A Systematic Review of Workplace Physical Activity Coaching.

Aim Studies show that about 60 min of moderate physical activity (PA) per day compensate for sitting all day at work. However, the workplace offers an ideal setting for health-promoting interventions such as PA coaching as a person-centered intervention aimed at achieving lasting health behavior changes. Given a good evidence base of health coaching studies in general, this systematic review aims to provide an overview of workplace PA coaching interventions. Methods This review was conducted according to PRISMA guidelines. Studies published up to July 2021 were considered based on the following inclusion criteria: (1) longitudinal intervention studies, (2) analysis of PA at work, (3) sedentary employees, (4) PA coaching in the workplace as intervention, (5) increasing workplace PA. Results Of 4323 studies found, 14 studies with 17 interventions met inclusion criteria. All 17 interventions indicated an increase in at least one PA outcome. Twelve interventions indicated significant improvements in at least one workplace or total PA outcome. There is a high variation within the different coaching parameters, such as behavior change techniques and communication channels. The study quality showed a moderate to high risk of bias. Conclusions The majority of interventions provided evidence for the effectiveness of workplace PA coaching. Nevertheless, the results are inconclusive with regard to the variety of coaching parameters and thus no general statement can be made about the effectiveness of individual parameters. However, this variety of parameters also leads to a high degree of individualization of workplace PA coaching interventions to increase PA for different groups of employees and different types of workplaces.

[Daytime flexible application of Insulin degludec in patients with type 1 diabetes or type 2 diabetes]. / Tageszeitlich flexible Gabe von Insulin degludec bei Patienten mit Typ-1-Diabetes oderTyp-2-Diabetes.

BACKGROUND: Insulin degludec (IDeg) is a basal insulin with a stable, flat action profile and an even distribution of the blood glucose lowering effect over 24 hou rs. The terminal half-life of IDeg is about 25 hours, which reflects a mean prolongation by factor 2 compared to Insulin glargin (lGlar).This may enable for a more flexible daytime dosing versus up to now available basal insulins. METHOD: Two open, randomized, treat-to-target studies enrolled patients with type 1 diabetes (n =493) or type 2 diabetes (n = 687). Both phase 3 studies compared a daytime flexible dosing of IDeg (IDeg-flex) with IDeg at the evening meal (IDeg-evening) and IDler at a fixed daytime. In the IDeg-flex-group dosing intervals were predefined with variations between 8 and 40 hours. RESULTS: In patients with type 1 diabetes IDeg-flex proved to be non-inferior with respect to reduction of HbA1C (-0.40%) versus IDeg-evening (-0.41%) and IGlar (-0.58%) after 26 weeks. In addition, nocturnal hypoglycemic events were reduced by 40% (p < 0.01) with IDeg-flex versus IGlar. In patients with type 2 diabetes reduction of HbA1C with ID)eg-flex (-1.28%) was non-inferior to IDeg-evening (-1.07%) and IGlar (-1.26%), respectively, whereas rates for hypoglycemia were comparable. CONCLUSION: Patients with diabetes mellitus are enabled to dose a basal insulin flexibly when needed (minimum interval of 8 hours afterthe last injection is necessary). Impacts of this treatment option on quality of life and adherence and outcomes should be examined in observational trials.

[Daytime flexible application of Insulin degludec in patients with type 1 diabetes or type 2 diabetes]. / Tageszeitlich flexible Gabe von Insulin degludec bei Patienten mit Typ-1-Diabetes oderTyp-2-Diabetes.

BACKGROUND: Insulin degludec (IDeg) is a basal insulin with a stable, flat action profile and an even distribution of the blood glucose lowering effect over 24 hou rs. The terminal half-life of IDeg is about 25 hours, which reflects a mean prolongation by factor 2 compared to Insulin glargin (lGlar).This may enable for a more flexible daytime dosing versus up to now available basal insulins. METHOD: Two open, randomized, treat-to-target studies enrolled patients with type 1 diabetes (n =493) or type 2 diabetes (n = 687). Both phase 3 studies compared a daytime flexible dosing of IDeg (IDeg-flex) with IDeg at the evening meal (IDeg-evening) and IDler at a fixed daytime. In the IDeg-flex-group dosing intervals were predefined with variations between 8 and 40 hours. RESULTS: In patients with type 1 diabetes IDeg-flex proved to be non-inferior with respect to reduction of HbA1C (-0.40%) versus IDeg-evening (-0.41%) and IGlar (-0.58%) after 26 weeks. In addition, nocturnal hypoglycemic events were reduced by 40% (p < 0.01) with IDeg-flex versus IGlar. In patients with type 2 diabetes reduction of HbA1C with ID)eg-flex (-1.28%) was non-inferior to IDeg-evening (-1.07%) and IGlar (-1.26%), respectively, whereas rates for hypoglycemia were comparable. CONCLUSION: Patients with diabetes mellitus are enabled to dose a basal insulin flexibly when needed (minimum interval of 8 hours after the last injection is necessary). Impacts of this treatment option on quality of life and adherence and outcomes should be examined in observational trials.

