[Knowledge of Human Papillomavirus Infection and the Possibilities for Prevention among 13- to 21-Year-Old Students from Fulda, Hessen]. / Kenntnisstand zu Infektionen mit humanen Papillomaviren und deren Präventionsmöglichkeiten von 13- bis 21-jährigen Schülerinnen und Schülern aus Fulda, Hessen.

Study Aim: The aim of this investigation was to assess awareness and knowledge of HPV and HPV vaccination in a sample of female and male students from Fulda. Further vaccination uptake was investigated. Methods: In 2011 a regional cross-sectional survey of 13- to 21-year-old students (n=1 515) was conducted by using a standardised questionnaire. Results: Overall, the awareness and knowledge of human papillomavirus (HPV) was poor. 29% of the sample had heard of HPV. Multivariate analyses demonstrate that females as well as Christians knew HPV better than males and Muslims. Mean HPV knowledge score was 7.8 of 21 (SD=3.3). None of the tested sociodemographic variables was a predictor for better HPV knowledge. 77% of the sample was aware of the HPV vaccination. Females, persons without migration background as well as persons with middle or higher education knew HPV vaccination better than males, persons with migration background and lower educational level. Mean HPV vaccination knowledge score of the female students was 2.9 of 5 (SD=1.3). Older female students had a better level of knowledge than younger ones. 30% of the females had received at least one dose. Higher age, no migration background and middle or higher education status were tested as significant predictors of vaccine uptake. Conclusion: School lessons and consultations would be appropriate places to transfer knowledge in order to prevent health inequalities caused by social determinants.

[Prophylaxis and treatment of osteoporosis in patients with rheumatoid arthritis (ORA study)]. / Medikamentöse Osteoporoseprophylaxe und -Therapie bei Patienten mit Rheumatoider Arthritis (ORA-Studie).

OBJECTIVE: The aim of this study was to examine bone mineral density (BMD), frequency of osteopenia and osteoporosis in a representative sample of patients with rheumatoid arthritis (RA) and to describe chemoprophylaxis and treatment of osteoporosis compared to evidence-based guidelines. PATIENTS AND METHODS: In 2005 and 2006, 532 patients with RA (98 men, 434 women) aged 23-87 years were recruited from 9 German rheumatology centers. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine and femoral neck. Osteopenia and osteoporosis were defined according to the criteria of the World Health Organization. RESULTS: Of the RA patients 29% had normal BMD at the spine and femoral neck, 49% of the patients had osteopenia and 22% met the criteria for osteoporosis at any site. Of the patients 60% were receiving medication for prophylaxis or therapy of osteoporosis, 38% calcium/vitamin D alone, 20% as combinations mostly of calcium/vitamin D + bisphosphonate, 1% received bisphosphonate only and 1% hormone replacement therapy. Although the frequency of osteoporosis showed no significant differences between male and female patients, women with RA used osteoporosis medication more often than men (63% versus 49%, χ²-test, p <0.05). A total of 101 RA patients (83 menopausal women, 6 premenopausal women, 12 men) received corticosteroids in a daily dose of 7.5 mg or less for at least 3 months and had DXA T-scores below -2.0 at any site. In this patient group 41% of the menopausal women, 17% of the premenopausal women and 42% of the male patients were reported to receive medication with calcium/vitamin D + bisphosphonate. Calcium/vitamin D was used by 35% of the menopausal women, none of the premenopausal women and 50% of the male patients and 18% of the menopausal women, 67% of the premenopausal women and 8% of men received no prophylaxis or treatment for osteoporosis. CONCLUSION: According to the DVO (German Society for Osteoporosis) guidelines for osteoporosis (2009) menopausal women with corticosteroid therapy < 7.5 mg per day for at least 3 months and DXA T-scores below -2.0 should receive treatment with bisphosphonate and calcium/vitamin D. The data show that there were still deficits concerning prophylaxis and treatment of osteoporosis in RA.

