaptic formation. In this study, we present a set of methods to detect, describe and analyse the dynamics attributed to the process of cell contacting in cell cultures in vitro. This involves the dynamics of branching and seeking for synaptic partners. The proposed technique formally distinguishes between the actual formed synapses and the potential synaptic sites, i.e. where cell contacts are likely. The study investigates the dynamic behaviour of these potential synaptic sites within the process of seeking for contacts. The introduced tools use morphological image processing algorithms to automatically detect the sites of interest. Results indicate that the introduced tools can reliably describe experimentally observed branching and seeking for contacts dynamics. Being straightforward in terms of implementation and analysis, our framework represents a solid method for studying the neural preparation phases of synaptic formation via cell contacting in random networks using standard phase contrast microscopy.