A randomized non-inferiority study comparing the addition of exenatide twice daily to sitagliptin or switching from sitagliptin to exenatide twice daily in patients with type 2 diabetes experiencing inadequate glycaemic control on metformin and sitagliptin.

AIMS: To test the hypothesis that glycaemic control achieved when switching sitagliptin to exenatide twice daily plus metformin is non-inferior to adding exenatide twice daily to sitagliptin and metformin. METHODS: Patients with Type 2 diabetes inadequately controlled with sitagliptin plus metformin were randomly assigned to 20 weeks of treatment with twice-daily exenatide plus placebo and metformin (SWITCH, n = 127) or twice-daily exenatide plus sitagliptin and metformin (ADD, n = 128). RESULTS: Non-inferiority (0.4% margin) of SWITCH to ADD treatment, measured by change in HbA(1c) from baseline to week 20, was not shown {between-treatment difference in least-squares mean [95% CI 3 mmol/mol (0.30%)] [0.8-5.8 (0.07-0.53)]}. A greater reduction (P = 0.012) in HbA(1c) [least-squares mean (se)] was experienced by patients in the ADD group {-7 mmol/mol [-0.68%] [0.9 (0.08)]}, compared with those in the SWITCH group {-4 mmol/mol [-0.38%] [1.0 (0.09)]} and a greater proportion (P = 0.027) of patients in the ADD group (41.7%) reached < 7.0% (< 53 mmol/mol) HbA(1c) target, compared with those in the SWITCH group (26.6%) by week 20. Patients in the ADD group experienced greater fasting serum glucose (P = 0.038) and daily mean postprandial self-monitored blood glucose (P = 0.048) reductions, compared with patients in the SWITCH group, by week 20. Patients in both groups experienced a lower incidence of nausea and vomiting compared with previous exenatide studies. CONCLUSIONS: Non-inferiority of SWITCH to ADD treatment was not supported by the results of this study. In patients with Type 2 diabetes inadequately controlled with sitagliptin plus metformin, adding exenatide provided better glycaemic control than switching to exenatide. These results are consistent with the clinical approach that adding is better than switching to another oral anti-hyperglycaemic medication.

Plasma aldosterone levels and aldosterone-to-renin ratios are associated with endothelial dysfunction in young to middle-aged subjects.

OBJECTIVE: Small clinical studies suggested a role for aldosterone in the development of endothelial dysfunction. We investigated whether the plasma aldosterone concentration (PAC) or the aldosterone-to-renin ratio (ARR) were associated with decreased endothelial function as measured by flow-mediated dilation (FMD) of the brachial artery in the general population. METHODS: Our study population comprised 972 participants from the Study of Health in Pomerania, who were not treated with antihypertensive medication. We performed age-stratified (<50 and ≥ 50 years) ordinal logistic regression analyses. FMD was categorised as decreased (1st quintile), moderate (2nd-4th quintile), or increased (5th quintile). PAC and ARR were divided into low, moderate, and high values according to age- and sex-specific tertiles. All models were re-calculated for 871 subjects with PAC and ARR within the study-specific reference ranges. Odds ratios (OR) and 95% confidence intervals (CI) are presented. RESULTS: Subjects <50 years with high PAC (OR 1.60; 95% CI 1.07-2.38) or ARR (OR 1.81; 95% CI 1.21-2.73) had higher odds for decreased FMD than subjects with low PAC or ARR, respectively. Similar results were obtained in analyses restricted to subjects with PAC and ARR within the reference range. High-normal PAC (OR 1.62; 95% CI 1.07-2.47) or ARR (OR 1.62; 95% CI 1.05-2.50) was associated with higher odds for decreased FMD when compared with low-normal PAC or ARR, respectively. These associations were not observed in subjects ≥ 50 years. CONCLUSIONS: High and high-normal PAC or ARR contribute to an impaired FMD and subsequently the progression of subclinical atherosclerosis in young to middle-aged subjects.