[Diagnosis and treatment of osteoporosis and rheumatoid arthritis in accordance with German guidelines. Results of a survey of patients, primary care physicians and rheumatologists]. / Diagnostik und Behandlung der Osteoporose bei rheumatoider Arthritis vor dem Hintergrund der Leitliniennutzung. Ergebnisse einer Befragung von Patienten, Hausärzten und Rheumatologen (ORA-Studie).

In a cross-sectional study the prevalence of osteoporosis and osteopenia in patients with rheumatoid arthritis (ORA study) was investigated. Additionally, patients, their family doctors and rheumatologists were surveyed on their awareness of osteoporosis in RA, prevention, diagnosis, treatment and use of guidelines.In the years 2005 and 2006 a total of 532 patients with RA (98 men, 434 women) aged 23-87 years were consecutively recruited from 9 German centers for rheumatology. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) at the lumbar spine and neck of the femur. Questionnaires on osteoporosis were sent to 119 family doctors (87 men, 32 women) and 44 rheumatologists (30 men, 14 women).The survey showed that rheumatologists had a higher awareness of osteoporosis in RA and compared to family doctors they estimated a higher frequency and tested RA patients more often for osteoporosis. In line with osteoporosis guidelines rheumatologists and family doctors saw an indication for densitometry in RA patients on steroid therapy and/or low intensity trauma fractures. In contrast to the 2006 recommendations of osteoporosis guidelines 50% of family doctors and rheumatologists preferred bisphosphonate off-label-therapy for premeopausal women with RA and comorbid glucocorticoid-induced osteoporosis. On the other hand 50% of premenopausal RA patients with osteoporosis did not receive any osteoporosis medication.The survey revealed a high degree of guideline compliance in diagnosing osteoporosis in RA but deficits were observed in the administration of osteoporosis medication, especially in premenopausal women.

The Luebeck interview for psychosocial screening in patients with inflammatory bowel disease.

BACKGROUND: Psychosocial factors play an important role in the course of inflammatory bowel disease (IBD). However, a simple, valid psychosocial screening instrument that is suitable for short patient-physician contacts does not exist. Therefore, the Luebeck semistructured Interview for Psychosocial Screening was developed as a rating tool for psychosocial stress in IBD patients (LIPS-IBD). METHOD: The entire interview requires approximately 10 minutes. Interrater reliability was tested. Depression, anxiety, social support, impact of the disease, global level of psychosocial stress, and demand for psychosocial support were rated in 92 patients with IBD on 5 point Likert scales. Patients from the in- and out-patient clinic for gastroenterology were included. In addition, patients filled out self-report questionnaires regarding depression, anxiety, social support, and impact of the disease. Indices of disease activity (Colitis Activity Index, Crohn's Disease Activity Index) were recorded. RESULTS: Both patients and physicians found the interview feasible. Reliability was good, with interrater reliability ranging from .76 to .94. Convergence with self-report instruments was also high (r = .5-.6). Ratings of depression and impact of the disease were correlated with indices of disease activity. DISCUSSION: LIPS helps to identify patients with high levels of psychosocial stress and provide them with more detailed psychologic assessments. It was found to be a suitable instrument for daily clinical routine. It is potentially a valuable screening tool to obtain reliable, valid, and useful information in daily practice in IBD treatment settings.

Personality traits in young patients with Parkinson's disease.

OBJECTIVES: It has been hypothesized that the dopaminergic deficit of older patients with Parkinson's disease (PD) is associated with a reduction in the dopamine-dependent personality trait "novelty seeking". It is unknown whether this may also be found in younger patients with PD whose dopaminergic deficit is considered to be purely motor. MATERIAL AND METHODS: We interviewed 122 patients below 51 years of age and 122 age- and sex-matched healthy controls with regard to clinical and sociodemographic data. Both groups had to fill out the Tridimensional Personality Questionnaire (TPQ) of Cloninger. Neuropsychological testing of formal intelligence and depression was also applied. RESULTS: "Novelty seeking" was not different between both groups. Patients were more often depressed than controls, explaining their difference in "harm avoidance" on the TPQ. "Persistence", a sub-scale of the third TPQ dimension "reward dependence", was significantly higher in patients. Neither sex, nor age, nor educational status were correlated with one of the three personality traits. CONCLUSIONS: The higher rate of depression explains our finding of more "harm avoidance" among young PD patients. According to a literature review the choice and performance of controls is crucial whether personality traits in PD patients may be assessed as abnormal.

