How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well-treated HIV-positive population?

OBJECTIVES: Diagnosing neurocognitive impairment (NCI) in HIV infection requires time-consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI. METHODS: The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self-report forms [Center for Epidemiologic Studies Depression Scale (CES-D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated. RESULTS: Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV-associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV-associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001). CONCLUSIONS: The EACS screening questions had an NPV of 0.7 for excluding patients with HIV-associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile.

OBJECTIVES: The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study. METHODS: The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV-associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z-score means) were performed. RESULTS: Most patients (942; 96.2%) had viral loads < 50 HIV-1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV-associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non-Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration. CONCLUSIONS: In this large sample of aging people living with HIV with well-controlled infection in Switzerland, baseline HIV-associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.

[A multidisciplinary mModule for oncological documentation within a hospital information system]. / Ein interdisziplinäres Modul zur onkologischen Dokumentation in einem Klinikinformationssystem.

The follow-up documentation of oncological patients in Germany is inadequate in many cases: it is usually limited to a minimal dataset mandated by the epidemiological tumor registers; it is carried out in a paper-based fashion and rarely in a multi-disciplinary context. Parallel documentation efforts can result in redundant or erroneous data and excess work. The introduction of hospital information systems (HIS) allows the implementation of digital oncological documentation systems integrated in surrounding clinical workflows that can provide access to existing data sources as well as data entry and presentation across departmental boundaries. This concept enables the integration of tumor documentation, quality assurance and process optimization within HIS. Feasibility requirements include a high flexibility and adaptability of the underlying HIS to reach a seamless integration of oncological documentation forms within routine clinical workflows. This paper presents the conceptual design and implementation of a modular oncological documentation system at the Muenster University Hospital that is capable of integrating the documentation requirements of multiple departments within the hospital.

Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer).

BACKGROUND: Population-based figures on skin cancer are essential for a realistic assessment of the personal disease burden, prevention modes and the need for caring. The Robert Koch Institute in Germany estimates the incidence of melanoma skin cancer as seven cases in 100 000 persons (age-standardized by the European standard rate). Population-based studies presumably show higher incidence rates of 10-16 cases in 100 000 persons. Few data exist for non-melanoma skin cancer (NMSC) as this is not systematically registered in Germany. OBJECTIVES: To present the first population-based results from the Schleswig-Holstein (Germany) Cancer Registry on incidence, stage distribution, clinical types and localization of skin cancer and to compare the results with other studies. METHODS: The Cancer Registry of the Bundesland Schleswig-Holstein with 3500 registering institutions, 100 of which are dermatological institutions, investigates all notifiable incident cancer cases according to international standards. From the recorded data all melanoma and NMSC cases were identified and evaluated. RESULTS: Between 1998 and 2001, 1784 malignant melanoma (MM) and 12 956 NMSC cases underwent diagnostic and analytical evaluation. For MM, age-standardized incidence rates were 12.3 and 14.8 in 100 000 men and women, respectively, and the mean age of men was greater than that of women (56.6 vs. 54.9 years, P < 0.05). Superficial spreading melanoma was the most frequent clinical type (39.1%). The tumours were predominantly located on the trunk in men (46.8%) in contrast to leg and hip in women (39.5%). For NMSC, the age-standardized incidence rates were 100.2 and 72.6 in 100 000 men and women, respectively. More than 80% of all tumours were basal cell carcinoma. CONCLUSIONS: The first population-based data from Schleswig-Holstein on the characteristics (age, sex, histological subtypes, localization and stage) of skin tumours agree well with the existing literature and may thus be regarded as representative. However, markedly higher incidences for MM and NMSC in the north of Germany compared with other parts of the country were observed. As the incidence rates from the north of Germany fit well into the European geographical pattern, we assume no regional increase. Therefore, the official German estimates on cutaneous tumours may largely depend on regional factors and may not be regarded as representative for all regions in Germany.

[Relation of breast cancer tumour stage and the degree of registration in a population-based cancer registry]. / Abhängigkeit der Tumorstadien von der Vollzähligkeit der Registrierung bei Brustkrebs in einem bevölkerungsbezogenen Krebsregister.