[Treatment of type 2 diabetes mellitus--which role do GLP-1 receptor agonists play?]. / Therapieentscheidungen bei Diabetes mellitus Typ 2: Welche Rolle spielen GLP-1 -basierte Therapien?

The results of the ACCORD-, ADVANCE- and VADT- and further recent studies raised doubts regarding whether the guidelined therapy of type 2 diabetes mellitus, which aims at achieving HbA1c values of < 6.5%, is always beneficial. The higher rate of severe hypoglycemia and weight gain under intensive glycemic control has raised debates of whether the current guidelines should be adopted accordingly. Modern state-of-the-art treatment should consider: a) early treatment start, b) sustained blood sugar decrease, and c) simultaneously prevention of hypoglycemia and weight gain, d) prevention of little investigated multiple glucose-lowering agents, e) easy handling and easy to be integrated into daily schedules. The present work reviews current options with regard to these requirements with special focus on the new GLP-1 receptor agonists.

Reference intervals for aldosterone, renin, and the aldosterone-to-renin ratio in the population-based Study of Health in Pomerania (SHIP-1).

The renin-angiotensin-aldosterone system plays a key role in the regulation of human blood pressure. The aldosterone-to-renin ratio (ARR) is widely accepted for screening the primary hyperaldosteronism (PAL). Various cutoffs for positive PAL screening have been defined in patient cohorts from endocrinological referral centers and primary care. However, the distribution of the ARR in the general population is largely unknown. We aim to provide reference ranges for plasma aldosterone concentration (PAC), plasma renin concentration (PRC), and the ARR for the general population of north-east Germany. A cohort of 3 300 subjects participated in the first follow-up of the longitudinal, population-based Study of Health in Pomerania (SHIP). PAC and PRC were measured by radioimmunometric procedures. The reference interval was defined as the central 95% range between the 2.5(th) and 97.5(th) percentiles. A reference population comprising 1,347 healthy subjects was selected. Sex and age-specific (25-54 and 55-74 years) reference ranges are presented. The upper reference limit for the ARR was 14.2 and 20.3 in younger, and 22.4 and 25.5 in older men and women, respectively. Time of blood sampling had no influence on the ARR, while beta blockers, and agents acting on the renin-angiotensin system were associated with higher and lower ARR, respectively. Our upper reference limit for the ARR is clearly lower than previously reported values from studies of hypertensive patients in primary care or hypertension referral centers. We confirm that PAC and PRC are associated with various factors, including sex, age, intake of estrogen, and various antihypertensive medications.

Intracranial hypertension secondary to sigmoid sinus compression by group A streptococcal epidural abscess.

OBJECTIVE: We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess. METHOD: Case report and review of the world literature. RESULTS: A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up. CONCLUSION: This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.

Neutrophils in cerebrospinal fluid without pleocytosis.

Neutrophils in cerebrospinal fluid (CSF) samples are commonly considered a pathological feature; however, there is little information on the frequency and significance of these cells in CSF samples without pleocytosis. Therefore, the frequency and possible clinical significance of neutrophils in CSF was investigated. In a retrospective study comprising 1556 consecutive CSF samples, cytologies and patient records were reviewed. Five hundred thirty-eight CSF samples without pleocytosis were identified. Neutrophils were detected in 35.5% of these samples. The presence of neutrophils was associated with sepsis (P < 0.01), recent epileptic seizure (P < 0.0001), and blood contamination (P < 0.01). Amongst patients without CSF pleocytosis, CNS infections were not more frequent if neutrophils were present. Neutrophils are frequently observed in CSF with normal leukocyte counts. As sepsis but not CNS infection occurred more frequently in these patients, we conclude that in the absence of CSF pleocytosis, neutrophils are not indicative of CNS infections.

Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes.