Parkinson's disease in twins: a follow-up study.

OBJECTIVE: To reevaluate concordance rates in 9 monozygotic (MZ) and 12 dizygotic (DZ) twin pairs with PD 8 years after the initial study. BACKGROUND: Longitudinal investigations increase accuracy in clinical diagnosis of PD. METHODS: Follow-up by personal interview and clinical examination. RESULTS: Concordance rates were not different between MZ (3/9) and DZ (5/12) twin pairs at follow-up, even when PD-associated dementia and isolated postural tremor were considered diagnostic of familial Lewy body parkinsonism. Evaluation of medical history, personality traits, and blink rate did not reveal putative early or premorbid parkinsonism in 9 co-twins who were motor-asymptomatic during the follow-up interval. However, these co-twins had reduced semantic fluency in comparison with a healthy control group of similar age. None of 7 co-twins without motor signs who underwent PET investigation 6 years previously showed signs of extrapyramidal disease at follow-up, but verbal memory continued to be reduced in 5 of these co-twins. CONCLUSION: Based on concordance rates only, the findings in our twin sample do not support a major genetic impact for the motor expression of PD.

Selective attention is impaired in amyotrophic lateral sclerosis--a study of event-related EEG potentials.

In humans, selective attention is assumed to be under control of the frontal lobe. A significant proportion of patients with amyotrophic lateral sclerosis (ALS) shows impairments in various tasks touching frontal lobe function. We, therefore, undertook a study of event-related EEG potentials (ERPs) in eight non-demented ALS patients in order to investigate a possible deficit of auditory selective attention: tones were presented in random sequence to the left or right ear, one of which was to be attended. The negative shift of the ERPs evoked by attended tones in relation to unattended tones ('processing negativity': PN) was smaller in ALS patients than in age-matched healthy control persons. This was true for Fz and Cz and for both a slow and a fast presentation rate of the tones. In the patients, reduced PN amplitude correlated with functional motor impairment. The utility of ERP testing to assess impaired frontal lobe function is shown for the first time in ALS patients. The results of our study fit to recent positron emission tomography (PET) and fMRI data.

Dopa responsive dystonia with Turner's syndrome: clinical, genetic, and neuropsychological studies in a family with a new mutation in the GTP-cyclohydrolase I gene.

A 26 year old woman with dopa responsive dystonia and cytogenetically confirmed Turner's syndrome had bilateral globus pallidus hypointensity on brain MRI. Among the living members of a five generation pedigree the patient's mother and the mother's sister also had dopa responsive dystonia; a maternal grandfather had senile parkinsonism, his niece isolated postural tremor. No other family member had Turner's syndrome. A new missense mutation in exon I of the gene of GTP-cyclohydrolase I was found in the three family members with dopa responsive dystonia. With levodopa substitution the patients with dopa responsive dystonia improved clinically as well as in quantitative tests on hand tapping, verbal and performance IQ, concept formation, and set shifting abilities.

Personality, depression, and premorbid lifestyle in twin pairs discordant for Parkinson's disease.

Present personality traits (Freiburg personality inventory, FPI-R), depression (von Zerssen's depression scale), and self assessed state of health were evaluated in 15 twin pairs (six monozygotic and nine dizygotic; mean age 62.5 years) discordant for idiopathic Parkinson's disease and in 17 unrelated healthy control subjects. The twins had additional questionnaire based interviews on premorbid lifestyle. For disability, twins with Parkinson's disease scored lower on FPI-R than controls in "achievement orientation" and "extraversion", higher in "inhibitedness", "somatic complaints", and "emotionality". They scored higher for depression and for state of health than unaffected twins and controls. For zygosity, monozygotic twins scored lower than dizygotic twins in "achievement orientation", "aggressiveness", and "strain". Monozygotic twins had less "achievement orientation" and "extraversion" and more "somatic complaints" than controls. Monozygotic twins had a lower within pair difference than dizygotic twins in "social orientation". During premorbid times the affected twin with later Parkinson's disease was estimated to have been "less often the leader" in the twin pair. Although small in sample size, this twin study indicates a genetic impact for some personality features beyond the Parkinson's disease motor syndrome.