UNLABELLED: Population-based cancer registries provide a large database of cancer cases which can be used for evaluation of cancer epidemiological and care-related questions. In particular, the latest projects in breast cancer screening and quality assured breast cancer diagnostics represent appropriate databases in the use of cancer registry data for further evaluation. For breast cancer the tumour stage distribution is a well suited, early available indicator for evaluating such interventions. The problem in using data from cancer registries occurs with the rather long time period until registration can be completed (up to 3 years). Thus, early usage of cancer registry data remains rather questionable. AIM OF THE STUDY: This analysis aims to show whether the distribution of breast cancer tumour stage depends on the completeness of registration and whether a valid estimate of the tumour stage distribution is possible at an early stage, on the basis of a not fully completed registration. METHODS: The cancer registry records all new cancer cases of the Federal State of Schleswig-Holstein. For the period from 1998 to the beginning of 2003 all breast cancer cases and their tumour stage distribution were extracted at three-month' intervals. Completeness of registration for each date was estimated on the basis of cancer data from the Federal State of Saarland. The expected number of breast cancer cases for Schleswig-Holstein was set to 100%. RESULTS: In total, 7,418 patients with new breast cancer were analysed. Already at a degree of 50% of registration a stable distribution of tumour stage could be observed. For example, the variability of the T1-category (tumour size < or = 2 cm) showed a maximum of three per cent in the range from 50% up to 100% completeness. Also for lymph nodes and distant metastases just a small degree of variability from one to three per cent points could be shown. A 75% completeness of breast cancer registration was established about six months after the end of the year of diagnosis. Complete registration could only be reached significantly later, approximately after two years. CONCLUSION: For the cancer registry of Schleswig-Holstein a significant relation of the tumour stage distribution in the degree of registration could not be detected. A stable distribution could be shown with a completeness of 50-75%. Hence, it appears to be methodically justified to analyse the tumour stage of breast cancer data with sufficient validity with a completeness of 75 %. The tumour stage distribution can be used as an early indicator (about six months after the end of the year of diagnosis) for evaluation of projects like mammography screening, quality management or research on medical care.

Nocturnal sleep-disturbing nicotine craving: a newly described symptom of extreme nicotine dependence.

In our research on smoking and nicotine dependence we have noticed a sleep disturbance, which is a further symptom of extreme nicotine dependence. We call this symptom "nocturnal sleep-disturbing nicotine craving" (NSDNC). NSDNC is characterised by craving for cigarettes during the individual sleep times. The smoker awakes (one or several times per week) during his regular sleep time, and has to smoke a cigarette before he/she continues sleeping. This symptom can be explained by the decreasing nicotine levels during the sleep time, which results in nicotine craving. However, NSDNC should be carefully separated from other sleep disturbances, or sleep disturbing events (nycturia, medication side effects), when nicotine craving is not the main reason for awakening.

[Analysis of the needs for diagnosis and therapy of tobacco dependence in Austria]. / Diagnostik und Therapie der Tabakabhängigkeit--eine Analyse des Bedarfs in Osterreich.

In Austria we find 2.3 Mio. tobacco users (29% of the population). 1.3 Mio. are dissonant smokers, they want to stop (18%) or reduce (37%) tobacco consumption. The assumption that 10% of dissonant smokers (130,000 tobacco users) need a diagnosis and therapy leads to a bottleneck: 130,000 patients versus 20 therapists. Demanded consequences of this disproportion are training for health-care workers, implementation of diagnosis and treatment, financing and refunding. Diagnosis and therapy of tobacco dependence should be offered in highly specialised organisations such as the prototypical Nicotine Institute in Vienna, in hospitals and in primary health care.

[Early-summer meningo-encephalitis (ESME) and ESME-vaccination: status 2000]. / Frühsommer-Meningo-Enzephalitis (FSME) und FSME-Schutzimpfung: Status 2000.

Tick-borne encephalitis (TBE) is a public health problem very well under control in Austria because of a vaccination programme using a safe, efficient and well tolerated vaccine and a carefully designed social marketing concept. The Austrian vaccine underwent another technological updating and is now marketed under a new brand name (TicoVac) on the basis of an EU registration. A second product is also available (Encepur), but some limitations of use have to be taken into account. To improve the epidemiological situation even further (only 41 hospital cases in 1999) special attention has to be given to the age group 50 years and older as this is the segment of the population where the majority of cases is observed. TBE is a growing international health problem as awareness increases and cases are identified in many European countries, even in regions where TBE so far was not diagnosed. An "International Scientific Working-group on Tick-borne encephalitis (ISW-TBE)" was established to coordinate research and public health activities.

[Diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI)]. / Diagnostik und Therapie der nicht-okklusiven mesenterialen Ischämie (NOMI).

Pathophysiologically, the non-occlusive mesenteric ischemia (NOMI) results from reduced blood supply to the intestine, caused by "low cardiac output syndrome", or the use of certain drugs leading to intestinal vasoconstriction and stasis of the microcirculation. Regardless of the aetiopathogenesis, the patient's prognosis crucially depends on rapid diagnosis and initiation of adequate medical or surgical intervention. In a 10-year retrospective chart analysis (1989 to 1998) we identified a total of 62 patients that demonstrated classical features of NOMI. The investigation focused on patients' history, risk factors, clinical symptoms, diagnostic procedures and patient's clinical outcome. The most important associated risk factors and concomitant diseases were reduced cardiac output (caused by preexisting heart failure), renal diseases, diabetes and the use of some specific drugs (digitalis, furosemide, ergotamine). Except for leucocytosis, elevated serum lactate and an increased CK/CK-MB level, all laboratory findings were unspecific. Using abdominal ultrasound and plain abdominal x-ray, 80% of the cases showed positive signs of ileus, subileus and free intraabdominal fluid. The angiographic diagnostics (mesentericography) of non-occlusive mesenteric ischemia showed the typical signs of peripheral vasoconstriction in 90% of the cases. Fifty three patients (86%) presenting with peritoneal signs underwent operative bowel exploration. Necrotic bowel had to be resected in 37 cases (60%). The overall letality was 58%. The progress made in better understanding the pathophysiology of NOMI has led to differential treatment of the disease. Close cooperation between surgeons and radiologists, coupled with early diagnosis and prompt treatment are necessary to optimize the clinical outcome.