AIMS: Recent studies have suggested an association between depression and subclinical atherosclerosis as measured by presence of carotid atherosclerotic plaque and increased intima-media thickening in non-clinical populations. Given the high prevalence of depression in patients with Type 1 diabetes and the diabetes-related risk factors for atherosclerosis, we hypothesized that this relation might also be of special relevance in Type 1 diabetic patients. METHODS: Intima-media thickness (IMT) and the presence of plaques in the carotid arteries were quantitatively assessed by high-resolution ultrasound in 175 adults (89 men, 86 women) with an established diagnosis of Type 1 diabetes. Having been treated for depression or current Beck Depression Inventory scores > 10 were considered to indicate depression. RESULTS: In men, the risk of plaque was higher in depressed subjects relative to non-depressed participants after adjustment for age, smoking status, systolic blood pressure, dyslipidaemia and body mass index [odds ratio (OR) 5.19; 95% confidence interval (CI) 1.29, 20.81]. Depressed women did not have an increased risk of plaque compared with non-depressed women (OR 0.97; 95% 95% CI 0.22, 4.34). We did not observe an association between depression and IMT, in men or in women. CONCLUSIONS: In line with previous research, our findings suggest a link between depression and subclinical atherosclerosis in Type 1 diabetic men, but not in women.

Ibuprofen sodium dihydrate, an ibuprofen formulation with improved absorption characteristics, provides faster and greater pain relief than ibuprofen acid.

OBJECTIVE: The objective of this 6-hour study was to compare rate of pain relief, analgesic efficacy and tolerability of a novel ibuprofen formulation, ibuprofen sodium dihydrate, with that of ibuprofen acid in subjects with postoperative dental pain. MATERIAL AND METHODS: The test formulation of ibuprofen sodium dihydrate (256 mg sodium salt) and the reference product both contain 200 mg ibuprofen. Subjects with moderate-to-severe pain after extraction of third molars were randomized to receive two tablets of either ibuprofen sodium dihydrate (198 subjects) or ibuprofen (198 subjects) in this double-blind, multicenter trial. Pain was measured using traditional descriptor scales and onset of analgesia assessed using the stop-watch method. RESULTS: Median time to substantial pain relief occurred 14 minutes earlier in the ibuprofen sodium dihydrate group (p < 0.001). The first sign of pain relief, an increase in relief and time until the pain was half gone occurred significantly earlier and faster in the ibuprofen sodium dihydrate-treated patients (p < 0.02-0.00003). Corresponding numbers needed to treat were in the range 11. Reduction in pain intensity was evident within 5 minutes (p < 0.01) in the ibuprofen sodium dihydrate group compared to 15 minutes in the ibuprofen group. Pain intensity was reduced to half after 30 and 57 minutes in the ibuprofen sodium dihydrate and ibuprofen groups, respectively (p < 0.025). The overall analgesic efficacy in terms of summed pain intensity differences (SPID), total pain relief (TOTPAR) and remedication times in the two groups were similar. Both treatments were well tolerated and no serious events occurred. CONCLUSION: Ibuprofen sodium dihydrate provides faster and more efficacious pain relief during the first hour after intake when compared to a conventional ibuprofen acid formulation. The tolerability profiles are similar.

Choking on pins, needles and a blowdart: aspiration of sharp, metallic foreign bodies secondary to careless behavior in seven adolescents.

OBJECTIVE: To review the demographics, pathophysiology and management of aspiration of sharp, metallic foreign bodies; to review prevention strategies. DESIGN: Case series and review of the related literature (1932-2006). SETTING: Tertiary care pediatric hospital. PATIENTS: All patients presenting to BC Children's Hospital with aspiration of sharp, metallic foreign bodies since 1998. RESULTS: The seven patients ranged in age from 11 to 15 years (mean 13 years). The two boys had been playing with other boys at the time of aspiration. One aspirated a thumbtack and one aspirated a homemade blowdart (which traveled from his carina to his subglottis with coughing). Three of the five girls had been holding thumbtacks or a darting pin between their lips while putting up posters or sewing. The other two girls, who aspirated thumbtacks, refused to provide a history. One was treated successfully 6 days after the aspiration. The other girl withheld the history for over a year, presented with hemoptysis and eventually required thoractomy and right main bronchotomy to remove the tack. All of the other patients were diagnosed and successfully treated by rigid bronchoscopy within 24h. (Two patients initially had a failed attempt at foreign body removal by flexible bronchoscopy at another hospital.) This is the second largest series of aspiration of sharp, metallic foreign bodies since at least 1966. Adolescents are still aspirating sharp, metallic foreign bodies because of the same behaviors described by Jackson and Jackson in 1932. Education about choking hazards is needed for this age group. CONCLUSIONS: Aspiration of a sharp, metallic foreign body is a serious injury which is best treated by rigid bronchoscopy. These injuries potentially could be prevented through education.