Gait quantitation in Parkinson's disease--locomotor disability and correlation to clinical rating scales.

Stride parameters were established in 17 patients with idiopathic Parkinson's disease (PD; mean age 68.8 yrs.; Hoehn-Yahr stages 2 and 3) and in 33 healthy age-matched controls. Free-walking speed was lower in PD as were stride length and cadence. Impaired locomotor synergies in PD were reflected by a higher coefficient of variation of stride length; step width and its coefficient of variation (the latter related to postural imbalance in locomotion) were not changed. No stride parameter correlated with any total score of either the Hoehn-Yahr Scale, the Unified Parkinson's Disease Rating Scale Motor Examination ("UPDRS-III"), the Columbia Rating Scale (CURS) or the Webster Rating Scale. Stride length correlated with a CURS-Bradykinesia-Score, whereas gait velocity correlated with UPDRS-III-Axial-Motor-Score and with the CURS-Bradykinesia-Score. Hypokinesia of gait in moderately disabled PD patients is best assessed by combined analysis of stride parameters and locomotion-related subscores from conventional rating scales.

Are neuropsychological tests useful in screening for the genetic risk of Parkinson's disease?

We evaluated whether assessments of cognitive flexibility, memory, mood, somatic complaints, personality traits and finger tapping rate could be used to screen persons of at least 40 years of age for their possible genetic risk for idiopathic Parkinson's disease (PD). Thirty-five asymptomatic first-degree relatives (FPD) of PD families with at least two affected members were compared with 29 relatives (SPD) of sporadic PD patients and with 32 controls. After covarying for age and intelligence, FPD had lower scores in verbal fluency, achieved fewer categories and had more errors in the Wisconsin Card Sorting Test; they exhibited more impulsiveness, strain and less extraversion on personality assessment. FPD did not differ from SPD in any of these items. The global assessment of neuropsychological test performance, mood changes, somatic complaints, personality traits and fine motor abilities is of no help in differentiating persons at a putative genetic risk for PD from those without such risk.

[Multifactorial etiology of idiopathic Parkinson disease. A case-control study]. / Zur multifaktoriellen Atiologie der idiopathischen Parkinson-Krankheit. Eine Fall-Kontroll-Studie.

The etiology of Parkinson's disease (PD) is currently thought to be due to an interplay of genetic and environmental factors. We examined (1) familial prevalences of PD and essential tremor (ET) using a control population and personal investigation; (2) comorbidity and possible traits of a altered premorbid lifestyle in PD were also investigated. Sixty-six PD patients with disease onset after 40 and before 70 years of life and 72 age- and sex-matched hospital controls with chronic diseases underwent neurologic examination and a structured interview. Allegedly symptomatic relatives were investigated personally. For the time prior to 40 years of age, PD patients reported significantly less frequent cigarette smoking overall (Odds ratio = OR 0.37); significantly less frequently a smoking duration of more than 2 years (OR 0.42); significantly less frequently an amount of more than 10 cigarettes smoked per diem (OR 0.24); they did report, however, more frequently an onset for smoking before the age of 20 (OR 3.56). Place of residence and source of drinking water during the first 15 years of life, and number of moves and journeys outside Europe before 40th year of life were not significantly different. PD patients demonstrated an increased risk of a 1st or 2nd degree relative with PD (OR 7.14) or ET (OR 3.62) compared to the control families. Congenital or perinatal abnormalities, and comorbid diseases did not suggest greater risk for PD. Stepwise logistic regression analysis yielded three variables that separated PD patients and controls most significantly, though not completely: "smoking more than 10 cigarettes per diem", "additional family members with PD", "additional family members with ET".