Fabrication of a quantum point contact by the dynamic plowing technique and wet-chemical etching

We have fabricated extremely confined ballistic constrictions using a nanolithography technique based on an atomic force microscope. Vector-scan controlled dynamic plowing with the vibrating tip enables to plastically indent a thin resist layer along a prearranged path. Transfer of the resist pattern into the semiconductor substrate is achieved by a strongly diluted aqueous etchant. In this way approximately 30 nm deep gooves were etched in the channel area of a modulation-doped GaAs/GaA1As field-effect transistor. The quantum point contacts were defined by a broken line whose 60 nm width represents the length and the sub-100 nm gap determines the width of the constriction. At liquid-helium temperature the conductance as a function of gate voltage shows a stepwise increase in units of 2e2/h. Signatures of the conductance quantization persist up to 50 K, which indicates a large subband spacing.

Nanoscale devices fabricated by direct machining of GaAs with an atomic force microscope

We demonstrate a lithography wherein the tapping mode of an atomic force microscope the Si tip is used as a chiseling tool for direct machining of a GaAs surface. Single-groove drawing movements in a vector-scan mode result in approximately 3-4 nm deep and 30 nm wide furrows, which can be combined to arbitrary noncontiguous polygon patterns. Beneath such a groove a barrier arises in the electron channel of a GaAs/A1GaAs modulation-doped field effect transistor (MODFET). Using appropriate sub-100 nm line patterns we prepared quantum point contacts and single electron devices. At T = 4.2 K the transconductance characteristics of these nanoscale MODFETs exhibit structures, which represent signatures of either the quantized conductance or Coulomb-blockade effects.

Blood pressure awareness in Austria. A 20-year evaluation, 1978-1998.

AIM: To evaluate public awareness following a nationwide educational campaign on hypertension. METHODS AND RESULTS: In 1978 the Austrian Heart Foundation conducted a nationwide educational campaign to increase the awareness of the population regarding the importance of recognizing and treating high blood pressure. Following this campaign, five opinion polls of random and representative samples were conducted to measure the awareness and knowledge of the population relating to issues of high blood pressure. The poll results indicated that during the period immediately following the awareness campaign, knowledge and perception of the dangers of high blood pressure increased. However, this effect dissipated during subsequent years. In 1978, 14% of the population were reported to be hypertensive and 10% had no relevant information about their blood pressure status. In 1998, those who labelled themselves as hypertensive dropped to 12%, while those who did not know their blood pressure values, increased to 14%. The percentage of the population who recalled having their blood pressure measured during the last 3 months dropped from 49% in 1978, to 34% in 1993, and remained at 34% in 1998. CONCLUSION: We conclude that the intensive blood pressure education campaign had only a temporary effect on improving blood pressure awareness. Improved strategies are needed to achieve better community control of hypertension.

[Influenza pandemic: does Austria need an emergency plan?]. / Influenza-Pandemie: Braucht Osterreich einen Vorsorgeplan?

Even in present times and given the current state of medical science, an influenza pandemic may be expected to occur in addition to the usual annual epidemic of the disease. A pandemic is defined as a concentrated worldwide occurrence of a disease within a short period. Such a pandemic has been registered three times in this century. The influenza epidemic of 1918 to 1919 ("Spanish flu") killed 20 to 40 million people. A similar pandemic occurred in 1957 to 1958 (Hong Kong) and in 1968 (Asia). Although the current state of medicine is such that the high morbidity and mortality of 1918 is unlikely to recur, adequate preventive measures are warranted in health care as well as in social and political fields. In the event of such a pandemic, a large number of persons in Austria may be expected to be affected by the disease. In contrast to other countries, a detailed plan of prevention does not exist in Austria at the present time. A sudden influenza pandemic would give rise to a number of grave problems in the medical field (increase in mortality rates) as well as in social and political areas (maintaining the infrastructure of the country). In light of this fact it appears necessary to investigate the possibility of an influenza pandemic and to take suitable precautionary measures.

[Thrombosed temporary vena cava filter]. / Der thrombosierte temporäre Vena-cava-Schirmfilter.

The application of temporary vena cava filters for the treatment of deep venous thrombosis of the lower extremity has become increasingly important in recent years. The filters are supposed to guarantee temporary protection from more extensive pulmonary embolism. Occlusion of the filter system by a larger embolus as well as vena cava thrombosis including the filter struts present major therapeutic problems. We report on one patient in whom the temporarily inserted filter was trapped in a large vena cava thrombus and had to be removed surgically by caval thrombectomy. Because of possible complications such as the above, the indication for insertion of temporary vena cava filters requires thorough consideration. Their duration of stay should be as short as possible and should be limited to the high risk phase, not exceeding ten days.