Mental and physical complaints in thyroid disorders in the general population.

OBJECTIVE: To test the hypothesis that untreated overt and subclinical thyroid disorders and autoimmune thyroiditis (AIT) are associated with mental and physical complaints in the general population. METHOD: A total of 3790 participants from the Study of Health in Pomerania (SHIP) with no known thyroid disorders were analyzed concerning their thyroid function (TSH, FT3, FT4), autoantibodies (TPO-Ab), their thyroid structure and size and their mental and physical complaints (Zerssen Complaint Scale). RESULTS: Overt hyperthyroidism (prevalence: 0.4%) was associated with a significantly lower total complaint-score than euthyroid subjects. Subjects with overt hypothyroidism (0.5%), subclinical hypothyroidism (0.7%), or subclinical hyperthyroidism (1.6%) were not different from controls in their total complaints. Females with AIT showed higher scores of tachycardia and anxiety independent from their thyroid function. CONCLUSION: In non-patient samples, hyperthyroidism is associated with positive effects on self-rated mental and physical health. AIT may be associated with negative effects on health also in euthyroid subjects.

Relation between psychological strain and carotid atherosclerosis in a general population.

OBJECTIVE: To investigate the hypothesis that psychological strain is related to carotid atherosclerosis in a large general population sample. METHODS: Intima-media thickness and the prevalence of atherosclerotic plaques in the carotid arteries were quantitatively assessed by high resolution ultrasound among 2164 participants (1112 women and 1052 men, aged 45 to 75 years) of the SHIP (study of health in Pomerania), an epidemiological survey of a random sample of the population of north eastern Germany. Psychological strain was measured by 13 items reflecting typical psychological complaints. Each item was graded by the study participants on a four point scale (from 0, absent, to 3, severe) and a psychological strain score was generated by summing these 13 items. RESULTS: Mean psychological strain score was 10.8 (7.0) (median score 10) among women and 8.5 (6.2) (median score 8) among men. Psychological strain did not predict carotid intima-media thickness among either men or women. However, after adjustment for covariates, high psychological strain and carotid plaques were independently and linearly related, with plaque prevalence odds of 1.03 (95% confidence interval (CI) 1.01 to 1.05, p = 0.009) per increment of the psychological strain score among women and 1.04 (95% CI 1.01 to 1.07, p = 0.003) among men. CONCLUSIONS: This study identified a relation between general psychological strain and carotid atherosclerosis.

A short form of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index in two adult population samples.

Few data exist about the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) from population samples. The goal was to prove to what degree (1) a reduced item solution of the FTND and (2) the HSI represent the FTND. Two randomized adult population samples were used from northern Germany. Sample 1 included 1462 and sample 2 included 1042 current daily cigarette smokers aged 20-64 years with FTND data. The results show that four items of the FTND as well as the HSI represent the FTND. It is concluded that both are valid measures of the urge to smoke and the tobacco-smoke-seeking behavior.

Florid infectious mononucleosis: clinicopathological correlation in acute tonsillectomy.

In patients with infectious mononucleosis (IM), acute tonsillectomy is advocated only in the minority who develop severe airway compromise. In such florid cases, the pathological diagnosis of IM, well known to morphologically simulate that of lymphoma, is particularly challenging. The present case describes a 15-year old male with a clinical course consistent with IM in whom acute tonsillectomy was performed due to progressive airway obstruction. The striking histological findings emphasize the need for close clinicopathological correlation. Recently available ancillary studies are described which both surgeon and pathologist should be familiar with in the differentiation of IM from other lymphoproliferative conditions.

Leukocyte/endothelium activation and interactions during femoral percutaneous transluminal angioplasty.

Recent data suggest that leukocyte-endothelium activation/interactions are important for restenosis after percutaneous transluminal angioplasty (PTA). Ten patients with superficial femoral artery occlusive disease (stage Fontaine IIb) were examined after a percutaneous transluminal angioplasty (PTA) versus a preceding aortoangiography (AAG). Blood samples from corresponding femoral arteries and veins were obtained before, immediately after, and 4 hours after each procedure. The authors examined the ex vivo respiratory burst and leukocytic expression of adhesion molecules flowcytometrically, adhesion molecule plasma concentrations, and inflammatory mediators concentrations in plasma and in endotoxin-stimulated whole blood cultures by ELISA, and the leukocyte counts. After PTA, venous plasma concentrations of soluble (s)L-selectin (148.2 +/-14.7%, p<0.05 vs 100% baseline +/- sem), sP-selectin (130.7 +/-6.9%, p<0.01; sE-selectin (117.5 +/-8.3%, p<0.05 vs arterial), sLFA-3 (130.7 +/-15.8%, p<0.05) were increased. Expressions of L-selectin (93.0 +/-5.7%, p<0.05 vs arterial), CD11a (98.8 +/-3.8%, p=0.06), CD18 (96.9 +/-4.0%, p<0.05 vs arterial), and ICAM-1 (89.1 +/-7.7%, p<0.05) on polymorphonuclear neutrophils (PMN), and arteriovenous leukocyte counts (arterial: 103.5 +/-5.4%, venous: 91.1 +/-3.3%, p<0.05) decreased. Venous ex vivo secretions of oxygen radicals (141.4 +/-28.1%, p<0.05 vs AAG), PMN-elastase (173.7 +/-35.7%, p<0.05 vs AAG), and interleukin (IL)-8 (226.5 +/-56.4%, p<0.001; p<0.0001 vs AAG), as well as PMN-elastase (173.7 +/-35.7%, p<0.05 vs AAG) and tumor necrosis factor (TNF)-alpha plasma concentrations (124.1 +/-11.9%, p=0.06) rose. Four hours after PTA, a leukocytosis and exhausted TNF-alpha (69.8 +/-10.4%, p<0.05) and IL-8 secretions (72.4 +/-4.6%, p<0.01) occurred. PTA induced local leukocyte-endothelium activations (stronger ex vivo mediator productions) and interactions (decreased venous leukocyte counts, increased plasma concentrations, and decreased leukocytic expression of adhesion molecules) with the release of inflammatory mediators (higher plasma concentrations and exhaustions after 4 hours).

Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design.

OBJECTIVES: The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR. METHODS: A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.

Masses of the salivary gland region in children.

BACKGROUND: Noninflammatory masses of the salivary gland region in children are extremely rare. Therefore, very few published individual and institution-based experiences exist. DESIGN: Retrospective chart review from 1990 through 1997. SETTING: University-based children's hospital. DESIGN: Patients 18 years of age or younger with a tumor in the salivary gland region. Masses of infectious origin were excluded. Hemangiomas and lymphangiomas were tallied for relative incidences only. RESULTS: Three hundred twenty-four consecutive cases of salivary gland masses were found: 192 hemangiomas (59.2%), 89 lymphangiomas (27.5%), and 43 (13.3%) solid masses. No significant difference was found between the age at presentation of the patients with benign solid tumors and the patients with malignant solid tumors (mean + SEM age, 7.2 + 0.7 years). Sixty-one percent of the masses were found in the parotid region; 18% were localized to the submandibular gland region; and the remaining 21% were located in a minor salivary gland site. The most common benign perisalivary masses were pilomatrixomas (20.9%), followed by pleomorphic adenomas (11.6%). The most common malignant masses were mucoepidermoid carcinomas (9.3%), followed by rhabdomyosarcomas (7.0%). Treatment was individualized to the disease. Twenty-two patients had adequate data for follow-up analysis (mean + SEM follow-up, 30.0 + 8.4 months). Four patients (18.2%) experienced recurrent or residual disease and were alive with disease at last follow-up, and 100% of our population demonstrated disease-specific survival at last follow-up. CONCLUSIONS: Vascular lesions outnumber solid tumors of the salivary gland region. The most common salivary tumors were pleomorphic adenomas, followed by mucoepidermoid carcinomas. Although certain solid salivary masses may demonstrate locally aggressive behavior, the overall prognosis is favorable. Arch Otolaryngol Head Neck Surg. 2000;126:1435-1439